The EPHA Secretariat recently received a query from a medical communications agency in Japan about why there are media reports of a surplus of nurses in Spain. The message was passed to EPHA member, the European Federation of Nurses Associations (PCN), which invited a response from their national member, the Spanish General Council of Nursing.
To add a personal touch to the information, a member of the EPHA Secretariat has added some comments. Ana Hernandez is a Spanish nurse who left her country to continue her training, and who now works in Belgium as a qualified midwife. Ana is volunteering as a researcher for EPHA since June 2005.
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Surplus of Spanish Nurses
Since the late 90s, the international media has often featured articles about the surplus of Spanish nurses and how they go abroad to work in other European countries that do not have enough nurses.
Myriam Ovalle, from the Spanish General Council of Nursing, explains the situation:
The reasons for a surplus of Spanish nurses are manifold. Among them are academic, regulatory measures and social image factors.
Academic factors. Since 1977, all nurses must have a university qualification. This means that they have to fulfill the same requirements to enter into university as students for any other course such as medicine, law etc. They are educated to the same level and with the same rights as all university students.
Nursing studies are very popular and many people apply but only those with the highest scores from the entrance exam can get onto the nursing courses.
The schools of nursing have to fulfil the requirements and standards established by the Ministry of Education and the Council of Universities, in all universities of the country, in order to ensure the same quality of education and that the students acquire the established competencies.
Regulatory measures. Nursing studies is regulated by national law, defining the mission, the functions, the standards, the quality, the continuing education and the autonomy of practice, based on scientific evidence and ethical principles. In the health care systems, nurses operate as partners and team members with other health professionals.
The nursing specialities are also recognized by the Ministries of Health and Education and regulated through legislation. This sets out the standards and competencies of the nurse specialist in the same terms that for medical and other health specialists. Nurses are represented in all official regulatory bodies that affect nurses and health issues.
Nurses are also able to follow an academic career if they fulfil the requirements established by the universities.
Social aspects. The nursing profession has gained more prestige since becoming a university level qualification. In all surveys of patient satisfaction, nurses score the highest of all the healthcare professionals and patients report being very satisfied with the nursing care. Overall there is a positive image of nurses as well as healthcare professionals and institutions.
The answer to the surplus is a complex one, but maybe the summary of these facts could explain why young people are attracted to apply to nursing studies and the health services in Spain are able to retain practising nurses.
Since there is a surplus, upon graduation, not all nurses manage to find a nursing job and therefore some of them accept offers of employment in other European countries that suffer from shortages of qualified nurses.
The reports from the countries where they work show evidence of the effectiveness and quality of Spanish nurses.
Comments from a Spanish nurse working abroad
Ana Hernandez trained as a nurse in Murcia, Spain. In 1999, a few months after finishing her studies, she decided to go to Belgium to train as a midwife, as the prospects for getting a job in Spain as a nurse were not looking good. Once qualified and working as a midwife in Belgium, she continued her studies and obtained a Degree in Public Health and a Master in Epidemiology and Statistics.
"None of my classmates from the nursing studies in Spain stayed there. They are all working or studying abroad. Nowadays, there are virtually no permanent contracts offered to nurses in Spain".
However, Ana thinks carefully when asked about the surplus of Spanish nurses.
"In Spain we ’produce’ the number of nurses that we need. The problem is that there is a lack of planification of the human resources in the Spanish health care system."
The organisation of the health care services is a regional competence in Spain. For historical reasons, the de-centralisation of the health care services has been done at different speeds in different regions. It is the central administration that allocates the resources to the regions, this allocation has to be negotiated between the region and the central administration, which may be a disadvantage to politically weak regions or regions that only recently were given the responsibility for the management of the health services.
"The Spanish Health Authorities are reluctant to hire the number of nurses that are actually needed to effectively deliver health care services. The working conditions are very bad, eventually you find temporary contracts for very short periods of time."
The Spanish Trade Union for Nurses has recently published a report about the Valencia region which shows that there is a shortage of 2.244 nurses, and foresees that this number would be as high as 9,057 in the year 2008.
The report shows that the Valencia Regional Authority had 1 nurse per 345 inhabitants in 1990. In the year 1997 the ratio was 1/355 and in 2005 the number is 1/405, far from the recommendations of the World Health Organisation (WHO) which recommends a ratio of 1/140.
The report also indicates that since 1990 the Valencia Region has created 2,959 nursing posts of which only 715 have been fulfilled with permanent staff. This means that 2.200 vacancies are being filled by staff with temporary contracts.
Spanish hospitals in tourist areas intentionally decrease their activities during the summer to avoid the need to hire more nurses, while at the same time the number of users of their health care services increases in this season.
"Spanish nurses who want to work in Spain often do not have the opportunities to do so, and staying there might mean giving up plans for a good job and a career."
