Health trajectories of early career hospital nurses and midwives compared to other graduates in Denmark

Hospitals worldwide face workforce shortages, making an understanding of early-career health dynamics central to addressing recruitment and retention challenges. This study examines whether early-career health trajectories among hospital-employed nurses and midwives differ from those of workers in other industries. Using Danish nationwide register data, we conduct a longitudinal cohort study of newly educated individuals entering the labour market between 2010 and 2015. To reduce selection bias, we emulate a target trial by constructing an inception cohort with limited prior labour market exposure and no prior history of the outcomes of interest. Matching is applied to construct the final study population of 8,752 graduates. Health trajectories are analysed over six years using fixed-effects event study models. Secondary analyses examine trajectories around exit from hospital employment. We show that hospital-employed nurses and midwives develop fewer recorded mental health conditions (up to 1.3 percentage points lower annual risk), more back disorders (up to 0.6 percentage points higher annual risk), and higher levels of long-term sick leave (up to 2.8 percentage points higher annual risk) than matched workers in other industries. Excess back disorders and long-term sick leave attenuate after four years. Secondary analyses suggest health-related selection into exit, as health improve following exit from hospital. Hospital-employed nurses and midwives experience worse early-career health trajectories than comparable workers in other industries. Lower recorded mental health conditions should be interpreted cautiously, as elevated sick leave may capture early or unrecognised distress. Overall, the findings have implications for building a sustainable hospital workforce.