There is an acute shortage of staff in Swiss intensive care units – also because too few nurses are undergoing further training. Politicians’ demand for more IPS beds has thus degenerated into wishful thinking.
Nurse Salome Reichenbach has been working in the intensive care unit for a few months.
Salome Reichenbach is now where life and death are at stake. Last November, the 29-year-old nurse reported in an interview with the NZZ why so many people burn out in their job – and why it happened to her too. But instead of pushing a calmer ball in another profession, Reichenbach switched to one of the toughest areas of care: she has been working in the intensive care unit since the beginning of the year. “It takes an extremely high level of physical and mental presence at the bed, especially with highly unstable patients,” she says. “You can’t just switch off. Mistakes can have fatal consequences.”
Reichenbach is completing the two-year training course to become an expert in intensive care, and she should be finished in May 2024. Health politicians have high hopes for women and men like her. The number of intensive care beds in Switzerland has become a political issue during the pandemic. If there is a risk of overload in this area, the Federal Council will tighten the anti-corona measures – this could also be the case again next autumn and winter. A seemingly simple solution to the problem would be to provide more capacity in the intensive care units. The Health Commission of the National Council is calling for the number of IPS beds to be increased to 1,000.
Less IPS places than 2019
But that’s wishful thinking. There are already fewer IPS places today than at the beginning of the pandemic. Of the 880 certified beds, only around 770 are currently in operation. According to the responsible federal agencies, the reason is the lack of staff. Holiday absences are the smallest problem. What is more serious is that many IPS specialists have left the profession because they are overworked or are absent due to illness. Individual hospitals state that they lack a fifth of the necessary staff on the IPS. According to industry insiders, the fight for the rare specialists is fiercely fought, and some hospitals even pay them a kind of transfer fee like in football.
That doesn’t particularly impress those calling for capacity expansion. Then you just have to train more people, they say. For example, the former SVP President Albert Rösti, who argued in Parliament: “People say there are too few staff. But if we had started the expansion two years ago, when we said so, more staff would have been trained today.” Parliament must put pressure on the cantons to make an effort.
It just doesn’t look particularly rosy on the youth front. Priska Braun, head of the Aargau technical school for anesthesia, intensive care and emergency care, is alarmed. Due to the high media presence, interest in jobs at the IPS and their social prestige has increased. But that is obviously not sustainable. “A discreet hype vanishes into thin air,” says Braun, who once worked at the IPS herself.
It gets difficult with the family
According to Braun, the number of students is declining “in an alarming way”, which means that companies can no longer fill their open training positions. In 2020, 23 nursing professionals began further training in Aargau, in 2021 there were 20, this year only 14. The dropout rate is also increasing. Eight students gave up early last year. “When I then hear politicians say that we should increase the number of IPS places, I have to laugh,” says Braun. ‘It’s insane. We’re already fishing for the existing beds in the empty pond.”
Many potential female candidates do not even begin their training, while others drop out during their studies or in the years after graduation. There are various explanations for this. One concerns the compatibility of work and family. The prerequisite for a postgraduate course in intensive care is a completed training as a nursing specialist, which has already lasted three years, plus several months of professional experience. “The women are in their mid-twenties when they are eligible for further training,” says Priska Braun. “Many then think about family planning and don’t want to complete a strict training program with a 100 percent workload.” But even without having children, members of Generation Z would prefer to work part-time.
Salome Reichenbach also dealt with the question of the workload. «Because of my previous history with burnout, I said to myself: One hundred percent with the change between day and night shifts and also learning in my free time, that’s too much. I have to be able to clear my head from time to time.” With her new employer, a smaller Bernese regional hospital, she found a model that suits everyone: She started working at the IPS a few months before the start of her training, so she can complete her studies with a 90 percent workload.
Difficult working conditions
According to Priska Braun, the fact that a job at the IPS is currently not very attractive also has to do with the working conditions. “When I worked at the IPS, we had a lot more time, we could laugh together or reflect on the serious ethical dilemmas we encountered.” By this she means, for example, the difficult handling of relatives of brain-dead patients who could not accept it if the therapy was terminated. “These days, the nurses at the IPS are often left alone with such conflicts.” In addition, there would be paternalism by doctors, severe physical wear and tear, violent attacks by confused patients or an increased risk of infection.
Salome Reichenbach is still shielded from such things in her small team. Nevertheless, she realizes how scarce resources are. Her caregivers keep saying they would like more time to discuss something with her. They sometimes write performance reviews from home. “You go the extra mile for me, I really appreciate that,” says Reichenbach. But it’s not healthy at all. “I feel that my caregivers sacrifice themselves for me, just as I used to sacrifice myself for my patients.”
Priska Braun is also observing a great deal of wear and tear among vocational training people. “It’s difficult for her to do her job in bed and also take care of the students.” Training is not particularly important in crisis situations. So there is a vicious circle: Because the experienced staff hardly has time for them, some students give up in frustration. So there is a lack of young people who could help to improve the tense personnel situation.
Fewer shortages in Zurich or Basel
But there are also people who see the situation more positively. These include Lukas Furler, President of OdA Gesundheit Zürich, the cantonal industry association for vocational training in the healthcare sector. In Zurich, the number of students in the IPS area has risen from 24 to 32 since 2020. This is due to specific advertising measures, but also to the fact that many nursing professionals from other areas were temporarily deployed to the IPS during the pandemic. “They saw how interesting the job is, which motivated some to do the training.”
In the Basel region and in central Switzerland, too, the number of IPS students has not fallen so far. Across Switzerland, around 250 nursing professionals are likely to have started postgraduate studies in 2021, about the same number as in previous years. Jörg Meyer, Director of the Central Switzerland Health Education Center (Xund), says: “There are still enough young people to fill the training positions. However, the hospitals in our region have less and less choice because the number of applications is falling significantly.” According to Meyer, the entire care sector has recruitment problems. “In view of the shortage of skilled workers, many industries are vying for young people.”
So it will be very difficult to meet the political demand for an expansion of the IPS places. Despite all the adverse circumstances, Priska Braun from Aargau has not yet given up hope of a turnaround. “If the federal government were to pay higher contributions for training as part of the implementation of the nursing initiative, the hospitals could pay the trainers better wages, this field of activity would be more attractive.”
And Salome Reichenbach? She would not put her hand in the fire that she will still be working in an intensive care unit in ten years. “The job is extremely exciting. But we are dependent on politicians improving the framework conditions in such a way that we no longer have to wear ourselves out.”