Striking nurses make for striking debate

David Landes looks at press reaction to the Swedish nursing strike.

• Papers study college fees for non-Europeans (27 Jun 08)
• Nursing strike over (28 May 08)
• Nurses pledge further strike action (13 May 08)

After weeks of speculation and warnings, Sweden’s nurses finally made good this week on their threat to strike. As reported in The Local on Monday, members of the Swedish Association of Health Professionals (Vårdförbundet) walked off the job after their demands for higher pay were not met.

Sweden’s newspapers devoted a great deal of space to the strike on their editorial pages as they debated the merits of the nurses’ demands, as well as the likelihood of a timely resolution to the conflict.

Dagens Nyheter (DN) starts out by explaining that the current strike came about because of an unusual occurrence in the Swedish labour market: a union’s membership overruled its governing board. It reminds readers that, a few weeks before the strike, the board of the healthcare workers union and SALAR were prepared to accept an offer put forward by the mediators. But the union’s membership said no.

The paper feels the union erred by allowing membership veto power over a governing board which has much more insight into the strategy of collective bargaining negotiations. The refusal undermined the authority of board chair Anna-Karin Eklund and made it even harder for an agreement to be reached.

“In part because the union’s leadership isn’t thought to have control over the situation, in part because the membership see themselves as being discriminated against and dealt with unfairly,” writes DN.

But the paper points out that the reality for nurses is more complicated than their own world view allows, noting that nurses have actually had a better wage growth over the last 10 to 15 years than most other public sector employees at the county-level.

“Has the union’s leadership told this to their members? Or are they trying to wrongly claim that other public sector workers have had better wage development?” asks DN.

In its contribution to the debate, Svenska Dagbladet (SvD) argues that nurses could raise their salaries, not by striking, but by introducing market forces into Sweden’s healthcare sector.

The paper argues that the reason healthcare workers’ salaries are low is not because the profession is dominated by women but because nursing jobs are public sector jobs.

“The majority of activity in the healthcare sector lies outside the laws of a market economy. That means that labour competition is minimal for healthcare workers. Such conditions are hardly conducive to a positive development in salaries,” writes the paper.

The paper sees nothing wrong with the union’s demands that minimum salaries for nurses be set at 22,000 kronor a month ($44,000 a year), and that all union members receive a salary increase of 1,700 kronor a month this year and next. But County Councils could likely only pay for such an increase by increasing taxes—something for which the paper feels taxpayers would not stand.

“When County Councils are the more or less unthreatened employer in such a large labour market, it’s not strange that it results in difficulties solving labour strife, and that higher taxes are a possible result,” it writes.

The way forward, according to SvD, is to extend the patient choice (vårdval) programme to the entire country as proposed in a government inquiry recently handed over to health minister Göran Hägglund.

Patient choice, which has been implemented recently in Halland and Stockholm counties, allows patients to register at the health clinic or hospital of their choosing anywhere within their county of residence. The level of public funding for any given clinic is determined in part by the number of patients registered at the facility. As public funding is tied to individual patients, rather than a given hospital or clinic, the money follows the patient to the facility of their choice.

The system is designed to give patients freedom when it comes to choosing a hospital or clinic, encouraging clinics to improve their level of service to ensure that dissatisfied patients don’t choose another clinic, depriving the first clinic of a portion of its income from the state.

“Apart from patient choice raising the level of service and strengthening healthcare consumers’ position and ability to affect the system, there are other positive effects” to patient choice, writes SvD.

“Competition makes productivity and quality the deciding factors, which naturally also affects how salaries are set.”

Writing on the eve of the strike, Expressen emphasizes how important the work of nurses is, calling it “a matter of life and death.” The paper doesn’t buy the argument put forward by the nurses’ employers, the Swedish Association of Local Authorities and Regions (SALAR), that it is irresponsible of the nurses to strike because it only hurts the public and patients.

“That line of argument is old fashioned and unwise. SALAR is basically saying that nurses are selfish,” writes Expressen.

“Just that gender stereotype—that nurses should be self-sacrificing—is the historic reason behind the frustration in the profession.”

But Expressen is critical of the nurses’ demand to raise entry-level salaries, which the paper argues devalues nurses with decades of experience who “barely earn more than a rookie,” and can lead to wage inflation.

“High entry-level salaries are a curse. The most important thing can’t be to earn more when starting out, but to have the opportunity to earn more as one gains more experience,” writes the paper.

The Sydsvenskan newspaper also expresses concerns about the nursing strike leading to wage inflation, laying some of the blame on the way salaries in Sweden are set.

“In few other areas in the labour market is the problem with a compressed Swedish salary structure so obvious,” writes the paper.

According to Sydsvenskan, the nurses have a legitimate gripe when it comes to demanding fair compensation for the long and costly training their profession demands. Like teachers and social workers, nurses belong to what the paper describes as “an educated low-wage proletariat” which includes hundreds of thousands employed in female-dominated public sector professions.

However, the fact that many other labour groups are closely watching what the head of the teachers union called a “fight for higher pay for women” causes Sydsvenskan to fear the end result may simply be runaway wage inflation, which serves no one.

Nevertheless, Sydsvenskan supports the right of the nurses to strike as a last resort, but advises the union not too lose sight of the fact that public support for the strike will wane as the strike drags on and more people have their medical procedures postponed indefinitely.

Rather than focusing on the perception of the general public, Aftonbladet columnist Ingvar Persson instead focuses on the effect the strike has had within the nursing profession. He points out the strike has boosted Vårdförbundet membership by the hundreds.

“I suspect that among the union’s new members there are many who have more than a purely economic motive; who perhaps for the first time understand what an organized labour union is all about. A strike can be an excellent lesson in the strength of collective bargaining,” he writes.

However, Persson is sober about the consequences of the strike, noting that the nurses may very well not have their demands met. But regardless of what happens, he urges the nurses to take away “pride in knowing that they stood up together for their demands.”


Where the main newspapers stand:

Dagens Nyheter, "independently liberal", Stockholm-based, owned by the Bonnier family.

Svenska Dagbladet, "independently liberal-conservative",
Stockholm-based, owned by Norwegian media company Schibsted.

Göteborgs-Posten, "independently liberal",
Gothenburg-based, owned by the Stampen media group.

Sydsvenska Dagbladet (Sydsvenskan), "independently liberal", Malmö-based, owned by the Bonnier family.

Aftonbladet, "independently Social Democrat", Stockholm-based, owned by trade union federation LO and Norwegian media company Schibsted.

Expressen, "independently liberal", Stockholm-based, owned by the Bonnier family.