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

Ada Spitzer, Didier Camus, Cécile Desaulles, Nicolas Kuhne

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1796-1810
Number of pages15
JournalSocial Science and Medicine
Issue number7
StatePublished - Oct 2006

Bibliographical note

Funding Information:
This project was supported by the FORESO—Fondation pour la Recherche en Soins, Lausanne, Switzerland.


  • Convergence
  • Cross-national research
  • Divergence
  • Health-care reforms
  • Nursing problematics

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

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