As Western countries face a growing nursing shortage over the next decade, they will have to compete for healthcare professionals to fill the gap. The winners and losers in this race will depend on how well they attract and retain international healthcare workers.

Finland, like other Western countries, will likely have to compete for healthcare professionals from countries like the Philippines, India, and some African nations.

However, attracting nurses from these workforce-exporting countries is not without challenges. Ethical concerns arise, as recruiting healthcare professionals from developing countries can exacerbate shortages in their home countries. Quality and standards, language and cultural barriers, and integration and support also play a role in the success of international recruitment efforts.Representatives of 50 of 53 member states of the World Health Organization European region convened in Bucharest on March 22 to address the widespread crisis of insufficient health workforce across the region. The meeting called for immediate action and commitment to protect, support, and invest in health and care workers across Europe and central Asia. The members adopted the Bucharest Declaration, outlining significant political actions, including improving and retaining health and care workers and working on supply mechanisms.

Dr. Hans Henri P. Kluge, the WHO Regional Director for Europe, expressed his concern about the health workforce crisis in Europe, saying that it is no longer a looming threat but a present reality. “The COVID-19 pandemic has revealed the fragility of health systems and the importance of a robust and resilient health workforce. We cannot wait any longer to address the pressing challenges facing our health workforce,” Dr. Kluge said in the meeting.

The declaration comes at a time when heated clashes among political parties over the issue of public health systems and the induction of international health workforces have garnered a lot of media and public attention in the run-up to elections in Finland. The issue is as prevalent in Finland as globally, where around 200,000 new health and social workers are needed by 2030, with at least 10 percent of them to be recruited from abroad, according to Finland’s Employment Ministry.

As of 2021, many Western countries were facing nursing shortages, and these shortages were projected to continue or worsen by 2030. Some of these countries included:
  1. United States: According to the American Nurses Association, the U.S. was projected to experience a shortage of over 1 million nurses by 2030.
  2. Canada: A study by the Canadian Nurses Association estimated a shortage of around 60,000 nurses by 2030.
  3. United Kingdom: The UK's National Health Service (NHS) reported that there could be a shortage of around 108,000 full-time equivalent (FTE) nurses by 2030.
  4. Germany: The German Federal Employment Agency predicted a shortage of 150,000 nurses by 2025, and this number was expected to increase by 2030.
  5. France: In 2018, France faced a deficit of approximately 20,000 nurses. This figure was projected to grow by 2030, but specific numbers were not available.
  6. Australia: According to a 2019 report by Health Workforce Australia, the country could face a shortage of over 85,000 nurses by 2030.

Lesser internationally educated nurses registered

The shortage of health and social workers stems from an aging population and health staff, lack of incentives for health workers, and difficulty in learning the Finnish language, among others. The Ministry of Social Affairs and Health has laid out a roadmap for 2022-2027 to secure the adequacy and availability of personnel in the social and health sector.

The ministry points out that while COVID-19 has brought attention to the shortage of healthcare workers in other countries, Finland has been facing this challenge due to its aging population and increasing needs. “In many other countries, COVID-19 has been a major driver, but not so much in Finland. Also, social and health care staff is aging, and the increase in education done by the current government should have been done earlier,” Taina Mäntyranta, Medical Advisor, Ministry of Social Affairs and Health, explained.

In the last five months, a total of 1,894 practice rights as a nurse were granted, according to data provided by the National Supervisory Authority for Welfare and Health, Valvira, to Helsinki Times. Out of these, 31 had completed their education abroad, including 14 in the EU/EEA area and 17 out of the region. The data from Valvira shows that despite the increase of 3.6 percent in the total number of registered nurses between 2020-2022, the licenses granted to staff nurses with abroad education has decreased during the same period.

As per the register (Terhikki) of all registered nurses from outside Finland, the majority are from Estonia, Sweden, Spain, Germany, and the Philippines. “In recent years, the countries have been, for the EU/EEA-area, Sweden and Estonia, and for countries outside the EU/EEA-area, the Philippines,” said Jenni Kangas, Head of Unit, Valvira.

Finland in the global race

In comparison to other Western countries competing for international nurses, Finland faces challenges due to its relatively lower average salary (€2,800/month) and the high cost of living, which impacts purchasing power. Despite the high taxation rate in Finland, nurses in countries like Germany, the United States, and Canada earn higher average salaries and enjoy better purchasing power.

The following annual salaries of nurses in some western countries (2021) are presented in euros for comparison. Other factors such as taxation and cost of living can also affect purchase power significantly.
  1. Finland: The average annual salary for a registered nurse in Finland is around €38,000 to €45,000. Finland has a high cost of living, with relatively high income taxes and value-added tax (VAT) rates. However, the country offers a comprehensive social welfare system, including public healthcare, education, and subsidized childcare. These services help offset the cost of living and taxation, improving the overall purchasing power for nurses.
  2. United States: The average annual salary for a registered nurse in the United States is approximately €58,000 to €70,000 (converted from USD). The United States has a moderate cost of living, with significant regional variations. Generally, income taxes are lower than in many European countries, but the country has less comprehensive social welfare systems. This means nurses in the US might have higher disposable income, but they may also face higher out-of-pocket expenses for healthcare, education, and childcare.
  3. Canada: The average annual salary for a registered nurse in Canada ranges from €42,000 to €65,000 (converted from CAD). Canada's cost of living is somewhat lower than that of the United States, and it has a more comprehensive social welfare system, including public healthcare. Income taxes are higher than in the US, but overall purchasing power for nurses in Canada is relatively strong, considering the balance between income, taxes, and social benefits.
  4. United Kingdom: The average annual salary for a registered nurse in the United Kingdom is around €28,000 to €39,000 (converted from GBP). The cost of living in the UK is relatively high, particularly in cities like London. Income taxes are moderate, and the country provides a comprehensive social welfare system, including public healthcare through the National Health Service (NHS). While nursing salaries are lower than in some other countries, the social benefits help offset the cost of living, resulting in moderate purchasing power.
  5. Germany: The average annual salary for a registered nurse in Germany is approximately €35,000 to €45,000. Germany has a moderate cost of living and relatively high income taxes. However, the country offers a strong social welfare system, including public healthcare, education, and childcare services. This support helps to improve the purchasing power of nurses in Germany, despite the higher taxes.
  6. Australia: The average annual salary for a registered nurse in Australia is around €45,000 to €65,000 (converted from AUD). Australia has a relatively high cost of living, but it also provides a strong social welfare system, including public healthcare, education, and childcare services. Income taxes are moderate, and overall purchasing power for nurses in Australia is relatively strong, considering the balance between income, taxes, and social benefits.

Canada has recently opened a new immigration operation centre in the Philippines, and similar centres are planned for Turkey and India. In 2022, Texas announced hiring bonuses of up to $5,000 for certain positions at state healthcare facilities.

Elaborating on initiatives taken by Finland, Mäntyranta said, “Finland has a package of actions to recruit nurses from non-EU/ETA countries. A new task force has started to make the application process easier and smoother.” Mäntyranta added that in addition to making the recruitment process smoother, a plan for permanent education, including language skills, is planned. “At the moment, education is financed with short-term funding, and a permanent solution is needed,” Mäntyranta said.

‘Disappointed and demotivated'

The Filipino Nurses Association in the Nordic Region (FiNAN) believes that internationally educated nurses (IENs) face challenges in both transition and integration phases, which makes it difficult to retain them in Finland for longer. These challenges include recruitment hardships, mismatched Finnish language training, family migration, licensing process, and work culture differences, among others.

“When employers from Finland ask recruitment agencies to recruit IENs, monitoring the quality of Finnish language curriculum should be the key priority. Filipino nurses I have interviewed in my research, language training is not enough. They talk about their desire to learn more professional language that they could have used when they arrived in Finland, especially for those who are posted to cities outside Helsinki with a strong dialect, such as Kuopio and Rauma,” Floro Cubelo, President of FiNAN and Senior Lecturer/Head of the Degree Programme in Nursing, Oulu University of Applied Science said.

The association has urged for the Philippines and the Nordic nations to sign a bilateral labor agreement to strengthen the rights of recruited IENs for making the transition of the recruited nurses easier. “Most of the recruited IENs are recruited as Nursing Assistants. There are no concrete transition guidelines that would help them get qualified as Registered Nurses. The lack of opportunities to practice as registered nurses often leaves them disappointed and demotivated,” Cubelo added.

The Ministry of Social Affairs and Health also highlighted that international recruiting is only one action in the toolbox. “Nurses and doctors are often doing tasks that someone with less/different training could do. We need to have a proper division of labour with different professional groups,” Mäntyranta said.

Sonali Telang - HT