Bulgaria has experienced a significant decline in its nursing workforce, with over 10% of nurses lost in the past decade, according to an analysis by the Institute for Market Economics. This has led to growing concerns over the shortage of nurses in the country, especially as the number of doctors has slightly increased. The situation has raised serious questions about the quality of medical services, as there is now an average of less than one nurse per doctor, a trend that has worsened since 2019.

To address this issue, the Institute for Market Economics has proposed a set of ten solutions to combat the shortage of nurses. One of the key suggestions is to significantly raise nurses’ salaries, with a goal of doubling them within one or two years. This would require an adequate financing mechanism to ensure that the funds reach the nurses directly. Additionally, the scope of tasks for caregivers and unqualified nurses should be expanded, allowing them to perform certain duties under specific conditions in healthcare settings.

Another recommendation is to shorten the duration of nursing education by two semesters, aligning it with the minimum requirements of EU Directive 2005/36. There is also a need for targeted measures aimed at improving the retention rate of nursing students in Bulgaria. Furthermore, the country should explore options for attracting nurses from non-EU countries, where there is a strong demand for healthcare professionals.

The proposal also suggests allowing nurses to establish their own practices and negotiate their remuneration with the National Health Insurance Fund (NHIF). To help with career development, a clear path for progression should be introduced, including defined horizons for salary growth, further education, and ethical standards. Another recommendation is to provide stronger incentives for a more even distribution of nurses across regions, alongside a reduction in the number of hospitals or selective contracting with medical institutions.

The analysis also calls for the removal of regulations restricting nurses' work in childcare facilities and schools. Finally, the Institute suggests that, in addition to funding for doctors and other specialists working in remote areas, a comprehensive transformation of Bulgaria’s healthcare system should be considered.

The data highlights that while Bulgaria has a relatively high number of doctors compared to its population, the number of nurses is far below EU standards. Several factors contribute to this issue, including challenges in training, qualification, job retention, pay, and regional distribution. These interconnected problems require urgent attention and action, but their resolution is often hindered by political factors and strong lobbying interests within the healthcare system.

Sources:

• Institute for Market Economics
• Bulgarian National Radio (BNR)