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Switzerland
The advantages of the Swiss federalist system include its strong local autonomy allowing tailored political solutions close to the citizens’ needs and will at the level of the cantons and communes. Disadvantages include a protracted political decision-making process, sometimes leaving urgent matters, such as nursing education, on the agenda but unresolved for many years. Swiss nursing education relies strongly on vocational education and training programmes in the tertiary and upper secondary levels. Those education systems reflect the overall successful tradition of the Swiss dual education system. With the education reforms in the last decade, however, it has led – step by step – to the integration of nursing education into the Swiss higher educational system, including its incorporation into regulatory structures at the Federal level, in keeping with other professions. Furthermore, for the tertiary level A education a major initiative is under way to legally regulate nursing education and practice alongside other health professions at the tertiary level across Switzerland with the Law on Health Professions. Given the scarcity of nurse workforce data in Switzerland, a strong emphasis should be given at the Federal and cantonal levels to reform and/or establish databases for reliable and prospective health workforce planning. Standardized mandatory data collection procedures and easily accessible statistics about nurse education, as well as detailed information on the professionally active nurse workforce in the various health care settings, are urgently needed. Current initiatives involving legal regulation of the nursing professions may leverage databased workforce planning instruments such as a reliable and accessible nurse registry at the Federal level. With standardized, mandatory nurse-specific data collection on an ongoing basis, cross-sectional studies such as the RN4CAST could be replaced by prospective longitudinal data analysis allowing for better and more reliable steering of health workforce planning. To meet future needs for health care services, National Health Systems with their hospitals and related institutions will have to recruit and retain the right numbers, calibre and skill-mix of staff on a long-term basis. With this in mind, the RN4CAST consortium will further study the issue, including nurse survey results, and feed further qualitative information into forecasting models to provide strategies for national forecasting scenarios. The Swiss RN4CAST study group, in collaboration with the OBSAN, elaborated on that issue and provided respective nurse workforce information to the Swiss Health System.
Finally, the Swiss Health System relies on a significant proportion of foreign-trained nursing personnel to meet its workforce needs. This might be also be true in health care, meaning that Switzerland will have to recruit foreign-trained nurses and integrate them into multiprofessional teams in health care settings. As long as the Swiss health care system has strong ‘pull’ factors (such as good working conditions with relatively high wages, good career pathways and opportunities for development and overall high job satisfaction), welleducated nurses from neighbouring countries will be attracted to work in Switzerland. The pressure to develop a sustainable strategy in Switzerland for a nurse education policy geared to increasing the numbers of students and graduates needs to be matched with investment in leadership and family friendly policies for better nurse retention. Such policy interventions rely upon the specifics of the Swiss federalist system, as well as the ability of professional organizations and individuals to inspire and mobilize nurse power, including policy lobbying to guarantee a nurse workforce which relies less on immigration and more on its self-renewing and selfsustaining capacity. 14.5 References Addor V et al. (2016). ‘Nurses at work’ – Studie zu den Laufbahnen im Pflegeberuf über die letzten 40 Jahre in der Schweiz [A study of developments in healthcare over the last forty years in Switzerland] (Obsan Bulletin 8/2016). Neuchâtel: Schweizerisches Gesundheitsobservatorium. Aiken LH et al. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344:e1717. BAG (2011). Bundesrat eröffnet Vernehmlassung der Teilrevision des Medizinalberufesgesetzes. Bern: Bundesamt für Gesundheit. Available at: http://www.bag.admin.ch/themen/ berufe/00993/11990/index.html?lang=de (accessed 15 October 2015). BAG (2016). Vorentwurf zu einem Bundesgesetz über die Gesundheitsberufe. Bern: Bundesamt für Gesundheit. Available at: https://www.bag.admin.ch/bag/de/home/themen/berufeim-gesundheitswesen/gesundheitsberufe-der-tertiaerstufe/ bundesgesetz-ueber-die-gesundheitsberufe.html. BFH (2011). Master of Science in Nursing. Berner Fachhochschule. Available at: https://www.bfh.ch/en/studies/ master/health/nursing.html (accessed 15 October 2015). BFH (2015). Bachelor of Science in Nursing. Berner Fachhochschule. Available at: https://www.gesundheit.bfh.ch/ en/bachelor/nursing.html (accessed 15 October 2015). Bundesamt für Statistik (2014). Population size and population composition – Data, indicators. Available at: http://www.bfs.admin.ch/bfs/portal/en/index/themen/01/02/ blank/key/bevoelkerungsstand.html (accessed 15 October 2015).