Healthcare staff in Sweden look forward to stricter daily rest rules

“Negotiations were comprehensive and difficult with many people involved since this was about large organisations with 1.2 million employees in municipalities and regions,” Annelie Söderberg tells the Nordic Labour Journal. 

She is head of negotiations at the Swedish Association of Health Professionals, which represents more than 114,000 nurses, midwives, biomedical scientists and radiographers in addition to students of those occupations. Negotiations with the Swedish Medical Association are still ongoing. 

Annelie Söderberg, head of negotiations at the Swedish Association of Health Professionals. Photo: Ulf Huett.

“This was about the right for workers to have a minimum of 11 hours daily rest, and also about people’s right to support, healthcare and care services. There are a lot of rural areas in Sweden and we must always be able to secure these things along with access to water, food and medicines. At the same time, we must protect the workers’ right to daily rest,” says Annelie Söderberg.

In Sweden, the right to rest between shifts is not only regulated by the EU, but also through collective agreements and national legislation regulating working time. The national laws and regulations can vary, but the EU regulations – in this case, the European Commission’s working time directive – are binding for all EU member states. 

Complicated issues, long negotiations

On 20 August last year, employers and trade unions sat down to start negotiating. More than three months later they had agreed and were able to present new rules for daily rest. 

Jeanette Hedberg is head of negotiations and one of the representatives from the Swedish Association of Local Authorities and Regions, SKR. 

“We are happy that we came to an agreement with the trade unions. It was a given for all involved that the agreement had to be compatible with the directive, but it is a complicated set of rules we have had to handle.

"We have taken onboard the Commission’s criticism and sharpened the rules around protection because it is important that these are clear – both for the individual worker and their ability to keep their rights and for leaders whose responsibility it is to make sure the rules are followed,” she says to the Nordic Labour Journal.

Jeanette Hedberg, head of negotiations, SKR. Photo: Hans Alm.

The new agreement will come into effect on 1 October this year, because employers need time to process roster changes for the huge number of workers who are affected by the new rules. At the time of writing it is not clear whether the changes will be accepted by the European Commission.

“We as parties believe the agreement lives up to the demands in the directive, but we will not know for sure until the Commission has given its answer,” says Jeanette Hedberg. 

The need to catch up

Nadja Ståhl is one of those who are thankful for the new rules. She has been a registered nurse for 18 months and works at Sunderby hospital, between Luleå and Boden in the very north of Sweden.

“I began working on a ward, but was forced to quit because of the roster,” she says.  

While working on the ward, Nadja Ståhl’s roster often included so-called “vändpass” which meant she had to work a day shift straight after an evening shift – from 1 pm to 10 pm one day and from 7 am to 4 pm the day after. 

“After a vändpass, even if I was off until midday the next day, I did not have enough time to recover,” she says. 

Today she works in the hospital’s emergency department. Her current roster gives her more time to catch up with a roster that follows these rules: 

• 2–4 days work and 2–4 days off.
• 12–15 percent reduction in working time, equivalent to around 35 days a year.
• So-called buffer time with around 15 shifts a year that are not planned in advance.
• Everyone works day, evening and night.

“It is great that we get longer periods of rest from the autumn, but this should have been done a long time ago. We work so incredibly hard when we work, so we are exhausted when we get home. New rosters will help us all because these vändpass are not sustainable,” says Nadja Ståhl.

An old tradition

Nurse and midwife Emma Johnsson works at the Karolinska University Hospital in Stockholm. She also welcomes the new rules and the fact that daily rest must now be “regularly alternated”, which is also part of the new agreement. That means work followed by rest and so on.

“Everything we do in our job is based on science, but not our roster,” she says, alluding to the fact that research has shown the advantages of regularity of both work and rest. 

Emma Jonsson works in a post-care pregnancy and childbirth ward and is also a trade union rep for the Swedish Association of Health Professionals. She often debates with her colleagues about working hours.

Emma Jonsson, Nurse and midwife at Karolinska University Hospital, and trade union rep. Photo: Ulf Huett.

“We have a roster computer program that makes sure we put in the right amount of hours. The program lets us know if we get less than nine hours of rest, but sadly not based on the rules which ought to be followed and are coming into effect from 1 October,” she says. 

Some of her colleagues will put in an evening shift from 1 or 1.30 pm until 9.30 pm, followed by a morning shift from 7 am until 3.30 pm. The idea is that this creates continuity and will benefit patients who will see the same personnel on either side of the night, explains Jonsson.

“This is a strong tradition which the trade union has been working to change for a long time in order to get healthier rosters,” she says.

“Continuity is at least as good when you work two or three days or evenings in a row. That is the only way we can get the regular rest that researchers say is necessary in order to catch up properly.”

Emma Jonsson has already heard negative reactions to the new rules, like ‘this will not work, this particular ward is so important that they should be exempt from the new rules’. But she is determined. 

“We cannot have too many local interpretations. The reason for 11 hours of daily rest and alternating work and rest is to give us a more sustainable job, and that is important if we are to work until retirement and manage to work full-time,” she says.

Support at hand

The new agreement also includes the setting up of a working hour authority and a working hour council which will advise and support local parties in relation to the new rules. This is something Emma Jonsson welcomes. 

“To begin with, there will probably be many questions about how you get the rosters working in real life. What is it we don’t understand? How do we solve this? It is good to know there is someone who can explain.” 

Unhappy neighbouring countries

Nurses are raising questions about their rosters in other counties besides Sweden too. In recent years, Norwegian and Danish nurses have been striking both for higher pay and in protest against their work environment.

The Nordic Labour Journal spoke to theatre nurse Camilla Dam at the Odense University Hospital. During a 12 weeks roster period, she works between eight and ten emergency shifts. During weekdays, this means that after having worked an eight-hour day shift, she can go straight into an emergency shift that lasts until 7.30 am the next morning. At weekends she can be on call from home. 

Camilla Dam thinks the most important thing is to create a rule for how many hours a nurse is allowed to work during one week. 

“There is no such rule right now, and that is why a working week can be made up of 12-hour shifts six days in a row, resulting in a 72-hour working week,” she says.

“My husband is a truck driver. There are rules for how many hours he is allowed to drive, he is not allowed to become too tired. There are no such rules for Danish hospital staff.” 

The Nordic Labour Journal has been in touch with the Danish Ministry of Employment, which says the Danish government has not been presented with any criticism of the daily rest from the European Commission.