{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:22Z","timestamp":1790575042063,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Introduction<\/jats:title>\n Kazakhstan introduced the Applied Bachelor of Nursing programme in 2014 as part of a broader effort to upgrade nursing education to degree level. Over the same period, the population grew from 14.9 to 20.0 million and the hospital network contracted by 27%. Whether these simultaneous pressures on workforce supply and demand translated into measurable changes in nursing density has not been examined.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted an ecological time series study using administrative data from the Bureau of National Statistics (2003 to 2024). The primary outcome was nursing and midwifery personnel per 10,000 population, a composite indicator of which nurses constitute approximately 77%. We combined interrupted time series analysis (ITSA) with a pre-specified 2014 intervention point and data-driven joinpoint regression to identify structural breakpoints. A generalized least squares (GLS) model with second-order autoregressive AR(2) errors served as the primary specification, supported by six sensitivity analyses, regional analysis, and autoregressive integrated moving average (ARIMA) forecasting to 2035.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Nursing density rose from 77.4 per 10,000 in 2003 to a peak of 101.2 in 2012, then stabilized between 93.3 and 100.0 through 2024. Joinpoint regression placed the structural breakpoint at approximately 2012 (95% CI: 2010 to 2014), 2 years before the reform. Sensitivity analyses confirmed this was not a denominator artifact. The GLS model identified significant coefficients at 2014 (level change: minus 5.45,\n p<\/jats:italic>\n = 0.001; slope change: minus 2.16 per year,\n p<\/jats:italic>\n &lt; 0.001), but these reflected the proximity of the cut point to the actual trend reversal rather than a causal effect. The nurse-to-physician ratio declined from 2.62 in 2012 to 2.30 in 2024, below the WHO-recommended 3:1. Regional density ranged from 72.0 to 134.8 per 10,000 in 2024. The forecast projected 111.0 per 10,000 by 2035 (95% prediction interval: 92.6 to 129.4).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The deceleration of nursing density growth preceded the 2014 reform by 2 years and coincided with the end of post-independence recovery and hospital contraction. Kazakhstan's density exceeds the WHO European Region average, but the nurse-to-physician ratio has been declining and educational output cannot keep pace with population growth. Expanding programme capacity and setting explicit ratio targets are needed.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1913586","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:45:27Z","timestamp":1790574327000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nursing workforce trends in Kazakhstan, 2003\u20132024: an interrupted time series and joinpoint regression analysis in the context of educational reform"],"prefix":"10.3389","volume":"14","author":[{"given":"Dinara","family":"Ospanova","sequence":"first","affiliation":[{"name":"Department of Nursing, Al-Farabi Kazakh National University","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raushan","family":"Issayeva","sequence":"additional","affiliation":[{"name":"Department of Nursing, Al-Farabi Kazakh National University","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyazzat","family":"Alibekova","sequence":"additional","affiliation":[{"name":"Higher Medical College of the Almaty Public Health Department","place":["Almaty, Kazakhstan"]},{"name":"Department of Public Health, Asfendiyarov Kazakh National Medical University","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makhigul","family":"Maxudova","sequence":"additional","affiliation":[{"name":"Department of Nursing, Al-Farabi Kazakh National University","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neilya","family":"Ussebayeva","sequence":"additional","affiliation":[{"name":"Department of Nursing, Al-Farabi Kazakh National University","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meruyert","family":"Suleimenova","sequence":"additional","affiliation":[{"name":"Department of 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