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The Andalucía region of southern Spain needs at least 30,000 more nurses in public and also private hospitals to reach the average of the 27 EU countries, as calculated by the Ministry of Health using data provided by each Spanish region and the World Health Organization. At the current rate, it will take at least 24 years to reach an optimum figure. Applied to Malaga, the province would require at least 6,000 nurses more to reach the European standard.
According to a ministry report on the current situation and estimated need for nurses in Spain it was stressed that, in order to address future needs in this field of healthcare, it is key to compare the ratios of nurses per 1,000 inhabitants in other EU countries to those in Spain. The data used will come from Eurostat, OECD (Organisation for Economic Co-operation and Development) and WHO. As of 31 December 2023, Spain's INE national institute of statistics data revealed that Spain currently has 306,268 nurses, which means a ratio of 6.28 nurses per 1,000 inhabitants. This figure places Spain below the average for EU countries, where the ratio is around 9 nurses per 1,000 inhabitants.
Spain requires a surge in the number of active nurses to match European standards - an increase of more than 100,000 nurses, to be precise, to reach the ratios declared by the above mentioned sources (103,634 for Eurostat, 134,865 for OECD and 130,961 for WHO).
By region, the ratios farthest from the European average are Murcia (4.79), Galicia (5.13), Valencia (5.46), Andalucía (5.51) and the Balearic Islands (5.93). The only region with a ratio similar to the European average is Navarre (8.84), making it the region with the lowest need for more nurses. The report stated that at least 100,000 nurses are needed across the whole country.
Andalucía - net sender of nurses
According to an extensive report by SEPE, the public employment service in Spain, the labour mobility of nurses within Spain is a "key" indicator for understanding how the labour market in the health sector behaves across the country's 17 regions. The report highlighted the situation in Andalucía in particular. The analysis makes it possible to visualise the dynamics of recruitment and the flow of workers moving between regions, as well as the proportion of contracts that hire nurses within their region of residence versus those that involve moving to another region.
The data outlined refer to non-specialist nurses, non-midwifery specialists and midwives and make it possible to identify the areas that are "net receivers of nurses", such as Catalonia (positive balance of 3,880 nurses), Madrid (1,423 nurses), Navarre (1,027 nurses) and the Basque Country (1,001). The regions with a deficit are Andalucía (-1,937 nurses), Castile-La Mancha (-1,129 nurses) and Castile y Leon (-679 nurses). "These communities are characterised by being net senders, with a greater number of outflows than inflows," stated the report. Specifically, 1,315 nurses moved into Andalucía, while 3,252 left - almost twice as many.
The report indicated that the vast majority of 2023 contracts (83.7%) were those of nurses who remained in their region of residence, while 4,257 contracts involved mobility. Although the mobility rate stood at 16.31%, there has been a slight decrease from the previous year in the proportion of this type of contracts, with a positive variation in the mobility rate from the previous year (18.61%) at state level.
Analysing why Andalucía faces such a significant shortage of nurses or why the number of nurses leaving for other parts of Spain is double that of those staying has several factors, though salary does not appear to be one of them.The region does not have the highest salaries, but neither does it have the lowest. Salaries are at an average for the country, with figures higher than those in regions that have a bigger inflow of nurses in some cases.
So what is the problem? One of the most striking reasons is employability: hiring and the increase of unemployment. According to the report, the number of contracts in Andalucía dropped by 36.2% between 2021 and 2023, making it the region with the second largest decrease. In fact, the number of unemployed nurses in the region increased by 80%, from 517 to 920, within that period.
To try to alleviate the nursing shortage, the Ministry of Health announced that it plans to approve the strategic framework for healthcare at a meeting of the Spanish regions, with 65 actions divided into nine points. Among other measures, the document plans to boost the financing for undergraduate places in nursing education, incorporate specialist nurses into primary care and require regions to offer good conditions to their professionals, so that they remain in their region's health systems.
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