How Switzerland recruits nursing staff abroad

For years the proportion of nursing staff in Swiss hospitals has been between 30-40%. Keystone / Gaetan Bally

Swiss hospitals are increasingly forced to recruit nursing staff abroad. It is widely considered a problematic situation but there are no signs the shortage of skilled workers in the health sector will abate.

Switzerland has one of the highest densities of nursing staff in the world. In 2019, it had an averageExternal link of 18 nurses per 1,000 inhabitants. That’s about twice the average of fellow wealthy nations in the Organisation for Economic Co-operation and Development (OECD).

The country also has a high proportion of foreign nursing staff. For years, this has ranged between 30% and 40%. Many cross-border commuters work in hospitals near the border, for example in Basel and Geneva. But in other parts of the country, too, there are more and more staff who have completed their training abroad.

This will not change soon. The shortage of skilled workers is growing in Switzerland, as it is in other European countries. The situation became particularly pandemic after the pandemic. Competition for staff has intensified.

Media reports that the Kantonsspital Aarau (Aarau Cantonal Hospital) has embarked on a search for suitable staff in Italy caused a stir in Switzerland. “Italy suits the purpose because its good training qualifications are recognised in Switzerland,” says Boris Rauscher, a spokesman for the hospital in the Swiss German-speaking canton. He said this pilot project is one of numerous measures to recruit nursing staff.

The Aarau Cantonal Hospital mostly receives direct applications. However, there are also numerous agencies that recruit nursing staff, such as Carenea, which specialises in recruiting Polish professionals.

“While many hospitals in German-speaking Switzerland already do their own recruiting Germany, it’s more difficult for them to do that in countries where other languages are spoken,” says Grazyna Scheiwiller at Carenea. “You have to prepare these professionals linguistically, culturally and technically for a career in Switzerland.” Her company not only handles the recruitment on the ground, but also prepares candidates for between eight and 12 months with technical and cultural training modules. Language skills and the Swiss Red Cross’s recognition of diplomas are prerequisites for employment in Switzerland.

Unethical approach?

The practice of recruiting nursing staff abroad is not without critics. Yvonne Ribi of the Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner (Swiss Professional Association of Nurses), considers this approach an inadequate solution. She even finds it harmful and unethical. “By doing this, Switzerland is taking staff away from other countries, which exacerbates shortages there,” she says.

Ribi points to Germany as an example. If German medical staff migrate to Switzerland, then German hospitals will have to recruit specialists in Poland, for example. The gaps in Poland, in turn, might be filled with employees from Romania; and so forth. “This sets off an unhealthy domino effect,” she says.

The brain drain, she added, is also accompanied by tangible economic losses as people leave the country that financed their education.

What is the view on this at the Aarau Cantonal Hospital? Rauscher argues the project is ethical. “There is high unemployment among nurses in Italy,” he says. “We familiarised ourselves with the labour market in advance and analysed it in detail. Many hospitals have been recruiting successfully for decades in Germany and Austria, but also in Holland, Spain and – since January 2022 – in Croatia and other countries.”

Foreign nurses are also appealing to employers due to their high motivation, which Scheiwiller says is not primarily based on salary considerations. “What is important to the candidates is the working environment that awaits them in Switzerland,” she says. “For many, professional development is a key reason to move to Switzerland. A job in Switzerland often offers better working conditions and career prospects.”

Benefitting from the EU

In 2011, Switzerland signed a World Health Organisation Code of ConductExternal link recommending ethical principles in international recruitment. The basic premise is that each country must train enough of its own personnel and that appropriate measures should also be taken to retain them. International recruitment in numerous countries is a sign of the failure to meet these goals.

But the fact that Switzerland benefits particularly strongly from international recruitment in the medical sector became public knowledge during the pandemic. For the overburdened health system, it was particularly important that Switzerland was able to recruit personnel from the European Union/European Free Trade Association area, according to a reportExternal link by the State Secretariat for Economic Affairs. In 2020, there were 63,000 people working in the entire health sector – an additional 13,000 employees came from third countries, so almost a quarter of all professionals in the sector.

The pandemic meant people became aware for the first time of the dependencies that such a situation creates, says Ribi. “Around two-thirds of all foreign staff are cross-border commuters,” she notes. During the acute phase of the pandemic, this caused great concern and intensive diplomatic exchanges when neighbouring countries imposed strict lockdowns. “Suddenly people realised that these professionals are systemically important.”

Range of measures required

The Aarau Cantonal Hospital knows that recruitment abroad can only be a partial solution. So, in addition to an active recruiting drive, the hospital also offers “re-entry programmes for nurses, training and further education opportunities, as well as appropriate bonuses for night and weekend shifts for employees”.

This suits the nursing association. “First, we have to look at how we can bring more people into the nursing profession,” Ribi says. “But we also have to look at how we can keep them.” This is one of the reasons why her association brought the nursing initiative to the ballot box in 2021. It was accepted by the Swiss electorate, which voted 61% in favour.

The first step is a training campaign, for which parliament has now created the legal basis and approved additional costs of CHF500 million ($542 million). The second part focuses on working conditions, the possibility of professional development and the remuneration of care services.

Issues remain

But everyone knows that it will take time for these measures to bear fruit. “The next few years will be very demanding,” Health Minister Alain Berset said in January. Recruitment abroad will therefore remain part of the solution – and the problem is not easing. “Even in Poland it is difficult to find enough suitable professionals willing to move to Switzerland,” Scheiwiller says.

Employees are increasingly sceptical. Switzerland’s high wages are effectively neutralised by the high cost of living. In terms of relative income, Switzerland is at the lower endExternal link of the scale in the OECD compared to average incomes. This is partly because part-time work is widespread in the industry. It is poorly paid but often necessary. Shift work and regular overtime do not allow enough time off in a full-time job.

Growing interest in freedom of movement

Freedom of movement is increasingly valued by professionals in the EU/EFTA area. According to a 2022 surveyExternal link, 58% of EU citizens felt that the free movement of workers was positive for the labour market –  up from 45% in 2009. And this opportunity is also being taken up with more enthusiasm: 17% of respondents said they had already worked in another EU country. Another 18% intended to do so in the future. Some may have Switzerland in mind.

Translated from German by Catherine Hickley/ds