Accountability: Update to A Proposed Policy for Federal Recognition of Nurses’ Responsibility in Switzerland

Policy/Theory Exemplar 

Contributor: Maria Müller Staub*
Initial Policy Proposal

Year of implementation – 2021


The Swiss Constitution as the top-level law regulating the Swiss health care system and assuring its quality as well as its’ access for all citizens.

Policy summary

The policy itself is the new article on nursing in the Swiss Constitution. This is the original version of the articles in the Constitution in German language:

Art. 117b75 Pflege76*

1 Bund und Kantone anerkennen und fördern die Pflege als wichtigen Bestandteil der Gesundheitsversorgung und sorgen für eine ausreichende, allen zugängliche Pflege von hoher Qualität.

2 Sie stellen sicher, dass eine genügende Anzahl diplomierter Pflegefachpersonen für den zunehmenden Bedarf zur Verfügung steht und dass die in der Pflege tätigen Personen entsprechend ihrer Ausbildung und ihren Kompetenzen eingesetzt werden.


Art. 117b75 Care76

  1. The Confederation and the cantons recognize and promote nursing as an important part of healthcare and ensure that there is sufficient, high-quality nursing care that is accessible to all.
  2. They ensure that a sufficient number of qualified nursing professionals is available to meet the increasing demand and that the people working in nursing are deployed in accordance with their training and skills.

Key nurses and their role

The key nurses are part of the board of the Swiss Nurses Association and the Initiative committee. The committee was composed of nurse leaders, nursing researchers, and politicians. The description and names of the persons who launched the initiative are available here.

Left: Maria Müller-Staub, Professor in Nursing, President of Swiss Nursing Science Association
Middle: Kessler Margrit, President Swiss Patient Organization, former member of Swiss Government GLP
Right: Lüthi Regula, MPH, Director Nursing & MTD, Social Work, President Swiss Nurse Leaders
left: Helena Zaugg, SBK President at time of initiative submission 
right: Maria Müller-Staub, Professor in Nursing, President of Swiss Nursing Science Association, Member initiative committee and author of this policy exemplar

Detailed description

Title: Nursing is part of the Constitution

It’s a great pleasure to inform on the follow-up of the formerly published policy exemplar.

I’m happy to report that the Swiss people accepted the formerly described political initiative stating that nursing must be recognized as an independent profession and be named in the Swiss Constitution. The vote and the year-long process to prepare the legal texts – as well as the policy making process to inform politicians, all nurses, the public and specifically the voters – was Influenced by the policy exemplar named “A Proposed Policy for Federal Recognition of Nurses’ Responsibility in Switzerland”, which is published in Nursology at (Müller-Staub, 2019).

On November 28, 2021, we as nursing profession and namely the Initiative Committee has won the public vote on this formerly described initiative. This success is unique in different ways:
First, it was the first time that over 64% of citizens took part in a vote on a Swiss initiative.
Second, over 61% of Swiss voters as well as all (exempt one) of the 26 Swiss states agreed that nursing must be stated in the Constitution as an important, self-responsible profession to assure good quality care.

Nursing is the second profession (among family medicine) which is stated in the Constitution. And world-wide, Switzerland is the only country where nursing is part of the Constitution!
Therefore, winning this vote was exemptional and a huge success on behalf of good nursing care.

In article 117b of the Swiss Constitution, nursing is now described as an important pillar of the health care system. The article also says that Swiss cantons and the state must assure access for all to high nursing care quality. Cantons and the state have to ascertain that Switzerland has enough well educated, registered nurses (Bachelor level) in the workforce to cover the rising demands for nursing care (; Schweizerische Eidgenossenschaft, 1999/2022).
The initiative also includes nurse-to-patient ratios, good working conditions and better nursing salaries to assure high nursing care quality (

As initiative committee, we started the political process which was influenced by the literature on the Advanced Nursing Process that bases on valid classifications (Müller-Staub, Abt, Brenner, & Hofer, 2015): by stating accurate, relevant nursing diagnoses and performing effective nursing interventions, nursing-sensitive patient outcomes are achieved (Leoni-Scheiber, Mayer, & Muller-Staub, 2019a, 2019b, 2020, 2021; Müller-Staub, Needham, Odenbreit, Lavin, & van Achterberg, 2007, 2008).

The expert paper described in the former policy exemplar promotes the application of the Advanced Nursing Process to make nursing visible (Müller Staub, Abt, Brenner, & Hofer, 2015; Müller-Staub, Abt, Brenner, & Hofer, 2015a, 2015b). This process relies on Standardized Nursing Languages (SNLs) which are provided by valid nursing classifications that make nursing visible (Müller Staub & Rappold, 2017).
Nursing diagnoses as part of SNLs describe patients’ care needs, respectively the human responses/experiences related to health problems (Herdman, Kamitsuru, & Lopes, 2021), and evidence-based nursing interventions provide effective care (Butcher, Bulechek, McCloskey Dochtermann, & Wagner, 2018) to achieve good, nursing-sensitive patient outcomes (Moorhead, Johnson, Maas, & Swanson, 2018).

SNLs allow to teach, clinically perform and research wholistic nursing assessments leading to accurate nursing diagnoses (Ackley, Ladwig, & Flynn Makic, 2020; Georg & Müller-Staub, 2013; Gordon, 2008).
Nursing diagnoses are linked to evidence-based interventions leading to measurable, nursing-sensitive patient outcomes (Johnson et al., 2012; Moorhead et al., 2021).

As professionals, nurses have the special knowledge and are responsible to state accurate nursing diagnoses in order to provide effective, evidence-based nursing interventions (Jones, Lunney, Keenan, & Moorhead, 2010), and indeed it’s time to make nursing visible, politically rooted and an important part of patients’ Electronic Health Records!

Research indicates that the best researched SNLs in the Advanced Nursing Process (Müller Staub & Rappold, 2017; Müller-Staub, 2009; Muller-Staub & Paans, 2016; Odenbreit, Müller-Staub, Brokel, Avant, & Keenan, 2012; Tastan et al., 2014) allow producing interoperable big nursing data which are needed for implementing SNLs into the Electronic Health Record (Müller-Staub, 2009; Muller-Staub, de Graaf-Waar, & Paans, 2016) and to develop meaningful Artificial Intelligence systems for nursing.


Ackley, B. J., Ladwig, G. B., & Flynn Makic, M. B. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12 ed.). St. Louis: Mosby/Elsevier.

Butcher, H., Bulechek, G., McCloskey Dochtermann, J., & Wagner, C. (2018). Nursing Interventions Classification (NIC) (7 ed.). Philadelphia: Mosby.

Georg, J., & Müller-Staub, M. (Eds.). (2013). Pflegeassessment Notes: Pflegeassessment und klinische Entscheidungsfindung (1 ed.). Bern: Huber.

Gordon, M. (2008). Assess Notes: Nursing assessment and diagnostic reasoning. Philadelphia: F.A. Davis.

Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (2021). NANDA International Nursing Diagnoses: Definitions and Classification, 2021-2023 (12 ed.). New York: Thieme.

Johnson, M., Moorhead, S., Bulechek, G., Butcher, H., Maas, M., & Swanson, E. (2012). NOC and NIC linkages to NANDA-I and clinical conditions (3 ed.). Maryland Heights: Elsevier Mosby.

Leoni-Scheiber, C., Mayer, H., & Muller-Staub, M. (2019a). Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses’ knowledge and attitude: Study protocol. Nurs Open, 6(3), 1269-1280. doi:10.1002/nop2.299

Leoni-Scheiber, C., Mayer, H., & Muller-Staub, M. (2019b). Ubereinstimmung des Advanced Nursing Process mit Beobachtungen, Interviews und Pflegedokumentationen im Akutspital. Pflege, 1-10. doi:10.1024/1012-5302/a000704

Leoni-Scheiber, C., Mayer, H., & Muller-Staub, M. (2020). Relationships between the Advanced Nursing Process quality and nurses’ and patient’ characteristics: A cross-sectional study. Nurs Open, 7(1), 419-429. doi:10.1002/nop2.405

Leoni-Scheiber, C., Mayer, H., & Muller-Staub, M. (2021). Effekte von Guided Clinical Reasoning auf die Qualitat des Advanced Nursing Process. Pflege, 34(2), 92-102. doi:10.1024/1012-5302/a000792

Moorhead, S., Johnson, M., Maas, M., & Swanson, E. (2018). Nursing outcomes classification (NOC) (6 ed.). St. Louis: Elsevier.

Moorhead, S., Macieira, T. G. R., Lopez, K. D., Mantovani, V. M., Swanson, E., Wagner, C., & Abe, N. (2021). NANDA-I, NOC, and NIC Linkages to SARS-Cov-2 (Covid-19): Part 1. Community Response. Int J Nurs Knowl, 32(1), 59-67. doi:10.1111/2047-3095.12291

Müller Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015). Rapport d’expertes concernant le domaine de responsabilité des soins infirmiers. Bern: Association Suisse Pour les Sciences Infirmières (AAPSI).

Müller Staub, M., & Rappold, E. (2017). Klassifikationen/Systeme – Beurteilung anhand von Studien. In M. Müller Staub, K. Schalek, & P. König (Eds.), Pflegeklassifikationen: Anwendung in Praxis, Bildung und elektronischer Pflegedokumentation (Vol. 1, pp. 261-305). Bern: Hogrefe.

Müller-Staub, M. (2009). Preparing nurses to use standardized nursing language in the electronic health record. Studies in health technology and informatics: Connecting Health and Humans, 146, 337-341.

Müller-Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015a). Expert report on nurses’ responsibility. Bern: Swiss Nursing Science Association (ANS).

Müller-Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015b). Expertenbericht zum Verantwortungsbereich der Pflege. Bern: Schweizerischer Verein für Pflegewissenschaft VFP.

Muller-Staub, M., de Graaf-Waar, H., & Paans, W. (2016). An Internationally Consented Standard for Nursing Process-Clinical Decision Support Systems in Electronic Health Records. Comput Inform Nurs, 34(11), 493-502. doi:10.1097/CIN.0000000000000277

Müller-Staub, M., Needham, I., Odenbreit, M., Lavin, M. A., & van Achterberg, T. (2007). Improved quality of nursing documentation: Results of a nursing diagnoses, interventions and outcomes implementation study. International Journal of Nursing Terminologies and Classifications, 18(1), 5-17.

Müller-Staub, M., Needham, I., Odenbreit, M., Lavin, M. A., & van Achterberg, T. (2008). Implementing nursing diagnostics effectively: cluster randomized trial. Journal of Advanced Nursing, 63(3), 291-301.

Muller-Staub, M., & Paans, W. (2016). A Standard for Nursing Process – Clinical Decision Support Systems (NP-CDSS). Studies in health technology and informatics, 225, 810-811. Retrieved from

Odenbreit, M., Müller-Staub, M., Brokel, J. M., Avant, K., & Keenan, G. (2012). Nursing classifications: Criteria and evaluation. In T. H. Herdman (Ed.), NANDA International Nursing Diagnoses: Definitions and classification 2012-2014 (pp. 133-143). Oxford: Wiley-Blackwell.

Schweizerische Eidgenossenschaft. (1999/2022). Bundesverfassung der Schweizerischen Eidgenossenschaft, Art. 117b, 75, Pflege76*. 2022. Retrieved from

Tastan, S., Linch, G. C., Keenan, G. M., Stifter, J., McKinney, D., Fahey, L., . . . Wilkie, D. J. (2014). Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: a systematic review. International journal of nursing studies, 51(8), 1160-1170. doi:10.1016/j.ijnurstu.2013.12.004

This paper shows the summary of the steps taken in the policy process and photos of the key leaders at voting day – view PDF

About Maria Müller Staub

Maria Müller-Staub is Professor at the Lectoraat for Nursing Diagnostics at the Hanze University Groningen, Netherlands, and founder of Pflege PBS (Nurse Consulting, Teaching, & Research), Wil. Switzerland. She worked on more than 68 research projects, mainly as principal investigator. Prof. Müller-Staub’s main focus is on nursing diagnostics, clinical decision-making and critical thinking, e-Health, nursing documentation, nursing care quality and Clinical Information Systems (CIS). She consults healthcare institutions and nursing education program developers for implementing nursing language related to the classifications of nursing diagnoses, interventions and outcomes (NANDA-I, NIC & NOC).

Prof. Müller-Staub teaches in post-graduate nursing programs and supervises doctoral students. She is an expert in curriculum development and was Dean of a nursing school offering advanced degree programs and is a lecturer in national and international programs. Prof. Müller-Staub is President of the Association for Common Nursing Diagnoses, Interventions and Outcomes (ACENDIO). She was President of the Swiss Association for Nursing Research (2012 – 2018) representing nine Academic Societies: Cardiovascular Nursing, Patient Education, Nursing Ethics, Gerontology Nursing; Home Health Nursing, Oncology Nursing, Pediatric Nursing, Psychiatric Nursing and Rehabilitation Nursing. Prof. Müller-Staub has published over 335 scientific articles (143 in peer-reviewed/indexed, 135 non-peer-reviewed, 57 books/book chapters), and has held 209 conference presentations.