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Project file

EQUANU | Equality in social and professional recognition of nurses

A longitudinal, international comparison on the status and evolution of social and professional recognition of European nurses




Globally, the professionalisation of the nursing profession is increasing due to the ever more extensive development of knowledge and skills. Despite this trend towards greater professionalisation and an improved image in certain countries, studies also show that a large proportion of the public still does not fully appreciate the competences of nurses. The image that nurses have of themselves appears to partly create this public image. Their sometimes low self-esteem, combined with a limited presence in the public debate, leads to insufficient social appreciation of the job.

The profession's poor image means that healthcare institutions are experiencing increasing difficulties in attracting and retaining qualified nurses. Job differentiation is one way of addressing this problem and improving the efficiency of healthcare delivery. It involves assigning certain tasks of nurses to staff with different qualifications. In this way, a dynamic, high-quality care service is created, adapted to the specific needs of each patient. With job differentiation, the work of nurses is made more attractive and more interesting career opportunities can be offered.

Furthermore, job differentiation and clear role descriptions are crucial to facilitate labour mobility. Due to shortages in nursing staff, international mobility has become even more important in the last years. International mobility of nurses is an increasing phenomenon both in the European Union (EU) and worldwide. The EU has a common labour market and nurses are trained for the EU as a whole. Several benefits have been described, including: a balance between supply and demand of health professionals; health professionals educated abroad can fill gaps in services and shortages of nurses; greater cultural diversity; lower average age to maintain salaries; and remittances to less prosperous home countries.

There still seem to be important differences in societal and professional recognitions of nurses within Europe. One way of describing differences in professional recognition of nurses is by making explicit how nurses’ role is perceived on a continuum from being limited to mainly performing tasks imposed by a physician, to nurses with advanced autonomous responsibilities and tasks.

Examples of these advanced tasks relate to clinical reasoning and nursing diagnosis, to evidence based nursing and to pharmaceutical care.


This study will map the differences in the social recognition of nurses, as well as their professional recognition through the advanced roles in pharmaceutical care (especially prescription management), clinical reasoning and evidence based practice, in European countries, taking into account the differentiation in function per country. We want to follow up on these factors longitudinally over a period of 9 years (2022-2031).

By showing what is possible, the benchmark between countries can help nurses in countries with a lower level of recognition to strive for a better recognition, with potential benefits for quality of care. More equality can be supportive for labour mobility for the European nurse.


9-year longitudinal study: 2022 - 2031

For nine years, two questionnaires will be distributed annually to potential participants.

The section on social recognition will be offered annually, while the section on advanced

roles will be offered on a 3-yearly rotation basis.

Years 1, 4, 7: societal recognition + professional recognition (prescription management)

Years 2, 5, 8: societal recognition + professional recognition (clinical reasoning)

Years 3, 6, 9: societal recognition + professional recognition (evidence based practice)


Poster presented on the Eurodurg Conference in June 2023.

Publication of the first year data in a peer reviewed journal is being prepared – updates will be provided on this project page.


Contact details

Dr Elyne De Baetselier

The EQUANU project team:

Team Belgium: Prof Tinne Dilles, dr Elyne De Baetselier, dr Filip Haegdorens, dr Maarten Wauters, drs Elke Loots

Team Czech Republic: Prof Jana Heczkova, dr Dana Dolanova, Prof Andrea Pokorná

Team Germany: dr Gero Langer, Prof  Gabriele Meier

Team Greece: Prof Styliani Tziaferi

Team Italy: Dr Alba Malara, Dr Francesco Talarico

Team the Netherlands: Prof Nienke Dijkstra

Team Norway: Prof Vigdis A Grøndahl, Prof Ann Karin Helgesen

Team Portugal: Prof Luis Batalha

Team Slovenia: Prof Mirko Prosen, Prof Sabina Licen, drs Rebeka Lekše

Team Spain: Prof Manuel Lillo-Crespo

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