Advanced Practice Nursing in Finland

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*Finland will allow transferral of RN licensure from various parts of the EU (FNA)
Not able to find information regarding transferral of advanced practice degrees

Contact:
Finnish Nurses Association
Terveydenhuollon Oikeusturvakeskus (National Authority for Medico-Legal Affairs)

Role

The role of the Advanced Practice Nurse has developed over the years in Finland.  The initial discussions of advancing nursing practice in Finland started in the 1980’s (FNA, 2018).  Over time the advanced practice nursing role grew to two chief roles, that of the Advanced Nurse and Public Health Nurse, both of which were prepared with graduated level schooling (Delamaire & Lafortune, 2010).

Starting in 2001, the first Clinical Nurse Specialists (CNS) started practicing at the Helsinki University Hospital (FNA, 2018, p.29).  Since then the CNS role has grown significantly.  Meanwhile need to improve access for health care services for an aging population has promoted the advancement of the Nurse Practitioner role (NP / APN Network, 2017).

Meanwhile, Delamaire and Lafortune (2010), reported that Finland was of the top nations with the highest number of nurses per 1000 people in the country at 15.5; thus indicating a surplus of nurses.  Meanwhile, they indicated that Finland held a mildly below average ratio of doctors per capita (2.7 to 1000 people; European average was 2.8) (Delamaire & Lafortune, 2010).  As a result, Finland presents itself as good place to further develop the Advanced Practice Nursing role, with a higher ratio of nurses and a lower number of doctors per capita, similar to that of the United States and United Kingdom (Delamaire & Lafortune, 2010).

Specialties and Education

APNs have been working in various roles including rural healthcare, general practice, and acute care (Delamaire & Lafortune, 2010, FNA, 2018).  As described above, the roles of CNS and Nurse Practitioner are prevalent, but in addition to these registered nurses in Finland have the choice of specializing in various categories nearing graduation of nursing school in acute care, geriatric care, mental health, multi-cultural, pediatrics, palliative care and youth and adolescent care (Robinson & Griffiths, 2007, NP / APN Network, 2017).  Additionally, an individual can choose to be a nurse midwife with an additional year of schooling (Robinson & Griffiths, 2007).

Education for Advanced Practice Nurses in Finland produced it’s first graduates in 2006 (DeGeest et al., 2008; Fagerström & Glasberg, 2011).  Education for the registered nurse is comparable to various other EU nations, usually requires a bachelor degree typically taking 3.5 years, and 4 years for the public health nurse (Robinson & Griffiths, 2007; FNA, 2018).  The advanced degrees are available afterward to those who desire further advancement in scope of practice at the graduate level (Delamaire & Lafortune, 2010).  Registration for healthcare individuals within Finland is maintained by the National Authority for Medico-Legal Affairs (Terveydenhuollon Oikeusturvakeskus).

According to the Finnish Nurses Association (2018) the most developed roles of AP Ns in Finland are the Clinical Nurse Specialist and Nurse Practitioner.  Both roles are described as, “At the advanced level, independent clinical nursing and health promotion as well as the related ethical decision-making, teaching and instruction, consultation, evidence-based practices, management, cooperation, research, and development” (p.32).  In addition to this the roles are more clearly differentiated below:

  • Clinical Nurse Specialist (CNS)
    • The role has been in existence since 2001 in Finland (FNA, 2018, p.29).
    • CNSs are employed in various parts of the hospital systems in Finland, more predominantly at the university hospitals (FNA, 2018, p.29).
    • The role has four spheres: patient care, nursing organization, and scholarship.  Any of the CNS roles require a master’s level degree (NP / APN Network, 2017).
    • “Broad-based work aimed to ensure and develop the quality of nursing, foster the implementation of evidence-based nursing and support the organization’s strategic work.” (FNA, 2018, p.32)
  • Nurse Practitioner
    • The FNA (2018) identifies the Nurse Practitioner role as one that more specifically is, “Broad-based and comprehensive nursing, independent examination of patients and assessments of their need for care as well as starting treatment based on symptoms and monitoring both acute and chronic health conditions.” (p.32)
    • The role requires a master’s degree and primarily performed by APNs working in primary care.  Individuals can additionally pursue an academic post graduate degree (doctorate) (FNA, 2018, p.32).
    • The role is not nationally regulated, and as a result it varies according to organizational oversight.

Other roles identified NP / APN Network (2017) are:

  • Specialized Nurses in Clinical Practice
    • Roles largely reflect specialization in a specific area of concentration.  This requires 30-60 ETCS (European Credit Transfer and Accumulation System) and provides advanced professional roles in the selected specialization (NP / APN Network, 2017).
    • The expanded roles are not regulated, and rather institution specific (NP / APN Network, 2017).
  • Nurse Prescriber
    • A role designated for limited prescribing of medications.  This is performed with physician oversight and requires 45 ECTS post graduate training in order to be able to have this permission (FNA, 2018, p.33).
    • According to the NP / APN Network (2017), most APNs in Finland do not have prescribing authority.

Have information to add to this page?

References and Influential Articles:
De Geest, S., Moons, P., Callens, B., Gut., C., Lindpainter, L., & Sprig, R. (2008).  Introducting advanced practice nurses/nurse practitioners in health care systems: A framework for reflection and analysis.  Swiss Med Weekly, 138(43-44),621-628.

Delamaire, M. & Lafortune, G. (2010). Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries.  OECD Health Working Papers, 54, OECD Publishing.http://dx.doi.org/10.1787/5kmbrcfms5g7-en

Fagerström, L. & Glasberg, A.L. (2011).  The first evaluation of the advanced practice nurse role in Finland – The perspective of nurse leaders.  Journal of Nursing Management, 19, 925-932.  doi:10.1111/j.1365-2834.2011.01280.x

Finnish Nurses Association [FNA] (2018). New roles for nurses – Quality to future social welfare and health care services.  Retrieved May 17, 2022 from: https://1553422.169.directo.fi/@Bin/e02495795f0c2e137dc85385beb70747/1652808570/application/pdf/256215/APN_RAPORTTI_ENG_VALMIS_pieni.pdf

HAI Europe (2012). The next chapter in promotion of healthcare professionals: Nurse prescribers [fact sheet]. Retrieved from: http://haieurope.org/wp-content/uploads/2012/02/27-July-2011-HAI-Europe-Nurse-Prescribers-Factsheet.pdf

Jokiniemi K. (2014). Clinical Nurse Specialist Role in Finnish Health Care. Dissertations in Health Science. U niversity of Eastern Finland. Available in: http://epublications.uef.fi/pub/urn_isbn_978‐952‐61‐1579‐ 5/urn_isbn_978‐952‐61‐1579‐5.pdf

NP / APN Network (2017). Country specific practice profiles. Retrieved May 16, 2022 from: https://international.aanp.org/Practice/Profiles

Robinson, S. & Griffiths, P. (2007).  Nursing education and regulation: International profiles and perspectives [online publication].  Retrieved from: http://eprints.soton.ac.uk/348772/1/NurseEduProfiles.pdf

Tynkkynen, L.K. (n.d.). Limited right for nurses to prescribe medication.  Health Policy Monitor.  Retrieved from: http://www.hpm.org/en/Surveys/THL_-_Finland/15/Limited_right_for_nurses_to_prescribe_medication.html

[ORIGINALLY POSTED SEPTEMBER 24, 2013.  UPDATED MAY 17, 2022]

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