PCP
Qualification begins a professional journey
Training more people is necessary when care needs grow and recruitment is insufficient. Yet several steps separate a study place from a presence on a ward: entering training, being able to complete it, finding suitable working conditions and remaining in practice. A policy measuring enrolment alone does not yet know its outcome.
The number of graduates does not, by itself, reveal available working time. Employment rates, absences and departures also matter. Reduced hours should not automatically be treated as an unconstrained choice. Someone may want to remain a nurse while being unable to sustain the organisation of full-time work. The objective is to make work sustainable, rather than individually urging nurses to provide more hours.
Training itself depends on existing teams. Placements require supervision, learning opportunities and time to pass on knowledge. Increasing places without protecting that support can put more pressure on the very professionals the system needs to retain. Funding must therefore connect the school, students’ material circumstances and the practice setting.
What the constitutional vote required
Article 117b recognises nursing as an important part of care. It requires the Confederation and cantons to support it, ensure sufficient access and quality, and secure enough qualified nurses. It also connects assigned tasks to training and competencies.
That last dimension matters. Using a qualification does not mean indiscriminately loading every task onto the same person. Nursing judgement, the work of other professions and coordination need to be distinguished. Cooperation becomes stronger through clear responsibilities, rather than every team constantly compensating for every other team’s gaps.
The transitional provision also addresses working conditions, remuneration, professional development and billing. The vote did not, however, immediately establish a uniform salary, identical staffing in every institution or a tariff for every service. A constitutional decision creates a mandate. Applicable rules and budgets require further decisions by the competent authorities.
Two stages decided after 2021
On 12 January 2022, the Federal Council chose implementation in two stages. It announced rapid work on training and direct billing proposals already contained in the indirect counterproposal. Working conditions and appropriate remuneration would require more time. This timetable belongs after the vote; it does not describe measures already operating in November 2021.
The Federal Office of Public Health’s information sheet of 25 January 2023 then explained the first stage: support for practical training, assistance to students and resources for schools. It confirmed that the constitutional article did not fundamentally change the division of federal and cantonal responsibilities. A national ambition still requires institutions, cantonal legal foundations and finance capable of delivering it.
Staging can allow some measures to start sooner. It also carries a political risk: presenting training as a complete response while working conditions remain decisive. This does not establish that every later measure failed. It supplies a monitoring criterion: progress in the two stages should be assessed together.
Billing and working conditions address different questions
Direct billing for certain services can recognise professional responsibility and reduce administrative detours. It is neither general freedom to bill for all care nor an automatic improvement in rosters. Defining services, remunerating them and organising work are separate questions.
Funding education does not ensure a future employer can stabilise its team. Equally, improving present conditions does not remove the need to prepare future qualifications. Setting the two against each other resembles choosing between filling a reservoir and stopping it draining. The image has limits: professionals are not interchangeable units; experience, specialisms and knowledge of patients matter too.
For the PCP, the 2021 mandate calls today for public responsibility across the whole journey. Completion, entry into employment, retention and care quality should be evaluated, rather than celebrating enrolment in isolation. Employers and social partners shape hours, predictability and careers; public authorities must provide finance consistent with the obligations they impose.
Patients experience the intended result through continuity of teams, time for explanations, coordination and less reliance on improvised cover. The constitutional promise should be judged against that lasting capacity. A qualification achieves its full value when conditions allow it to become a sustainable long-term profession.