Observation (CEACR) - adopted 2003, published 92nd ILC session (2004)

Nursing Personnel Convention, 1977 (No. 149) - Poland (Ratification: 1980)

The Committee notes the information supplied in the Government’s report and the attached documentation. It also notes the observations communicated by the Polish Trade Union of Nurses and Midwives on 27 January 2003 concerning the application of the Convention and the Government’s reply dated 1 October 2003.

Article 2, paragraph 2(a), of the Convention. The Committee recalls its previous observation in which it requested the Government to supply additional information on the new educational and training programmes introduced for the nursing profession and also to indicate whether the ongoing reforms and restructuring policy in the field of health care have been formulated in consultation with the employers and workers concerned, as required under Article 2, paragraph 3, of the Convention. In its reply, the Government reports that the new system of nurses’ and midwives’ education consists of higher vocational studies organized by medical academies and higher vocational schools and that at present 29 centres, including 11 medical academies and 18 higher vocational schools, provide such education. The Government also indicates that, under the 2001 Act regarding the nursing profession, the National Accreditation Board of Medical Schooling was set up for the purpose of monitoring the education standards of the faculties offering nursing and midwifery studies. As regards social dialogue in the health-care sector, the Government refers to the first meeting of a "round table" conference held in April 2003 which brought together representatives of more than 90 organizations such as autonomous governments and territories, medical academies, employers’ organizations, the pharmaceutical industry and trade unions, including representatives of nurses and midwives, to discuss the problems in the health-care system which require legislative changes. The Committee stresses the importance of open and continuous dialogue with the social partners since negotiated solutions have a much better chance of succeeding in a context where social consensus is the only solid basis for the continuation of painful structural reforms.

In addition, the Committee notes the Government’s detailed explanations concerning the group nursing and midwifery practice which was introduced by virtue of the 1998 Act concerning the amendment of the laws on health-care establishments and medical professions. The Committee requests the Government once again to indicate whether the employers’ and workers’ organizations concerned were consulted in this respect.

Article 2, paragraph 2(b). Further to its previous request for detailed information with regard to the working conditions and remuneration levels of nursing personnel, the Committee notes that the Government refers to insufficient financial resources in the health-care system and the resulting necessity of ongoing adjustment of the employment level and pay conditions of nurses and midwives. The Government reiterates that the main objective of the restructuring process launched in 1999 was to adjust the level of medical personnel employment to the real needs of the health-care system and to the financial possibilities of the State. The Government indicates that in the period 1999-2002, a total number of 92,000 health-care employees were laid off and that significant public funds are allocated every year for redundancy pay, adjustment assistance, preferential loans and other rehabilitation measures in an effort to mitigate the unfavourable effects for nurses and midwives of restructuring programmes. With regard to any possible improvements in the working conditions of the active nursing personnel, the Government makes renewed reference to the Ministerial Regulation of December 1999 on the setting of minimum standards concerning the staffing of health-care establishments with nurses and midwives which prevents unjustified downsizing of employment and guarantees adequate care to patients. The Governments adds, however, that in November 2002 the Minister of Health, reacting to information referring to instances of non-compliance with the said Regulation on the part of health-care provider managers called upon all entities to fully respect the nurses’ and midwives’ employment standards in force. The Committee invites the Government to supply more specific information on the nature and extent of those instances of non-compliance and to indicate the practical measures taken in response.

For its part, the Polish Trade Union of Nurses and Midwives (OZZPiP) denounces extensive violations of the labour legislation, mainly in the form of delayed payment of wages, non-payment of statutory pay increases, wage supplements and annual bonuses, unjustified wage deductions, and non-payment of redundancy pay or other benefits upon termination of employment. The Committee examines these allegations in an observation addressed to the Government under Convention No. 95. Suffice it to note here that the facts and practices denounced in the communication of OZZPiP - and entirely confirmed by official statistics provided by the National Labour Inspection Service (PIP) - seem to corroborate the allegation that nurses and midwives are in fact experiencing difficult working conditions, especially income insecurity.

Article 7. The Committee notes the information supplied by the Government in response to its previous direct request on this point. The Government indicates that educational activities related to HIV prevention continue within the framework of the "National Programme on preventing HIV, care of persons living with HIV and persons with AIDS for the years 1999-2003". The Government also refers to recent publications on prophylactic and diagnostic procedures in the case of HIV infection or AIDS disease which are made available to nurses free of charge throughout the country. The Committee would be grateful if the Government would continue to provide information on future activities in matters affecting the occupational health and safety of nursing personnel.

Part V of the report form. The Committee notes the Government’s statement that the main difficulties encountered in the practical application of the Convention relate to the bad financial situation of most health-care institutions and the pressing need to readjust employment and pay levels in order to ensure the financial stability of the health-care providers. The Committee asks the Government to continue to provide general information on the effect given to the Convention in practice, including relevant statistics, extracts from official reports and recent studies on the socio-economic conditions prevailing in the nursing profession and any other particulars which would enable the Committee to better evaluate the Government’s policy concerning nursing services and nursing personnel.