Transitioning nursing education from vocational to bachelor pathways in the WHO European Region: Comparative policy analysis of European cases

Background and Aim:
Across the WHO European Region, countries have adopted different pathways to transition from vocational to bachelor-level nursing education. While international evidence supports bachelor-level preparation, less is known about how countries have operationalised this transition and the factors shaping implementation. This study aimed to examine comparative experiences of countries transitioning to bachelor-level nursing education and to identify enablers and challenges influencing reform.

Methods:
A comparative mixed-methods study was conducted using a structured inter-country questionnaire completed by expert respondents from 11 countries, mostly from Europe, within the WHO European Region. Quantitative data were analysed descriptively, and qualitative responses were analysed thematically. Findings were integrated using the WHO Toolkit for a Sustainable Health Workforce Framework for Action (2018) to enable systematic comparison across four strategic domains: education and performance; planning and investment; capacity building; and analysis and monitoring.

Results:
All participating countries had introduced bachelor-level nursing education, though transition pathways varied considerably. Policy- and legislation-driven reform was widespread, often shaped by European Union directives and transnational guidance. However, stakeholder resistance, limited educator and mentor capacity, and uneven investment in workforce planning constrained implementation. Flexible planning approaches, bridging programmes, and strong coordination by national nursing bodies facilitated smoother transitions. Few countries reported systematic monitoring or use of performance indicators to assess reform impact.

Conclusion:
Transition to bachelor-level nursing education is not a uniform process but a context-dependent reform shaped by governance, capacity, and professional culture. Findings reveals that policy alignment alone is insufficient; sustained investment in educator capacity and monitoring mechanisms is critical. These findings offer practical insights for countries undertaking similar reforms.