Nurse staffing in our hospitals is half of what is required

The number of nurses in hospital care facilities in Bulgaria is half of what is required. This is shown by the data analysis from the new tool of the Bulgarian Association of Healthcare Professionals (BAHP) – “Health Index.” Through this tool, the BAHP will annually present the state of the human resource potential of healthcare professionals in the country and the progress of policies aimed at resolving the staffing shortage, the professional organization reports.

What do the statistics show about the number of nurses in Bulgaria?

The total number of nurses in Bulgaria in 2024 is 21,984, which is 30% lower compared to 2015. In addition to the decrease in absolute numbers, the number of nurses per capita is more than twice as low as the EU average, according to BAHP data. In 2024, there were 341 nurses per 100,000 people in Bulgaria, compared to an EU average of 786 per 100,000 people.

The distribution of nurses across the country is also uneven, the Association further points out. These professionals are most numerous in the North Central and Northwest regions—416 and 399 per 100,000 people, respectively. The lowest numbers of nurses are in the South Central and Northeast regions—295 and 298 per 100,000 people, respectively, the Association reports.

The number of nurses in hospital care has also been decreasing over the years and is now more than twice as low as required, both according to the draft Medical Standard for “Healthcare” and according to EU average indicators.

Last year, 17,243 nurses worked in healthcare facilities, which shows a 35% decrease compared to 2015. Their number per 100,000 people was 268, compared to an EU average of 574 per 100,000 people—more than twice as low. This also proves to be half the number required by the standards set in the BAHP draft Medical Standard for “Healthcare” when correlated with the current number of hospitals in the country. At the end of last year, the National Health Insurance Fund (NHIF) had contracts to fund 49,512 beds; the required number of nurses for these, according to the draft Medical Standard for Healthcare, is 35,366—twice the number of those actually working in hospitals. The situation is even more dramatic if the required number is calculated based on all hospital beds—55,724 according to 2023 data from the National Center of Public Health and Analyses (NCPHA). In that case, the required number of nurses for healthcare facilities would be 39,802.

There is also a shortage of nurses in outpatient care, although their numbers have increased in recent years. The count rose from 4,284 in 2015 to 4,705 in 2024. However, there were only 73 nurses per 100,000 people in Bulgaria last year, compared to an EU average of 212.

In addition to being insufficient in number, nurses in Bulgaria also have a high average age.

20% of those working in the healthcare system are of retirement age, compared to only 4% on average in the EU. Last year, the average age of nurses was 49. It decreased by one year compared to 2015, but not because enough young professionals entered the system, but because older specialists left for biological reasons.

The lack of sufficient new recruits in the system is also evident from the number of healthcare graduates. Although university admission quotas have not decreased, the number of graduating nurses is lower due to a lack of interest in the profession, the Association adds, emphasizing that many graduates do not even register with the BAHP because they immediately seek work abroad or outside the healthcare system.

There is a direct link between staffing shortages and the quality of healthcare provided within a system. The 50% shortage of required nurses in the country affects vital elements of the medical services patients receive, such as effectiveness, person-centeredness, equity regardless of social status, region, age, gender, or religion, as well as adequacy, timeliness, efficiency, and safety. According to 2023 WHO data, one in ten patients was harmed during treatment, and there are 3 million deaths per year due to unsafe medical care. In low- and middle-income countries, 4 out of 100 people die from unsafe medical care. At the same time, the WHO estimates that 50% of this harm is preventable.

To limit these poor practices in Bulgaria and overcome the staffing shortage among healthcare professionals, the BAHP has for years proposed a series of measures and regulatory changes, the organization reminds. These include adopting a Medical Standard for Healthcare; realizing the right and opportunity for the BAHP to become a contracting partner of the NHIF; ensuring NHIF funding for outpatient healthcare practices for all patient groups; refining healthcare algorithms in hospital and outpatient care; and determining the value of healthcare activities and the labor of healthcare professionals. Other proposals include setting requirements for a minimum number of nurses in hospitals for NHIF contracting and introducing autonomous healthcare management in hospitals.