Independent nurses in Ticino: recognition and criticism

Context

In brief

• Independent nurses in Ticino: from 200 to 700 in a few years
• Criticism for the increase in health insurance premiums
• Precarious working conditions for nurses
• Concrete examples: Lugano and Bellinzona
• Regulations: Federal Law on Health Insurance (LAMal) and cost-sharing from April 1, 2023

Key facts

• What: Increase in the number of independent nurses in Ticino
• When: From 2015 to today
• Where: Canton Ticino, with a focus on Lugano and Bellinzona
• Who: Andrè Brusasco and colleagues
• Amount: From 200 to 700 independent nurses
• Health expenditure: Independent nurses represent about 2% of total health expenditure

Andrè Brusasco, an independent nurse in Ticino, shares his experience and the challenges of home care work. During the Covid pandemic, nurses were considered angels, applauded by the population. Today, however, they are under media attack for the increase in health insurance premiums. Brusasco has been working as an independent nurse since 2015, when he requested the right to practice independently. In a few years, the number of independent nurses has grown from 200 to 700, with a significant concentration in Lugano and Bellinzona.

The current situation

Brusasco criticizes the current situation, where independent nurses are considered the main responsible for the increase in health insurance premiums. However, they represent only a small part of health expenditure, about 2%. The cost-sharing for home care services came into effect on April 1, 2023, further increasing criticism towards independent nurses. According to the Federal Law on Health Insurance (LAMal), patients must now contribute with 10% of the cost of the services, with a maximum of 500 francs per year.

Working conditions

Independent nurses in Ticino work under precarious conditions, without the security of a salaried job. Brusasco emphasizes that many colleagues have left secure jobs to become independent, but working conditions are much more difficult. For example, a salaried nurse in a hospital in Lugano earns about 7,000 francs per month, while an independent nurse can earn between 5,000 and 6,000 francs, but with significant operating costs such as renting an office and purchasing medical supplies.

📊 Operational checklist for independent nurses:

• Fixed costs: Office rent (1,500-2,500 francs/month), professional insurance (1,000-1,500 francs/year), medical supplies (2,000-3,000 francs/year).
• Variable costs: Transportation (500-1,000 francs/month), continuing education (500-1,000 francs/year).
• Average earnings: 5,000-6,000 francs/month, with an average of 20-30 patients per week.

Practical comparisons

Comparing the situation of independent nurses with that of salaried nurses, a significant difference in net earnings emerges. A salaried nurse in a hospital in Bellinzona can count on a net salary of about 6,000 francs per month, with benefits such as paid holidays and pension contributions. On the other hand, an independent nurse must manage all operating costs and does not have the same economic security.

Proposed solutions

Brusasco proposes to improve working conditions for nurses in public and private facilities, increasing their salaries. In this way, no one would be forced to become independent to earn more. Furthermore, he suggests making hospital work more attractive, instead of tightening the rules for independent nurses. For example, a bonus could be introduced for nurses working in public hospitals, as already happens in some Swiss cantons.

⚠️ Warning: The situation of independent nurses in Ticino is complex and requires a balanced approach. It is important to consider both the needs of patients and those of healthcare workers, to ensure a sustainable and quality healthcare system.

Operational details

Analysis of Critical Issues

The situation of self-employed nurses in Ticino is complex and requires an in-depth analysis. On one hand, there is recognition of their work during Covid, on the other, criticism for the increase in health insurance premiums. Brusasco emphasizes that self-employed nurses represent only 3% of healthcare spending but are easily targeted by the media.

Comparison with Employed Work

Employed nurses in Ticino have more secure working conditions, with social costs paid, holidays, and a thirteenth salary. According to 2022 data, an employed nurse in Ticino earns an average of CHF 7,500 per month, with a collective labor agreement guaranteeing at least 20 days of vacation and a thirteenth month. Self-employed nurses, on the other hand, work without security and without the possibility of unemployment benefits. This creates a significant gap between the two groups of workers.

Implications for Cross-Border Workers

Cross-border workers who work as self-employed nurses in Ticino face additional challenges. Double taxation and differences in pension and healthcare systems between Italy and Switzerland can make the situation even more complex. For example, a self-employed nurse working in Lugano and residing in Italy must pay taxes in both countries, with a rate that can reach 30% of income. Additionally, participation in home care costs can affect their disposable income.

Future Scenarios

If working conditions for employed nurses do not improve, it is likely that more nurses will choose the path of self-employment. This could lead to an increase in the number of self-employed nurses and further criticism towards this group of workers. However, if working conditions improve, there could be a return to employed work.

Operational Checklist for Self-Employed Nurses

1. Registration: Registration with the Register of Independent Activities (RAI) of the Canton of Ticino. 2. Insurance: Subscription to mandatory health insurance and professional accident insurance. 3. Invoicing: Use of invoicing software compliant with Swiss regulations. 4. Taxes: Payment of taxes in Switzerland and, if necessary, in Italy. 5. Pensions: Contributions to professional pension provision (second pillar) and individual pension provision (third pillar).

Comparison of Practical Scenarios

• Scenario 1: A self-employed nurse working in Bellinzona and residing in Italy must pay an overall tax rate of 28%. With an annual income of CHF 100,000, the tax burden would be CHF 28,000.
• Scenario 2: An employed nurse working in Locarno and residing in Switzerland pays a tax rate of 15%. With the same annual income, the tax burden would be CHF 15,000.

Relevant Regulations

• Federal Law on Mandatory Health Insurance (LAMal): Obligation to insure all residents in Switzerland.
• Italy-Switzerland Bilateral Agreement: Regulation of double taxation.
• Ordinance on the Register of Independent Activities (RAI): Obligation to register for self-employed nurses.

📊 Relevant Data

• Number of self-employed nurses in Ticino: Approximately 200 (2023 data).
• Total healthcare spending in Ticino: CHF 2.5 billion (2022 data).
• Average health insurance premiums in Ticino: CHF 400 per month for an adult.

💡 Practical Tips

• Tax Planning: Use a tax expert experienced in cross-border taxation.
• Risk Management: Subscribe to professional accident insurance.
• Continuous Training: Participate in refresher courses to maintain professional competence.

⚠️ Warnings

• Double Taxation: Verify tax regulations in both Switzerland and Italy.
• Health Insurance: Choose insurance compliant with LAMal.
• Pension: Contribute regularly to professional and individual pension provision.

Useful tools to protect your net income

To reduce FX leakage, compare CHF-EUR exchange options and banks for cross-border workers.

Key points

What to do now

For self-employed nurses in Ticino, it is crucial to know their rights and responsibilities. Here are some detailed steps to follow:

1. Learn about regulations: Know the laws and regulations governing the work of self-employed nurses in Ticino. For example, the Federal Law on the Nursing Profession of 2007 (LProfI) and the Ordinance on the Nursing Profession of 2008 (OProfI) establish the requirements for practicing the profession. It is important to know that, as of 2021, self-employed nurses must be registered in the Registry of Health Professions (RPS).

2. Join associations: Join professional associations such as the Ticino Nurses Association (AIT) or the Swiss Federation of Nurses (FSI) for support and representation. These associations offer legal advice, continuing education, and union representation. For example, AIT has negotiated wage agreements that provide a minimum of CHF 4,500 per month for experienced self-employed nurses.

3. Monitor expenses: Keep track of expenses and earnings to manage your income effectively. It is useful to use accounting software such as QuickBooks or Sage, which allow you to monitor income and expenses. For example, a self-employed nurse in Lugano might have monthly expenses of approximately CHF 2,000 for rent, health insurance, and work materials.

4. Evaluate options: Consider the options of employed and self-employed work, weighing the pros and cons of each. For example, a nurse employed in a hospital in Bellinzona might earn CHF 6,000 per month, while a self-employed nurse might earn CHF 8,000 per month but with greater tax and administrative responsibilities.

5. Use available tools: Use tools such as the salary calculator to compare salaries and plan your future. For example, the calculator can show that a self-employed nurse in Locarno might earn CHF 7,500 per month after tax deductions, while an employed nurse might earn CHF 5,500 per month.

Operational Checklist

• Verify registration in the Registry of Health Professions (RPS).
• Join a professional association.
• Use accounting software to monitor expenses.
• Compare employed and self-employed work options.
• Use the salary calculator to plan your income.

Comparisons between practical scenarios

• Employed nurse: Fixed salary, company benefits, fewer administrative responsibilities.
• Self-employed nurse: Higher potential earnings, flexible hours, greater tax and administrative responsibilities.

Conclusions

The situation of self-employed nurses in Ticino is complex and requires special attention. It is important that authorities and institutions work together to improve working conditions and ensure a better future for all nurses. For more information, consult the salary calculator and other resources available on the site.

"The self-employed nursing profession offers great opportunities, but also requires great responsibility." - A self-employed nurse from Lugano

For more details, you can consult the AIT or FSI website, where practical guides and contract templates are available.

Source: tio.ch