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The public has voted to give nurses more than just a round of applause

04.02.2022 – EVELINE RUTZ

Swiss nurses want better working conditions, more autonomy and greater recognition. The public has listened to them. The “Strong healthcare” initiative, championed by the Swiss Professional Association of Nurses (SBK-ASI), scored a historic referendum victory at the end of November. Implementation is the next challenge.

“Applause is not enough” rang the slogan a few months ago, as nurses campaigned for better working conditions. The majority of Swiss voters share this view, after some 61 per cent approved the “Strong healthcare” initiative on 28 November 2021 (see also “Swiss Review” 5/2021). The Swiss Abroad were also clearly in favour, with 58.3 voting yes.

The people gave a resounding yes to the strong healthcare initiative. The “Fifth Switzerland” vote was similar with 58 per cent in favour.

This result is remarkable in a number of ways. A trade union proposal has succeeded at the ballot box for the first-ever time at national level. It is also only the 24th popular initiative that has been passed since the birth of the modern federal Swiss state, attracting an unusually high level of support and democratic participation. Voter turnout was 65.3 per cent – the fourth highest since 1971, when the electorate approved the introduction of women’s suffrage. The Covid-19 Act was another reason why so many people voted – this matter was also included on the ballot paper after being the subject of heated debate.

Yes in almost all cantons

Early opinion polls had shown that the public was very sympathetic to nurses’ demands, but no one was sure whether the proposal would achieve the necessary cantonal majority – often a stumbling block in plebiscites. But the initiative easily cleared this hurdle. All cantons voted in favour apart from Appenzell Innerrhoden.

There was a general consensus that healthcare reforms are necessary. More and more nurses are reaching breaking point. Many are leaving the profession early, often at a young age. HR departments are finding it hard to recruit people – the additional nurses that Switzerland’s ageing society will need in future. Without effective reforms, the shortfall in nurses is therefore likely to be around 65,000 by 2030, warn experts.

Pandemic brought the situation into focus

The “Strong healthcare” initiative, launched by the Swiss Professional Association of Nurses (SBK-ASI) back in 2017, also owes its resounding success to Covid. The media have reported extensively on the situation in hospitals and care homes, reminding the public of the job that nurses and carers do around the clock. Many people now realise that they or their loved ones may also need looking after one day. The situation with Covid worsened again in the weeks running up to the vote. Case numbers soared – just as reports of the new Omicron variant were about to come through. And by the time of the referendum, hospitals were saying they would probably soon have to resort to triage and make deeply uncomfortable life-or-death decisions on whom to treat.

“What we now expect from politicians is that they take our wishes seriously and act swiftly.”

Yvonne Ribi

SBK-ASI Managing Director

Esteem and appreciation

“In moments like this, nurses demonstrate to each and every one of us how important they are,” said Health Minister Alain Berset on the day of the vote. The emphatic yes at the polls was a collective show of esteem and appreciation, he added. Nurses celebrated the result, with SBK-ASI Managing Director Yvonne Ribi (see “Top pick”) hailing public solidarity. The measures that had been passed would help to address the nursing crisis, she said. “What we now expect from politicians is that they take our wishes seriously and act swiftly.”

No time to lose

Normally, the Federal Council would now make a proposal on how to implement the initiative. But the initiative committee has suggested a different approach to get the ball rolling quicker: start investing in education and further training as soon as possible (as parliament unequivocally agreed) and just leave the remaining points to the Federal Council. New rules already established by parliament in line with a counterproposal to the initiative, governing when nurses can prescribe and invoice treatments themselves in future, should not be up for renegotiation either, say the referendum winners, adding that their introduction should not be delayed. The Social Democrats have submitted a motion to this effect. The Centre has not ruled out giving the motion its backing. One of its National Councillors, Ruth Humbel (canton of Aargau), nevertheless told Radio SRF that such a solution will also take time. “If everything goes well with this first, uncontroversial part, I can see the legislation coming into force in two to three years.” Not so fast, say the centre-right and right-wing parties. Parliament made compromises in order to get the authors of the initiative to step back, noted FDP National Councillor Matthias Jauslin (canton of Aargau). These compromises are up for debate again. “The legislative process is at square one,” he said. Under the terms of the initiative, both chambers have four years to complete this process.

Unresolved questions on staffing and pay

The Federal Council’s role in this two-track process is to flesh out the additional points within 18 months and, in particular, provide a roadmap to ensure greater job satisfaction and longevity in the nursing profession. For example, the federal government will have to address the issue of wages including overtime pay for night and Sunday shifts, not to mention specify nurse-to-patient ratios. Delivering solutions that command majority support will be anything but easy. Yvonne Ribi said the initiative committee would not sit back and watch parliament water down the initiative. “We will not let up,” warned the SBK-ASI boss. Meanwhile, opponents of the initiative have vowed to scrutinise costs. They will hold the Yes camp to the promise that these will not balloon.

Role of the cantons

When and how the proposals are to take effect not only depends on the government, however. The Federal Council only has the authority to provide guidelines. Responsibility for implementation lies with the cantons and partly with the municipalities. This federal structure makes it more difficult to push through reforms quickly and consistently. Hence, it could still take a few years before nurses notice any tangible improvement.

Voters back Covid-19 measures – again

The electorate has endorsed the pandemic policy of the Federal Council and parliament for a second time, with 62 per cent of voters giving their backing to the Covid-19 Act, which governs things like the Covid-19 certificate requirement and financial support for businesses. The “Fifth Switzerland” was even more clearly in favour, with 68.5 per cent voting yes. Commentators said it was a vote of confidence for the government’s handling of the pandemic, after what was a fractious referendum campaign at times. The result was more emphatic than in June, when the Covid-19 Act was first put to the people. The yes vote accounted for 60.2 per cent then. Switzerland is the only country in the world that allows people to vote directly on measures to curb the pandemic. The referendum on the Covid-19 Act came after numerous rallies against the measures, some of them violent.

No drawing of lots to appoint judges

The Justice Initiative was decisively rejected by 68.1 per cent of the electorate. All cantons said no to the idea of drawing lots in future to choose the members of the Federal Supreme Court (FSC), with 65.3 per cent of Swiss Abroad also voting against. Political parties will therefore continue to influence the process of appointing FSC judges. Judges in Switzerland must belong to a political party, to which they pay an annual subscription fee. (ERU)