At the end of his nursing studies, three years ago, Loïc did not hesitate for a second. Trained in the north of France, at the Nursing Training Institute (IFSI) in Roubaix, the young man preferred to leave the French hospital system to practice in Switzerland. On the other side of the border, he says he has “won everything”. “A better salary, better working conditions, a better relationship with patients,” he summarizes. This decision, far from being trivial, nevertheless imposed itself on him as obvious. Interested in care for the elderly, Loïc says he is “shocked” by certain scenes observed during his internships in different French nursing homes. “I chose this job for the relational, and I attended during my studies to what is close to mistreatment”, he testifies. During one of his first internships, the student at the time thus found himself in a structure “with few financial means”, in which the protections intended for caregivers were counted, and where a single nurse took care of sixty residents. “There were dressings to be done, medication to be given, no time to discuss with the residents”, remembers Loïc.
One day, the intern accompanies a nurse to one of the rooms, where a resident is found in psychological distress. “He was really not well, he started crying. He needed us, to express things… But we didn’t have time to stop. I was told that the priority was the treatment, not the relationship.” It’s too much for Loïc. “So I went to Switzerland, and I don’t regret it,” he breathes. In Lausanne, where he quickly found a job in a medico-social establishment – equivalent to the French Ehpad -, he found a more acceptable professional life. In his service, accompanied by five caregivers, he takes care of only 20 residents. “In France, it was more like one nurse for 60, even 70, 80 residents,” he says. From a material point of view, too, Loïc admits to having seen the difference. “During my internships in France, we clearly did not have the means to do our job properly: it was dangerous for the patients and for the caregivers. Here, there is no material problem”, compares the nurse, whose salary is also much higher than in France.
When he left school in 2019, the French establishments to which he applied offered him a net salary of 1,700 euros per month, compared to 4,400 euros in Switzerland. On the other side of the border, this salary is also increased each year by 150 euros gross per month, against “about fifteen or twenty euros in France”. “So of course, the standard of living is not the same in Switzerland: rents and food are more expensive. But I did the math, and I’m still a winner,” said the caregiver. In the midst of a health crisis, he is far from being the only one to have decided to leave the French system: while Loïc recently joined the surgery department of a hospital located a few kilometers from the border, he assures us that ” more than half” of his colleagues are French.
“I saw the French hospital in pain”
Ehpad staff, nurses, caregivers… “For years, there has been a flight of caregivers to Belgium, Switzerland or Luxembourg, countries in which the salary and working conditions are more advantageous. The crisis health has only accentuated the phenomenon”, confirms Thierry Amouroux, spokesperson for the National Union of Nursing Professionals. Despite a salary increase of around 300 euros net per month from the Ségur de la santé, in July 2020, the man notes a massive disinterest in the exercise of the profession in France. “In addition to the salary, there is a real contempt for the skills of these caregivers in the services, and their working conditions are only deteriorating. So if they can, the nurses flee abroad”, insists the trade unionist, disappointed.
At 25, Julie* thus assumes her choice perfectly: since December 2020, this young nurse from the east of France has been working in Luxembourg, a country located a few kilometers from her home. “I currently earn 3,000 euros net per month, compared to around 1,700 euros if I had stayed in France”, she announces from the outset. But beware: the young woman wishes to specify that the salary is not the only reason for his professional departure to the Grand Duchy. During the pandemic, the nurse worked for six months in the outpatient department of a Moselle hospital, before accepting various temporary assignments in various hospitals and departments in eastern France. “I saw the French hospital in pain. There were few staff, stressed teams, the superiors, exhausted, only trained us briefly … It did not suit me”, she argues.
In Luxembourg, she finds a job where the patient is placed “at the heart” of her days. “We are much more in contact, we have time to listen, to share, without spending our time between a thousand administrative tasks. In France, I felt like a robot. Here, I find a real authenticity”, says Julie, who shares 15 patients with one of her colleagues. In France, the nurse alone cared for 30 patients. For her, the observation is clear: here, her patients are much more reassured than in French services. “They ask fewer questions, their care is faster. They leave serenely,” she says.
“Fed up with stinginess”
From Belgium, Aline* abounds. “If we speak bluntly, I was just fed up with the stinginess,” admits this 28-year-old nurse, trained in France. Former caregiver in the Paris region, then nurse in an establishment in the north, the young woman decided to cross the Belgian border two and a half years ago, disappointed by the French infrastructure. “We always lacked the means. We often had to pay attention to the equipment, take the cheapest syringes and electrocardiograms, use the same dressing set for three different wounds…”, she lists. “While here, the material is unlimited: there are the latest machines, I clearly see the difference in means.”
In terms of working conditions, Aline admits to having also noticed a radical change: her salary now amounts to 1950 euros net, against 1750 euros on the other side of the border. Above all, his work rhythm is no longer the same: despite 39 hours worked per week – compared to 35 in France -, and sequences that can reach ten working days in a row – which remains prohibited on our territory -, the nurse admits to feeling “much less tired” by her schedules. “In France, my person was abused a little,” she sums up, referring to days sometimes extended to eight hours due to lack of staff, chain of custody or the guilt generated by her management in the event of a request for rest. “I worked in a ward specializing in blood diseases and chemotherapy. If there was no one to replace me, they insisted that I would endanger the lives of my patients if I left… Without me then give me the means to rest”, she explains, annoyed. “It happened more than once, while in Belgium I was only asked to stay once, right at the height of Covid.” The nurse pauses. “In fact, here, there is not this ‘extreme’ side that there is in France.”
And her French colleagues have understood this well: according to Aline, the cross-border hospital in which she works – whose name she prefers to keep silent – “could not function without the French”. A few kilometers away, the Center hospitalier de Wallonie picarde, in Tournai, confirms the trend. “Of the 1,250 employees of the nursing department, 309 of them are French, or around 25%”, indicates the communication department of the Belgian institution. Among the 2,700 employees of the establishment, 156 French people also benefit from the status of cross-border worker, which allows them in particular to be less taxed.
“Massive Phenomenon”
In France, this flight of white coats to Switzerland, Belgium or Luxembourg is not without consequences. According to Dominique Gros, former mayor of Metz and director of the supervisory board of the CHR Metz-Thionville for twelve years, around “a third” of the students trained by the IFSI dependent on the CHR leave for Luxembourg each year. “The phenomenon is massive”, estimates the former elected official, recalling that around 350 nurses are trained each year by these schools, and that 150 more caregivers will obtain their diploma from June 2023. “And I am only talking to you about the students , but it’s the same for the caregivers already in post”, adds Dominique Gros, who regrets the lack of staff in certain hospitals in the region, even the closure of certain services. “I’m not saying that the situation is only caused by the departure of these caregivers abroad, but it contributes to it,” he laments.
“Among our students, there is a real enthusiasm for Switzerland: I have students who have even gone to share flats at the border!”, relates Alain Messien, director of the IFSI in Roubaix. While 140 students are welcomed each year in the first year in his establishment, and only 80 end up graduates, he assures that “15 to 20 of them” flee to Switzerland once the precious diploma is in their pocket. “They are looking for a better salary, and often better working conditions. They spread the word, discuss together on social networks, and generally leave for two years before returning to practice as a liberal on French territory”, says Alain Messien. Abdel, a former educator converted into a nurse, is one of these former students of the IFSI in Roubaix. “We are not going to hide the face: in Switzerland, I can work for two or three times more, with much better working conditions”, he slices.
Graduated for a year and still acting within various structures in the north of France, the 30-year-old is “two fingers away” from crossing the border. “Here, my colleagues are at their wit’s end and don’t necessarily have the time to accompany me to learn,” he says. “Hardware level, I always come across broken patient lifts, malfunctioning equipment… It’s boring.” For several weeks, Abdel has been undertaking administrative procedures to work in Switzerland, looking for accommodation at the border, and increasing his research on the cost of living and the tax rate as a cross-border worker. Sometimes he admits to being overtaken by a certain guilt. “I tell myself that it’s not great to have been trained in France and to leave everything, I have the impression of turning my back on the country… But when I see that everyone finds their benefit there , it really makes me want to leave,” he concludes. Last year, “a dozen” students from his promotion went into exile in Luxembourg or Switzerland to practice, without even accepting a first contract in France.