29.4.2016 Marianne Sipilä Reproductive, maternity and child health in primary healthcare in Finland

1. NURSES IN FINNISH
HEALTH CARE SYSTEM
Marianne Sipilä
R.N., McS, Senior Lecturer
29.4.2016
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Picture Finnish Nurses Association

2. WHAT YOU’LL HEAR TODAY
 Introdution
 Nursing education:
- Background
- Bachelor level, UAS, University
 Right to Practice
 Statistics of Nursing
 Where Do the Nurses Work
 Finnish Health Care and Nurses Role
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3. Finnish Nurses Association
Metropolia University of Applied Science
National Institute for Health and Wellfare
Children, young people and families - Promoting the well-being of
children
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My background

4. BACKGROUND OF NURSING EDUCATION
 Nursing education in Finland go back to the early 19th
century
 Since the beginning of 1990s registered nurses (RNs) have
been educated at Universities of Applied Sciences (UAS,
also called Polytechnics)
 It takes 3,5 years to complete bachelor level degree, which
is worth 210 ECTS. (ECTS is a standard for comparing the study
attainment and performance of students of higher education across the European
Union and other collaborating European countries. One academic year corresponds to
60 ECTS credits that are equivalent to 1500–1800 hours of study).
 National legislation closely regulates the education and
professional practice of health care personnel.
 Also based on the European Union’s Directive 2013/55/EU
amending Directive 2005/36/EC. The requirements in
Finland are similar to those of elsewhere in the European
Union and other collaborating European countries.
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5. OTHER BACHELOR LEVEL DEGREES
 The public health nursing degree (four years/240
ECTS)
 The paramedic degree (four years/240 ECTS)
 The midwife degree (four-and-a-half years/270
ECTS)
 They all include the right to practice as a
registered nurse.
 Altogether, there are 74 781 registered nurses of
working age in Finland (statistics by Valvira
31.12.2014).
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6. MASTER’S LEVEL EDUCATION IN
UNIVERSITY OF APPLIED SCIENCES (UAS)
The requirements for studying for a Master's
degree at a UAS:
 at least three years work experience
 worth 90 ECTS and takes about one-and-a-half to
two years.
 There are 7 UASs in Finland that offer Master’
degree courses in health care. The degree
programmes vary, for example Clinical Nursing,
Emergency and Critical Care Nursing,
Management in Social and Health Care, or
Health Promotion.
 They have employed in different positions in the
labour market
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7. MASTER’S EDUCATION IN UNIVERSITY
 5 universities in Finland offering Master’s courses in
nursing sciences
 To enrol one needs to be a registered nurse or to have an
equivalent qualification in health care.
 The curricula vary between the universities.
 The Bachelor of Nursing Science degree is a lower
academic qualification (180 ECTS)
 The Master of Nursing Science is a higher qualification
(120 ECTS). Depending on their previous studies,
registered nurses need to obtain about 80-100 ECTS for the
Bachelor degree and 120 ECTS for the Master’s degree,
amounting in total to about 200-220 ECTS.
 Universities provide postgraduate Licentiate and Doctoral
degree courses (~4 yrs). One can also take Licentiate or
Doctoral degrees after completing a Master's at a UAS
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8. RIGHT TO PRACTICE
 The National Supervisory Authority for Welfare
and Health (Valvira) grants upon application the
right to practice as a licenced or authorised
professional and authorises the use of the
occupational title of healthcare professional
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Picture Finnish Nurses Association

9. STATISTIC IN FINLAND
In 2011
 102 800 degrees of nurses, midwifes, public health
nurses
 21 300 of them were retired
 81 500 were of working age: 77 200 (94,7%) employed
and 1 100 unemployed (1,3%)
 3 200 on study leave or maternity leave ect
(Ailasmaa THL/ Report of statistics 8/2014)
o 28 862 worked in the public sector, of which 91,5% were
women
o 10,3 nurses per 1000 inhabitants
o 4 nurses per 1 physician
o 63,7 graduated nurses per 100 000 inhabitants in 2011
o 0,8% of the nursing workforce from abroad
o Not re-registration
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10. STATISTICS IN EUROPE AND GLOBALLY
o estimated 7.3 million nurses and midwives in the
WHO European Region
o Estimated 6 million nurses in European Union
Member States (EFN 2015)
 42,9 graduated nurses per 100 000 in OECD (2013)
 19,3 nurses and midwifes in global (WHO 2011)
 3,1 million in USA
 15 in Niue in the Pacific Ocean
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11. WHERE DO THE NURSES WORK?
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 A nurse can be employed in different operational environments in the
public, private or third sector.
 The most typical jobs are within the public sector, i.e. social and health
care services owned and organised by municipalities or the state. The
maintenance and provision of these services are funded primarily by tax
revenues.
 Other opportunities e.g.:
 health care facilities within social welfare, such as home help service,
assisted living residences, old people’s homes or substance abuse units.
 the private sector: private clinics, care homes, care enterprises and patient
transport.
 pharmaceutical companies, e.g. as pharmaceutical representatives or
product demonstrators with manufacturers of treatment supplies and
assistive devices.
 the third sector, e.g. Finnish Heart Association, Finnish Diabetes
Association, welfare and volunteer work conducted by the church.
 to found own company and work as a self-employed care entrepreneur.
 to work as planners, specialists and consultants within different health
care development projects.
Picture Finnish Nurses Association

12. SOCIAL AND HEALTH CARE REFORM
 Who knows what is coming?
 Nurses - Be prepared
 Show your skills and competences
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Picture Finnish Nurses Association

13. FINNISH HEALTH CARE
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 Universal health care > Everyone in Finland is entitled to
adequate social and health services.
 Municipalities are responsible for arranging and funding health
care at this moment
> State and/or Regions and/or 3rd sector and/or Private in the
future?
 Strong emphasis on health promotion and prevention of diseases.
 Health services are divided into primary health care and
specialized medical care.
 Primary health care services are provided at municipal health centres.
 Most specialised medical care is performed in hospitals.
 Occupational health care: Employers are responsible for
preventive health care.
 Private health care services supplement municipal services.
Municipalities or joint municipal authorities may also procure
services from private service providers.

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In February 2012, the OECD published a country
report from Finland. According to this report, the Finns
are more satisfied with their health care than people in
many other OECD countries. However, the Finns are
less satisfied with availability of their local services.
During the last twenty years, health differences
between demographic groups have increased, although
diminishing of inequality has been a clear objective of
the Finnish health policy for a long time.
Available at http://www.oecd.org/finland/

15. FINNISH HEALTH SYSTEM: CHALLENGES
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 Structure and funding of health care – reform in progress
 Prioritization – can we afford to treat all?
 Changing needs and expectations, growing costs of health
care -> huge challenges to the promotion of the nation’s
health.
 Ageing population and work force – shortage of health care
professionals in future
 Finland is ageing as the first country in Europe
 Approximately one in four persons over 75 years is in need of
regular services because of reduced functional capacity, such as
home service, home nursing, support for informal care, or 24-hour
caring.
 OECD estimates: by 2020 there is a lack of 1 000 000 health
personnel in EU area – this means that 15% of the needed care
can not be taken care of

16. FINNISH PUBLIC HEALTH: CHALLENGES
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 Work disability due to mental disorders,
psychosocial problems among young people
and their repercussions in later life
 NCDs: allergy, asthma, diabetes, obesity and
alcohol-related health problems
• The life expectancy of Finnish men is mainly
deteriorated by cardiovascular disease, excessive
consumption of alcohol and accidents.
• Alarming trend: already 20% of our children and
adolescents are over weight
 Injuries sustained in home and leisure
activities
The level of health has improved a lot in recent decades, STILL:
health inequalities a major problem - health differences among
subgroups of the population are in some instances even
increasing.

17. Nurses play a key role
in carrying out and improving
patient-centered care.
Studies Confirms That Nurses Are Key to
Hospital Success
• McHugh M, Aiken L, Burns L, et al. Achieving Kaiser Permanente
quality. Healthcare Manage Rev. 2015.
• Read E, Laschinger H, Finegan J, et al. The influence of nursing
unit empowerment and social capital on unit effectiveness and
nurse perceptions of patient care quality. Journal of Nursing
Administration. 2015.
16.5.2016

18. ADVANCED PRACTICE NURSING
ROLES
 Finnish Nurses Association have 4th April, 2016 launched a
report on APN in Finland. There are introduced two APN
roles, Clinical Nurse Specialist (CNS) and Nurse Practitioner
(NP), and have also made suggestions for Finnish translations
for the titles.
 The report describes the Finnish clinical career path for nurse.
We base it on international literature and adapt to national
grounds and demands.
The report includes 5 recommendations related to
1. coherent titles, defined job descriptions and needs for
legislation changes,
2. needs to develop education to ensure the competencies
needed,
3. the amount of APN nurses should be based on population’s
health needs,
4. wage should correlate to the demands of the work,
5. we need to evaluate and follow the effectiveness of the roles.
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19. LIMITED RIGHT TO PRESCRIBE SINCE 2010
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Requirements
 employment relationship with the health
centre
 post graduate training (45 ECTS)
 authorisation from the physician-in-
charge
 competence recorded by the National
Supervisory Authority for Welfare and
Health
All together 200 nurse prescribers throughout Finland.

20. A FOUR-CATEGORY MODEL TO DEFINE THE DIFFERENT EXPERT ROLES
OF NURSES IN EVIDENCE BASED PRACTICE IN FINLAND.
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21. 16.5.2016
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Thank you!
Kiitos!