The declining number of nurses in Bulgaria over recent decades puts hospital healthcare services at risk. There is an unwritten rule that every doctor should have between two and three nurses to support their work effectively.
However, in Bulgaria, this ratio is lower. Just a few days ago, the director of the multidisciplinary hospital in Pernik resigned due to difficulties in staffing hospital departments with nurses and midwives. While smaller hospitals in remote and sparsely populated areas are most affected by this issue, larger hospitals are not immune to it either.
Why Is Low Number of Nurses a Poblem?
The negative consequences of a reduced number of nurses include a drop in quality due to overburdened medical staff, less time spent with patients, more mistakes, increased stress, burnout, high turnover, and professionals leaving the field altogether, among other issues. Several international organizations have studied this problem and have found that when the nurse-to-doctor ratio falls below 2.1, the quality of healthcare services begins to deteriorate. In hospitals, this ratio should be even higher.
Data from Bulgaria’s Ministry of Health shows that in state and municipal hospitals, there are on average between 1.43 and 2.07 healthcare professionals per doctor. Multidisciplinary hospitals show less variation in this ratio compared to specialized hospitals, which is expected, as specialized hospitals provide highly specific healthcare services in different medical areas, making staff requirements harder to compare directly.
Note: The Ministry’s data does not distinguish nurses from the total number, but we can consider the total number of healthcare professionals in hospitals as a sufficiently adequate proxy for assessing the nurse-to-doctor ratio.
There are two state hospitals where the nurse-to-doctor ratio is below 1 (there are more doctors than nurses): the “Aleksandrovska” and “Tsaritsa Yoanna” hospitals in Sofia. The highest ratios in state hospitals are observed in Montana, Sliven, and Vratsa. Among municipal multiprofile hospitals, the ratio falls below 1:1 in five facilities—Devnya, Plovdiv, Velingrad, Svoge, and First City Hospital, Sofia. The highest ratios among municipal hospitals are reported in Rakovski, Lom, Aytos, Karnobat, and Dulovo. Alarmingly, 12 hospitals employ more doctors than healthcare professionals.
Solving the shortage of nurses is neither quick nor easy, and there is no one-size-fits-all solution, which is why it is critically important to start addressing the issue as soon as possible.
To address the issue, the Institute for Market Economics (IME) organized a roundtable discussion to explore concrete proposals for tackling the nurse shortage. Topics included economic incentives to retain and attract nurses, reforms in nurse education, and models for sustainable financing of nursing labor. Our policy suggestions on the topic can be found in the report “10 Solutions to the Nursing Crisis.”
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