Nurses bridging north: Strengthening a diverse and sustainable workforce in the Nordic region

Demographic ageing and the retirement of large cohorts of nurses are intensifying healthcare workforce shortages across the Nordic countries. Although internationally educated nurses (IENs) play an increasingly important role in addressing these gaps, the fragmented and nationally bounded bridging education highlights the need for a Nordic network to support IENs effective integration and mobility to the Nordic region.

Ageing and the Nordic nursing workforce

The Nordic countries are undergoing a demographic shift (Fritzell et al., 2022) marked by rapid population ageing and increasing longevity. The share of older adults, particularly those aged 80 years and above, is growing faster than in most other OECD countries (Navigating the Golden Years, 2025), leading to higher demand for health and long-term care services. At the same time, large cohorts of nurses educated during the expansion of the Nordic welfare state are reaching retirement age, creating significant workforce gaps in healthcare (Kansallinen ikäohjelma vuoteen 2030, n.d.; Kuntatyönantajat, 2025).

To mitigate these shortages, Nordic healthcare systems have become increasingly reliant on internationally educated nurses (IENs) (Cubelo et al., 2024). Migration of nurses to high-income countries in the region has intensified in response to persistent domestic shortages and growing care needs driven by ageing populations. While IENs represent a vital resource for sustaining healthcare services, their integration into regulated nursing roles is often delayed by complex credential recognition processes, language requirements, and regulatory barriers (Cubelo et al., 2024; Cubelo & Vaittinen, 2026; Kamau et al., 2022).

As a result, many IENs work in positions below their qualifications such as nursing assistants or care aides, particularly in elder care settings. This phenomenon of deskilling has been widely documented across Nordic countries and reflects systemic difficulties in fully utilising migrant nurses’ competencies (Marekovic, 2026). Deskilling not only affects nurses’ professional trajectories and well-being but also limits the effectiveness of international recruitment as a long-term solution to workforce shortages (International nurses in health care system, 2024; Yabal et al., 2026).

Given continued population ageing and retirements, improving pathways for recognising and integrating internationally educated nurses is increasingly critical. Ethical and sustainable recruitment and integration, as emphasised by the ICN (Reporting Round Global Code for the Recruitment of International Health Personnel.Pdf, n.d.) and WHO Global Code of Practice, is essential to ensure that the Nordic region can meet future care needs while avoiding the underutilisation of skilled nursing professionals.

Integration of internationally educated nurses (IENs)

Across literature, similar barriers consistently emerge considering integration of internationally educated nurses (IENs) to host countries. The strongest available evidence largely consists of reviews and qualitative studies from Canada, the United States, the United Kingdom, Finland, and other Nordic countries (Atack et al., 2012; Cubelo et al., 2024; Kamau et al., 2022; Kamau et al., 2023; Marekovic, 2026; Rajpoot et al., 2024; Shiju et al., 2024). As such, the current understanding is based more on synthesised lived experiences, yet there is a clear gap to strengthen the evidence to promote high-quality bridging education. A 2024 narrative systematic review identified three overarching themes: migration-related pressures, a “one-way integration logic,” and mismatches between expectations and reality (Rajpoot et al., 2024). The review concluded that integration requires a collaborative organisational approach that actively addresses discrimination, racism, and communication barriers. Similarly, qualitative evidence synthesis by (Shiju et al., 2024) identified challenges at the individual, organisational, and contextual levels. Identified key barriers included language differences, inadequate leadership, racism, and discrimination, as well as legal and regulatory challenges. Reported facilitators included a willingness to learn and adapt, self-efficacy, structured and multifaceted transition programs, supportive workplace environments, and mentorship.

Importantly, the literature suggests that effective support for IENs is not achieved through isolated interventions such as single orientation sessions. Instead, success is associated with coherent and comprehensive transition models. For example, already in 2012, a qualitative study (Atack et al., 2012) of an integrated bridging program emphasised the importance of occupation-specific language training combined with sufficient clinical practice time. A 2025 Canadian program (ET, n.d.) evaluation similarly found improvements in critical thinking, communication, clinical reasoning, and professional judgment following a customised supervised-practice program. Although these results are promising, they are still preliminary given the complexity of a coherent, comprehensive process.

A key theoretical insight across literature is that integration should be understood as a two-way process. While IENs must adapt to new professional and cultural environments, healthcare organisations must also adjust to support them effectively (Kamau et al., 2023). This perspective, raised in earlier literature, has been shown to hold true throughout and appears consistently in both case studies and reviews, which emphasise leadership commitment to equity, workforce diversity, peer support, and anti-racist practices as critical factors for retention and job satisfaction (Atack et al., 2012).

Based on previous research, there remains a notable gap in rigorous comparative research and systematic development, and best practice especially considering the Nordic region. Few studies systematically evaluate which integration- and educational models are most effective, or whether specific approaches consistently improve retention or patient outcomes across different settings. Most existing studies are descriptive or qualitative, supplemented by a small number of limited bridging education program evaluations. Further targeted research could more closely examine country-specific policy frameworks and provide deeper evaluation of transition- and bridging education programs. 

Internationally educated nurses in the Nordic region?

The Nordic countries share both cultural commonalities and similarities in terms of higher education at bachelor’s level (The European Higher Education Area in 2020: Bologna Process Implementation Report, n.d.). In the Nordic context, nurse mobility operates within a largely shared workforce, supported by open labour markets (Nicola et al., 2021; Nordic Council of Ministers for Education and Research (MR-U), n.d.; Nordregio-Policy Brief, n.d.; Norlén et al., 2024) and aligned regulatory systems across countries. However, this only applies to those who hold a bachelor’s degree from an EU/EHEA country. Even if you are licensed to work as a registered nurse in another Nordic country, this license is not transferable, if you hold a bachelor's in nursing from outside the region.

A preliminary search in literature identified an area of Nordic research on internationally educated nurses (IENs), consisting primarily of review articles alongside a limited number of country-specific qualitative studies. The most comprehensive Nordic contribution is a (Dræbel et al., 2026) scoping review examining immigrant physicians and nurses across the Nordic countries. Drawing 37 studies, it identified a consistent set of retention factors, including a sense of belonging, supportive management and colleagues, collegial workplace cultures, recognition of cultural competencies, and access to professional networks. Key barriers included unfamiliar healthcare systems, experiences of discrimination, insufficient entry-level support, poor psychosocial work environments, and limited professional networks.

In addition, a Finland-specific qualitative study (Cubelo et al., 2024) focusing on Filipino IENs explored experiences within the recognition and credentialing pathway. The study found that both pre-migration orientation and workplace integration processes significantly influenced participants’ intentions to remain in the Finnish workforce. The authors emphasise that licensure and integration pathways require stronger coordination across stakeholders, including regulators, employers, and educational institutions. Overall, while Nordic research on IEN integration is to be found (Cubelo et al., 2024; Cubelo et al., 2024; Kamau et al., 2022, 2025; Kamau et al., 2023; Kamau et al., 2023; Oja-Lipasti et al., 2026), it remains relatively limited in scope and is largely descriptive rather than intervention based. There is a clear need for more targeted co-operation, educational development, and research within the Nordic region to offer a more nuanced understanding of regional policy and practice differences considering bridging education programs.

Conclusively, unclear education pathways and poor recognition of IENs qualifications lead to deskilling and limit practice opportunities within Nordic countries. Strengthening collaboration around bridging education- and integration policies can support IENs' professional development and enable fuller contributions to the healthcare system within the host country as well as within the whole region.

A Nordic network for quality assurance

Based on a clear need, a Nordic network named Nurses Bridging the North, has been established in 2025 across higher education institutions in Finland, Sweden and Norway. The overall goal of the network is to strengthen collaboration and quality among higher education institutions in the development and quality assurance of bridging education programs for internationally educated nurses (IENs). The aim of the network is to enhance pedagogical approaches, curriculum design, learning outcomes, and assessment methods in alignment with national and EU requirements.

To date, two network meetings including presentations, invited speakers and workshops have been conducted in Norway (2025) and Sweden (2026). The days have been bringing together researchers, lecturers, student counsellors and administrative staff to exchange experiences and identify common challenges and opportunities. Building on this work, the central objective of the network is to develop a shared Nordic Framework for educational and professional pathways for IENs, with the intention of informing policy at both national and Nordic levels. The network further seeks to advance joint development in pedagogy, integration of support structures, and research.

The overall goal is to improve the quality, relevance, and sustainability of bridging education for IENs across Nordic countries through knowledge exchange, shared perspectives, and support for student and staff mobility. In the longer term, the network aims to facilitate effective integration of IENs into the Nordic healthcare workforce, strengthen their career pathways, and contribute to safe, high-quality patient care through collaborative educational development. A follow-up study examining workforce establishment and integration outcomes is planned as the next step in addition to curricula development and shared course development and content.

In summary, the mobility of nurses in the Nordic countries is characterised by relatively open labor markets and common regulatory frameworks; however, successful integration depends less on mobility itself and more on the recognition of qualifications that validate prior competence, e.g. recognition of qualifications and inclusion in the workplace, as well as access to professional networks, particularly given the international nurses present in the region and the need for them. By strengthening Nordic cooperation, the network contributes to ethical and sustainable integration (WHO Health Workforce Support and Safeguards List 2023, n.d.) of IENs into the Nordic healthcare workforce.

Lotta Eronen, PhD, MSc, RN. senior lecturer in healthcare.

Terese Sjölund, MSc, RN. Degree Program director Nursing Programme.

Members of the Nordic Network: Nurses Bridging North

Finland: Yrkeshögskolan Arcada & Yrkeshögskolan Novia 
Norway: OsloMet, Høgskulen på Vestlandet & NTNU-Norwegian University of Science and Technology
Sweden: Karolinska Institutet, Göteborgs Universitet & Högskolan i Gävle

References

Atack, L., Cruz, E. V., Maher, J., & Murphy, S. (2012). Internationally Educated Nurses’ Experiences With an Integrated Bridge Program. The Journal of Continuing Education in Nursing, 43(8), 370–378. https://doi.org/10.3928/00220124-20120615-62

Cubelo, F., Langari, M. N. M., Jokiniemi, K., & Turunen, H. (2024). Recognition of nursing qualification and credentialing pathway of Filipino nurses in Finland: A qualitative study. International Nursing Review, 71(3), 661–669. https://doi.org/10.1111/inr.12901

Cubelo, F., Turunen, H., & Jokiniemi, K. (2024). Recruit, integrate, and retain: Internationally educated nurses mobility to the Nordic region: A two-round policy Delphi study. Nursing Outlook, 72(6), 102299. https://doi.org/10.1016/j.outlook.2024.102299

Cubelo, F., & Vaittinen, T. (2026). International Recruitment and Nursing Shortage in the Nordic Region: Ethical Implication and the Global Code: A Policy Analysis. International Nursing Review, 73(1), e70164. https://doi.org/10.1111/inr.70164

Dræbel, T. A., Larsen, K., Petterson, E. B., Sørensen, J. B., & Konradsen, F. (2026). Retention of immigrant doctors and nurses in the medical labour markets of the Nordic countries: A scoping review. Scandinavian Journal of Public Health, 54(1), 34–48. https://doi.org/10.1177/14034948241293179

ET. (n.d.). Canada introduces free support program for internationally educated nurses. The Economic Times. Retrieved 23 April 2026, from https://economictimes.indiatimes.com/nri/work/canada-introduces-free-support-program-for-internationally-educated-nurses/articleshow/122932152.cms

Fritzell, J., Agahi, N., Jylhä, M., & Rostgaard, T. (2022). Social inequalities in ageing in the Nordic countries. European Journal of Ageing, 19(2), 155–159. https://doi.org/10.1007/s10433-022-0070…
International nurses in health care system: Deskilling to upskilling. (2024, October 28). Julkaisut@SEAMK. https://lehti.seamk.fi/verkkolehti/international-nurses-in-health-care-system-deskilling-to-upskilling/

Kamau, S., Koskenranta, M., Isakov, T.-M., Kuivila, H., Oikarainen, A., Tomietto, M., & Mikkonen, K. (2023). Culturally and linguistically diverse registered nurses’ experiences of integration into nursing workforce – A qualitative descriptive study. Nurse Education Today, 121, 105700. https://doi.org/10.1016/j.nedt.2022.105700

Kamau, S., Koskenranta, M., Kuivila, H., Oikarainen, A., Tomietto, M., Juntunen, J., Tuomikoski, A.-M., & Mikkonen, K. (2022). Integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments: An umbrella review. International Journal of Nursing Studies, 136, 104377. https://doi.org/10.1016/j.ijnurstu.2022.104377

Kamau, S., Oikarainen, A., Juntunen, M., Koskenranta, M., Kuivila, H., Tomietto, M., & Mikkonen, K. (2023). Nurse educators’ views of integrating culturally and linguistically diverse future registered nurses into healthcare settings: A qualitative descriptive study. Journal of Advanced Nursing, 79(9), 3412–3425. https://doi.org/10.1111/jan.15683

Kamau, S., Oikarainen, A., Kiviniitty, N., Koskenranta, M., Kuivila, H., Tomietto, M., Kanste, O., & Mikkonen, K. (2023). Nurse leaders’ experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings: An interview study. International Journal of Nursing Studies, 146, 104559. https://doi.org/10.1016/j.ijnurstu.2023.104559

Kamau, S., Tomietto, M., Cubelo, F., & Mikkonen, K. (2025). Strategic Measures in Recruiting and Integrating Culturally and Linguistically Diverse Nurses to Finnish Healthcare Context. In R. El Moubadder, R. Wojtiuk, & R. Lee (Eds.), Globalization and Integration of Internationally Educated Nurses: A Comprehensive Analysis (pp. 63–85). Springer Nature Switzerland. https://doi.org/10.1007/978-3-032-01106-0_3

Kansallinen ikäohjelma vuoteen 2030. (n.d.).

Kuntatyönantajat. (2025, May 21). Alanvaihtajat ja eläkeläiset voivat helpottaa hoitajapulaa. Kunta- ja hyvinvointialuetyönantajat KT. https://www.kt.fi/uutiset-ja-tiedotteet/2025/alanvaihtajat-ja-elakelaiset-voivat-helpottaa-hoitajapulaa

Marekovic, A.-M. S. (2026). Between Benefit and Risk: Constructions of Skill and Competency of Internationally Educated Nurses in Sweden. Nordic Journal of Migration Research, 16(3), 2. https://doi.org/10.33134/njmr.1042

Navigating the golden years: Making the labour market work for older workers: OECD Employment Outlook 2025. (2025, July 9). OECD. https://www.oecd.org/en/publications/oecd-employment-outlook-2025_194a947b-en/full-report/navigating-the-golden-years-making-the-labour-market-work-for-older-workers_2bc681ed.html

Nicola, B., Sara, E., Klaus, M. H., Ómar, H., Marie, R. H., Anne, Helge, N. N., & Kaija, R. (2021). Nordic Cross-border Statistics: The results of the Nordic Mobility project 2016-2020. Nordic Council of Ministers.

Nordic Council of Ministers for Education and Research (MR-U). (n.d.). Nordic Declaration on the Recognition of Qualifications Concerning Higher Education The Reykjavik Declaration (Revised 2022) | Nordic cooperation. Retrieved 25 June 2025, from https://www.norden.org/en/declaration/nordic-declaration-recognition-qualifications-concerning-higher-education-reykjavik

Nordregio-Policy Brief. (n.d.). Nordregio—Recruitment and retention in the welfare sector: Nordic best practice. Retrieved 28 March 2025, from https://pub.nordregio.org/pb-2021-1-recruitment-and-retention-in-welfare-sector/#

Norlén, G., Heleniak, T., Sánchez Gassen, N., Stjerneberg, M., Maersk, E., Berbert, K., Jessen, S., Refsgaard, K., & Tapia, C. (2024). State of the Nordic Region 2024. Nordregio. https://doi.org/10.6027/R2024:13.1403-2503

Oja-Lipasti, P., Oikarinen, A., Kamau, S., Petäistö, S., Mikkonen, K., & Kuivila, H.-M. (2026). Internationally educated nurses’ experiences of recruitment—An ethical perspective. Nursing Ethics, 33(1), 188–204. https://doi.org/10.1177/09697330251350391

Rajpoot, A., Merriman, C., Rafferty, A.-M., & Henshall, C. (2024). Transitioning experiences of internationally educated nurses in host countries: A narrative systematic review. International Journal of Nursing Studies Advances, 6, 100195. https://doi.org/10.1016/j.ijnsa.2024.100195

Reporting Round Global Code for the Recruitment of International Health Personnel.pdf. (n.d.). Retrieved 24 April 2026, from https://www.icn.ch/sites/default/files/2024-08/Reporting%20Round%20Global%20Code%20for%20the%20Recruitment%20of%20International%20Health%20Personnel.pdf

Shiju, M., Hall, H., Lee, C., & Whitehouse, C. (2024). Barriers and Enablers of Successful Workplace Integration of Internationally Educated Nurses (IENs) in a Host Country: A Qualitative Evidence Synthesis. Policy, Politics, & Nursing Practice, 25(4), 228–240. https://doi.org/10.1177/15271544241276860

The European Higher Education Area in 2020: Bologna Process Implementation Report. (n.d.). 32.
WHO health workforce support and safeguards list 2023. (n.d.). Retrieved 24 April 2026, from https://www.who.int/publications/i/item/9789240069787

Yabal, J., Kamau, S., Tomietto, M., & Mikkonen, K. (2026). Psychological Safety of Culturally and Linguistically Diverse Nurses in Healthcare Work Environments—Systematic Review of Mixed‐Methodology. Journal of Advanced Nursing, jan.70575. https://doi.org/10.1111/jan.70575