The Nordic state of nursing research: The case of Denmark

The question of how nursing knowledge gains legitimacy has shaped Danish nursing for more than a century, although it remains unresolved at a time when the field has reached unprecedented academic maturity. The academic trajectory of nursing in Denmark reveals sustained growth; however, this progress has far too often taken place on terms defined by others. Research capacity and postgraduate education have expanded over the past three decades, although consolidation as a self-standing academic field has been uneven. This tension, between building capability and lacking a secure disciplinary base, frames the developments that follow.^1,2

To understand why, it is helpful to recall the profession's formative identity. For much of the 20th century, Danish nursing was narrated as a moral calling that conferred ethical strength and public trust, while also entrenching hierarchical arrangements that subordinated nursing to medicine. As the nursing historian Gunilla Svensmark reminds us, this legacy produced a semi-professional status in which responsibility increased faster than authority, and in which nursing knowledge was repeatedly measured against medical standards of legitimacy rather than on its own epistemic grounds.^3,4 The move into higher education was therefore both an opportunity and a test. The professional bachelor's degree created a foothold, and access to master's and doctoral education began to reshape the knowledge ecology of the field. At the same time, the most accessible early venues for research into nursing were often located within medical clinics and cross-disciplinary hospital units. As Petersen et al. ¹ illuminate, this institutional placement brought proximity to clinical questions and infrastructures; however, it also meant that topics, methods and markers of excellence were frequently filtered through biomedical priorities, with predictable implications for what could be studied and how it was valued.

Empirical work tracing educational trajectories between 1998 and 2017 confirms this point. The number of PhD-prepared nurses grew substantially, and many assumed research-active roles. Even so, the ambition to consolidate nursing science as an independent field was only partially realised, largely because nurse researchers remained embedded within medical organisations that understandably set agendas and evaluative criteria according to their own logics. ¹ What has been less openly addressed is that this arrangement, although productive in the short term, has also stabilised a structural asymmetry in which nursing's academic development remains contingent rather than self-determined. In parallel, the longstanding difficulty of integrating theory and practice persisted. Despite curricular ambitions foregrounding evidence, reflection and inquiry, clinical environments often lack structures that sustain scholarly activity at the point of care. The result is a familiar paradox: nurses are prepared to engage with research and to lead improvement, although the routines and incentives of service delivery rarely make sustained participation in research either normal or feasible. ⁵ This gap cannot be explained by professional readiness alone; it reflects organisational decisions about how certain forms of knowledge are prioritised, legitimized and sustained in everyday practice.

Nevertheless, this history is not reducible to constraint. There has been a steady rise in the number of nurses holding doctorates, with posts distributed across universities, university colleges and hospital-based research units. There has also been an important broadening of the profession's postgraduate repertoire. Across Denmark, Finland and Norway, Advanced Practice Nursing (APN) programmes are associated with strong self-reported competencies in value-based care, clinical decision-making and interprofessional collaboration, precisely the capabilities demanded by complex service environments. ⁶ In light of these developments, the ongoing fragility of nursing's academic infrastructure stands in marked contradiction to the demonstrable expertise and advanced competencies the field has achieved.

Taken together, these developments point to a dual conclusion. Danish nursing has advanced academically and diversified the methods and competencies with which it approaches practice. However, it has not secured an institutional base strong enough to set agendas on equal terms or to protect its epistemic distinctiveness. At this stage, continued reliance on externally defined academic conditions risks reproducing the very dependency that higher education was intended to overcome. This unresolved historical tension forms the backdrop to contemporary challenges and to the decisions that must now be made about the field's future direction.^1,2 For a research community committed to critical inquiry, this raises an unavoidable question: whether nursing can continue to expand within existing organisational arrangements without also accepting limits on its capacity to define what counts as relevant knowledge? Addressing this question will require more than incremental adjustment. It will require explicit reflection on organisational location, leadership of research agendas, funding pathways and evaluative standards. Against this background, the task facing the field is no longer simply to demonstrate academic growth, but to assume responsibility for the institutional conditions under which nursing research is produced, recognised and sustained.

Regarding the current state of nursing research, key challenges and the directions they imply are evident in a landscape that displays striking achievements alongside structural fragilities that must be read together rather than in isolation. A considerable body of PhD-educated nurses now contributes to research across hospitals, universities and university colleges. However, their academic presence remains dispersed and insufficiently anchored, and this fragmentation constrains the field's capacity to articulate a coherent national agenda. Together, these patterns signal that nursing remains institutionally positioned within frameworks over which it has limited influence, shaping both what is researched and what becomes possible.^2,7 In addition, the absence of a national overview of PhD-educated nurses means that planning currently depends on fragmented organisational memory rather than structured knowledge about who conducts research, in which institutions and on what topics. This is more than an administrative oversight: it reflects a persistent perception of nursing research as auxiliary rather than strategic. When capacity cannot be mapped, it is difficult to cultivate, coordinate or develop it further.^8,9

Moreover, the institutional homes in which most nursing research unfolds, typically comprising clinical research units or broad Health Sciences faculties, are shaped by evaluative logics that are not necessarily calibrated to nursing's epistemic priorities. This misalignment becomes evident in funding evaluations that privilege designs aligned with biomedical reductionism, even as many of nursing's most pressing questions concern ethics, coordination and the lived experience of care. The fact that nurse researchers must routinely adapt proposals to criteria rooted in adjacent disciplines underscores that nursing is still expected to conform to prevailing institutional norms rather than helping to define them.^1,2

At the same time, the broader Danish health system is evolving rapidly. Denmark's leadership in digital health has generated opportunities for new models of care, from telemedicine to decentralised home-based services. However, these innovations highlight a paradox. While they offer space for nursing leadership, they can also relegate nurses to implementers of technologies they did not help to shape. This tension underscores the need for research capacity capable of engaging with digitalisation not only as technical transformation, but also as a reconfiguration of professional judgement, care relationships and patient autonomy.^10,11 Similarly, demographic change intensifies demand for advanced clinical competencies, and APN programmes show that nurses possess strong foundations for expanded roles. However, these postgraduate routes realise their full potential only when embedded in environments that recognise nursing as an intellectual enterprise, rather than merely a set of tasks, with its own theoretical and methodological foundations. ⁶

When we consider these developments together, a pattern becomes visible. The present challenges, including weak institutional anchoring, fragmented career pathways, funding mechanisms calibrated to other disciplines and a health system undergoing rapid transformation, underline the urgency for nursing to articulate a clearer and more assertive academic presence. The direction implied is not a checklist of policy steps, but a fundamental shift in how nursing positions itself within the academic landscape of Denmark. What is required is a cohesive scholarly community that can set its own priorities, negotiate its own space and actively shape the healthcare system rather than merely respond to it.^1,2 The question is therefore not only how Denmark can support nursing research, but also how nursing research can reposition itself to assert influence over the academic and clinical futures it is already deeply implicated in. This is the lens through which we now consider the implications of nursing's integration into the broader Health Sciences.

Reflections on the implications for nursing and nursing science as they are integrated into broader academic fields (Health Sciences) reveal a landscape in which integration is frequently presented as an unquestioned good, promising interdisciplinarity, shared infrastructures and intellectual cross-fertilisation. Much of that promise is real. However, integration without autonomy can create a quieter form of disciplinary absorption, in which the evaluative criteria and epistemic preferences of larger and more established fields effectively dictate what counts as legitimate nursing research. The Danish case makes this tension particularly visible because the absence of dedicated university homes for nursing science means that the field must continually negotiate its place within academic structures never designed with nursing's epistemic concerns at their centre.^1,2

The first implication concerns epistemology. Many of nursing's most consequential questions, relational care, coordination across trajectories and the moral labour of everyday practice, require methods that can attend to complexity: qualitative depth, mixed-methods integration and longitudinal designs that follow implementation over time. However, as Nielsen and Dau argued more than a decade ago, such questions struggle to gain traction in systems whose evaluative cultures privilege reductionist designs and decontextualised endpoints. ⁵ Interdisciplinarity only functions effectively when each discipline enters with a confident, institutionally supported epistemology; the current Danish arrangements offer little assurance that nursing's epistemic foundations will be safeguarded or allowed to shape shared research agendas.

The second implication is organisational. Without centres or departments that anchor nursing science, participation in faculty governance depends on informal alliances and short-term project affiliations. This reality severely limits the ability to build sustainable doctoral cohorts, coherent mid-career pathways, and stable professorial leadership. As Danielsen et al. ⁷ have shown, even well-intentioned interdisciplinary units often rely on nursing participation without necessarily strengthening nursing's own academic infrastructure. A parallel pattern appears in DASYS Research Council's description of research nurses as important but structurally vulnerable actors within hospital settings. ⁸ The cumulative effect is a persistent dependency on personal networks and temporary funding rather than embedding research in durable organisational structures.

The third implication concerns academic visibility and strategic voice. In Denmark, the frameworks governing “research into nursing” diverge significantly from those of neighbouring Nordic countries. The result is a set of persistent questions that speak directly to the integrity of nursing within Health Sciences: how many Danish higher education institutions actually provide doctoral training explicitly in nursing rather than in adjacent fields? To what extent are nurses compelled to pursue their PhDs in other disciplines because nursing lacks a secure academic home? And how visible is nursing science relative to medicine when research councils, promotion systems and faculty strategies determine what counts as core academic work? These are not merely descriptive questions; they diagnose whether integration occurs on equal terms or masks an ongoing asymmetry in academic power. ¹

A fourth and increasingly pressing implication concerns the wider innovation ecosystem. Denmark's internationally recognised leadership in digital health, coupled with public–private innovation pipelines and a national emphasis on sustainability, positions the healthcare system as unusually agile in testing and scaling new solutions. However, agility without disciplinary voice can easily marginalise nursing. If nurses are positioned only as implementers of technologies they did not help to design, the system forfeits the profession's deep understanding of workflow, equity, ethical judgement and the lived experience of patients.^10,11 Digitalisation functions here as a critical test case: it exposes the stakes of integration by showing what occurs when major system transformations proceed without nursing science at the design table.

It is precisely within this context that the Novo Nordisk Foundation's targeted PhD Scholarships in Nursing Research emerge as a telling indicator of the current state of the field. When the country's most influential philanthropic research foundation deems it necessary to establish bespoke scholarships “to support ambitious nurses to pursue a career within nursing research”, this highlights the considerable distance still separating nursing from recognition as a routine academic pathway within the Danish university system. Rather than signalling disciplinary maturity, such targeted initiatives expose the ongoing reliance of nursing science on exceptional, externally driven measures rather than on stable, institutionally embedded career structures. ¹² Far from undermining the argument above, this example reinforces it: the academic development of nursing presently depends on interventions originating outside the university sector because internal structures for sustaining autonomous disciplinary growth remain insufficiently developed.

Seen together, these epistemic, organisational and political implications point toward a path best described as integrated autonomy. We are not advocating isolation from the Health Sciences; rather, we argue for collaboration founded on a strong disciplinary presence. This requires building academic architecture that allows nursing to participate as a peer, not as a perennial guest. It also requires aligning advanced postgraduate routes, including APN education, with research strategies, so that practice and inquiry reinforce one another rather than unfolding on parallel tracks that meet only occasionally.^6,12–14

We end by concluding that the Danish nursing academy has travelled far from its vocational origins. It has built doctoral capacity, diversified roles and contributed substantively to clinical improvement. The critical question is whether these gains will be consolidated into a durable disciplinary presence or dispersed across agendas defined elsewhere. We argue that the future should be chosen rather than drifted into. Nursing in Denmark should claim integrated autonomy: an arrangement in which the field retains an institutional base strong enough to sustain its own intellectual projects while collaborating across the Health Sciences on terms of parity. Only under such conditions can a digitally mature and innovation-oriented health system ensure that technology serves care, that equity remains central, and that professional judgement is protected. Only under these conditions can nursing continue to act not merely as a clinical workforce but as a co-author of the knowledge shaping contemporary and future care.