Sustaining nursing practice in Greenland: insights from a positive deviance study on motivation, resilience, and holistic care in arctic healthcare

Health disparities in the Arctic remain substantial, with Inuit populations experiencing shorter life expectancy and higher morbidity than global averages. Nurse shortage exacerbates these challenges, and Greenland continues to rely on nurses from other countries. Despite these constraints, health outcomes have improved over time, including increased life expectancy, enhanced diabetes care, and better child growth indicators. To sustain professional well-being and retention in the Greenlandic nursing workforce, this study explores how nurses deliver high-quality care under constrained conditions, and what motivates them to remain in healthcare using a positive deviance framework. Ethnographic fieldwork was conducted across five Greenland regions, involving participant observations and interviews with nurses and students across professional roles. Across backgrounds and seniority, nurses demonstrated a shared passion for their work, with patient encounters central to practice. Resilient communities, shaped through collaboration and humour, supported creative problem-solving and a strong sense of responsibility, extending from individual patients to healthcare and society. Nurses sustain their practice through patient-centred values, community resilience, improvisational competencies, and commitment to societal well-being. Using a positive deviance perspective, insights from effective nursing practices can inform nursing education and Arctic healthcare, improving patient care, job satisfaction, staff retention, and long-term cost efficiency.