Direct Request (CEACR) - adopted 2021, published 110th ILC session (2022)

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

The Committee notes the observations of the General Confederation of Labour Force Ouvrière (CGT–FO). It requests the Government to provide its comments in this regard.

Article 2 of the Convention. Measures to attract nursing personnel to the profession and to retain them. In response to its previous comments, the Committee notes the statistics provided by the Government for 2003–13. The Committee refers however to the recent publication by the Directorate for Research, Studies, Evaluation and Statistics (DREES) on “healthcare establishments” (DREES 2021), which provides a more up-to-date synthesis of the main available data on French healthcare establishments, and notes that the number of nurses increased by 23 per cent between the end of 2003 and the end of 2018. Nursing personnel as a percentage of total staff also increased, from 24.1 per cent to 26.1 per cent over the same period. The percentage of auxiliary healthcare workers (21.1 per cent at the end of 2018) and of administrative personnel (10.8 per cent at the end of 2018) as a proportion of total hospital personnel remained broadly stable for 15 years. With regard to the distribution of nursing personnel throughout the national territory, the Committee notes, according to DREES 2021, at national level, public health establishments accounted for 60 per cent of hospital beds and places, non-profit private establishments for 15 per cent and profit-making private clinics for 25 per cent. This distribution is however very unequal across the departments. With regard to reforms, the Committee notes the information provided by the Government in respect of demographics, teaching and training, those actively engaged in the profession, career and remuneration and international cooperation for the recognition of occupational qualifications and authorization to practice allowing international mobility of nurses (general and specialized health care). In particular, it notes that nursing personnel have benefited generally from the “Professional development, career and remuneration” (PPCR) protocol, which has resulted in a rebalancing of remuneration in favour of index-related wages (a measure referred to as “bonus-points transfer”), and a revaluation over several years (between 2016 and 2020) of wage scales, with an average increase of around 12 index points. The Government indicates, moreover, that plans to develop status and benefits are in progress. These include the creation, in autumn 2019, of a special status for advanced-practice auxiliary medical workers. The exercise of advanced practice was included in a specific section of the Act of 26 January 2016 modernizing the health system, and its development was reaffirmed as a means of improving career prospects. It will initially concern only nursing personnel, as the diploma and exercise of advanced practice were recognized in France in 2018. As a complement to recognition of advanced practice, a new allowance was to be put in place in the summer of 2019 to reward engagement by healthcare workers in the inter-professional cooperation protocols established under Act No 2009-879, of 21 July 2009 on reforming the hospital and relative to patients, health and the territories (the HPST Act). In this regard, the CGT–FO observes that the establishment of a category of “advanced-practice nurses” looks like a crutch to prop up organized medical shortages. According to the CGT–FO, these specialized nurses will be paid lower wages than doctors and will be called on to perform and take full responsibility for medical acts, in a structure that has not been designed accordingly. The Government further indicates that implementation of the agreement of 2 February 2010 was completed on 1 September 2017, with the reclassification of the body of re-education workers and the body of electro-radiology technicians within Category A of public hospital personnel. The reclassification was optional for a six-month period, during which time the professionals could choose between their revalued status as a body under Category A or their previous status as a body under Category B, which was being phased out, with maintenance of their early retirement rights. In this connection, the CGT–FO observes that the option to choose between early retirement and thus turning down an increase in wages in a profession where wages were already very low, is additional proof of the difficulties encountered by nurses that the Government was not trying to solve. The Committee requests the Government to continue providing detailed and up-to-date information on the impact of recent reforms, in particular regarding employment and working conditions, including on career prospects and remuneration which are likely to attract persons to the nursing profession and retain them in it (Article 2(2)(b)).

Article 5. Consultation with nursing personnel on decisions concerning them. In response to the Committee’s previous comments, the Government indicates that trade unions are involved at local level in developments concerning internal organization of services. These phases of dialogue involve consulting the various groups of personnel, including the nursing personnel represented on the establishments’ technical committees and on the health, safety and working conditions committees. Employment and working conditions require obligatory consultations with these bodies. The Government adds that healthcare establishment professionals, including nurses, can benefit from support provided through mediation. In its observations, the CGT–FO refers to the creation of the “Nursing Order”, membership of which became compulsory in 2016, to point out that this measure simply increases the unattractiveness of the profession, and weakens the representation of nursing personnel, who are largely opposed to such membership. The Committee requests the Government to provide information on the content and development of the support procedure for nurses implemented through mediation. The Government is also requested to provide examples of consultations held with the social partners on issues covered by the Convention.

Article 7. Occupational safety and health. The Government indicates that French occupational safety and health legislation does not provide for specific measures aimed at improving the working conditions (as regards health, safety and security) of nursing personnel. However, the Labour Code provides that certain workers exposed to particular occupational hazards (asbestos, lead, ionising radiations, etc.) must be covered by a reinforced medical follow-up, the form of which is determined by the occupational physician. Nursing personnel may therefore, according to their function, benefit from this follow-up. Moreover, the occupational physician in charge of the multidisciplinary occupational health team can request authorization from the director of the establishment to seek the aid of persons or bodies “with the competences required to prevent occupational hazards and improve working conditions” (R4627-17 of the Labour Code), such persons or bodies may provide advice specifically concerning nurses. In this regard, the CGT–FO observes that the reform of the staff representative bodies under the 2017 Ordinances, as well as the abolition of the health, security and working conditions committee (CHSCT) and of the technical committees, greatly reduce the consideration given to matters of occupational safety, health and security, and worsen nurses’ working conditions. The Government’s revision of the table of occupational diseases and its refusal to take risks to mental health into account also add to the difficulties encountered by workers, in particular nurses. The CGT–FO also observes that the recent reforms led by the Government have resulted in the abolition of individual exposure sheets for exposure to certain factors of occupational hazards. This has also entailed excluding exposure to certain hazardous chemicals as a criterion for entry into the arduous or dangerous work category, regardless of the use of numerous hazardous chemical substances in healthcare establishments that put nurses’ health in danger. The CGT–FO further recalls that the nursing profession is primarily comprised of women and therefore requires solutions adapted to women in respect of working conditions, particularly to combat precarious work for women and gender-based inequality. The Committee also notes the CGT–FO’s observations, which draw attention to the current high level of distress of the healthcare personnel, including nursing personnel. Noting that, because of the specific nature of their work, nursing personnel are often in close contact with patients and so exposed to a very high risk of infection when providing care to patients presenting symptoms of infectious diseases, including COVID-19, especially if precautions to combat infection, such as the use of personal protective equipment (PPE) and vaccines, are not strictly applied or readily available, the Committee requests the Government to provide detailed and up-to-date information on all the safety measures taken or envisaged, to improve working conditions in respect of safety, health and security for nursing personnel specifically.