The changing context of Western European healthcare systems: Convergence versus divergence in nursing problematics

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.