The Ministry of Social Affairs and the Ministry of Education and Research have signed a third national higher education healthcare agreement, valid through 2030, together with universities and professional associations. The agreement aims to increase enrollment in health-related degree programs.

According to the Estonian Nurses Union, the development is certainly positive, but in addition to numbers, broader questions of system sustainability also need to be considered.

Nurse practitioners include, among others, intensive care and mental health nurses who have completed a master's degree in health sciences. There are just over 1,000 of them in Estonia. For the first time, the newly signed agreement sets specific training targets for nurse practitioner graduate programs. Starting next academic year, 80 students will be admitted annually, increasing to 120 by 2030.

The broader goal, according to Katrin Kivisild, head of workforce policy at the Ministry of Social Affairs, is to give nurse practitioners a wider range of responsibilities in order to reduce doctors' workloads.

"For example, nurse practitioners could carry out certain procedures independently or offer e-consultations. These are important steps toward making services more quickly accessible to patients. Not everything needs to be done by a doctor — nurse practitioners can also provide a number of services," Kivisild said.

Enrollment capacity has also been increased for nursing, biomedical laboratory science, physiotherapy, radiography and occupational therapy programs. Pharmacist training spots were slightly reduced. According to Kivisild, the agreement is at the edge of feasibility, because the issue isn't just about education but also about clinical training capacity.

"There's not much more room to increase these numbers, because our clinical training sites don't have the resources to accommodate so many students. They face limited resources — there aren't enough supervisors and there's not enough time available to support students properly," she said.

Margit Lenk-Adusoo, vice president of the Estonian Nurses Union, said that while agreeing on training volumes is an important step, attention must also be paid to retaining existing staff. According to the Health Board, there are more than 16,000 registered nurses in Estonia, but Lenk-Adusoo said only about 9,000 currently work in the field.

"One key question is how to bring back nurses who have left the system. And looking ahead, the next step is how to keep health professionals in the system. One thing that needs to be reviewed is whether, how and to what extent health workers can develop professionally and study as part of their work, as well as what their career paths and opportunities actually look like," said Lenk-Adusoo.

The union vice president also stressed the importance of ensuring that all specialists can work within their scope of competence and are not burdened with administrative tasks, such as answering phones.

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