Nursing Personnel Convention, 1977 (No. 149) - Slovenia (RATIFICATION: 2003)

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The Committee notes with concern that the Government’s report has not been received. It hopes that the next report will contain full information on the matters raised in its previous comments.

Repetition

Articles 2 and 3 of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. In response to the Committee’s 2014 comments, the Government reports that its training programme for nurses was supplemented in 2014 to provide nursing education and training in accordance with the standards established in relevant directives of the European Council on the recognition of professional qualifications (2005/36/EC) and on administrative cooperation through the Internal Market Information System (Directive 2013/55/EU). The Government further indicates that the Regulations governing the professional development of health workers and health assistants were amended in 2017 to include courses on quality and safety in healthcare. In this respect, the Committee notes that all health professionals in Slovenia are required to complete such courses once every seven years. The Government adds that, as of 2016, the proportion of men in the nursing sector in Slovenia was 13.8 per cent, representing a 2.3 per cent increase from 2011. The Committee notes, however, that the ratio of nursing personnel to the population remains low. According to Eurostat, in 2016, there were 307 nursing professionals per 100,000 people, including only nine practising midwives, the lowest ratio recorded in Europe that year.Noting that the Government has provided no updated information on the implementation of the national programmes listed in the Committee’s previous comments, the Committee reiterates its request that the Government supply detailed updated information on the national programmes and their outcomes, including information on any developments concerning the short-cycle higher education programmes, higher education study programmes for senior nurses or other long-term education initiatives, as well as any other programmes relevant to the employment conditions of nursing personnel. Moreover, taking account of the shortage of nursing personnel, particularly midwives, the Committee requests the Government to provide information on measures taken or envisaged to ensure access to quality nursing care, including access to midwifery care, particularly in rural areas.

Article 6. Employment conditions of nursing personnel. Hours of work – Annual holidays with pay. In its 2014 comments, the Committee invited the Government to consider amending the Health Services Act to establish a maximum limit on overtime hours for nursing personnel. In its report, the Government undertakes to consider amending the Health Services Act to establish maximum overtime hours for nursing personnel. The Government further indicates that the collective agreement governing the employment conditions of nursing personnel has not yet been amended to provide for the increased annual leave provided for in section 159 of the Employment Relations Act.The Committee requests the Government to indicate the manner in which it ensures a maximum limit on overtime hours for nursing personnel in both law and practice. The Committee also reiterates its request that the Government provide a copy of the collective agreement once it has been amended.

CMNT_TITLE

The Committee notes that the Government’s report has not been received. It hopes that the next report will contain full information on the matters raised in its previous comments.

Repetition

Articles 2 and 3 of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. In response to the Committee’s 2014 comments, the Government reports that its training programme for nurses was supplemented in 2014 to provide nursing education and training in accordance with the standards established in relevant directives of the European Council on the recognition of professional qualifications (2005/36/EC) and on administrative cooperation through the Internal Market Information System (Directive 2013/55/EU). The Government further indicates that the Regulations governing the professional development of health workers and health assistants were amended in 2017 to include courses on quality and safety in healthcare. In this respect, the Committee notes that all health professionals in Slovenia are required to complete such courses once every seven years. The Government adds that, as of 2016, the proportion of men in the nursing sector in Slovenia was 13.8 per cent, representing a 2.3 per cent increase from 2011. The Committee notes, however, that the ratio of nursing personnel to the population remains low. According to Eurostat, in 2016, there were 307 nursing professionals per 100,000 people, including only nine practising midwives, the lowest ratio recorded in Europe that year. Noting that the Government has provided no updated information on the implementation of the national programmes listed in the Committee’s previous comments, the Committee reiterates its request that the Government supply detailed updated information on the national programmes and their outcomes, including information on any developments concerning the short-cycle higher education programmes, higher education study programmes for senior nurses or other long-term education initiatives, as well as any other programmes relevant to the employment conditions of nursing personnel. Moreover, taking account of the shortage of nursing personnel, particularly midwives, the Committee requests the Government to provide information on measures taken or envisaged to ensure access to quality nursing care, including access to midwifery care, particularly in rural areas.

Article 6. Employment conditions of nursing personnel. Hours of work – Annual holidays with pay. In its 2014 comments, the Committee invited the Government to consider amending the Health Services Act to establish a maximum limit on overtime hours for nursing personnel. In its report, the Government undertakes to consider amending the Health Services Act to establish maximum overtime hours for nursing personnel. The Government further indicates that the collective agreement governing the employment conditions of nursing personnel has not yet been amended to provide for the increased annual leave provided for in section 159 of the Employment Relations Act. The Committee requests the Government to indicate the manner in which it ensures a maximum limit on overtime hours for nursing personnel in both law and practice. The Committee also reiterates its request that the Government provide a copy of the collective agreement once it has been amended.

CMNT_TITLE

Articles 2 and 3 of the Convention. National policy concerning nursing services and nursing personnel. Nursing education and training. In response to the Committee’s 2014 comments, the Government reports that its training programme for nurses was supplemented in 2014 to provide nursing education and training in accordance with the standards established in relevant directives of the European Council on the recognition of professional qualifications (2005/36/EC) and on administrative cooperation through the Internal Market Information System (Directive 2013/55/EU). The Government further indicates that the Regulations governing the professional development of health workers and health assistants were amended in 2017 to include courses on quality and safety in healthcare. In this respect, the Committee notes that all health professionals in Slovenia are required to complete such courses once every seven years. The Government adds that, as of 2016, the proportion of men in the nursing sector in Slovenia was 13.8 per cent, representing a 2.3 per cent increase from 2011. The Committee notes, however, that the ratio of nursing personnel to the population remains low. According to Eurostat, in 2016, there were 307 nursing professionals per 100,000 people, including only nine practising midwives, the lowest ratio recorded in Europe that year. Noting that the Government has provided no updated information on the implementation of the national programmes listed in the Committee’s previous comments, the Committee reiterates its request that the Government supply detailed updated information on the national programmes and their outcomes, including information on any developments concerning the short-cycle higher education programmes, higher education study programmes for senior nurses or other long-term education initiatives, as well as any other programmes relevant to the employment conditions of nursing personnel. Moreover, taking account of the shortage of nursing personnel, particularly midwives, the Committee requests the Government to provide information on measures taken or envisaged to ensure access to quality nursing care, including access to midwifery care, particularly in rural areas.

Article 6. Employment conditions of nursing personnel. Hours of work – Annual holidays with pay. In its 2014 comments, the Committee invited the Government to consider amending the Health Services Act to establish a maximum limit on overtime hours for nursing personnel. In its report, the Government undertakes to consider amending the Health Services Act to establish maximum overtime hours for nursing personnel. The Government further indicates that the collective agreement governing the employment conditions of nursing personnel has not yet been amended to provide for the increased annual leave provided for in section 159 of the Employment Relations Act. The Committee requests the Government to indicate the manner in which it ensures a maximum limit on overtime hours for nursing personnel in both law and practice. The Committee also reiterates its request that the Government provide a copy of the collective agreement once it has been amended.

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Articles 2 and 3 of the Convention. National policy concerning nursing services and nursing personnel – Nursing education and training. The Committee notes the Government’s information concerning the 2008–13 National Health Care Plan, entitled “Satisfied Users and Providers of Health Care Services”, which includes a framework for long-term planning of education and training in the health sector, as well as its indication that an evaluation report is under preparation. The Committee further notes the Government’s reference to the National Strategy on Quality and Safety in Health Care (2010–15) which aims to, among others, implement education and training in quality and safety. The Committee further understands that a national programme entitled “Health Care System Upgrade by 2020” was established in February 2011 which includes among its priorities investing in human resources and training of healthcare professionals. Finally, the Committee notes the Government’s indications that planned short-cycle higher education programmes have not yet been implemented and that preparations for a higher education study programme for senior staff nurses are in process. The Committee requests the Government to provide up to date information on the implementation of these programmes, including any developments concerning the short-cycle higher education programmes, higher education study programmes for senior nurses or other long-term education initiatives, as well as any other programmes which may impact the employment conditions of nursing personnel.

Article 6. Employment conditions of nursing personnel. Hours of work – Annual holidays with pay. The Committee recalls its previous comment which had asked for explanations concerning possible discrepancies between the national provisions for nursing personnel and those for all other workers. The Committee notes, in this respect, the Government’s explanation that section 52b of the Health Service Act, which permits overtime work for healthcare professionals to exceed the eight-hour weekly limit in cases of written consent, is limited by section 52c, which entitles health care professionals to daily rest of at least 12 uninterrupted hours and to weekly rest of at least 24 uninterrupted hours. Nevertheless, the Committee notes that section 52c – which permits working time of over 16 hours to be authorized by the written consent of the health care professionals – contains no absolute limit, in contrast to the overtime provision for all other workers under the Employment Relations Act (ZDR-1) (Official Gazette No. 21/2012), which is limited under section 144(4) to a maximum of 230 overtime hours per year. While recalling that this Article of the Convention aims to ensure that nursing personnel – as any other worker – is entitled to sufficient rest and leisure in order to avoid fatigue, the Committee requests the Government to consider modifying the provisions of the Health Services Act in order to provide a maximum limit of the overtime work for nursing personnel. The Committee also notes the Government’s explanations that section 159 of the Employment Relations Act now provides for a minimum of four weeks of annual leave per calendar year for all workers, including health care staff, but that the collective agreement has not yet been amended to reflect this increase. The Committee accordingly requests the Government to provide a copy of the collective agreement once it has been amended to provide for the increased annual leave for nursing personnel.

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Article 2, paragraphs 1 and 2, of the Convention. National policy for nursing services and nursing personnel. The Committee notes the detailed information provided by the Government regarding the new National Health Care Plan 2008–2013 entitled “Satisfied Users and Performers of Healthcare Services”, which was adopted on 26 June 2008 to follow up on the previous National Health Care Programme that had expired in 2004. It notes in particular that the Plan provides for improved training of health care staff in order to fill the skills and knowledge gap and envisages greater powers for nurses. The Committee also notes the reform of the salary system and the system of career progression in the nursing sector which were undertaken following the introduction of the new salary system in the public sector in 2002. According to the Government’s explanations, the new salary system is transparent, permitting the uniform evaluation of the work of nursing staff and has resulted in a major increase of approximately 20 per cent in the salaries of health-care workers. Available statistics for the period 2003–06 show an increasing trend in the number of health‑care workers in the public sector which may well be a reflection of the policy reforms. The Committee would appreciate if the Government would provide in future reports up to date information on the implementation of the National Health Care Plan, in particular as regards any measures designed to improve the quality of nursing care or measures likely to affect the employment and working conditions of nursing personnel.

Article 2, paragraph 3. Consultations with the social partners. The Committee notes the Government’s indications concerning the participation of professional associations and trade unions in the drafting of the Resolution on the National Health Care Plan 2008–2013 and the broad public debate that preceded the adoption of the Resolution by the National Assembly. It requests the Government to elaborate on the nursing-specific policy objectives and priorities as may be defined in the five-year health-care action plan, and also to clarify whether any nurses associations have participated in the formulation of that policy.

Article 3. Nursing education and training. The Committee notes the information about the new secondary school educational programmes for the area of health care following the adoption of the 2006 Vocational and Technical Education Act as well as the preparations for the implementation of a new post-secondary professional education programme for senior staff nurses. It also notes that according to the National Health Care Plan, the number of nurses is expected to rise by 17 per cent in the period 2008–13 and that in anticipation of growing needs two new nursing colleges have recently been established. The Committee requests the Government to continue to transmit all available information on the organization of nursing studies, including basic education and practical training, and the evolution of the nursing workforce.

Article 6. Employment conditions of nursing personnel. Hours of work. Further to its previous comment on this point, the Committee notes the Government’s explanations that under the revised Health Services Act, overtime work may exceed the limitation of eight hours per week provided that there is the worker’s written consent and an agreement between the employer and the employee on overtime work. It also notes that working time which exceeds 16 continuous hours requires written consent of the medical professional. In this connection, the Committee notes that section 143(3) of the Employment Act limits overtime work to eight hours a week, 20 hours a month and 180 hours a year, while section 145(2) prohibits an employer to impose overtime work to certain categories of workers such as workers with special health or family needs. The Committee is therefore obliged to once again ask the Government to explain how it is ensured that nursing personnel enjoy conditions at least equivalent to those of other workers with respect to hours of work, overtime work and on-call work.

Annual holidays with pay. The Committee notes the Government’s explanations concerning the discrepancy between the statutory minimum annual leave entitlement of four weeks provided for in section 159 of the Employment Act and the basic annual leave of 18 days provided for in section 47 of the Collective Agreement for Nursing Personnel. It notes in particular that following the recommendations of a tripartite working group, which was set up in 2003 to examine that incongruity, it was decided not to abrogate the provisions of collective agreements which provide for annual leave lower than the legal minimum but to ensure that the combined total of basic and any additional leave may never be lower than the legal minimum. Moreover, even when the worker is not entitled to any additional leave, he/she should nevertheless be granted the minimum period of four weeks prescribed by the Employment Act. The Committee requests the Government to confirm the understanding that, as a matter of established practice, nursing personnel are never granted less than four weeks of annual holidays with pay. It also asks the Government to keep the Office informed of any new measure that might be taken to ensure that nursing personnel enjoy not only in practice but also in law paid annual holidays at least equivalent to those of other workers.

Article 7. Occupational health and safety of nursing personnel. The Committee notes the Government’s statement that apart from the generally applicable Occupational Health and Safety Act and its implementing regulations, there are no specific instruments to regulate health and safety at work for medical professionals. It also notes the information on a newly designed online application entitled “Ergonomics in Healthcare” which is about to be launched by the Ministry of Labour, Family and Social Affairs. The Committee requests the Government to continue providing full particulars on any measures, legislative, administrative or others, seeking to improve the occupational health and safety standards applicable to health care workers.

In this respect, the Committee draws the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to assisting health services in building their capacities to provide their workers with a safe, healthy and decent working environment as the most effective way both to reduce transmission of HIV and to improve the delivery of care to patients. The Committee wishes also to refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS.

Part V of the report form. Application in practice. The Committee notes the statistical information concerning labour inspection results in the healthcare sector for the period 2005–08. The Committee would be grateful if the Government would supply information concerning the application of the Convention in practice, including, for instance, statistical data and characteristics of the composition of the nursing workforce (e.g. age, gender), the number of nurses exiting or joining the profession every year, the nurse-to-population ratio, copies of official reports or studies addressing nursing-related issues, any practical difficulties such as shortage of qualified nurses, etc.

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The Committee notes with interest the information provided in the Government’s first detailed report. It asks the Government to supply additional information on the following points.

Article 2, paragraph 1, of the Convention. The Committee notes the Government’s reference to the National Programme of Healthcare - "Health for all by 2004". It asks the Government to provide a copy of this programme and also to elaborate on any follow-up activities, including major achievements so far in terms of improving the quantity and quality of nursing services offered to the population.

Article 2, paragraph 2(b). The Committee notes that the Government’s report does not indicate any particular incentive measures, such as career development plans or special remuneration packages, designed to attract persons to the nursing profession and retain them in it. It therefore requests the Government to provide additional information in this respect.

Article 2, paragraphs 3 and 4. The Committee notes that the Government does not specify in its report whether the National Programme of Healthcare was formulated with the participation of the employers’ and workers’ organizations concerned. While noting that under section 6 of the Health Care and Health Insurance Act, health-care plans are prepared with the participation of the Health Council, the Institute for Health Insurance, competent chambers, health associations and other institutions and organizations that perform health activities, the Committee would appreciate receiving additional information on the manner in which professional organizations of nurses may have contributed to the current policies on nursing services and nursing personnel.

Article 3, paragraph 2. The Committee would be grateful if the Government would provide further explanations as to whether and how the nursing education and training fits into a broader and coordinated plan for education and training in the health sector.

Article 6, paragraph (a). The Committee notes the Government’s reference to new sections 52a, 52b and 52c of the Health Services Act as providing for conditions related to working time and rest time of health workers and health associates. As the text of the corresponding amendments to the Health Services Act is not available, the Committee would appreciate receiving a copy of the Act incorporating the most recent amendments. The Committee also notes the Government’s indication that, under section 52b of the Health Services Act, the limitation of overtime to eight hours per week may be exceeded upon the health worker’s written consent. It asks the Government to provide additional explanations as to the exact conditions under which, and most importantly, the limits within which the health worker may perform overtime in this case.

Article 6, paragraph (c). The Committee notes that under section 159(1) of the Employment Act, the annual leave with pay in a calendar year may not be shorter than four weeks, regardless of whether the employee works full time or part-time. However, section 47 of the Collective Agreement for Nursing Personnel provides for an annual leave of 18 days for certain health workers and health associates. The Committee asks the Government to provide clarifications on this point.

In addition, the Committee notes that the Employment Act provides for additional benefits in respect of annual leave, such as, for instance, section 159(3) that requires longer annual leave for night workers. It asks the Government to specify whether such additional benefits apply also to health workers and health associates.

Article 7. The Committee asks the Government to indicate any concrete measures taken or envisaged to improve existing legislation on occupational safety and health by adapting it to the special characteristics and difficulties of the working environment in which the nursing profession is exercised.

Part V of the report form. The Committee requests the Government to provide all available information on the practical application of the Convention, including for instance statistics on the nurse-to-population ratio, the number of students attending nursing schools, the number of nurses leaving or joining the profession, information concerning reported problems of unemployment or shortage of nurses and midwives, copies of official reports or research studies examining the problems and prospects of the nursing profession, etc. The Committee also requests the Government to forward copies of the following documents which are not available in the Office: Rules on the professional training of health workers; Rules on the promotion of workers employed in healthcare; List of professions in health services.