Observation (CEACR) - adopted 2023, published 112nd ILC session (2024)

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

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The Committee notes the observations of the Independent and Self-Governing Trade Union “Solidarność”, received on 30 August 2021 raising issues addressed by the Committee below, as well as the Government’s reply thereon.

Articles 2 and 5 of the Convention. National policy concerning nursing services and nursing personnel. Consultations with social partners. The Committee notes that the Government informs of the adoption on 15 October 2019 of the “Long-term State Policy for the Development of Nursing and Midwifery in Poland” (hereinafter “State Policy”). Its objective is to ensure access to high quality nursing and midwifery care by increasing the number of nurses and midwives in the Polish healthcare system. In this regard, it envisages the adoption of measures to motivate persons to enter into the profession, halt their economic migration and retaining nurses and midwives, including those acquiring retirement rights. According to information available in the government’s website, the State Policy envisages the adoption of measures to improve the working conditions of nurses and midwives; determine the actual number of nurses and the number of midwives in the health care system; and develop mechanisms to motivate medical entities with an agreement with the National Health Fund to define minimum employment standards. With regard to the conditions of remuneration of nursing personnel, the Government refers to the introduction of several amendments to the Act of 8 June 2017 on the manner of determining the lowest base remuneration of employees in medical professions employed in medical entities (hereinafter “Act of 8 June 2017”). Changes were introduced to the annex to the Act of 8 June 2017 related to the different professional groups of nurses and midwives and work factors applicable to the determination of their lowest base salary (Act of 13 September 2018). Moreover, the base amount on the basis of which the lowest base remuneration is calculated, was increased from Polish zloty (PLN)3,900 (approximately US$897.31) to PLN4,200 (US$966.51) (Act of 19 July 2019). In addition, following consultations with employers’ and workers’ organizations that were reflected in the position of the Tripartite Team for Health Care of 17 March 2021, the requirement for all health entities to achieve the statutory guaranteed levels of base salaries of medical employees took effect on 1 July 2021 (Act of 28 May 2021). The work coefficients for persons employed in nursing or midwifery positions where a bachelor’s degree is required was increased from 0.73 to 0.81. Therefore, as of 1 July 2021, the lowest base salary was fixed at PLN4,186 gross (approximately US$963.25) for nurses and midwives employed in positions where a bachelor’s degree is required. Moreover, the Government refers to the adoption of the Act of 27 November 2020 amending certain acts in order to ensure health personnel during the declaration of the state of epidemic emergency, which established that medical entities employing nurses or midwives, which obtained an increase in remuneration on the basis of regulations issued pursuant to Act of 27 August 2004 on health care services financed from public funds (section 137 paragraph 2), are obliged to provide them with remuneration in an amount not lower than their remuneration they received on 30 June 2021. This requirement was introduced into the Act at the request of the Polish National Trade Union of Nurses and Midwives. Furthermore, since February 2021, tripartite consultations have been held within the Tripartite Team for Health Projection regarding further amendments to be introduced to the Act of 8 June 2017. During its meetings, it was agreed to continue working on the regulation of minimum remuneration in line with the envisaged increase in health care financing at 7 per cent by 2027. Lastly, the Committee notes that the Government indicates that, in the framework of the project “Development of nursing competences” a campaign was launched to promote the nursing and midwifery profession. The Committee requests the Government to continue to provide information on the content and the impact of the measures taken to ensure that all nursing personnel are provided with employment and working conditions, including in relation to career prospects and remuneration, aimed at attracting individuals to the profession and retaining them in the nursing profession. In particular, it requests to provide information on those measures taken in the framework of the State Policy.

Article 3. Education and training of nursing personnel. The Committee observes that the State Policy envisages the adoption of measures to increase the number of students and to improve the quality of education in the fields of nursing and midwifery as well as changes in the postgraduate education system. The Committee also notes the Government’s indication that a six-day paid training leave for nurses and midwives was introduced with the aim of increasing the number of nursing personnel undertaking postgraduate education, and thus improving their professional qualifications and competencies. The possibility of taking up education in the nursing profession in a part-time was also introduced. The Government reports that the Ministry of Health provides annual subsidies for the professional development of nurses and midwives (of a maximum of PLN3,950 per student – approximately US$908.46 – during the entire period of specialization). The Committee requests the Government to provide detailed information on the nature, the content and the impact of the measures adopted with a view to ensuring that nursing personnel are provided with education and training appropriate to the exercise of their functions, including those adopted in the framework of the State Policy.

Article 6.Employment conditions of nursing personnel under civil law contracts. The Committee notes that, in its observations, Solidarność argues that a large number of nursing personnel work in healthcare entities on the basis of civil law contracts, which are not covered by the working standards established in the Act of 15 April 2011 on medical activity (hereinafter “Act of 15 April 2011”) and the Labour Code. Solidarność points out that, as of 1 July 2020, there were 166,525 nurses working under employment contracts, 47,672 under civil law contracts, and 465 working in the framework of a professional relationship. Solidarność claims that nurses employed on civil law contracts work from 14-hour to 24-hour shifts, often working more than 200 hours per month. Solidarność states that, according to a survey carried out by the Digital Nurses Association, among 2,334 women and 195 men in the nursing and midwifery profession, 42 per cent of the respondents earned between PLN3,001 (approximately US$689.95) and PLN4,500 (approximately US$1,034.65), 35 per cent between PLN2,500 (approximately US$574.93) and PLN3,000 (approximately US$689.93), and 12.1 per cent between PLN4,001 (approximately US$920.04) and PLN5,000 (approximately US$1,149.77). Moreover, 45.4 per cent of the respondents worked in an additional medical entity, most of them due to economic needs. In its reply, the Government indicates that, in accordance with the Act of 15 April 2011 and Act of 15 July 2011 on the profession of nurse and midwife, nurses can be employed in a medical entity under both employment and civil law contracts, and they may also practice the profession in the form of self-employment. Regarding the applicability of the working time limits and standards established in the legislation to nursing personnel under civil law contracts, the Government indicates that a civil law contract concluded by the head of a medical entity with a nurse or other health employee, the subject of which is to provide healthcare services, should guarantee not only the proper functioning of a medical entity but above all the safety of both patients and employed staff. The Governments adds that, if concluded contracts lack a guarantee of necessary daily and weekly rest, they do not guarantee the provision of proper care to patients.

In this respect, the Committee observes that the recourse to non-standard forms of work has been increasing globally, resulting in greater use of temporary work, part-time work, temporary agency work and subcontracting, dependent self-employment and disguised employment relationships. It notes that well-designed and regulated non-standard forms of employment (NSFE) can provide flexibility to both employers and workers and facilitate the participation of workers in the labour market by allowing those who wish to freely choose part-time work arrangements to better reconcile work, life and family responsibilities. However, at the same time, certain flexible forms of employment are often associated with greater insecurities for workers and when widespread, workers risk cycling between non-standard jobs and unemployment. Where contractual arrangements have blurred the employment relationship, there is evidence that workers have difficulty exercising their fundamental rights at work, or gaining access to social security benefits and on-the-job training. Employment injury rates are also higher among workers in NSFE. From the employer perspective, short-term cost and flexibility gains from using NSFE may be outweighed by longer-term productivity losses. There is evidence that greater reliance on NSFE tend to underinvest in training, both of temporary and permanent employees, as well as in productivity-enhancing technologies and innovation. The Committee therefore wishes to highlight that it is essential to design policies to improve the quality of non-standard jobs, while helping enterprises to adjust to market volatility and to guarantee that, regardless of their contractual arrangement, workers are provided with adequate and stable earnings, protection from occupational hazards, social protection and the right to organize and bargain collectively (2022 General Survey on Securing decent work for nursing personnel and domestic workers, key actors in the care economy, paragraphs 440, 443 and 1097 (i)). Recalling that the Convention applies to all nursing personnel irrespective of their employment status (Article 1(3) of the Convention), the Committee requests the Government to provide specific information on the manner in which it is ensured that nurses and midwives working under civil law contracts enjoy conditions at least equivalent to those of other workers in the country, particularly with regard to the terms and conditions of employment stipulated in Article 6 of the Convention.

Application in practice. The Committee requests the Government to provide updated detailed information on the application of the Convention in practice, including statistical data disaggregated by sex, age and region concerning: the ratio of nursing personnel to the population; the number of persons enrolled in nursing schools; the number of female and male nurses who enter and leave the profession each year; the organization and the operation of all institutions which provide healthcare services; as well as official studies, surveys and reports addressing health workforce issues in the health sector.