From healthcare system reform to role erosion – nurse leaders in Finland have told Nursing Times about the biggest challenges facing their country’s workforce.
Last week, the Finnish Nurses Association (FNA) hosted the 2025 International Council of Nurses (ICN) Congress in Helsinki.
“We are so honoured to have this meeting here”
Heljä Lundgrén-Laine
At the event, more than 7,000 nurses from over 140 countries gathered to exchange ideas, against a backdrop of global instability, widening inequalities and world-wide workforce difficulties.
FNA executive director Anne Pauna and president Dr Heljä Lundgrén-Laine, speaking exclusively with Nursing Times, discussed the issues nurses in their country face, and what they could bring to the global meeting of the profession.
Ms Pauna, a nurse and paramedic by background, said one of the key issues facing nurses was the impact of a 2023 restructure of the health system in Finland.
During these reforms, she explained that the system was centralised, with many specialist hospitals’ services wrapped into larger hospitals. Hundreds of locally-run municipalities became 22 “wellbeing service counties”.
Explaining the impact of this, and accompanying budget constraints, on nurses, Ms Pauna said: “They are not firing nurses, but they have been [cutting support staff], they’re cutting all the cleaners.
“And who does the work? The nurses… the problem is that all the workload is coming on the nurses.”
Ms Pauna said nurses had found themselves needing to clean operating rooms due to the lack of other staff, adding: “The nurses… need assistance. We need everyone to do their own job.”
Experienced intensive care nurse Dr Lundgrén-Laine, who has worked as a nurse director, said this big reform to the health system also meant that in some rural areas like hers, in mid-Finland, some people had been left very far from their nearest major hospital.
She spoke about an ongoing brain drain of nurses from rural areas to cities: “It’s similar all over the world.
“Nurses are going to the big cities. It’s seen as more interesting to work in a university hospital than in elderly care… that’s a huge problem for us.”
Further, Dr Lundgrén-Laine said that her organisation had been calling for improvements to the strength of nursing leadership.
Heljä Lundgrén-Laine
She explained that, currently, there lacked a legal mandate of a chief nursing officer for every county, where there was one for a medical leader.
“Our law says that there should be responsible doctor and responsible social care director in every place, but not a nurse,” she said.
“Almost every county… has some kind of nurse officer, but their position is really, really different.”
Ms Pauna explained that, in some counties, the chief nursing officer lacked a budget or significant decision-making power.
The FNA leaders also discussed the positives of Finnish nursing.
Finland has an above-average proportion of nurses compared to population, with 19 nurses per 1,000 people compared to the European Union average of 8.5.
This, Ms Pauna and Dr Lundgrén-Laine said, was something other countries could learn from Finland.
They also said that, on the whole, nurse education in the country – and across the Nordic nations – was good and that nurses had been embracing digital tools in their practice.
However, Dr Lundgrén-Laine added that, like the UK nursing profession, more support and education on using emerging technologies was needed to help take advantage of these new tools.
