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

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.