Utilising the professional skills of a nurse recruited from abroad and ensuring career opportunities

It is important for nurses recruited from abroad to be able to use their previously acquired competence and professional skills also in Finland within a reasonable timeframe. This is an important part of ethical recruitment. Attention should also be paid to systematic support for development and enabling career paths.

Diverse professional backgrounds

At its best, the educational background and work experience of nurses recruited from abroad meet the needs of the organisation. It is therefore important for organisations to determine in advance what kind of professional background is sought from the recruited nurses. Additionally, it is good to ensure that the nurses will get to perform work that corresponds to their competence as well as possible.

The educational and professional backgrounds of nurses recruited from abroad vary. Some of the recruited nurses have completed a degree in their home country or country of origin that mainly corresponds to a practical nurse’s or care giver’s degree, while others have graduated as registered nurses. Some nurses bring with them solid clinical competence and a long experience of demanding tasks in the healthcare sector. Others, however, may hold a degree in nursing but have work experience in a completely different field. When recruiting nurses and placing them in different units, it is important to take into account their previous educational background and work experience.

Recruitment from abroad is known to be associated with the deskilling phenomenon in which people moving from abroad to work in the healthcare sector are placed in work that does not correspond to their education. This means that people educated abroad are recruited for tasks that require less training. This becomes a problem when opportunities for more demanding tasks are not offered. This prevents the nurses from using and developing their competence, which in turn leads to a decline in their competence. In addition, the consequences for the nurse’s professional identity and motivation should be acknowledged.

Tasks corresponding to education and work experience

It is important for the organisation to support nurses’ opportunities to find positions corresponding to their education and work experience. For example, recruitment as a care giver or practical nurse should be avoided if the registered nurse who has graduated outside the EU or the EEA has the capability and willingness to qualify as a registered nurse in Finland. At first, it is inevitable that the tasks do not fully correspond to existing competence. The tasks must be modified as the nurse receives the necessary permits, such as the license to administer medication, and ultimately qualifies as a registered nurse or receives the right to use the title of practical nurse.

It is important that nurses recruited from abroad can make career decisions that meet their goals based on a well-informed foundation. Nurses seeking to move to Finland should be offered clear information on the job descriptions and responsibilities of different positions and alternative career opportunities already during the pre-departure training. It may also be a good idea to provide information on the impacts of different educational options on career development. It should also be noted that not all nurses with a registered-nurse background may want to assume a registered nurse’s duties immediately, but they may be ready for this later.

In other words, the nurse may have long experience and in-depth expertise in their field, but their previous job description and experience of working methods may differ from Finnish practices. For example, the responsibilities and obligations of pharmacotherapy may vary in different countries. In addition, the duties of a registered nurse in Finland include a wide range of different tasks, and they often also participate in basic care when necessary. In some countries, basic care is not part of the job description of registered nurses, but is the responsibility of, for example, family members. Therefore, a nurse recruited from abroad may have a high level of clinical competence in, for example, specialised medical care tasks, but their experience may only focus on certain areas, and it does not necessarily cover basic care skills.

The previously acquired competence of all recruited nurses cannot be fully utilised immediately due to, for example, missing permits or qualifications. Transition to lower-skilled positions may negatively affect the professional identity of the nurse and cause frustration. The competence of a nurse recruited from abroad should be recognised in the work community so that they can progress gradually to more demanding tasks that better correspond to their competence, through training, the development of competence at work and the accumulation of language skills.

Qualification as a registered nurse and practical nurse apprenticeship

Valvira grants the right to use the protected occupational title of practical nurse or to practise the profession of registered nurse in Finland. The procedures for recognising registered nurse degrees differ between those educated in and outside EU/EEA countries. The challenge of international recruitment in the healthcare and social services sector has been the absence of a permanent qualification pathway for nurses who have completed their degrees outside EU/EEA countries.

A prerequisite for a registered nurse’s right to practise is that a nurse educated outside the EU and EEA complements their studies and demonstrates that their competence corresponds to the level of the Finnish registered nurse degree.

When applying for a practical nurse’s professional practice right, Valvira also assesses whether education acquired outside the EU and EEA countries corresponds to Finnish education and additional studies may be required if the education differs from that in Finland. In addition, Valvira requires a certificate of sufficient language proficiency.

More information on qualification paths in Finland

Niina Glerean and Lotta Tiikkainen (eds.)
Sairaanhoitajaksi Suomessa. Pätevöitymiskoulutuksen hyvät käytännöt 2022–2025.
[Becoming a registered nurse in Finland. Good practices in qualification training 2022–2025.]
Laurea Publications 232. Laurea University of Applied Sciences.
(in Finnish)

Saila – Sairaanhoitajan laillistaminen Suomessa -hanke (Metropolia)
[Recognition as Registered Nurse in Finland project]
(in Finnish)

Registered nurses recruited to the City of Helsinki from abroad who have already completed a nursing degree outside the EU/EEA are employed in the organisation under the title of qualifying registered nurse. The idea is that competence that has already been acquired is recognised and utilised, and the same degree is not completed again. In other words, the qualification training required of registered nurses is considered to complement a previously completed degree so that it meets Finnish requirements and makes it possible to work as a qualified registered nurse in Finland quickly.

The path of qualifying registered nurse consists of four stages, and the nurses build up their competence in stages. Tasks and pay are determined by these steps. Finnish language studies have also been integrated into the theoretical studies.

A training channel has been designed for qualifying registered nurses in cooperation with the selected university of applied sciences. There is one study day a week and these are paid hours. The education lasts approximately one year, although it can be extended if necessary. During clinical practice, the nurse has an assigned registered nurse instructor.

Once the complementary studies have been completed and language proficiency is at the level YKI3, Valvira grants the professional practice rights of a registered nurse.

Language as a potential challenge in training

Apprenticeship training for practical nurses and registered nurse qualification training for the recruited persons in Finland are mainly provided in Finnish. In addition, teaching of Finnish/Swedish has been integrated into these training programmes.

It is sometimes stated that the starting level of the Finnish/Swedish language of the student group is not sufficient for starting or progressing in studies related to the profession. In this case, it is advisable to organise either a language intensive course before starting vocational studies or a separate course supporting language learning. A good practice is to ensure a sufficient level of language proficiency even before launching the training.

Cooperation with educational institutions is essential

Seamless cooperation between recruiting organisations and educational institutions is essential in ensuring the smooth combination of education and work. Cooperation is needed, for example, in the planning of training and shifts and in responding to potential problems.

During the training, it is important to define and agree on the tasks of a nurse recruited from abroad together with them. In order to avoid misunderstandings, the work community should also be clearly informed about the nurse’s job description and the limitations of the tasks, that is, the tasks that the nurse may and may not perform during their studies.

Opportunity to focus on studies

Units should ensure that nurses recruited from abroad have sufficient opportunities to focus on their studies. The studies are helped by smooth work shift arrangements that support the studies. This may mean, for example, that shift planning sometimes reserves shifts where those recruited from abroad are not included in the dimensioning of nursing staff and where they have the opportunity to focus on learning.

The possibility of receiving pay for study days can increase stability in the studies and personal life of those recruited from abroad. The possibility to participate in the teaching days (apprenticeship training and registered nurse qualification training) during working hours is also likely to be part of the consideration when people make their decision to move to Finland.

Organisations often finance the education of a nurse recruited from abroad, in which case they may require the employee’s commitment to work in the organisation for a certain period of time after the education. If the employee decides to withdraw from the contract before the term is completed, they may have to reimburse the training costs to the organisation. The objective of such arrangements is to ensure that investments in education benefit the organisation and support the retaining of its personnel. If such commitments are in use, it is important to clearly explain the principles and criteria to the nurses recruited from abroad.

Developing competence at work

An employee can develop their competence by adopting new knowledge or practising new skills. Learning also takes place at the work community level. It is particularly important for a new employee to understand the work and its practices and also to have the opportunity to develop the practices together with the work community.

It is good for the supervisor to recognise the professional skills and experience of a nurse recruited from abroad from an early stage. This helps utilise the nurse’s competence, target orientation, and plan how competence is developed.

Motivation and commitment to the workplace can be increased by giving the nurse the opportunity to utilise their previously acquired professional competence and strengths to the extent permitted by their stage of studies and phase of the licensure process.

Gradually to more demanding tasks

Learning more demanding tasks and independently completing them should be practised in stages. Practice opportunities for new work tasks and situations that seem difficult should be actively organised and it should be ensured that the practice takes place in a psychologically safe environment.

The practice can be carried out, for example, in pairs with an instructor or another colleague. When the goal is to practise demanding linguistic situations, the nurse can first be offered opportunities to follow situations in which discussions are held with, for example, family members or a doctor. Later, they can practice similar situations independently and in such a way that the support of a more experienced colleague is available if necessary.

It is important that the work community provides constructive support and avoids a degrading or critical tone that may negatively affect the experiences of the nurse.

The organisation should offer equal opportunities to develop competence and participate in training for all employees, including nurses recruited from abroad. It is important to ensure that the content of training and exams is available in plain language, clear standard language or other supported material, so that linguistic barriers do not unnecessarily hinder learning. This approach will benefit all that participate in the training. If appropriate, the training courses can also be translated into English so that nurses who master English better than Finnish understand the content correctly.

License to administer medication

A nurse’s competence and area of responsibility includes sufficient competence in pharmacotherapy and ensuring safe pharmacotherapy. Obtaining pharmaceutical licences is often an important and critical stage in receiving professional qualifications for a nurse recruited from abroad.

The license to administer medication is granted after the nurse completes the pharmacotherapy courses and is able to pass the related exams. Sufficient time should be reserved for studying the course material, especially when Finnish language skills are still developing.

It should be noted that exams are often perceived as linguistically difficult and may contain trick questions. Training related to obtaining a pharmaceutical licence should be supplemented with language studies that prepare the nurse for pharmacotherapy materials, pharmaceutical calculations and exam requirements.

In addition, it must be ensured that in the future, clear standard language or plain language is used in the services for ensuring competence in pharmacotherapy.

Diverse experience of different health care units and working environments supports the development of the nurse's competence. Job rotation and internship opportunities in different types of units provide new experience, strengthen professional skills and develop capabilities for adapting to the practices and requirements of a wide range of working environments. This reduces the risk that nurses get stuck in tasks that are too narrow.

Support for career development

Supporting the career paths of nurses recruited from abroad is a key part of their professional development and the efforts of organisations to maintain competent and motivated personnel. The nurses may have valuable experience and special expertise that can be utilised in different tasks in a versatile manner. It is important to give nurses recruited from abroad the opportunity to share their expertise and utilise their prior learning, exactly as for other personnel.

In organisations, regardless of background, each employee must be ensured an equal opportunity to take on more responsibility in the work community and also progress to more demanding tasks or to become a supervisor if they so wish. In addition, ensuring that nurses recruited from abroad can participate in workplace working groups and decision-making strengthens their participation and representation in the work community.

Development discussions, regular feedback discussions and other one-on-one meetings with the supervisor can help map the nurse’s own work goals. These meetings may need to be held more frequently than usual at first. Mentoring and peer support, for example, through mentoring programmes or an assigned mentor, can also help in perceiving the professional direction and offer discussion opportunities and information about different career opportunities.

Wellbeing services county of Vantaa and Kerava introduced future discussions as part of their mentoring. The purpose of the discussions is to support the professional development of nurses recruited from abroad and to ensure that they can perform work that reflects their interests and goals.

The discussions are carried out as individual discussions with the mentoring coordinator. The nurse’s thoughts about their future career, their wishes and goals, and the organisation’s opportunities to support the achievement of these goals and to offer meaningful tasks are discussed.

The discussion will take place when the nurse is about to obtain their registered nurse qualification or graduate as practical nurse.

Positive career stories

Sharing positive career stories can motivate new employees and serve as an example of how competence development can open up new career opportunities.

Nurses who have worked in the organisation for a long time and who have moved to Finland from abroad can tell them about their career path and possible progress to tasks that they like best. This can inspire others and strengthen their belief in their career opportunities. Career stories can be shared with the entire personnel through the organisation’s information channels or through events organised for nurses recruited from abroad.

Progress in one’s career may also require expanding the workplace’s networks. Strengthening networks within the organisation may open up new opportunities and promote the integration of employees into the wider work community.