Throughout 2020, we will be highlighting the Queen Silvia Nursing Award partners that bring the scholarship to life in their respective regions.

Currently in its 6th year, The Queen Silvia Nursing Award motivates nursing students in Germany, Finland, Poland, and Sweden to contribute to the quality of life and care of the elderly and people living with a dementia diagnosis. This program is made possible with the dedication and commitment of partners with a firm focus on the growth of nursing talent and nursing opportunities.

In this article, we speak with the Chairperson of Vårdförbundet (The Swedish Association of Health Professionals) Sineva Ribeiro, about the critical role of healthcare professionals in the current pandemic, the organization’s efforts to safeguard the conditions and professional standards for its members during these challenging times, and how the agility and creativity of nurses impact healthcare structures and teams for the better.

Sineva, could you give us a brief introduction to Vårdförbundet and yourself before we delve further?

Vårdförbundet is a professional association that safeguards the union interests and professional development of over 114,000 healthcare professionals in Sweden. Amongst our membership base are midwives, biomedical analysts, x-ray nurses, nurses and students in our joint trade union.

Of great importance to us, regardless of today’s Covid-19 pandemic, is the development of sustainable care structures that enable long-term opportunities and good conditions for our professional members. Our mission is based on some basic values that drive the organization forward. In essence, we want to:

  1. develop and strengthen our professional members and promote the development of the individual in their professional role
  2. improve conditions for  the individual and the collective for the profession and opportunities for development in working life
  3. influence the development of healthcare in the workplace locally, regionally,  nationally and internationally
  4. influence societal development issues
Sineva Ribeiro
Chairwoman of Vårdförbundet (The Swedish Association of Health Professionals)

(image credit: Vårdförbundet)

Vårdförbundet has a long tradition of multidisciplinary health professionals working together on our shared ambitions. Our history stretches back to 1886 with the same fundamental ideals of development and improvement. While things have changed a lot over the years, what we do to further the professions of our members and the valuable contributions they make to the Swedish healthcare system is still at the heart of our mission.

As for myself, I am 50 this year and am trained as a specialist nurse in surgery. I have been the Chairperson for Vårdförbundet since 2011. I worked in the ER at Sahlgrenska Hospital in Göteborg, where I am still based, and have had extensive experience in a variety of different care environments throughout the years.

Has Vårdförbundet’s work changed in the current Covid-19 environment?

There are a lot of challenges now that we are addressing on multiple fronts. I can give you a few examples of what the team is trying to deal with on behalf of our members.

Firstly, there is a legitimate fear of catching the virus and getting sick. There are guidelines in place for our healthcare professionals to be very attentive for any signs of illness, and if that might be the case, they are asked to abstain from work. This limits the spread of potential infection amongst colleagues and patients, but at the cost of where many places are deeply understaffed. On average we are working with only 60% of manpower in place, which makes it very difficult for the remaining team members. The workload does not cease when there is less talent in place to do the heavy lifting. It just means that each person who is feeling well enough to be at work needs to do a little extra to keep up the pace. This situation – long-term –  will be an exhausting one for members to sustain.

Secondly, based on historical ups and down with viruses, we have a good idea when it might be challenging for healthcare professionals in Sweden. For example, we know that late winter to early spring tends to be high-season for the flu, which will make for difficult working conditions for a few intensive weeks before the weather warms up.  While we have not had typical influenza cases this year, we have a much more different challenge with this strain of coronavirus. What makes Covid-19 very difficult for all of us is that there is no idea when this will end. For example, we could estimate the slowdown of winter influenza cases by around March every year. But with the coronavirus our healthcare professionals are facing today, we are not sure since if and when things will ease up since it is such a new challenge for healthcare structures all over the world.

“There are new issues that our members are facing in their day-to-day work that we are not entirely equipped or prepared for.”
Sineva Ribeiro, Chairwoman, Vårdförbundet

(image credit: Jonathan Borba)

Furthermore, we can’t afford to delay other medical procedures either. There still remain cancer treatments, operations, procedures, etc. that are waiting to be scheduled for the many non-coronavirus patients in the system. They need to get addressed in a timely fashion so that treatments are not delayed.

Lastly – we are experiencing an unprecedented level of ethical challenges during the pandemic. There are new issues that our members are facing in their day-to-day work that we are not entirely equipped or prepared for. For example, if we have a patient who is struggling but cannot make his way to the ER due to his delicate health, then the least we can do is to assist with any pain and anxiety he could be experiencing. But with this pandemic, there has been a lack of personal protection equipment (PPE) which does not allow our professionals to carry out their duties as they would like. Without proper PPE you are simply unable to provide the level of care that you are trained and driven to give patients – even just wiping a brow or holding a hand to give some relief. Therefore Vårdförbundet is actively advocating for workplaces to ensure that their team members not only have the protection to do their job but also set aside ample time for reflection. We need to ensure that all of our members can effectively tackle these difficult new challenges together.

How do you find time to discuss and reflect and think in the midst of a global health crisis?

If we do not do this, then we will be in even worse shape down the road. This is the time in which our ability to communicate effectively and openly is at a premium.

We need to prepare healthcare professionals properly before they enter their workday. Shift leaders should address a wide variety of aspects to set the stage before our members start their day. They can summarize the reality of the situation in the ward, to who is part of the team set-up for the day. Additional comments might include what skills might be missing with someone absent and how to address the gap effectively, or any critical patient status updates. Professionals appreciate the ability to be up-front and transparent about what might be lying ahead so they can prepare and pace themselves accordingly.

And likewise, before everyone rushes off their shift, we also need a moment to touch base and reflect on what was done during the day. Was it effective? Were we able to work well as a team? Could we have communicated better throughout the day? Was there a common understanding between ourselves and the patients? Ourselves and family members? What did we do really well together? What can we improve for tomorrow?

These sessions are critical because we have a collective responsibility to protect not only public health, but also the mental and physical well-being of our healthcare professionals. Reflection and communications are skills that we need to hone now during coronavirus times, and we are encouraging workplaces to adopt this into their daily practice.

Covid-19 is not bound by borders and has impacted almost every country in the world. How does Vårdförbundet share strategies with your international sister organizations?

Yes, healthcare professional associations around the world are being very active in communicating and cooperating with each other. Just about every country has a professional body that brings together nurses and other health professionals who are fighting the virus day-in and day-out. I have been communicating with our sister organizations in China, Portugal and Spain since the outbreak. While our healthcare systems differ in many ways, we are all in agreement that we must safeguard the frontline. We know that keeping our frontline healthcare professionals fit, healthy, protected and cared for is absolutely crucial so that they can continue fighting the virus for the long-term.  

“There has been a lot of media attention on the global lack of PPE for example, but just as devastating is the mental and emotional stress that healthcare professionals are experiencing.”
Sineva Ribeiro, Chairwoman, Vårdförbundet
(image credit: EVG photos)

It is important to emphasize that safeguarding these professionals includes the physical and the psychological elements of their work. There has been a lot of media attention on the global lack of PPE for example, but just as devastating is the mental and emotional stress that healthcare professionals are experiencing. What they see, and what they are asked to do during these times is absolutely out of the ordinary. These are professionals who took an oath to provide care and comfort for people in need, and this basis of their personal and professional operating standards is being compromised. Therefore, we must ensure that each member has an opportunity to speak about his/her experiences, work through any difficulties, and offload burdens.

Workplace health is incredibly critical for Swedish healthcare professionals now, so we are advocating for psychiatric discussion therapy to help them through these tough times.

Are there healthcare professional challenges that are more pronounced now during the pandemic that Vårdförbundet is trying to address?

We are basically in daily discussions with government representatives such as the Minister for Health and Social Affairs Lena Hallengren, Minister for Employment Eva Nordmark and the Minister for Higher Education and Research Matilda Ernkrans. Together we communicate regularly about the conditions in which Vårdförbundet members are working in at this time. And yes, the current fight against Covid-19 is also emphasizing some key challenges for our Swedish members.

One issue that is especially sensitive now is down-time such as holidays and weekends. Because this is a long-term fight with a virus that we have little experience with, we need to be resilient for months ahead. This means that our members need to be cared for both on and off the job. They must be allowed to take the time to step away from the pressures of the Swedish healthcare system and rest, recuperate and relax. It is unethical to remove these opportunities for down-time from our members – so we must advocate for the safeguarding of holidays and weekends for our healthcare professionals to get better themselves before they can help others do the same.

“… we must advocate for the safeguarding of holidays and weekends for healthcare professionals to get better themselves before they can help others do the same.”
Sineva Riberio, Vårdförbundet

(image credit: Oles kanebckuu)

Vårdförbundet is also highlighting issues with salaries, particularly for nurses in Sweden. According to our studies, there is something akin to two glass ceilings for nurses in Sweden. What we have seen is that peak earnings for nurses is reached at about 35 years of age , and thereafter it tends to stabilize. At the age of 45, it starts going down. What we notice is that there is a poor correlation between nursing experience and education – even with specialization within key areas of need such as dementia – and salary development. This is highly detrimental, because we can have nurses working until 65 with minimal advancement in their salaries.

From Vårdförbundet’s standpoint, this is an unacceptable situation that has continued for far longer than necessary. We need to challenge workplaces to value the knowledge, competency and expertise nursing professionals hold. Those who have dedicated their careers to caregiving need to be recognized not only through the evening applause, but on paycheques. There is also an entire demographic of specialist nurses who took the time and money to invest in their skills development. These are men and women who are extremely familiar with specialized challenges and can maneuver entire care teams towards sustainable plans and strategies. But they need recognition, and most definitely during a time in which health is so incredibly important for all of our communities.

What does the future of Swedish nurses within our healthcare system look like to you, Sineva?

Well – if we have any chance to really make a difference, we need the government to get involved to help us encourage and motivate people to go into healthcare professions such as nursing. According to our analysis, the number of young talent applying for nursing studies is decreasing around 1% per year. Sweden is not effectively filling up the vacant nursing positions in our schools, and by default the training opportunities that are available for talented individuals. The responsibility to find and nurture the next generation of nursing can no longer lie solely in the hands of universities or unions. We need a large scale drive to motivate a shift in mindset of students about the care profession, especially  nursing.

That said, we know that there is enormous interest and passion to give care within our communities. Earlier this winter, 6000 people in Sweden signed on to volunteer in healthcare. While this is heart-warming, there were only 30 that had nurse training. The challenge here is not that we lack intention or heart, but that the competence is simply not going to be available. If we consider the large-scale field hospital at Älvsjömässan with an extra 600 beds in place of which 100 are reserved for intensive care, we need skills and the ability to care for the people who will be staying there. Allow me also to clarify that it is not simply technical capabilities that matter but also the ability to work quickly and effectively in highly complex care teams that requires careful consideration. Covid-19 is a tricky virus that needs constant monitoring and analysis so the people addressing this challenge must not only to be able to work within multidisciplinary teams, but also have the heart and capacity to assist struggling patients.

We need the right people with the right skill set to provide care in these high-pressure situations. But we know that to cultivate this type of talent, we have to work together on a much larger scale to find them.

Why does Vårdförbundet support the Queen Silvia Nursing Award?

I think the Queen Silvia Nursing Award is important for so many reasons.

Nurses are known for getting things done, adapting to changing parameters quickly, and thinking out of the box with ease.”
Sineva Riberio, Chairwoman, Vårdförbundet

(image credit: Andrea Piacquadio)

Firstly, for overall competence in geriatric nursing, it is important that nursing students see that there is plenty of opportunities to create a lasting impact for the elderly that is rewarding. There are unique challenges within elderly care and we need nurses with the right competencies to help us provide sustainable long-lasting care. Populations around the world are aging rapidly and this area needs a lot of passionate and engaged men and women who can make a difference.

Secondly, the Queen Silvia Nursing Award is a celebration of ideas and innovation from nurses who are driven to make improvements and a difference. I can guarantee you that the number of ideas and creative solutions that have come out of our global fight against Covid-19 is enormous. If we take nothing out of this battle, at least we have the stories, little hacks and great ideas that nurses have somehow put together to make things work in the toughest of times.

My suggestion to these nurses who are in the midst of the battle is to get out a notebook and start recording what you see, feel and how you worked during this global pandemic. We will need to gather these learning experiences from across the spectrum so we can reflect on new and better social and healthcare change for the future. We need to transparently review what worked well, and what did not. Vårdförbundet is part of the regional, state, and professional associations with the combined ambitions to ensure that we are better equipped for future pandemics. The input from nurses will be very important in this regard.

Nurses have a crucial role in stabilizing every kind of healthcare structure they enter. Nurses are known for getting things done, adapting to changing parameters quickly and for quick thinking in tough circumstances. These are the skills of the men and women who preceded us, and will continue to define nurses into the next generation. What the Queen Silvia Nursing Award allows us to do with so many engaged partners is to structurally celebrate and foster your great ideas together for improved patient care and professional growth into the future.