Swedish doctors and nurses' battle for proper rest breaks

The criticism from the commission triggered negotiations between Swedish employers and trade unions with the purpose to rewrite certain parts of a collective bargaining agreement from 2020.

The negotiations were comprehensive. They involved representatives from the Swedish Association of Local Authorities and Regions plus the municipal employers' organisation Sobona, and workers represented by the Swedish Association of Health Professionals plus 24 additional trade unions.

Negotiations with the Swedish Medical Association are still ongoing.

It took more than three months for the parties to reach an agreement. They finished their work 30 November last year. "It was a given for all involved that the agreement had to be compatible with the directive, but it was a complicated set of rules we had to handle", said Jeanette Hedberg, head of negotiations at the Swedish Association of Local Authorities and Regions, and one of the representatives from this employers' organisation, to EUobserve.

She continued: "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."

The negotiations concerned large organisations, with 1.2m employees in various municipalities and regions, working all over this Scandinavian country with approximately 10.5m inhabitants and with a north–south distance of 1,572 kilometres.

"There are a lot of rural areas in Sweden and we must always be able to secure people's right to support, healthcare and care services along with access to water, food and medicines. At the same time, we must protect the workers' right to daily rest", Annelie Söderberg, head of negotiations at the Swedish Association of Health Professionals, told EUobserver.

Söderberg works for a trade union that represents more than 114,000 nurses, midwives, biomedical scientists and radiographers in addition to students of those occupations.

In Sweden, the right to rest between shifts is regulated through collective bargaining agreements and national legislation. And — like for every EU member state — by the European Working Time Directive.

Emma Jonsson, nurse and midwife at Karolinska University Hospital in Stockholm, is looking forward to the implementation of the new agreement that will come into effect on the 1 October this year. Employers need time to process roster changes for the huge number of workers who are affected by the new rules.

"Everything we do in our job is based on science, but not our roster," she said to EUobserver, alluding to the fact that research has shown the advantages of regularity of both work and rest for individuals.

Day and night

Besides working in a post-care pregnancy and childbirth ward Jonsson is also a trade union representative for the Swedish Association of Health Professionals and is used to discussing working hours with her colleagues. As an example, an evening shift from 1 or 1.30 pm until 9.30 pm, will frequently be followed by a morning shift from 7 am until 3.30 pm.

"The argument is that it creates continuity in work and will benefit patients who see the same personnel on either side of the night", explained 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. 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."

On a central level, two resource centres will be established: a working hour board and a working hour council — both with the mission to advice and support local parties in relation to the new rules, which Jonsson welcomes.

"In the beginning, there will probably be many questions about how you get the rotas 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", she said.

Negative reactions have already been heard, like 'this will not work; this particular ward is so important that they should be exempt from the new rules'. But Jonsson is determined.

"We cannot have too many local interpretations. The reason for having 11 hours of daily rest and alternating work and rest is that it will give us a more sustainable job. That is important if we are to work until retirement and manage to work full-time."

At the time of writing the Swedish Ministry of Employment does not yet know whether the changes will be accepted by the European Commission or not.

And since the communication with the commission is ongoing, the Swedish government had not yet taken any final position regarding the criticism from the European Commission, EUobserver was told.

Denmark and Norway

Sweden is not the only Scandinavian country where questions about nurses' rotas have been raised. In recent years, Norwegian and Danish nurses have been striking both for higher pay and in protest against their work environment.

EUobserver spoke to theatre nurse Camilla Dam at the Odense University Hospital in Denmark. She has a rota with between eight and ten emergency shifts during 12-week period.

This means that on weekdays 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 Dam can be on call from home.

"The most important thing for me 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 be can made up of 12-hour shifts six days in a row, resulting in a 72-hour working week," she said and added: "My husband is a truck driver. He is not allowed to become too tired so there are rules for how many hours he is allowed to drive. For Danish hospital staff there is no such rule."

EUobserver 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 right to rest from the European Commission.