What is the best way to resolve the nursing crisis in Switzerland?
Switzerland is facing a major shortage of nurses – and not just since the Covid-19 pandemic started. During lockdown, nurses were applauded from balconies. Now, they are calling for action to resolve the challenges facing their profession.
Parliament, however, is proposing different solutions from backers of the so-called “nursing initiative”, which Swiss voters will decide whether or not to approve on November 28.
In the article below, Katy Romy outlines the main arguments and proposals of both sides. In your opinion, which approach is the better one and why?
If you are working in health care in Switzerland, what are your experiences with staffing shortages, high workload and burnout?
Or are you a member of the Swiss abroad community? How is the situation for nurses in the country you live in, compared to Switzerland?
From the article Swiss voters give helping hand to nurses
From the article Swiss voters to decide on how to solve the nursing crisis
The government pays the family as a temporary nurse.
The real nurse advises the family and reduces the burden.
If they are unable to cope, the real nurses will take care of them.
Higher compensation for nurses will not increase the number of nurses if they work too hard.
家族を一時的に看護師として、政府が報酬を払う。
本当の看護師が家族にアドバイスすることで、負担を減らす。
どうしても対処できなくなった場合、本当の看護師が対応する。
看護師の報酬を高くしても過酷な労働では、看護師を増やすことにはならない。
It may be advisable to offer rapid antigen testing for those nurses unable to be vaccinated.
Part of the problem is probably demographics; there are relatively many old people who need care and relatively few young people who enter the workforce due to the age tree or the upside down age pyramid.
One may go and now try to recruit nursing professionals in other countries and lure them here with a good salary. But this obviously doesn't work, if you compare that Austria has about 2^000 intensive care beds for pandemic patients and Switzerland can only afford 900 intensive care beds despite or maybe because of the high wages. Good people apparently value a familiar honest environment more than a high wage.
To correct the age pyramid in the long term, the birth rate would have to be increased to a healthy level of 2.1. And since unfortunately many women have no or only 1 or 2 children, society, the economy and politics would have to strive for a 4+ child family policy. Therefore, how would a society have to be so that every woman loves to have four and more children of her own and the men do not run away, but support the women?
Or to support the initiative of NR Andrea Geissbühler and NR Yvette Estermann; how would society have to be so that women also like to have unplanned children?
Ein Teil des Problems liegt wohl in der Demografie; es gibt bedingt durch den Alters-Baum beziehungsweise der auf den Kopf stehenden Alterspyramide relativ viele alte Menschen welche Pflege bedürfen und relativ wenige junge Menschen welche ins Berufsleben eintreten.
Man mag hingehen und nun versuchen Pflegefachkräfte in anderen Länder zu rekrutieren und mit einem guten Lohn hier her zu locken. Nur funktioniert dies offensichtlich nicht, wenn man vergleicht dass Österreich rund 2^000 Intensivbetten für Pandemie-Patienten hat und die Schweiz trotz oder vielleicht gerade wegen den hohen Löhnen sich nur run 900 Intensivbetten leisten kann. Guten Leuten ist scheinbar ein vertrautes ehrliches Umfeld wichtiger als ein hoher Lohn.
Um die Alterspyramide langfristig zu korrigieren müsste die Geburtenrate auf ein gesundes Niveau von 2.1 erhöht werden. Und da leider viele Frauen keine oder nur 1, 2 Kinder haben müsste die Gesellschaft, die Wirtschaft und Politik eine 4+ Kind Familienpolitik anstreben. Daher, wie müsste eine Gesellschaft sein damit jede Frau es liebt vier und mehr eigene Kinder zu haben und die Männer nicht davon laufen, sondern die Frauen unterstützen?
Oder um die Initiative von NR Andrea Geissbühler und NR Yvette Estermann zu unterstützen; wie müsste die Gesellschaft sein damit Frauen auch gerne ungeplante Kinder haben?
The common language is one thing. Wouldn't it be good if people understood the same words and had the same value system in order to minimize misunderstandings?
In Switzerland, for example, the statement "I'll be right there" has a different weight than in the big canton. And so it is not surprising that recently a Swiss nurse in the cantonal hospital was on edge and she complained about the behavior of some "guest" doctors with a patient or asked to study medicine so that there are more Swiss doctors!
Die gemeinsame Sprache ist das eine. Wäre es nicht gut wenn man unter dem selben Wörter das selbe versteht und das selbe Wertesystem hat um Missverständnisse zu minimieren?
In der Schweiz hat zum Beispiel die Aussage "ich komme gleich" ein anderes Gewicht als im grossen Kanton. Und so ist es nicht verwunderlich, dass kürzlich einer schweizer Krankenschwester im Kantonsspital die Nerven blank lagen und sie sich über das Verhalten mancher "Gast"-Ärzte bei einem Patient beschwerte bzw. aufforderte Medizin zu studieren damit es mehr schweizer Ärzte gibt!
Here the question arises; does one want them in Switzerland at all on the basis of their values?
Hier stellt sich die Frage; will man die überhaupt in der Schweiz auf Grund ihrer Wertehaltung?
One way of attracting and retaining both foreign and Swiss nursing staff lies in the provision of a more clearly defined career structure, attractive social benefits and job security as well as a greater facility to move to different clinical, research and administrative areas and also between hospitals, clinics and other healthcare facilities throughout the country. Nurses also value post graduate training, continuous professional development and further opportunities to branch out into a wider variety of specialisms.
Nurses from outside Switzerland are often considered as short term which limits these opportunities. A body of research literature in the past has shown that pay is not the only, and often not the prime motivator, in job satisfaction.
I agree, this kind of flexibility would make the profession a lot more attractive. And that thinking beyond the issue of the salary is vital. I'm really curious to see how things develop now after the vote! I really appreciate your thoughtful inputs, thank you.
A career in nursing has almost unlimited potential and has always been so full of promise in theory. Sadly in practice it has to overcome so many different obstacles and despite the size of the workforce in any country and globally, the professionalism, dedication, higher education and training and the absolute dedication of the majority of its members, the profession has far too little influence both in the workplace, politically and elsewhere. It remains the Cinderella service by comparison with the medical profession.
Incidentally, I shouldn’t advertise, but do try and get a copy of the short inspirational book called clean hands which tells the story of how hand gel and the global acclaimed hand washing technique came into being. It started on my ward where I was unwittingly potentially included among one of the more sceptical Guinea pigs! :-)
The founder is in the dance at the end of this video
https://www.youtube.com/watch?v=5qWM9JyVUQ4
The book I mention in my previous comment is also published in other languages, German and I believe French. I can give further details if anyone would like them.
Very interesting! I will definitely have a look! Thank you!
Simple. Pay them more.
I suggest we operate the same system in the Gulf countries and in many countries of the world, we use nurses from countries like the Philippines and India and give them a seasonal visa because they don't know how much virus will deliver us in the future.
أنا أقترح أن نعتمد نفس النظام في دول الخليج وفي كثير من دول العالم، أي أن نقوم بتوظيف ممرضات من دول مثل الفلبين و الهند ونوفر لهن تأشيرات عمل موسمية لأننا لا نعرف كم عدد الفيروسات التي ستصل إلينا في المستقبل!
Perhaps this should be introduced in France and Germany first: All nurses and doctors come from other countries and are not locals.
Das sollte man vielleicht zuerst einmal in Frankreich und Deutschland einführen: Alle Krankenschwestern und Ärzte kommen aus anderen Länder und sind keine Einheimische.
The best way is to triple the pay scale and stop trying to chisel these people down in wages. Pay raises can be made by flogging politicians on Pay- per-View.
Luckily flogging isn't something that happens in Switzerland anymore! Even though I think this comment was meant in a funny way, please adhere to our [url=https://www.swissinfo.ch/eng/terms-of-use/44141966]guidelines[/url] and don't call for violence in your comments.
What wage do you think would be reasonable for health care staff?
To cure this shortfall of nurses quick, offer well educated nurses
with at least 5 years working experience from, other countries in Europe. German, French and English speaking.
Switzerland has one of the best healthcare in the world, beside
Singapore and the USA. The socialised healthcare is in collapse.
Do you know how many people die in the USA because they can’t afford life saving drugs like insulin? Medical bankruptcies are also one of the leading causes of personal bankruptcies in the USA. Is that the healthcare you want Switzerland to copy?
Switzerland has good healthcare, USA probably the best, even if its not available to everybody. Sweden who used to have a working socialistic healthcare system has now collapsed, you do not need to pay, however, its not available to most people.
You keep saying that the USA has the “best health care system” yet haven’t responded to the fact that people regularly die in the USA because they can’t afford insulin or that bankruptcies due to medical bills are one of the biggest reasons for personal bankruptcies in the USA.
You claim Sweden’s healthcare system has “collapsed” yet can’t provide a single example. Are people there dying because they can’t afford medicines or going bankrupt because of medical bills? I think not.
Don’t make claims you obviously can’t back up with facts.
Hey, I am Swedish, I know the situation first hand.
People die waiting for medical care, and its not transparent.
There is a shortage of nurses, doctors, space at hospitals.
In the USA people spend money on pleasures, tobacco, alkohol, cars juls food etc. and yes people die there because of money problem, exactly like the rest of the world. Obesity is one of the worst killers.
In socialistic countries statistics are fake, just to save the governments. I have doctor friends, sick relatives and friends
the situation is terrible. Medical care is expensive everywhere
paid by taxes or insurance. USA has the best medical education.
Hi both, thank you for your contributions. To come back to the topic of the discussion: are there things Switzerland could learn from the US or Sweden when it comes to solve the nursing crisis? What do you think will happen now that the [url=https://www.swissinfo.ch/eng/swiss-voters-set-to-give-helping-hand-to-nurses/47130266]nursing initiative has been accepted[/url]?
To respond to your question, paying nurses more would be a huge step forward as your website recently had a story about how Switzerland’s nurse’s pay is below the EU average.
Some people have recommended bringing in additional nurses from India or the Philippines which is unwise as nurses need to be able to clearly communicate with their patients and doctors in the local language, be it French, German, Italian, etc. The risk to patient lives because of mistranslation would be too great with nurses who could only speak English as would be the case with bringing in nurses from the countries I mentioned above.
Thank you! I am curious to see how things will unfold now after the vote. And paying higher wages is certainly a good start!
I agree that proficiency in the local language is vital when working as a nurse. There are [url=https://www.srk-zuerich.ch/lernen/pflege-betreuung/deutsch-als-zweitsprache-in-der-pflege]language courses[/url] specifically tailored to working in the medical field, so if nurses who would be invited from abroad would also go through language courses it might be a solution, or a part of a solution.
The initiative is based on the assumption that if more nurses are trained, there will also be more nurses and the shortage will be eliminated.
Only, some care organizations allegedly do not want to employ trained nurses but only "simply" trained health professionals with a four-year apprenticeship. In a way, this makes sense, since less wages have to be paid. If more health professionals were employed, so that they would not be under time pressure, the nursing shortage would be solved in a way. It is irritating that this is not the case. Either the money saved in this way is wasted somewhere, or there is a fundamental problem with the costs and the communes, cantons or whoever determines the price catalogue would have to dig deeper into their pockets.
Be that as it may, with the acceptance of the initiative and its implementation, there is a high risk that good nursing professionals will be trained and these will then not find employment due to the higher salary. So then at the end of the day the care specialists are frustrated because they are unemployed and by the centralization and today's form of the academization of the training analogous to the Numerus Clausus the general discontent increases. And the nursing crisis has not been solved.
On the other hand, with a Yes to the initiative, a signal can be sent out, as with a silent protest, that there is something wrong in the system.
Die Initiative setzt darauf, dass wenn mehr Pflegefachpersonen ausgebildet werden es auch auch mehr Pflegefachkräfte geben und der Notstand behoben wird.
Nur, manche Pflegeorganisationen wollen angeblich keine ausgebildete Pflegefachkräfte anstellen sondern nur "einfach" ausgebildete Fachfrau Gesundheit mit einer vierjährigen Lehre. Dies hat auf eine Art auch Sinn da man so weniger Lohn bezahlen muss. Wenn dafür mehr Fachfrauen Gesundheit angestellt würden, so dass diese keinen Zeitdruck hätten, wäre der Pflegenotstand auf eine Art gelöst. Irritierend ist, dass dies nicht der Fall ist. Entweder versickert das so eingesparte Geld irgend wo, oder man hat ein grundsätzliches Problem mit den Kosten und die Gemeinden, Kantone oder wer auch immer den Preis-Katalog fest legt müsste mal tiefer in die Taschen greifen.
Wie dem auch sei, mit der Annahme der Initiative und deren Umsetzung besteht das hohe Risiko, dass gute Pflegefachkräfte ausgebildet werde und diese dann auf Grund des höheren Lohnes aber keine Anstellung finden. So sind dann am Ende des Tages die Pflegefachkräfte frustriert weil sie arbeitslos sind und durch die Zentralisierung und heutige Form der Akademisierung der Ausbildung analog zum Numerus Clausus die allgemeine Unzufriedenheit zu nimmt. Und der Pflegenotstand ist nicht gelöst.
Auf der anderen Seite kann mit einem Ja zur Initiative ein Zeichen gesetzt werden wie bei einem stillen Protest dass da irgend etwas nicht stimmt im System.
I think it would be best if the hierarchy of doctors and nurses could be reduced as much as possible.
In order to keep the quality high, the diagnosis and the planning of measures (care or medical prescriptions) would have to be distributed among several heads. This would be technically feasible today (e.g. by means of technical aids such as the Internet).
Another important point should be the reduction of exorbitant incomes of specialists. Because this creates the wrong incentives.
Seen in this light, the care initiative would be a first step on a long road.
Ich denke, es wäre am Besten, wenn die Hierarchie von Arzt:innen und Pflegenden möglichst stark vermindert werden könnte.
Um die Qualtität hochzuhalten, müsste die Diagnoseerhebung und die Planung von Masnahmen (Pflege oder medizinische Verordnungen) auf mehrere Köpfe verteilt werden. Das wäre heute technisch machbar (etwa mittels technischen Hilfsmitteln wie das Internet).
Ein wesentlicher Punkt müsste auch der Abbau von exorbitanten Einkommen von Fachärzten sein. Denn dadurch werden falsche Anreize gesetzt.
So gesehen wäre die Pflegeinitiative ein erster Schritt auf einem langen Weg.
I agree with you there. In teams with rather flat hierarchies, in my experience, the exchange is better, the trust in each other is higher and the working atmosphere is better. However, for me, this also includes a convergence in salary and reputation. Especially the latter needs the commitment of everyone, society as a whole.
How exactly do you think that diagnosis and planning should be distributed among more heads? I would rather think "too many cooks spoil the broth". Especially with many specialties being so highly specialized and often only considering "their" organ, I would find it interesting to see how it would work if there were one or two professionals who had the overall view. Digitalization can certainly help with centralized data collection.
Da stimme ich Ihnen zu. In Teams mit eher flachen Hierarchien ist meiner Erfahrung nach der Austausch besser, das Vertrauen ineinander höher und das Arbeitsklima besser. Dazu gehört für mich allerdings auch eine Annährung in Gehalt und Ansehen. Vor allem letzteres braucht den Einsatz aller, gesamtgesellchaftlich.
Wie genau meinen Sie, dass die Diagnoseerhebung und Planung auf mehr Köpfe verteilt werden sollte? Ich würde eher denken "zu viele Köche verderben den Brei". Gerade auch dadurch, dass viele Fachrichtungen so hoch spezialisiert sind und häufig nur "ihr" Organ bedenken, fände ich es interessant zu sehen, wie es funktionieren würde, wenn es ein oder zwei Fachkräfte geben würde, die den Gesamtüberblick haben. Digitalisierung kann da sicher helfen mit einer zentralisierten Datenerhebung.
I suspect that at least the dual control principle should be introduced. Of course, the question is whether this is still affordable.
I would also find it helpful that, as you have written, coordinative tasks should also be introduced, so that hierarchies could be flattened.
Also that the collected data should be automatically evaluated and thus also automatically validated from this side.
I just think that nurses should have more creative freedom and say.
How that should be achieved: Of course, this can and must be argued about.
Ich vermute, dass mindestens das Vieraugenprinzip Einzug halten sollte. Natürlich stellt sich die Frage, ob das noch zahlbar ist.
Dass etwa, wie Sie geschrieben haben, auch koordinative Aufgabe eingeführt werden sollten, fände ich auch hilfreich, damit Hierarchien verflacht werden könnten.
Auch dass die erhobenen Daten automatische ausgewertet werden sollten und somit auch von dieser Seite automatisch validiert werden sollten.
Ich denke einfach, dass Pflegefachpersonen mehr Gestaltungsfreiraum und Mitspracherecht haben sollten.
Wie das erreicht werden sollte: Darüber kann und muss natürlich gestritten werden.
Yes, a four-eyes principle is definitely helpful - especially when (and this is often the case) it has to go fast and is stressful, a "check" by a colleague can avoid mistakes.
I agree with you that having a say and freedom to shape things is key. I am very curious to see what will happen after the voting weekend. I think there is agreement that something has to happen, just not in which form...
Ja, ein Vieraugenprinzip ist definitiv hilfreich - besonders wenn es (und das ist häufig der Fall), schnell gehen muss und stressig ist kann ein "check" durch einen Kollegen oder eine Kollegin Fehler vermeiden.
Ich stimme Ihnen zu, dass Mitsprache und Gestaltungsfreiraum zentral ist. Ich bin sehr gespannt, was nach dem Abstimmungswochenende geschehen wird. Ich denke, es herrscht EInigkeit darüber, dass etwas geschehen muss, nur nicht, in welcher Form...
The solution is to open the door to volunteering for students of colleges, health institutes and volunteers who have the basic medical basics.
الحل هو فتح باب التطوع لطلاب الكليات والمعاهد الصحية والمتطوعين الذي تتوافر لديهم الأساسيات الطبية.
Pay nurses better and limit working hours. There is no way to avoid it.
Ideally, but how do you limit hours when there are insufficient numbers to provide adequate patient care? Cutting down on administrative and other non-nursing tasks that could be carried out by others would be a good start. Eliminating more unnecessary rituals would also be helpful.
1. Better training and budgets
2. Better trainers and mentors
3. Better salary, working conditions and job guarantees
4. Better image building for these workers
5. Better amount of empathy for these "risky" jobs
In a nutshell, pay more attention to these work force because our lives depend on it.
There should be a Law that stipulates that the starting salary of nurses should be, at the very least, in line with the average salary of all university graduates - I'm certain if such a statistic is not available, one can be produced by the National Statistics Office. There is also an argument that those qualified within the medical profession should receive a higher remuneration than this average as, in times of need, the populace depends on them more to get through emergencies.
In addition, there should be an enforceable agreement that conditions - including hours - must be within the national norm.
Firstly, the Swiss health system needs to be massively transformed. It should be to emulate what successful neighbouring countries have done such as Germany.
The Swiss private model is painfully extracting too much money from people for basic healthcare. If people want to pay for a private bed and a nice view, great, let them pay extra, but basic healthcare is a fundamental right in a civilised society, and it must be funded from basic taxation.
As part of such a transformation the new health service owned by the people would ensure that enough nurses are trained and work in decent conditions, similarly with doctors.
This exploitative, privatised system which turns doctors and other medical care and equipment providers into millionaires, and allows insurance companies to have trendy new offices, needs to end.
I don’t believe that would happen.
The people own the NHS in the UK. Unfortunately it certainly does not ensure anywhere near adequate working conditions, has very far from sufficient numbers of trained staff and considerable problems in the provision of healthcare to the nation with very long waiting lists.
The situation has been very poor for decades and has been considerably worsened by severe austerity following the financial crisis of 2008 and now is very badly hit as a result of the pandemic with absenteeism caused directly by, or as a result of, Covid with a very high and increasing drop out rate of qualified and experienced staff who are needed to pass on their skills to the next generation. Many are changing careers or taking early retirement.
Thank you for your comment. I agree, the health system needs to be transformed.
As someone who worked in health care both in Germany and Switzerland I have to say though that the health system in Germany is not successful. Similar to Switzerland, nurses in Germany are overworked and underpaid. And many nurses (including myself) leave their job at some point in their career, which means that there are not enough nurses anymore...
At the turn of the millennium there were too many nurses looking for work in Switzerland with an impossibility for older nurses with years of experience in the Swiss healthcare systems and elsewhere, after a career break, to find a job and climb up the career ladder.
At that time there was an influx of nurses, including a high number of young East German workers to Switzerland who were often newly qualified and cheaper to employ. I heard that employers favoured short term workers who considered Switzerland an attractive place to work and ski in winter. Once they had achieved this aim many would then return to Germany. It was also said, at that time, that younger and newer workers were more flexible and less critical of the system they were working in; a fact that might be disputed today with younger and more self-determined generations of workers.
There are large fluctuations in the labour market over time and this phenomenon possibly contributed in part to the shortages we see now as well as many other and varied factors such as too few entrants to training, attrition rates during training, difficulties in recruitment and issues with retention due to poor working conditions, inadequate management, overwork, disillusionment and powerlessness to deliver the scope and quality of services nurses are trained for, constant high levels of stress, exhaustion which may lead to burnout, poor work/life balance and work related illnesses, as well as personal matters and, with all the transferable skills acquired by nurses, more attractive and appealing career opportunities elsewhere.
The solution? Is to make more money available for training and to make working conditions and pay better for existing staff. It isn’t poaching staff from overseas because those countries need their people too.
The Swiss Government can also recruit some well trained nurses from the Universities and colleges who are been approved and recommended by their masters. Thank you!
Overcome this ever-present Communist phobia when it comes to countries like Cuba. Cuba has a very large, well trained, number of medical personnel - always ready to assist all over the world when tragedies strike. Why not approach the Cuban government and investigate if trained nurses could be brought to Switzerland - at least until the Covid pandemic is over.
ABSOLUTELY
Because the Cuban people may require those nurses which they trained so highly? Is it moral to take them away to a rich country which hasn't fixed it's own problems?
Cuba has approx. 70,000 trained medical personnel...I am sure it can spare a few hundred.
Absolutely not, Cuba is a third wold country with third world standard.
Have you ever visited Cuba? Highest literacy rate in all of the Americas (as confirmed by the UN) and universal health care for all Cubans. Third world?
You can find an overview of ongoing debates with our journalists here. Please join us!
If you want to start a conversation about a topic raised in this article or want to report factual errors, email us at english@swissinfo.ch.