Finnish nurse enjoys life and work in Sweden

By Mari Manninen
     
     After hearing all of the angry complaints from Finnish nurses about how poorly they are paid, it is a pleasure to listen to Virpi Vaarala. In her home in Stockholm, the 39-year-old surgical nurse is all smiles.
     "I am very satisfied with my pay", Says Vaarala as she prepares her coffee in her one-room apartment in Södermalm - Stockholm's trendiest neighbourhood.
      Vaarala earns a basic monthly salary of 30,000 Swedish krona (EUR 3,250). Extras for evening shifts, staying on call by her home phone, and overtime work means that her total earnings are EUR 3,800 a month.
     "I am also very satisfied at how my pay has developed", Vaarala enthuses, and not without reason.
     
Five years ago Vaarala left Meilahti Hospital in Helsinki for Södersjukhuset in Stockholm. Her basic pay without extras shot up by nearly EUR 800. Like Meilahti, Södersjukhuset is a public sector hospital , and Vaarala did the same work in both facilities, as a nurse assisting in surgery.
     "The pay was partially responsible for my move, but the greatest reason was that only fixed term jobs were available in Finland then. In Sweden I got a permanent post right away.
      Vaarala got on a Viking Line boat, even though her knowledge of Swedish left much to be desired.
      The linguistically challenged Finnish nurse fit right in to the multicultural environment in the hospital. "At first I had to speak English in the operating room, as I didn't even know the names of the implements in Swedish."
      Vaarala's basic salary went up more than EUR 100 a month when she transferred to another public hospital in Södertälje, and again by about as much when she took a job at Ersta, a private hospital in Stockholm.
      In Ersta, Vaarala's monthly salary has risen by at least EUR 100 each year - most recently a couple of weeks ago, she got a raise of EUR 140.
      The figures are enough to make a Finnish nurse feel jealous. How is such pay development possible in Sweden?
     
The easiest answer is naturally that five years ago, when Vaarala moved to Sweden, there was a shortage of nurses, especially specialist nurses like Vaarala.
      Agencies providing temp services for nursing staff were popping up. Even the public sector had to raise pay to get enough staff.
      Vaarala was practically bought four years ago from Södertälje hospital to Ersta in Stockholm. "They called me from Ersta and said that they had heard about me from my friends, and they told me to come right away. They even paid the rent for my Södertälje apartment for the period of notice."
      Vaarala was promised a pay hike and an apartment in the centre of Stockholm. The rent for her flat right next to the hospital where she works is less than EUR 300 a month. It is a fantastic deal on the hot rental market in the Swedish capital.
      One might imagine that the fact that Vaarala's job is at a private facility would explain why she is so well-paid.
      However, the surgical nurses at Ersta are only slightly better paid than those working at equivalent jobs in public hospitals in the Stockholm region, says ward nurse Maj Bäckelin.
      So how much more do nurses in Sweden earn than their Finnish colleagues?
     
A direct comparison of pay scales of Finnish and Swedish nurses is not easy, as statistics are kept differently in the two countries.
      In Finland, the municipal sector is the biggest employer of nurses. In Sweden, most hospital personnel work for the provinces.
      In Finland's municipal sector, the basic monthly salary, including extras for experience and other personal supplements, was an average EUR 2,050 last year - before extras for shift work and overtime. In Sweden, the equivalent average basic salary for a nurse was nearly EUR 2,500, according to the local nurses union Vårdförbundet.
      This is about how much colleagues in Finland earn with all of the extras for night work, Sunday and holiday work, and overtime. This means that nurses in Finland had to work more, and less pleasant hours to earn as much as nurses in Sweden do without the extra compensation.
      "Wage trends in Sweden have been downright dizzying. Members of Vårdförbundet - including personnel other than nurses - saw their earnings shoot up by as much as 58 per cent in 1995-2005, which is a record for the local labour market.
      They were helped in this by the possibility to agree on pay and terms of employment at a local level.
     
The nurses' shortage alone will not explain the trend.
      Sweden has developed a pay system in which it is possible to negotiate relatively large pay hikes at individual work places, and even between employers and individual employees. These are the kinds of local agreements that many Finnish labour union activists still abhor.
     Nurses have been in the front lines of this kind of system. Nurses in Sweden today negotiate their own pay increases themselves, directly with their supervisors.
     On the national level, the employers' organisation and the labour union have agreed that pay hikes under each employer must be an average of at least two per cent a year.
     This means that the pay increases for reach individual nurse can be as high as possible, or none at all.
     So how does an immigrant fare in such a system? At least Virpi Vaarala seems to have done quite well.
     Each year in Ersta, the ward nurse has offered such a high pay hike that Vaarala has agreed to it without hesitation.
     "Swedes say that you Finns ask for too little. But as a Finn, I am not accustomed to making demands."
     The ward nurse insists that Vaarala is one of the better-paid nurses on her ward.
     
Pay hikes are not based on the competitive situation alone. The spirit of local contracts includes that nurses are paid more, the more demanding the work, and how well the work is done.
     Nursing has become an increasingly challenging profession, which has tended to raise the pay level.
     Measures have also been adopted for evaluating personal success at the work place.
     "Results, initiative, cooperative skills, development..." are some of the criteria that Ersta has for raising pay.
     "Beginners get less. Pay goes up as experience and skills increase. This is how it should be", Bäckelin says.
     Vaarala loves the Swedish model. "No matter how hard you struggle at work in Finland, it is not reflected in your pay. Here it is. Personal pay motivates in a very different manner."
     
So could such a system work in Finland?
      Mikko Mäenpää, chairman of the Finnish Confederation of Salaried Employees (STTK) recently called for more flexibility in municipal pay levels, including greater differentials in personal pay. However, he did not specify how this should be implemented.
      Nurse Virpi Vaarala feels that the Swedish model would not work in Finland. "Finns are more envious. People there would feel bitter if they did not know how much a colleague is paid."
      Jaana Laitinen-Pesola, chairwoman of the Union of Health and Social Care Professionals (Tehy) also does not see Finland adopting the model.
     "Not everything can be left to negotiations at the private level. The employer would have too much power. There has to be a national framework."
     In fact, a small-scale version of the same system that Sweden has implemented has been used in Finnish municipalities in recent years: the system involves local evaluation of the demands of various jobs, with pay levels adjusted accordingly. A certain amount of personal bonus pay can also come from a job well done.
      Ulla-Riitta Parikka, negotiation manager of the Commission for Local Authority Employers, says that increasing the possibilities for local negotiation of pay levels could be gradually increased. However, she does not warm up to the idea that pay levels would be negotiable on the level of individual employees.
     Even in Sweden, the transition to local agreement was a long and painful process.
     
When Sweden's nurses gradually moved over to a personal pay model in the 1980s, there was a great deal of confusion. At events organised by the nurses' union many were amazed at the idea that hospitals in Gothenburg and Malmö might have different pay levels for their nurses.
     But they really can. And pay differentials for nurses in Sweden are high anyway.
     The basic pay of a beginning nurse can be fairly low - just slightly above EUR 1,800, or about the same level as the lowest nurses' salaries in Finland. In the best of cases, nurses in supervisory positions can earn as much as doctors - close to EUR 5,000 a month.
     Private employers pay their nurses more, but there are also big differentials in pay for the same work between different provinces and between municipalities, which are responsible for care for the elderly.
     The fewer nurses in an area, the more nurses tend to earn. One extreme example is from the summer. A midwife working in areas near Umeå on Sweden's east coast could earn up to EUR 8,000 in a single summer month by postponing the annual leave and working in the city of Umeå, which suffered from a shortage of substitutes.
     University hospitals do not necessarily have to use pay as an enticement for personnel, as nurses like to develop their professional skills at such institutions anyway.
     Swedish nurses are accustomed to their pay system and the increased pay differentials that go with it. After all, it has offered individual nurses the possibility for advancement, and average pay has also increased nicely.
     It has at least until recently.
     
During the past couple of years nurses working for provincial hospitals have seen their pay go up by an average of just a couple of per cent a year - only slightly more than the minimum contractual requirement.
     The greatest reason for the slower growth is that Sweden no longer suffers from a shortage of nurses, says Jan Svensson, a negotiator for the employers' organisation of Sweden's municipalities and provincial authorities. Specialist nurses are the exception: their pay levels have continued to grow.
     Another reason is that some employers have not rewarded nurses for good performance as they should have, preferring instead to pay as little as possible.
     This has angered Swedish nurses, who are considering whether or not their national contract should be altered.
     So it turns out that agreeing on pay levels locally is no guarantee of higher income.
     "Nurses in Sweden have done well, which is the result of the market situation. Teachers, for instance, do not have the same competitive edge because they do not have as many alternative potential employers", says Juhana Vartiainen, head of the research unit at Sweden's National Institute of Economic Research.
     Furthermore, Swedish teachers do not have a competing market in Norway, where nurses have also gone in hopes of better pay.
     
TI is said that there is a shortage of nurses in Finland as well, and there are moves to recruit nurses from as far as the Philippines.
     Is pay competition a possibility in Finland as well? In principle, municipal employers are allowed to pay nurses as much extra as they want to on top of the pay hikes that are agreed upon on the national level.
     "I would say that we are going toward a situation in which there is competition with pay levels", says Jaana Laitinen-Pesola of Tehy.
     And there are indeed signs that this may be happening.
     For instance, in Vantaa the parts of the payroll that have been subject to local agreement have been targeted at nurses. At the Tampere University Hospital a special recruitment supplement has been taken into use, worth up to about EUR 200.
     However, pay competition remains modest.
     Many municipalities could not even afford to compete for nurses with money.
     In Sweden, meanwhile, provincial finances are in good shape, admits employers' negotiator Jan Svensson.
     
But there is more to work than just money. Working conditions are decisive, and there are differences there as well.
     Virpi Vaarala has had her morning coffee, and is on her way to her job, for a shift that begins at noon. She has been allowed to choose to do the evening shift today, as has been the case with her other shifts. This is common practice in Sweden.
     "In Finland, the shifts were imposed on us. Naturally, I was always working on the evening or weekend that I wanted to have off. That kind of unhappiness is unknown here."
     In Sweden a nurse can often choose whether or not to do shift work at all. In Finland, shift work is more the rule than the exception.
     Vårdförbundet estimates that about half of Sweden's nurses work unpleasant hours. Some nurses do nothing but night shifts.
     The pace of work at Ersta is brisk, Vaarala says. When she was still working at public hospitals in Sweden she was surprised at how relaxed the work was compared with Finland.
     Today work at Ersta dose not appear to be particularly hurried. Surgical nurses have plenty of time to chat in the coffee room.
     "In Finland we did not have a lunch break on days when there was no time for it. In Swedish hospitals there is always a lunch break, even if it means closing the operating room for a time."
     
Virpi Vaarala feels that nurses in Sweden simply have a nicer time at work.
     She has no intention to come back to Finland. She speaks quite fluent Swedish now, while holding a wad of smokeless tobacco under her lip. Swedish words even slip into her sentences as she speaks Finnish.
     Not everything in Sweden revolves around her work. This weekend Vaarala is moving out of her job-linked apartment and is moving in with her new boyfriend.
     
Helsingin Sanomat / First published in print 30.10.2007


Previously in HS International Edition:
  Tehy rejects contract offer approved by other nurses´ union (1.10.2007)
  Union of Practical Nurses accepts municipal pay deal (28.9.2007)
  White collar union leader wants more flexibility in municipal pay levels (24.9.2007)
  Helsinki area goes after Finnish nurses working in Sweden (15.3.2007)
  Finnish nurses working abroad are to be recruited back (5.4.2006)

Links:
  Tehy, the Union of Health and Social Care Professionals
  SuPer, Finnish Union of Practical Nurses