Throughout Europe, poor working conditions and high workloads (Dall'Ora et al, 2020), low pay (OECD and European Union, 2022) and a lack of career opportunities (Royal College of Nursing, 2023) are contributing to high numbers of nurses quitting or considering quitting the profession. A 2020 review of UK working conditions found that public sector nurses had higher levels of stress, greater pressure from staff shortages and double the number of sickness days of those working in the private sector (West et al, 2020).
Nurses have an essential role across health systems, but they are particularly well-placed to deal with the challenges posed by non-communicable diseases (NCDs). NCDs are Europe's leading cause of mortality (Global Burden of Disease 2019 collaborators, 2020), and they account for significant health expenditure (Vandenberghe and Albrecht, 2020). One pressing challenge is represented by the backlogs resulting from the widespread disruption that the COVID-19 pandemic caused to NCD care services, including health appointments/clinics, screening, diagnostics, treatments and ongoing monitoring. Another is the sometimes severe shortage of services that could support the prevention of NCDs in the longer term. Prevention often requires changes in behavioural risk factors, such as tobacco smoking, sodium intake and alcohol use, as well as in metabolic risk factors, such as blood pressure and obesity.
A sufficient nursing workforce is key to these services. However, in the UK, the number of nurses working in relevant areas, such as mental health, disability and community care, was lower in 2020 than in 2010, with 25% of all nurse vacancies being in mental health care (Buchan et al, 2020).
The current crisis in the nursing workforce is interlinked with the increasing burden of NCDs, so policies that aim to improve the working situation for nurses and address shortages can also translate into improved NCD care. Our recent think piece, which was developed based on a literature review and with insights from representatives of the European Federation of Nurses Associations and the Royal College of Nursing, argues that piecemeal actions are not enough. Systemic changes that prioritise nurses' wellbeing must be implemented comprehensively. The think piece includes several recommendations for policymakers:
- Improve pay and working conditions. Nurses should be paid fairly, reflecting both the level of education they have received and the extent of their experience. Furthermore, nurses deserve to work in a safe and supportive environment that strives to improve mental health and provides access to flexible working conditions where feasible
- Ensure opportunities for professional advancement and recognition. Advanced practice nurses and other professional roles need to be harmonised across all countries in Europe and recognised by all regulatory and governmental bodies
- Invest in skills development. Health systems must invest in nurses' lifelong learning. Funding should be made available to equip nurses with in-demand skills, such as digital/IT, soft and green skills
- Empower nurses. Nurses who take on leadership and management roles can experience a higher degree of empowerment, which can increase satisfaction for nurses and patients alike
- Harness digital tools for nurses, with input from nurses. Co-creating new technologies with nurses can minimise the disruption caused by the introduction of such technologies and help with managing workloads.
Addressing nurses' needs must be seen as a high priority in all health systems, not only to protect a vital workforce but also to ensure that we can deliver effective and high-quality care to all people with NCDs.