On 28 November 2021, the Swiss electorate adopted, by 61.0% of voters and 24 cantons out of 26 (only the half-canton of Appenzell Innerrhoden rejecting with 52.95% No), the popular initiative «For strong nursing care», filed in March 2017 by the Swiss Nurses Association (SBK/ASI). It was the first time in modern Swiss history that a popular initiative concerning a specific profession was accepted.
The text inserts into the Constitution a new Article 117b instructing the Confederation and the cantons to ensure sufficient, universally accessible and high-quality nursing care — by promoting training and improving the working conditions of nursing professionals. The stated aim: to halt a chronic shortage that, according to OBSAN, sees roughly 2,400 nurses leave the profession each year.
The campaign came just 18 months after the first COVID-19 lockdown. Images of the «heroes in white coats» applauded from windows and then recalled to the front line in every wave weighed heavily on the debate. The Federal Council and the parliamentary majority (FDP, SVP, part of The Centre) recommended a No vote and put forward an indirect counter-proposal focused solely on training. The electorate chose the more ambitious text.
Four and a half years on, implementation is unfolding in two stages. Phase I, the training offensive, came into force on 1 July 2024. Phase II — the new federal law on working conditions in nursing — was submitted to Parliament on 21 May 2025, where the National Council Health Committee (SGK-N) significantly scaled back its scope in January 2026. This fiche tests the campaign arguments of both sides against what has actually happened since the vote.
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▲ Accepting cantons (24 cantons + 5 half-cantons)
All cantons except Appenzell Innerrhoden, with highest support in: Jura (66.4%), Neuchâtel (64.4%), Vaud (63.6%), Geneva (62.9%), Fribourg (61.6%), Valais (58.5%), Bern (~60%), Zurich, Basel-Stadt, Ticino, Lucerne, and others. |
▼ Rejecting cantons
Only Appenzell Innerrhoden (52.95% No) — the sole rejecting half-canton. |
Actors and personalities
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▲ Yes camp • Swiss Nurses Association (SBK/ASI) — initiative committee • Travail.Suisse, Swiss Trade Union Federation (SGB/USS), Public Services Union (VPOD/SSP) • Social Democratic Party (SP), Greens, Green Liberals (GLP) • Part of The Centre, including National and Council of States members • Swiss Medical Association (FMH) — partial support • Patient organisations, nursing homes, Curaviva, home-care federations |
▼ No camp • Federal Council in corpore, defence led by Alain Berset (SP, FDHA) • Parliamentary majority (National Council and Council of States) • FDP.The Liberals, SVP, majority of The Centre • Economiesuisse, Swiss Employers' Association, H+ The Hospitals of Switzerland • Santésuisse, Curafutura (health insurers) • Part of the cantons (Swiss Conference of Health Directors, official neutrality with expressed reservations) |
Arguments and verdicts — 4.5 years on
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▲ Arguments FOR (SBK, unions, SP, Greens) Without strong federal action, early exits from the profession will continue.
«Four nurses in ten leave the profession before retirement. This is an absolute emergency.»
— Yvonne Ribi, General Secretary of SBK, 2021 campaign ✓ Argument confirmed
Post-vote evidence confirms the argument. According to OBSAN (2024 workforce-renewal report), 42.5% of nurses trained in Switzerland still leave the profession before retirement, 31.8% before age 35. Annual graduates cover barely 60% of the necessary renewal up to 2025. Without the measures adopted, the trajectory would have remained identical.
Source: OBSAN, Nursing workforce renewal needs, Report 05/2024
Parliament's counter-proposal is inadequate because it only addresses training, not working conditions.
«Training more nurses is pointless if we keep losing graduates after five years.»
— Marina Carobbio (SP), member of the Council of States, parliamentary debates 2021 ✓ Argument confirmed
Factual post-vote finding: the indirect counter-proposal would have addressed only training. This is precisely the criticism that motivated Phase II — the new federal law on working conditions submitted by the Federal Council to Parliament on 21 May 2025, nearly four years after the vote. The counter-proposal alone would never have triggered this strand.
Source: FDHA/FOPH, press release of 21.05.2025 on the 2nd phase of the initiative
Enshrining nursing care in the Constitution is necessary to force the Confederation to act.
«Without a constitutional basis, nothing will really move.»
— Initiative committee, official brochure, 2021 ✓~ Partly confirmed
Article 117b has indeed served as the basis for two federal packages (Phase I 2024, Phase II message 2025). Without it, these laws would probably not have emerged. However, in January 2026, the SGK-N substantially reduced the scope of the working-conditions measures — Travail.Suisse spoke of «proposals cut back to almost nothing». The constitutional obligation exists, but its legislative translation remains partial.
Source: SGK-N press release, Parlament.ch, 09.01.2026
A massive training offensive will close the workforce gap.
«We need to train 70,000 nurses in ten years.»
— Core slogan of the Yes campaign ✗~ Partly refuted
The target is clearly behind schedule. Although Phase I has been operational since July 2024 (special programme over 8 years, ~CHF 1 billion planned by the Confederation and the cantons), only CHF 14.5 million in federal contributions were paid out in H2 2024 — i.e. 3.6% of the planned annual envelope. Real roll-out is hampered by cantonal adaptation delays and training capacity at the universities of applied sciences. The shortage remains very high.
Source: FOPH, implementation of Art. 117b FC, 2024 review
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▼ Arguments AGAINST (Federal Council, FDP, SVP, business) It is not the Confederation's role to regulate working conditions in hospitals and nursing homes — that is a cantonal and social-partner competence.
«The Constitution is not meant to mention one specific occupational group.»
— Alain Berset, Federal Councillor (SP), FDHA, press conference of 12.10.2021 ✗ Argument refuted
Four years on, the same Federal Council submitted to Parliament, on 21 May 2025, two federal bills laying down precisely national rules on working hours in nursing care (maximum weekly hours reduced from 50 to 45, normal weekly hours 40-42, rosters communicated four weeks in advance, financial compensation for last-minute changes). The federal competence denied during the campaign is now being exercised — by the same Federal Council.
Source: Federal Council, message 25.030 on improving working conditions, 21.05.2025
Parliament's indirect counter-proposal is faster to implement and as effective as the initiative.
«The counter-proposal lets us act immediately. The initiative will take years to implement.»
— FDP.The Liberals, official argumentation, October 2021 ✗~ Partly refuted
The counter-proposal would have delivered ~CHF 1 billion for training but would have left working conditions entirely untouched — the very point that drives graduates out of the profession. Implementing the initiative is indeed slow (Phase II still in parliamentary debate 4.5 years after the vote), but it leads for the first time to federal standards on working hours. The speed promised by the counter-proposal would have been inversely proportional to its ambition.
Source: Comparison of measure packages, FOPH & Travail.Suisse, 2024-2026
The initiative will cause healthcare costs and therefore health-insurance premiums to explode.
«It will cost hundreds of millions, ultimately paid by the insured.»
— Santésuisse / Curafutura, joint statements, November 2021 ✗~ Partly refuted
Phase I (training) is financed mainly by the Confederation and the cantons, not by premiums — its impact on KVG/LAMal premiums is marginal. Phase II does, however, raise a real debate: in January 2026 the SGK-N invoked cost control to scale back the working-conditions measures. The «exploding costs» argument has not been factually demonstrated, but does today serve as a political lever. An exaggerated concern, though not entirely groundless.
Source: SGK-N, press release of 09.01.2026; FOPH, financial-impact note on Phase II
An initiative will solve nothing: the real levers (wages, rosters, staffing ratios) lie with employers, not with the Constitution.
«A constitutional rule will not train a single additional nurse.»
— Petra Gössi (FDP), National Councillor, 2021 debates ✗ Argument refuted
Article 117b FC directly triggered the special programme of the higher-education institutions (CHF 25 million, 8 years), which has already increased demand for bachelor's places in nursing in 2024-2025. Without the constitutional basis, the programme would not have existed. The claim that «the Constitution does not train anyone» is refuted by the causal chain visible since 2022.
Source: Swiss Higher Education Council, special programme 2023-2030; FOPH, implementation of Art. 117b FC
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Factual record · 4.5 years on (2026)
2 Confirmed |
1 Partly confirmed |
3 Partly refuted |
2 Refuted |
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Training: Phase I in force since 1 July 2024
Special programme of the Swiss Higher Education Council over 8 years (around CHF 25 million), increase in capacity at the universities of applied sciences for the bachelor's degree in nursing, possibility of billing certain nursing services directly to compulsory health insurance. But the roll-out is slow: only 3.6% of planned annual federal contributions were paid out in H2 2024.
Source: FOPH, Art. 117b FC — 2024 implementation review; H+, situation report 12/2024
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Working conditions: Phase II in Parliament, scaled back by the SGK-N
On 21 May 2025, the Federal Council submitted two bills: maximum weekly hours cut from 50 to 45, rosters communicated four weeks in advance, financial compensation for last-minute changes, statutory recognition of the Advanced Practice Nurse (APN, master's required). In January 2026, the SGK-N substantially scaled back these measures, citing cost control — the parliamentary outcome remains open.
Source: Federal Council, message 25.030 of 21.05.2025; SGK-N press release of 09.01.2026
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Workforce shortage: trend not reversed
OBSAN still projects, by 2030, a deficit of 2,000-2,500 nurses and 450 healthcare assistants for hospitals, clinics, nursing homes and specialised institutions alone. The early-attrition rate remains 42.5% (31.8% before age 35). The improvement trajectory is not yet measurable.
Source: OBSAN, Nursing workforce renewal needs, Report 05/2024
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Political innovation: an occupation-specific initiative in the Constitution
This is the first time a popular initiative concerning a single occupation has succeeded in Switzerland. The precedent opens a legal debate on enshrining sectoral working conditions in the Constitution — used both by opponents (FDP, SVP) to resist future sectoral initiatives and by promoters (VPOD, SGB) to open the way to other occupations.
Source: VOTO, vote analysis of 28.11.2021; constitutional-law doctrine (Tschannen, Häner)
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Four and a half years after 28 November 2021, the factual record is paradoxical: the initiative has won legally but its implementation remains largely unfinished.
Its supporters were right on the essentials: the workforce shortage is as structural as they warned, Parliament's counter-proposal would have been insufficient because blind to working conditions, and the constitutional basis has indeed triggered — for the first time in Switzerland — federal rules on working hours in nursing care. The 2021 diagnosis («without the Constitution, nothing will move») holds up: Phase II would never have reached Parliament without Article 117b.
Opponents, by contrast, have seen several of their arguments fall away. The federal competence to regulate sectoral working conditions, vigorously contested by Alain Berset, is today being exercised by the Federal Council itself. The bet on a «fast and sufficient» counter-proposal has proved inoperative. Only the cost concern retains some currency — less as a demonstrated prediction than as a political lever invoked by the SGK-N to scale back the measures.
One grey area remains: the Yes camp's flagship promise — to train staff on a massive scale — has so far only been kept on a very small scale. The decisive test will come between 2027 and 2030, when Phase II is (or is not) adopted and the first effects on retention can be measured. The 2021 vote launched a real dynamic, but the final verdict still hinges on what Parliament does next.
The year 2026, however, dampened hopes of swift implementation. Considering the second stage — the federal law on working conditions in nursing, whose dispatch the Federal Council had adopted on 21 May 2025 — the National Council scaled back several measures in spring 2026, its committee deeming them too costly. Nearly five years after a historic popular Yes, the gap persists between victory at the ballot box and concrete, day-to-day improvement in nursing staff's working conditions.