Direct Request (CEACR) - adopted 2009, published 99th ILC session (2010)

Nursing Personnel Convention, 1977 (No. 149) - France (Ratification: 1984)

The Committee notes with regret that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 2, paragraphs 1 and 2, of the Convention. Measures to improve the employment and working conditions of nursing personnel. The Committee understands that the Government has launched in 2002 a major reform programme regarding hospital services (“Hospital 2007”) with the aim of harmonizing the funding and pricing procedures of public and private establishments, simplifying the financial management of institutional health-care providers, and modernizing the working methods of health professionals. The Committee would appreciate receiving additional information on the implementation of this programme and its possible impact on the employment conditions of nursing personnel. In addition, the Committee requests the Government to indicate whether the reform plan also concerns overseas departments and collectivities.

Moreover, the Committee notes the Government’s reference to the flow of nurses leaving the profession, it being estimated that between 7,000 and 9,000 nurses have been leaving work annually from 1997 to 2003. The Committee also notes that according to other sources of information, 6 per cent of the nursing workforce left the public sector in 2001, and 18,000 nurses leave public hospitals every year while the situation would appear even worse in the private sector. The Committee requests the Government to clarify whether this constant decrease in the overall number of nursing staff is in any manner linked to unsatisfactory employment and working conditions, for instance, low pay and poor career prospects, and also to supply full particulars on any additional incentives, financial or other, designed to retain qualified nurses in the profession.

Article 5, paragraph 2. Determination of conditions of employment and work by negotiation. Further to its previous comment, the Committee asks the Government to transmit copies of all national collective agreements in force covering nursing personnel in the private sector.

Article 7. Occupational health and safety. The Committee notes the detailed information provided by the Government on preventive and protective procedures against HIV-infection in medical establishments. It notes, in particular, circular DGS/DH/98/249 of 20 April 1998 which takes into account the particular risks of exposure of health-care workers to HIV and other blood-borne pathogens and sets a programme for the prevention and protection of health-care workers mainly based on vaccination, workers’ health surveillance, information and training, and the respect of March 1995 which specifies the modalities of handling
cases of HIV-infection as occupational accidents, and circular DGS/DHOS/DRT/DSS/2003/165 of 2 April 2003 which provides for a post-HIV exposure antiretroviral treatment. While noting that according to news reports, in France, of the 13 proven cases of occupational HIV infection, 12 concerned nurses, the Committee would be grateful if the Government would continue supplying information on any further developments on these matters.

Moreover, the Committee wishes to draw the Government’s attention to the adoption in April 2005 of the Joint ILO/WHO guidelines on health services and HIV/AIDS, which aim at promoting sound management of HIV/AIDS in health services providing for wide-ranging and practical approaches to protection, training, screening, treatment, confidentiality, prevention, the minimizing of occupational risk and the care and support of health-care workers. The Committee trusts that the Government will give due consideration to these guidelines with a view to improving existing laws and regulations on occupational health and safety for health professionals.

Part V of the report form. Application in practice. The Committee notes the statistical data provided by the Government on the number of nursing personnel by category and by grade, the proportion of nursing staff in relation to other health workers, and their geographical distribution by region and department. The Committee requests the Government to continue to provide up to date information on the organization of health services in general (e.g. number of medical establishments, nurse-to-population ratio, number of nurses attending nursing schools, new nursing positions established per year) as well as on any broader issues having an impact on the quality of nursing services (e.g. health system reforms, resources and funding of medical establishments, medical research and new technologies, shortage of specialized personnel, recruitment of nurses from foreign countries, etc.).