Nursing education in Denmark, Finland, Norway and Sweden – from Bachelor’s Degree to PhD

DISCUSSION PAPER

Nursing education in Denmark, Finland, Norway and Sweden – from

Bachelor’s Degree to PhD

Maj-Britt Raholm, Birte Larsen Hedegaard, Anna Lofmark & Ashild Slettebø

Accepted for publication 5 March 2010

Correspondence to M-B. Raholm:

e-mail: [email protected]

Maj-Britt Raholm PhD RN

Associate Professor

Faculty of Health, Stord/Haugesund

University College, Norway

Birte Larsen Hedegaard PhD RN

Associate Professor

Faculty of Health, VIA University College,

Viborg School of Nursing/The Regional

Hospital, Denmark

Anna Lofmark PhD RN

Associate Professor

Faculty of Health, Stord/Haugesund

University College, Norway, and

Department of Caring Sciences and

Sociology, University of Gavle, Sweden

Ashild Slettebø PhD RN

Professor

Faculty of Health and Sport, University of

Agder, Arendal, and

Faculty of Nursing, Oslo University College,

Norway

RARAHOLM M-B. , HEDEGAARD B.L. , LOFMARK A. & SLETTEBØ A. (2010)HOLM M-B. , HEDEGAARD B.L. , LOFMARK A. & SLETTEBØ A. (2010)

Nursing education in Denmark, Finland, Norway and Sweden – from Bachelor’s

Degree to PhD. Journal of Advanced Nursing 66(9), 2126–2137.

doi: 10.1111/j.1365-2648.2010.05331.x

AbstractAim. This paper is a discussion of the similarities and differences in baccalaureate

nursing education programme structures, content and pathways to postbaccalau-

reate education in the Scandinavian countries.

Background. For the last three decades nursing education internationally, as well

as in the Scandinavian countries, has experienced ongoing reforms. The driving

forces behind these reforms have been efforts for professional development within

nursing and to harmonize higher education in several European countries.

Data sources. The data were collected by a critical review of the guiding principles,

national directives and educational structures and content of Bachelor’s degree

programmes from 1990 to 2008 and of further educational levels in the four

Scandinavian countries.

Discussion. There are similarities as well as substantial differences in the educa-

tional structures, contents and lengths in the different nursing programmes. Nursing

education is organized in the three cycles described in the Bologna Process, but there

are differences regarding names and terms for degrees and allocation of European

Credit Transfer System credits.

Implications for nursing. Policymakers need to consider more carefully the direc-

tives in the Bologna Declaration when planning and implementing nursing pro-

grammes at Bachelor’s and postgraduate levels. Knowledge of the content and

structure of nursing education in these countries may enhance development and

cooperation between institutions.

Conclusion. A challenge for the ministries of education in the Scandinavian

countries is to compare and coordinate nursing educational programmes in order to

enable nursing students, educators, researchers and nurses to study and work in

Scandinavia, Europe or even globally.

Keywords: Bologna Process, competencies and Scandinavia, curricula, harmoniza-

tion, nursing education, professional development

2126 � 2010 The Authors. Journal compilation � 2010 Blackwell Publishing Ltd

J A N JOURNAL OF ADVANCED NURSING

Introduction

For the last three decades nursing education internationally as

well as in the Scandinavian countries of Denmark, Finland,

Norway and Sweden, has experienced recurring reforms. The

driving forces behind these reforms have been efforts for

professional development within nursing (Gerrish et al.

2003), and efforts to integrate the nursing programmes into

higher education. The Bologna Process is the latest of these

reforms, and its aim is to create convergence among a number

of European countries to harmonize higher education in

(Davies 2008).

From an international point of view, the nursing profes-

sion varies by country in how it is regulated. Regulation has

taken a variety of forms, and in some countries nursing has

not yet become an autonomous, regulated profession.

Differences in regulatory criteria are barriers to internation-

alization (ICN/WHO 2005). Although the ideal of world-

wide standards for nurses promoted by the ICN for over a

century remains unrealized, the forces of globalization have

created impetus for change. Among the projects focusing on

quality in nursing education is the recently formed Joint

Force on Creating a Global Nursing Education Community

(WHO/Sigma Theta Tau Honor Society of Nursing 2007).

While international and national nursing bodies are focusing

on international standards for nurses, there are also move-

ments such as the Bologna Process, which concentrates on

educational harmonization involving national governments.

The European Ministers of Education (1999) promoted

six objectives: (a) to adopt a system of academic degrees

which are transparent and easily compared, including the

introduction of the diploma supplement, (b) to adopt a

system based on two cycles: the undergraduate cycle of

3 years of study, which is mainly aimed at providing

qualified personnel for the job market; and the postgraduate

cycle for Master’s and doctoral degrees, conditional upon

completion of the undergraduate cycle; (c) to establish the

European Credit Transfer System (ECTS); (d) to promote

the mobility of students, teachers, and researchers; (e) to

promote cooperation in quality assurance; and (f) to

promote European dimensions in higher education. The

ECTS makes teaching and learning more transparent and

facilitates the recognition of studies. The system is used

throughout Europe for credit transfer (student mobility) and

credit accumulation (learning paths towards a degree). It is

also an aid in curriculum design and quality assurance

(European Commission 2009).

Scandinavian countries have similar cultural, religious,

social and political environments, including similar health-

care structures. Furthermore Danish, Norwegian and Swed-

ish belong to the same language group, and communication is

possible without shifting to a second language. The Nordic

Council of Ministers, which represents the countries where

these languages are spoken, as well as Iceland, has encour-

aged major collaboration on educational programmes,

research and teacher and student exchange (Nordic Council

of Ministers 2009). The number of inhabitants in each of the

Scandinavian countries is small, but altogether approximately

25 million people live in the four countries, and around

300,000 Registered Nurses work there (Table 1).The geo-

graphical, cultural and linguistic proximity enable nurses to

work in all Scandinavian countries. Table 1 shows the

number of inhabitants and recently Registered Nurses in

each of the four countries and the number of nurses employed

in each country in total in 2006. It also shows that Norway

employs the highest number of nurses from other Nordic

countries.

Background

Professionalization and professional development are often-

used terms in nursing, but they are not always clearly

defined (Ryan 2003). Throughout history, professionaliza-

tion has played an important role in the development of the

nursing profession in Scandinavia. Professions have been

defined as ‘occupations which are knowledge-based and

Table 1 Population and registered nurses in the Scandinavian countries in 2006

Country

Population

(total), million

Registered

(own country)

Registered

(Nordic countries)

Registered

(other countries)

Registered

(total)

Registered nurses

in total and working

as nurses

Denmark 5Æ4 1860 84 56 2000 55,556

Finland 5Æ2 2453 17 54 2524 70,889

Norway 4Æ6 3552 1687 289 5528 60,929

Sweden 9Æ1 4577 112 89 4778 112,021

Total 24Æ3 12,442 1900 488 14,830 299,395

JAN: DISCUSSION PAPER Nursing education in Scandinavian countries

� 2010 The Authors. Journal compilation � 2010 Blackwell Publishing Ltd 2127

achieved after following years of higher education and/or

vocational training’ (Evetts 1999, p. 120). Hilton and

Slotnick (2005, p. 62) define six domains of professional-

ism: ‘ethical practice, reflection and self-awareness, respon-

sibility for actions, respect for patients, teamwork and

social responsibility’. Evetts (1999) proposes a traditional

view on professionalization, and argues that professionali-

zation is a diverse process in which professional develop-

ment takes its own course in different countries.

Historically, professionalization in nursing education has

followed a similar path in Scandinavia. It can be divided

into two epochs – the training epoch and the academic

epoch. Struggles towards professional development have

characterized both eras.

The training epoch

Florence Nightingale (1820–1910) exerted the most domi-

nant influence over Scandinavian nursing history. Her

educational and hospital plans were implemented in all

Scandinavian countries. When Nightingale organized nurs-

ing education in London from 1861 onwards, students came

from all over the world to attend her school, and after

completing their studies they returned to their home

countries, mostly as managers and educators. Nursing

education was, in its early phase, dominated by students

working in the clinic to obtain their training, which was

organized in accordance with an apprenticeship system

(McMillan & Dwyer 1989, Tallberg 1994, Sarkio 2007). In

the early 1900s, when nursing education changed gradually

from hospital-based training to educational programmes

containing shorter theoretical periods of study, conflicts

arose between the nursing and medical professions regard-

ing professional recognition. Nightingale emphasized that

nursing was an autonomous profession with the following

essential elements: first, knowledge of the characteristics of

sickness, health and health promotion initiatives and,

second, knowledge of the characteristics, duties and skills

of the female sex. To her, the first and the latter were

founded in metaphysical theories concerning ‘human health

equilibrium’, ‘sickness and health’ and ‘human biological

characteristics’, respectively. To Nightingale, there were no

differences between the scientific level of theories related to

medicine and those related to sexual characteristics. There-

fore there were no relevant scientific distinctions which

could justify nursing as a subordinate profession to medicine

(Nightingale 1859, 1860, Cook 1913, Larsen 2006). From

the very beginning of the history of modern nursing, nurses

strongly defended this view. Metaphysical theories of sexual

characteristics changed over time. In the last part of the

19th century, the scientific foundation for the medical

profession changed dramatically from a metaphysical

towards a clinical experimental foundation. Nurses insisted

on the original foundation and therefore on metaphysical,

humanistic and social scientific changes. Nurses’ struggle for

professional recognition and an academic anchoring of

nursing practice, education and research has continued until

today (Larsen 2006).

The academic epoch

Reforms in Denmark, Finland, Norway and Sweden in the

late 20th century have changed nursing education from an

apprenticeship system to a higher education system. This

became reality in Denmark in 1990 (Executive Order 1990/

143), in Finland in 1990 (Salminen 2001), in Norway in 1983

(Kyrkjebø et al. 2002), and in Sweden in 1977 (Kapborg

1998). Subsequently, undergraduate nursing education was

integrated into university colleges, universities of applied

sciences and universities. According to Karseth (2004), this

shift implied greater economic, administrative and profes-

sional independency for the nursing profession. The guiding

principles of higher education require that nursing education

should be based on scientific and practical knowledge, and

thus should provide students with the necessary knowledge

for working in the profession and being well-prepared for

tomorrow’s labour market.

In the Scandinavian countries, nursing studies at doctoral

level were fully integrated into the higher education system

after 1979. Nursing research had previously been linked to

other scientific disciplines. Opportunities for doctoral studies

gave the nursing profession the chance to develop as an

academic discipline and enhance professional autonomy.

Care science scholars such as Kari Martinsen and Katie

Eriksson have influenced the professionalization of nursing

and the debate among nurses extensively from the 1970s

until today (Eriksson 1985, 1987, 2001, Martinsen 1989,

Martinsen & Eriksson 2009). On the basis of the Bologna

Process, nursing education is now regulated by Higher

Education Acts in each country. In Norway (Act-2008-12-

12-105) and Sweden (SFS 1992:1434) the Act is the same for

universities and university colleges, while in Denmark and

Finland there is one Act for universities (2003/403 and 1997/

645) and one for universities of applied sciences (2000/481

and 2003/351). The Act of Finnish Universities is under

reform and will gain legal validity in 2010.

In this paper, we present a discussion of the similarities and

differences in baccalaureate nursing education programme

structures and content and in pathways to postbaccalaureate

education in the Scandinavian countries.

M-B. Raholm et al.


Scandinavian nurse education systems

Content and structure of nursing education

in the Scandinavian countries

The general plans for nursing education in Scandinavia

(Executive Order 2008/29, Academic regulations 2008,

http://www.minedu.fi 2006, The Polytechnic Act 9.5 2003/

351, http://www.safh.no, White paper no 27, 2001, SFS

1993) show many similarities. They are, for example,

nationally-based and set a standard for nursing education.

They include aims and contents for the curricula. Some offer

detailed content, while others are more general. Universities,

university colleges and universities of applied sciences with

nursing programmes compile their own curricula based on

the national general plans. The curricula include information

about organization, progression, clinical education and the

relationship between theory and practice. Approval of the

quality of the programmes is set by a national agency for

higher education in each country.

According to the Bologna Process, the general plans require

that nursing students develop different kinds of competencies:

a) theoretical-analytical competence implies the ability and

will to learn through observation, analysis, reflection and

systematization, b) practical competence, which is the ability

to implement knowledge in the form of systematization and

problem-solving skills, c) learning competence, which refers

to the ability and will to acquire new knowledge and apply

this knowledge in new situations, d) social competence,

which refers to students’ ability to establish and sustain

interpersonal relationships, e) professional ethical compe-

tence, which enables students to be capable of ethical

justifications in relation to regulations and ethical guidelines

(Bologna Declaration 1999).

The academic and professional foundation of the nursing

programmes is based on theoretical and clinical knowledge

from the field of nursing in interplay with subjects such as

healthcare science, natural science, social sciences and the

liberal arts (Table 2). A nurse with a Bachelor of Science

Degree in Nursing is qualified to work as a Registered Nurse,

to enter into interdisciplinary cooperation and to enrol in

university second cycle programmes in nursing and health-

care sciences. The fact that nursing research has increased

contributes to the expansion of a specific body of nursing

knowledge. National and international research results are

included in the programmes, which are organized to allow

professional, academic and innovative competences develop

in dynamic interaction between theory and practice.

The general plans emphasize that nurses should relate to

the patients as whole persons, taking into consideration the

Table 2 Scientific areas and core subjects

in Bachelor of Science in Nursing in

ScandinaviaCountry

Scientific areas and

core subjects ECTS credits All together Thesis

Denmark Nursing science 120 210 20

Medical science 40 120 theoretical

Natural science 25 90 clinical

Humanities 15

Social science 10

Finland Nursing science 210 15

Theoretical and scientific

basis of nursing

6 120 theoretical

Professional/clinical studies 75 90 clinical

ICT, R & D 6

Communication and Languages 9

Social science 6

Natural and medical science 15

Optional studies 3

Norway Nursing science 180 12

Theoretical and scientific

basis of nursing

33 90 theoretical

Nursing theory and practice 72 90 clinical

Medicine and natural science 45

Social science 30

Sweden Nursing science 126Æ5 180 15

Medical science 53Æ5 135 theoretical

45 clinical

ICT, Information Communication Technology; R & D, Research and Development.



physical, mental, social, cultural and spiritual aspects. Fur-

thermore, nurses should reflect on how healthcare problems

relate to political and economic conditions. They should also

cooperate with other healthcare professionals and social

workers. Facilitating nurse–patient communication, coordi-

nating patient-related teamwork and supporting patients to

take an active part in the recovery process are essential

components of nursing education (Executive Order 2008/29,

Academic regulations 2008, http://www.minedu.fi 2006, Act

2003/351, http://www.safh.no, White paper no 27, 2001, SFS

1993).

When analyzing the nurse education curricula in the

Scandinavian countries, differences can also be seen. In

Denmark, nursing education at the Bachelor’s level encom-

passes studies in four scientific areas (Table 2) – nursing

science, medical science, natural science, humanities and

social science. The nursing programme consists of 120

theoretical and 90 clinical ECTS (European Credit Transfer

System) credits. The Bachelor’s dissertation is allocated 20

ECTS credits. Altogether, 14 core themes are covered

through research, developmental and practically-generated

knowledge and incorporated into clinical learning activities.

The term ‘knowledge’ influenced by the knowledge forms of

Aristotle, is understood in nursing broadly as scientific,

technical and ethical knowledge. Students are expected to

work as reflective practitioners. They are expected to provide

total care for patients and develop methods for assessing,

reflecting, planning, conducting, evaluating and developing

nursing and assisting medical treatment (Academic Regula-

tions 2008).

In Finland, the Act of Higher Education (351/2003, 426/

2005) stipulates that studies leading to a degree from a

University of Applied Sciences provide the necessary skills for

tasks requiring professional expertise (Table 2). In accordance

with the Government’s Act on Universities of Applied Sciences

(352/2003), studies are grouped as basic and professional

studies, optional studies, clinical studies (90 ECTS credits)

which enhance professional skills, and a Bachelor’s disserta-

tion (15 ECTS credits). Nurses’ professional competence is

based on knowledge of nursing science as well as theoretical

and practical skills (Ministry of Education 2006). Additionally

in Finland, nursing students must also study three different

languages: Finnish, Swedish and English.

In Norway, the general plan for nursing education

describes the aims, scope and content of the curriculum as

well as evaluation requirements and required skills on

completing the programme (Ministry of Education, Research

and Church Affairs 2000, 2005). The content requirements in

the general plan for nursing education in Norway are that

50% of the curriculum should be clinical studies (Table 2).

The Bachelor’s dissertation should be at least 12 ECTS

credits. The focus of their education enables nurses to provide

total care for patients and to develop clinical methods for

nursing patients with different conditions and assisting

medical treatment. Nurses are educated for ‘knowledge-

based’ work, which means using evidence-based nursing,

experience-based nursing and focusing on client-participation

(http://www.safh.no).

According to the objectives in the national guidelines in

Sweden (SFS 1992:1434, SFS 1993:100) and the Bologna

directives, the expected outcomes are described in specified

domains of knowledge and understanding, skills and abilities,

judgement and approach for certification as a nurse. Univer-

sities and university colleges in Sweden are relatively free to

develop their own and local curricula for nursing pro-

grammes; however, they are continuously scrutinized by the

National Agency for Higher Education. Table 2 shows two

main scientific areas, nursing science and medical science.

Other university colleges and universities have a more

detailed description where social and behavioural subjects

are specified. The Bachelor’s dissertation is stipulated as

having 15 ECTS credits. Programmes are arranged in courses,

some covering both theory and practice. The EEC Agreement

(DS 1992:34) states that the nursing programme should

comprise both theoretical and clinical studies.

Harmonizing nursing education in Scandinavia according

to the Bologna Process

According to Davies (2008), the Bologna Process is a quiet

revolution in higher education, affecting nursing education in

many countries in Western Europe.

The Bologna Declaration indicated that degree pro-

grammes should be organized at both undergraduate and

graduate levels (European Ministers of Education 1999,

Zeabalegui et al. 2006, Spitzer & Perrenoud 2006a,b). In

addition to The Bologna Declaration, nursing programmes

have been subjected to two European directives regarding the

qualifications of nurses responsible for general care. These are

directives 77/453/ECC of June 27, 1977 and 89/595/EEC of

October 10, 1989, which require that a degree programme

should be at least 3 years or 4600 hours. These directives do

not indicate academic status requirements for registration

(Zebalegui et al. 2006). According to Davies (2008), The

Bologna Process offers real opportunities for nurses to

establish closer links with their European colleagues across

spectra of clinical practice, management and academia and to

raise the profile of nursing as a graduate profession.

In 2000, a group of university leaders met the Bologna

Process challenge collectively and designed a pilot project

M-B. Raholm et al.


titled: ‘Tuning educational structures in Europe’ (Gonzales

& Wagenaar 2005a). The Tuning Project should enhance

curriculum development, e.g. in nursing education. During

the Tuning Project, a methodology was designed to make

different nursing curricula comparable across countries. The

following descriptors have been designed in recognition

of the Dublin descriptors (http://www.jointquality.org).

According to Gonzales and Wagenaar (2005b), the Tuning

Project has specified descriptors for first, second and third

cycle degrees. First cycle descriptors include, for example,

that a nursing student should be able to analyse profession-

oriented issues theoretically and apply this awareness in

practice, and be able to document, analyse and evaluate

various types of nursing practices. The second cycle

descriptors include development of academic knowledge

on an independent basis in order to be able to apply

scientific theories and methods. Third cycle descriptors

include the student achieving competences based on empir-

ical work that includes original research conducted on an

independent basis (Nursing and Midwifery Council 2009).

In the Scandinavian countries, pathways based on the three-

cycle system medio 2008 can be illustrated as in Table 3.

Academic pathways from Bachelor of Nursing to PhD

In Denmark (Table 3), the objectives for nursing education

are to qualify nurses to act autonomously and to participate

in interdisciplinary cooperation regarding patient care. The

objective is also to qualify nurses for further academic and

scientific education. Danish nurses are qualified at the

Bachelor level, and are registered in accordance with national

regulations and national supervision and control (Act 2006,

Executive Order 2008/29). Danish nursing education follows

the three-cycle model. The first cycle takes place in university

colleges, and the second and third cycles in universities. It is a

prerequisite for entering nursing education that students have

completed secondary school or have corresponding compe-

tencies. When entering nursing school, students attend a 3Æ5-

year (210 ECTS credits) professional Bachelor’s degree

programme and obtain the degree ‘Bachelor of Science in

Nursing’ (Table 3). A professional Bachelor’s degree in

nursing is the pathway to being a Registered Nurse and to

further education in nursing and healthcare educational

programmes. The title ‘candidate’ is used for the highest

scientific degree in the second cycle (120 ECTS credits) and is

the pathway to the third cycle, PhD level (180 ECTS credits).

The term ‘Master’ is used for a professional degree in the

second cycle (60–90 ECTS credits). A prerequisite for

enrolling in Master’s programmes is 2–5 years’ work expe-

rience. In order for a Master’s degree holder to continue

studies at doctoral level, a supplementary scientific pro-

gramme at a University is required. For nurses educated in

previous non-academic programmes, a diploma qualification

(60 ECTS credits) can be achieved, equivalent to a Bachelor’s

degree in the first cycle (Ministry of Education 2003, 2008).

Specialist nursing programmes are not part of the Bologna

educational system.

In Finland (Table 3), a Bachelor ‘a programme in nursing

consists of 210 ECTS credits. This is a 3Æ5-year full-time

programme of 60 ECTS credits/year (Table 3). In Finland,

there are opportunities to pursue specialist nurse studies

(20–30 ECTS credits) in, for example, psychiatric nursing,

operating theatre nursing, nursing older people, etc. This

specialization is not part of the Bologna system. In 2004,

the question was raised about juxtaposing second-cycle

Master’s degrees from universities of applied sciences

(professional master) with Master’s degrees obtained at

universities. The relevant degree amendment was actually

made in 2005 (A423/2005). At universities of applied

sciences, students cannot automatically proceed to second

cycle studies, but first have to acquire a minimum of 3 years

of work experience. The objective concerning student intake

is that 20% of first cycle graduates will take their second-

cycle professional degree. A Master’s programme at the

university level requires 120 ECTS credits, which means

2 years of full-time studies. Postgraduate studies (licentiate

degree and doctorate) take a further 3–5 years (Paulin

2003). Students admitted to university education in nursing

science are those who already have a Bachelor’s degree in

nursing and those who have just completed their matricu-

lation examination at upper secondary schools (i.e. people

who have no earlier education in nursing). A candidate

degree at the university still has the status of an intermediate

degree in Finland. Students may complete it if they wish, but

it is not compulsory (Ahola & Mesikammen 2003).

In Norway, the Bachelor of Nursing programme (Table 3)

consists of 180 ECTS credits. This means a 3-year full-time

programme of 60 ECTS credits a year (Kyrkjebø et al. 2002).

In 2005, the first Bachelor of Nursing Science degree was

offered at university level. Obtaining a bachelor’s degree in

nursing from a university college is still the regular route in

Norway. At the universities, as well as at certain university

colleges, students can pursue a Master’s and doctoral degree

in nursing science. In Norway, there are opportunities to

pursue specialist studies in nursing (60–90 ECTS credits) in,

for example, intensive care and operating theatre nursing.

This specialization is not part of the Bologna system,

however. These specializations are possible at present during

first-cycle studies, but there are changes to come where these

courses will be part of Master’s degree/second-cycle studies.



Table

3A

cadem

icpath

ways

from

Bach

elor

of

Sci

ence

inN

urs

ing

toPhD

Cycl

esD

enm

ark

Fin

land

Univ

ersi

ty

Univ

ersi

tyC

olleg

e

of

Appli

edSci

ence

sN

orw

aySw

eden

PhD

,3rd

cycl

ePhD

,180

cred

its

PhD

,240

cred

its

(may

incl

ude

lice

nti

ate

deg

ree)

PhD

,180

cred

its

PhD

,120

cred

its

Mast

er,

2nd

cycl

e

Cand

cur,

2yea

rs

120

cred

its

Rel

ate

dH

ealt

h

scie

nce

candid

ate

pro

gra

mm

es,

2yea

rs

120

cred

its

Suppl

scie

nti

fic

pro

gra

mm

e,½

–1

yea

r30–60–90

cred

its

Mast

er’s

Deg

ree,

120

cred

its

Mast

er’s

Deg

ree,

60–90

cred

its

(Thre

eyea

rsof

work

ing

exper

ience

acq

uir

ed)

Mast

er’s

Deg

ree,

90–120

cred

its

Mast

er’s

Deg

ree,

120

cred

its

Suppl

cours

es,

60

cred

its

Mast

erin

Cli

nic

al

Nurs

ing

and

rela

ted

hea

lth

scie

nce

mast

er

pro

gra

mm

es,

1–1½

yea

rs

60–90

cred

its

Magi

ster

,

60

cred

its,

Theo

reti

cal

or

spec

ialist

nurs

ing

educa

tion

Bach

elor,

1st

cycl

e

Bach

elor

of

Nurs

ing,

3½

yea

rs

210

cred

its

Bach

elor

of

Nurs

ing,

3½

yea

rs

210

cred

its

Bach

elor

of

Nurs

ing,

3½

yea

rs

210

cred

its

Candid

ate

pro

gra

mm

e,

180

cred

its

Bach

elor

of

Nurs

ing,

3½

yea

rs

210

cred

its

Bach

elor

of

Nurs

ing,

3yea

rs

180

cred

its

Bach

elor

of

Nurs

ing,

3yea

rs

180

cred

its

Bach

elor

of

Nurs

ing,

3yea

rs

180

cred

its

60

EC

TS

cred

its

acq

uir

esfu

ll-t

ime

study/y

ear.

Spec

iali

stco

urs

esouts

ide

the

Bolo

gna

Pro

cess

are

not

incl

uded

inth

ista

ble

.

M-B. Raholm et al.


In addition, there are opportunities to obtain a Master’s

degree of 90–120 ECTS credits and study at PhD level with

an additional 180 ECTS credits.

The Swedish nursing programme extends over 3 years and

results in a degree named ‘Bachelor of Science in Nursing’

and the professional qualification to work as a nurse. It is a

3-year full-time programme consisting of 180 ECTS credits

(SFS 1992:1934). The nursing programme (Table 3) is taught

at both universities and university colleges. Nursing students

can pursue a Master’s degree for 1 year, receiving 60 ECTS

credits for a degree called ¢Magister¢, or 2 years of study

receiving 120 ECTS credits and giving a Master’s degree At

universities and at most university colleges. Another 2 years

of full-time study is the pathway to a doctoral degree in

nursing science, encompassing altogether 420 ECTS credits.

When the Bologna Declaration was implemented in Sweden

2007, specialist nurse education became part of the second

cycle (60 ECTS credits), leading to a specialist graduate

diploma, e.g. in midwifery or primary health care.

Discussion

The data raise the question of to what extent the content,

structures and pathways to further education in nursing are

harmonized in the Scandinavian countries. To our knowl-

edge, this question has not been explored before.

Nursing science as the main subject in nursing education

At first glance, the content of nursing education at the

Bachelor’s level seems to differ substantially in Scandinavia

(Table 2). However, closer examination reveals that in all

Scandinavian countries, in spite of differences in the alloca-

tion of ECTS credits, nursing science is the main subject. It

also reveals that other scientific areas, such as the medical,

natural and social sciences, are important complementary

subjects.

From the 1960s, nursing science in Scandinavia was

influenced by care science scholars in the United States of

America, such as Virginia Henderson and Dorothea Orem. In

the 1970s, an oppositional trend appeared in the Scandina-

vian countries. This trend was mainly due to the Finnish care

science theorist and nurse Katie Eriksson and the Norwegian

philosopher and nurse Kari Martinsen (Alvsvag 2006,

Lindstrom et al. 2006). The perspectives of Eriksson and

Martinsen have influenced nursing education curricula in all

Scandinavian countries until the late 1990s.

Katie Eriksson has, extensively from the 1970s until the

present, influenced the professionalization of the nursing

programmes in terms of education, research and practice,

especially in Finland and Sweden. According to Eriksson

(1985), one of the problems for the academic anchoring of

nursing was that the scientific field of nursing had not yet

been created. She also claimed that the new curricula should

be based on a caring science-centered model in which the

leading principle was that every educational programme for

healthcare professionals was to be grounded in its own

scientific basis. Another principle emphasized by Eriksson

was that the starting point of academic education and

research is knowledge about the field and object of research,

not primarily practical activity (Eriksson1987). The central

idea of caring and the substance of nursing were made visible

through the caring process model developed by Eriksson,

which since the 1970s has been well-known in Scandinavian

nursing education (Eriksson 1987). Finnish professors such as

Hentinen (1988, 1998) and Lauri (1998) have also contrib-

uted to the professionalization of nursing and nursing

education by systematic construction of theory within the

discipline.

In Denmark and Norway, Kari Martinsen has extensively

influenced the professionalization debate among nurses. She

described nursing as a primarily ethical discipline. Martin-

sen referred to Aristotle’s three forms of knowledge –

episteme, techne and phronesis – and argued that phronesis

is the superior among these (Martinsen 1993). Discussing

scientific knowledge in nursing, Martinsen (1989) argued

that nursing research had to be generated closely to the

clinical field and to be qualitative, with a focus on

phenomena essential to patients and nurses. Knowledge

in nursing had to be care-oriented (Martinsen 1989).

Martinsen discussed the professionalization of nursing from

two perspectives – nursing as a person-oriented profession

and as a scientific-oriented profession – and claimed that

nurses must define the orientation of their tasks. To her, the

person-oriented perspective should be superior to the

scientific, and ethics should be superior to science. However,

scientific knowledge was indispensable in assessing a

patient’s health situation and need for nursing. When

deciding how to act, nurses need to assess the diagnoses,

prognoses, treatment and nursing possibilities related to the

illness-oriented factual conditions Assessments of what is

best for the patient are crucial and have to be considered

from both ethical and technical viewpoints before making

any decisions (Martinsen 1993).

Harmonization of higher education

In a cultural, political and economical entity like Scandinavia

one might expect a high level of harmonization in nursing

education. In this paper, we have shown that there are



similarities but also substantial differences in the programmes

in the Scandinavian countries, despite the Bologna Process

and Tuning Project. The most notable similarity in all

Scandinavian countries is that nursing education is organized

in three cycles in accordance with the Bologna Process. Yet

there are differences in the names and terms of degrees and

allocation of ECTS credits.

Bachelor of Nursing programmes in both Denmark and

Finland are placed in the first cycle and consist of 210 ECTS

(3Æ5 years of full-time studies). In Norway and Sweden, these

programmes are placed in the first cycle but consist of 180

ECTS (3 years of full-time studies). In Denmark, Finland and

Norway, clinical studies consist of 90 ECTS credits, but for

Sweden these encompass 45 ECTS credits. The directives 77/

453/ECC of June 27, 1977 and 89/595/EEC of October 10,

1989 require that a preregistration programme should be at

least 3 years or 4600 hours long, although these directives

prescribe that the clinical studies should be 50%. However,

there are certain differences in the interpretation and imple-

mentation of these directives in each of the four countries.

There are also minor differences in the number of ECTS

credits required for a Bachelor’s dissertation in Denmark,

Finland, Norway and Sweden (Table 2).

There are also differences concerning graduate diplomas

and graduate diplomas in specialist nursing. In Finland and in

Norway, specialist courses are allocated ECTS credits but are

placed outside the Bologna system. In Denmark, specialist

courses in paediatric nursing are a part of the first cycle. All

other specialization courses remain outside the Bologna

system.

In the second cycle, there are variations of between 60 and

120 ECTS credits in the length of studies and their content. In

this cycle, all Scandinavian countries have different pathways

up to Masters’ degrees. Students can acquire a Master’s

degree that equals 60, 90 or 120 ECTS credits. Furthermore,

the programmes can be either clinically- or academically-

oriented. For example, in Sweden specialist nursing education

is part of the second cycle. The degrees are also named

differently, e.g. candidate degrees (Denmark 120 ECTS

credits) and Master’s degrees (between 60 and 120 ECTS

credits in all Scandinavian countries). Furthermore, in

Finland the term candidate refers to an academic degree in

the first cycle (180 ECTS credits). Thus, it is impossible to

compare the content and level of different degrees in the

Scandinavian countries based only on the name and title

classifications. Direct comparisons between pathways for

further education are difficult to make as there are divergent

requirements for entering the second cycle. After a Bachelor’s

programme, students can enter the second cycle directly. The

only exception is Sweden, where students need to have

additional clinical experience before entering specialist nurs-

ing programmes (Table 3).

In the third cycle, there are also differences. In Sweden a

doctoral degree requires 120 ECTS credits, in Denmark and

Norway 180 ECTS credits and in Finland 240 ECTS credits.

In Finland and Sweden, postgraduate students may first earn

a licentiate degree in the third cycle before completing a full

What is already known about this topic

• For decades, initiatives in Scandinavian countries have

encouraged student/teacher and nurse exchange and

research collaboration.

• Nurses’ struggle for professional recognition and an

academic anchoring of nursing practice, education and

research has continued throughout the past century.

• A harmonization process in European countries known

as the Bologna Process has focused on educational

structures and content at the bachelor’s degree level and

on pathways to further education.

What this paper adds

• In spite of the Bologna Process, there are different

amounts of ECTS credits, content and names of degrees

in nursing programmes in the Scandinavian countries at

all stages.

• Although the Scandinavian countries have cultural,

geographical and linguistic similarities, differences in

these areas may prove to be obstacles for further

cooperation and, for example, exchange programmes.

• A common platform for the professionalization process

has played an important role in understanding and

communication between nurses and nurse educators in

the Scandinavian countries.

Implications for practice and/or policy

• Policy-makers in nursing education need to consider the

directives of the Bologna Process more carefully when

planning and implementing bachelor’s degree education

and pathways to further education in the Scandinavian

countries.

• As each of the Scandinavian countries is small, deeper

awareness of the content and structure of nursing

education and postgraduate studies in the field may

contribute to a valuable exchange of ideas.

• It is essential to examine common features of the

nursing programmes in order to achieve international

standards.

M-B. Raholm et al.


doctoral degree, but it is also possible to acquire a PhD

directly without pursuing a licentiate degree first. The

licentiate degree is not an option in Denmark and Norway.

For a nursing student to achieve a PhD degree, 510 ECTS

credits are required in Denmark, 570 ECTS credits in

Finland, 480 ECTS credits in Norway and 420 ECTS credits

in Sweden (Table 3).

Conclusion

This discussion shows that there are problems and challenges

concerning the harmonization process. There are different

numbers of ECTS credits, content and names for degrees in

nursing programmes in all cycles. It seems as if all policy-

makers in the Scandinavian countries have different ways of

interpreting and implementing the Bologna Process. Although

the ideal of worldwide standards for nurses promoted by the

ICN for over a century remains unrealized, the forces of

globalization have created impetus for change. Standards for

nursing education need to be established globally to provide

guidelines for local services, but also to assure a minimum

standard level of qualifications for nurse educators.

The Bologna Process offers the opportunity to standardize

nursing education, with the Bachelor’s degree as the entry

level to the profession, and Master’s and doctoral degrees

recognized in all EU countries. The ‘Tuning Educational

Structures in Europe’ project builds on previous endeavours

to enhance inter-university cooperation, and aims to identify

generic and specific competencies for nursing graduates at

all levels. Education has proved to be a valid instrument for

building a common professional identity, and so it has been

considered necessary in higher education to proceed via

internationalization (student exchanges) towards active

Europeanization. The goal of employability, in particular,

is closely connected with the degree structure reform of the

Bologna Process. Policymakers in nursing education need to

consider more carefully the intentions in the Bologna

Process in the planning and implementation of Bachelor’s

level nurse education and in the pathways to further

education.

Funding

This research received no specific grant from any funding

agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

No conflict of interest has been declared by the authors.

Author contributions

MBR, BLH, AL & AS were responsible for the study

conception and design. MBR, BLH, AL & AS performed

the data collection. MBR, BLH, AL & AS performed the data

analysis. MBR was responsible for the drafting of the

manuscript. MBR, BLH, AL & AS made critical revisions

to the paper for important intellectual content. MBR, BLH,

AL & AS supervised the study.

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