Katharina Molterer conducted another interview on the framework conditions for recruiting nursing and care professionals in Switzerland on 12.07.2022 with Heidrun Gattinger, Head of the Institute of Applied Nursing Science at the Eastern Switzerland University of Applied Sciences.
Recommendations for the recruitment of nurses
As an employer, you must be very clear about the competence you need in order to find the right staff for the job. In addition, the professional suitability for the target group that is being served and the personality of the candidate plays a major role. It is also important that the candidate fits into the team because care work requires more or less teamwork depending on the setting. In sum, I would say that the three factors that are essential in the recruitment of care personnel are professional competence, personality, and the ability to work in a team.
Is there a difference in recruitment for institutions vs. home care?
For home care, professional caregivers need to have broad and deep knowledge, precisely because they are on their own. For example, they must be able to assess medical situations very well to be able to decide afterward whether to take necessary measures or to contact the family doctor or the other services to be involved. You, therefore, need a high level of professional competence and the ability to work independently. Personality development is important when you work with clients at home. Their status of autonomy is usually higher because these clients do not easily put themselves in the patient role. As a caregiver, you are their guest and service provider and you have to be able to support that well. There are nurses who enjoy working in this setting. Those who are new to it need to be supported well because they need to develop. One has to be aware that Spitex and home care have different requirements than institutions. The home care requires working independently vs. feeling alone and overwhelmed because you can’t immediately ask your colleague. In the hospital, you share the work or you can hand it over. In the home care setting, you suddenly have to be good at making a diagnosis yourself. The autonomy in clinical decision-making is higher here than in the inpatient setting.
Recruitment challenges
In general, the biggest challenge is the shortage of skilled workers, there are too few nurses, especially the more highly educated ones. If you wanted more graduates from universities of applied sciences or a nursing expert with a Master’s degree, it will be difficult to find someone. It is also difficult to shape the framework conditions in such a way that the nursing professionals stay in a job for long term. Some of the legal requirements are difficult. Especially in Spitex, we have the problem of high bureaucratization, for example, nursing services have to be billed every five minutes. The nurses themselves experience this not only as accounting for services but also as control, coercion, and restriction in their professional actions. You make a plan in advance, of course, you can change it, but that is a bureaucratic effort because you have to justify to the insurance company why you need more time for activity xy. Actually, caring means being flexible, you have to be able to respond and attune to the requirements of the individual situation, and then it may be that instead of the planned intervention, a conversation makes the most sense. The system, therefore, contrasts this. We train the nurses to be aware of the situation and individuality and to act situationally, but the system pushes them in a completely different direction. This often puts the nurses in dilemmas, which can lead to “moral distress”.
It is the system that makes it difficult for caregivers to enjoy their work and work in a meaningful way. Very innovative forms of Spitex may have found more creative solutions to deal with this. But it takes a great deal of innovative power on the part of the managers to change these framework conditions.
What would be important is an investment in further education and competence development. Nurses in this area often find themselves in borderline situations where they are overwhelmed. You have to make sure that the organization offers good support. This means that you have to have experts in the background who constantly look at how their employees deal with substance addiction, aggressive events, or even physically very stressful situations. Private households are not set up in the same way as hospitals, where caregivers have all kinds of aids at their disposal. Self-employed caregivers are already individual players in this respect. I don’t know to what extent they support each other professionally within their association. That is certainly a challenge, even with platforms like HEROES and self-employment. Within an organization, I have the support and there is joint learning. In self-employment, you have to organize everything yourself.
Protection of the nursing staff
There are physical and psychological challenges and risks in the nursing profession: Physical strain is generally high in nursing – 65% of nurses experience work-related back pain in their professional life. The most frequent cause of this is assisting patients, e.g. when transferring them from bed to a wheelchair. Especially in-home care, the conditions are often difficult, e.g. the bathroom is very small or there are no suitable aids available. You cannot order the client to buy assistive material. Psychologically, the job can also be stressful, e.g. when you work with cognitively impaired people who do not let you into their homes or when verbal and physical abuse occurs. In cases of excessive demands, often paired with a lack of training, assaults by the caregiver can also occur. The difficulty in-home care is that this cannot be observed and is more easily covered up than in an institution.
No other profession gets as close to a person as a caregiver can. On the one hand, that is a special beauty, but at the same time, you need skills so that it can be beautiful. For example, acts of aggression often happen during physically close activities. The caregiver must have the appropriate skills and competencies, e.g. how can I move a person or how can I support them well. If this is done in such a way that a person does not feel overwhelmed or manipulated, then there are also fewer acts of aggression.
It’s also nice that you can build a relationship with people in the home setting because you’re taking care of them for a longer time.
Protection of the beneficiaries
I think one aspect is the formal training of the caregivers, which provides a professional standard and, if necessary, additional training. Specific additional knowledge is important, especially for service recipients with special needs or illnesses. The autonomy of the beneficiaries must be respected as well as their personal rights. This is a sticking point in the HEROES model because it is very much oriented towards individuality. You have to think about how to integrate a quality assurance system. A kind of self-declaration on the part of the care providers and also strengthening the beneficiaries by informing them of their rights. It would certainly be important to prepare information on which nursing training courses, which additional training courses are available, and which competencies are acquired with them. And then also prepare the legal situation, e.g. the Adult Protection Act. On the other hand, a code of conduct or something like that could be put up for the nursing professionals, which they have to accept before they register. This could be based on the ICN (international council of nursing) nursing code. That is the code of conduct for nursing.
How does recruitment differ between urban and rural areas?
It’s definitely a bit more difficult in rural areas, there are fewer people who want to work there. There are cantonal differences in earnings. Because many locations are very close to each other in Switzerland, it is often no problem to work where you earn more. However, salary is only one issue of job attractiveness, if you can’t keep up with the salary, you have to be attractive in the other areas, e.g. opportunities for further development. It is also important to strengthen the nursing profession, e.g. by having a nursing expert in the team who contributes to professionalization.
What kind of support can be provided by local authorities? And what legal requirements are needed to support cooperation between authorities and NGOs?
I think what needs to be pushed is a network of offers. The self-employed must be better supported by NGOs or authorities in terms of networking. Especially in rural areas, there should be places where professional caregivers can submit their wishes for further training or which help to build up networks among caregivers.
Volunteer work?
That’s an important point. We don’t have enough professionals, especially in the future. This could also be supported, they also need a contact point or a mediation platform. But volunteers also need to be well supported, as experience shows because difficult situations can arise here as well.
Advantages of digital recruitment?
Basically, it is certainly positive, especially for the younger generation of caregivers it is a matter of course and corresponds to the trend of the times. It also depends on the processes behind it. Qualification is an important point to consider. A personality match would still be interesting. Sure, it’s a professional caregiver, but nevertheless, not every constellation is a fitting match.
Further links:
The ICN Code of Ethics for nurses
SBK Informationen zur Freiberuflichen Pflege (information for self-employed nurses in Switzerland)
