Planning for an aging nursing workforce: data-driven implications for health policy and service sustainability in Italy

Abstract

Introduction – Nurses are a vital component of healthcare systems, directly influencing the quality and continuity of patient care. Globally, demographic shifts have led to a rising proportion of older nurses. In Italy, this trend presents challenges, given the rapidly aging population and ongoing workforce shortages. With a retirement age of 67, many older nurses remain in physically demanding roles despite medically documented work limitations, raising concerns about workforce sustainability, safety, and long-term planning. Methods – This study analyzed demographic trends among nurses at a major Italian public hospital. Data were extracted from the hospital's human resources system (IRIS WIN) for the period 2010–2024. A total of 2, 184 nurses employed as of 31 December 2024 were stratified into four age groups (24–44, 45–54, 55–58, and 59–67 years) and mapped against clinical settings with varying levels of work intensity. Retirement eligibility was projected through 2033. Health-related absenteeism and medically documented work limitations were analyzed by age group and job intensity level. Results – Between 2010 and 2024, the proportion of nurses aged 24–44 declined by 36.6%, while those aged 55–58 and 59–67 increased by 222.3% and 1, 914%, respectively. Projections indicate a further 91% increase in the oldest age group by 2033. In 2024, 66% of nurses aged 55–58 and 61% of those over 59 were working in high- or extremely high-intensity clinical areas. Older nurses (>55 years), representing 40% of the workforce, accounted for 54% of all health-related absenteeism, equivalent to 87 full-time nursing positions. The number of nurses with medically documented work limitations in the oldest age group is expected to double in the coming years. Discussion – This study highlights the urgent challenges of an aging nursing workforce which are not unique to Italy's NHS, but are a global issue. A growing proportion of older nurses, many with medically documented work limitations, are working in demanding clinical environments, trends already testing healthcare systems in many countries worldwide with a potential impact on patient safety, quality of care, and workforce resilience. Urgent investment in workforce planning, age-responsive role adaptation, and transitional pathways is essential to ensure sustainable, high-quality care delivery and to safeguard workforce health.