Nurses with the lowest salaries in Europe? The Government replies: ‘we have paid compensation’
Yesterday, the nurses were the protagonists of a question to the Chamber, presented by the deputy Roberto Novelli (FI), who asked, how, in the face of an important staff gap, a ban on places in universities below the need and in the face of salaries among the lowest in Europe, what this Government intends to do:
“In Italy there is an estimated shortage of nursing staff at around 63,000 compared to 456,000 operative nurses, of which 30,000 will retire in the next two years. According to the report Health at a Glance 2021 of the OECD in Italy the ratio between nurses and population is equal to 6.2 per thousand inhabitants, against 18 in Switzerland and Norway, 13 in Germany, 11 in France.
The recruitments made over the last two years to meet the increased need for nursing staff have in fact substantially lowered the number of qualified nurses available; in the future, given the reorganization of the health system and the demographic changes underway, a further growth in the demand for nurses is expected, both in hospital and local services.
In September 2021, the National Federation of Orders of Nursing Professions published a list of operational proposals to address the shortage of nurses in the short term and to reorganize and strengthen the sector in the medium and long term; the need was also highlighted to strengthen the training network by increasing the places in the three-year degree courses in health professions and, upstream, to identify interventions aimed at making the profession more attractive;
Against an increase in enrollment applications, the places available for enrollment in degree courses in the health professions for the academic year 2021/2022 were 17,394, in front of a requirement of 23,719, defined at the State-Regions Conference.
Negotiations are underway for the contractual renewal of the health sector which presents obstacles relating to economic and financial sustainability, also due to the budgetary difficulties of the regions deriving from the management costs of the pandemic; the average gross annual salary for nurses, according to OECD data referring to 2019, it amounts to 27,382 euros, compared to 32,092 in France, 34,212 in Spain, over 45,000 in Germany and 48,167 in Ireland.
The shortage of nursing staff, to which is added a worrying worsening of the phenomenon of burnoutrisks paralyzing hospital and care activities.
What initiatives of competence has undertaken or intends to undertake to address the shortage of nurses in order to strengthen the training offer and improve working conditions aimed at attracting young people to the profession and avoiding the risk of early exits due to the so-called burnout”.
For Undersecretary Costa, much has been done with regard to nursing professionals. In his reply to the question, he reiterated that – from the monitoring carried out by the Ministry of Health it emerged that, as of December 17, 2021, as a result of the emergency measures implemented, a total of 76,557 health professionals were recruited, of which 29,151 nurses. Within the aforementioned personnel, approximately 9,844 nurses were recruited for an indefinite period. Furthermore, in order to recognize the particular working conditions of health personnel operating in the emergency services, “including nurses, art. 1, paragraph 293, of law no. 234 of 30 December 2021, established for this purpose personnel, with effect from 1 January 2022, a specific indemnity of an ancillary nature, allocating specific resources “.
Below is the full reply from Undersecretary Costa.
“The repetition of the various cost containment measures, and in particular of the constraints for recruitment, has led, in recent years, to a significant reduction in the staff of the NHS. As regards, in particular, the nursing staff, the decrease in employees for an indefinite period recorded in the same period was equal to -3.0% (in absolute terms it went from 276,670 to 268,273, or -8,397 units in absolute value).
The emergency situation has further exacerbated the difficulties of the system and, therefore, since the outbreak of the COVID-19 pandemic, specific measures have been adopted to allow the Regions and Autonomous Provinces to be able to recruit professionals, in a very short time, and have been allocated, at the same time, specific resources to enhance services. From the monitoring carried out by the Ministry of Health it emerged that, as of December 17, 2021, as a result of the emergency measures implemented, a total of 76,557 health professionals were recruited, of which 29,151 nurses.
Within the aforementioned personnel, approximately 9,844 nurses were recruited for an indefinite period.
In fact, it should be pointed out that the introduction into the system of resources destined for the recruitment of personnel with flexible employment relationships has allowed the Regions to free up resources for the recruitment of permanent staff as well.
Furthermore, in order to enhance the professionalism acquired by the staff who served during the pandemic emergency, art. 1, paragraph 268, lett. b), of the budget law for 2022 has provided for a stabilization process, at the NHS entities and companies, of the staff hired on a fixed-term basis who have carried out a significant period of their service during the pandemic emergency.
That said, in addition to the aforementioned measures aimed at strengthening the NHS staff, including nurses, in order to meet the growing need for nurses recorded in recent years, starting from the Academic Year. 2017/2018, the number of places for access to the Degree Courses in Nursing was increased overall by over 20 percentage points.
The greatest increase was recorded in the last Academic Year (2021/2022), in which the universities announced 17,394 places, or 1,394 more places than the previous year (+ 9% in just one year).
Overall, over 49,000 places have been made available for access to the aforementioned degree courses in the last 3 years.
Considering that access to degree courses is closely linked to the training capacity of universities, precisely to meet the growing needs of registered health professionals, in consideration of the data relating to the incoming and outgoing flows of health professionals of the National Health Service, it is A permanent interinstitutional technical table was set up between the Ministry of University and Research and the Ministry of Health, to enhance the training offer.
In any case, a further element of reflection concerns the “vocational” question of the matriculants, that is the actual coverage of the places put up for tender since, for example in the academic year 2020/2021 it would seem that in some universities the ratio between the applications presented and the places available, for the degree course in nursing, was less than 1, i.e. that the number of enrollment requests was lower than the number of admissions actually available.
As regards the international comparisons reported in the text of the question, it should be specified that the appropriate conclusions of a possible “benchmark” analysis conducted on the subject must take into account at least two factors.
First of all, the question linked to a particular professional figure, i cosiddetti “Associate nurses”, that is, nurses with a lower qualification and training than professional nurses, which does not exist in our country, but which if counted for other countries inevitably invalidates the comparison and determination of the value of the nurses indicator per 1000 inhabitants. Suffice it to think, for example, that “Associate nurses” represent about two thirds of nurses in Slovenia and about one third of nurses in Switzerland, Iceland and Finland.
Secondly, the comparison should be made with the same “occupational status” of professionals, ie it is necessary to ascertain that all the data refer to the same quantity, whether they are “practicing”, “professionally active” or “licensed to practice”, which are the three definitions used by international organizations in their surveys and research studies.
It should be remembered that, with the aim of recognizing and enhancing the strategic role of nurses employed by companies and NHS entities, made even more evident during the Covid-19 pandemic, art. 1, paragraph 409, of the law of 30 December 2020, n. 178, provided for the recognition of a specific professional indemnity, as part of the basic remuneration.
Lastly, I specify that, in order to recognize the particular working conditions of health personnel operating in the emergency services, including nurses, art. 1, paragraph 293, of the law of 30 December 2021, n. 234, has established for such personnel, with effect from 1 January 2022, a specific indemnity of an ancillary nature, allocating specific resources “.