Educating nurses for rural healthcare: register-based sequence analyses modelling career paths of nurses from full-time and flexible study programmes

Abstract Background The WHO advocates for evidence-based policies to recruit and retain nurses in rural areas. While place-based admission and introducing flexibility into nursing education programmes are widely adopted approaches, such policies’ long-term effectiveness remains uncertain due to a lack of robust, longitudinal studies. Cross-sectional designs, small sample sizes, and inconsistent methodologies often limit existing research. In this study we address these gaps by using comprehensive, longitudinal registry data and sequence analyses to explore nurses’ career paths; comparing graduates from full-time and flexible programmes; and examining their contributions to rural healthcare over time. Methods UiT The Arctic University of Norway (UiT) has offered flexible nursing education programmes alongside full-time programmes since the early 1990 to address the needs of Northern Norway’s predominantly rural population. We analysed longitudinal registry data covering all nurses who graduated from UiT’s full-time and flexible programmes between 2003 and 2015, using workplace data from the years 2003–2024. Through sequence and cluster analyses, we compared the career paths of the two groups over a 10-year period. Additionally, we used multinomial logistic regression analysis to evaluate how having a northern or rural background was associated with career path choices. Results Among graduates from both the full-time ( n = 2,433) and the flexible programme ( n = 689), we identified three distinct career paths: Nurses working in northern urban areas, nurses working in northern rural areas, and nurses working in southern urban areas. The proportion of nurses following a rural career path was significantly higher among those who completed the flexible programme (52%) compared to those from the full-time programme (18%). Our findings show that having a northern background was significantly associated with the northern career paths, and a rural background was significantly associated with the rural career paths. Conclusions Findings from this study show the value of both flexibility and place-based admissions in building a sustainable rural nursing workforce. Flexible nursing education programmes enhance nurses’ recruitment and retention in rural areas compared to traditional full-time programmes. These findings provide actionable insights for designing nursing education programmes globally to address rural healthcare challenges.