Nursing Personnel Convention, 1977 (No. 149) - Greece (Ratification: 1987)

Observation (CEACR) - adopted 2020, published 109th ILC session (2021)

The Committee takes note of the supplementary information provided by the Government in light of the decision adopted by the Governing Body at its 338th Session (June 2020). The Committee proceeded with the examination of the application of the Convention on the basis of the supplementary information received from the Government this year, as well as on the basis of the information at its disposal in 2019.

The Committee takes note of the observations of the Greek General Confederation of Labour (GSEE) received on 3 September 2019. The Committee requests the Government to provide its comments in this respect.

Article 2 of the Convention. Formulation and implementation of a nursing services and personnel policy. Nursing education and training. The Committee recalls that, in its previous report, the Government had indicated that a national health strategy was being developed and that a bill concerning reform to primary health care had been submitted to the Parliament. The Government reports on a series of labour law provisions adopted since 2013, indicating that they apply to workers in dependent employment relationships in the private sector, including to nursing personnel. The Committee notes that amendments were introduced to Law No. 1579/1985 that define nursing specialties in Pathology, Surgery, Paediatrics and Mental Health. In addition, Ministerial Decision No. A4/203/1988 established the requirements for obtaining a special nursing certificate. The Committee further notes that, pursuant to Law No. 2519/1997, graduates of the Technological Educational Institutes (TEI) Departments of Health Visitors can obtain a nursing specialty in mental health. The National Council for the Professional Development of Nursing defined other nursing specialities through the promulgation of section 45 of Law No. 4486/2017. The Government reports that, according to data compiled by the Nursing Directorate, as of November 2018, 1,550 nurses had acquired a specialty in pathology, 1,953 nurses in surgery, 920 nurses in paediatrics and 945 nurses and health visitors in mental health. In respect of the education and training policy for nursing personnel, the Government indicates that substitute teachers in the relevant specialties are recruited through a call for candidates issued by Ministerial Decision, whereas school nurses are recruited by the Regional Directorates of Education. The Committee notes that, in the field of higher education, during the reference period, two Higher Educational Institutes (AEI) and seven TEI provided first cycle programmes of studies in nursing. In its supplementary information, the Government indicates that, in the context of addressing the COVID-19 pandemic, enhancing nursing personnel and upgrading their skills are among the key actions taken by the Ministry of Health to strengthen the health care system. In this respect, the Committee notes with interest the adoption of Law 4690/2020 ratifying: (a) the Emergency Law of 13 April 2020 on “Measures to address the continuing impact of the Coronavirus COVID-19 pandemic and other urgent provisions” and (b) the Emergency Law dated 1 May 2020 on “Additional measures to address the continuing impact of the Coronavirus COVID-19 pandemic and return to normal, social and economic life and other provisions”. According to Law 4690/2020, all nursing specialties are established in line with European standards. It also provides for the creation and filling of 2,250 posts for trainee specialist nurses. In order to meet the needs created by the pandemic, the Government introduced training programs in the specialties of Critical Care and ER Nursing and Public Health/Community Health Nursing, which will be offered for the period 2020–2021, targeted mainly at unemployed male and female nurses. Under the same law, the Programme “Be a Volunteer to tackle address Covid-19” was established and implemented in public health facilities until June 2020. The Committee notes that more than 10,000 participants providing voluntary services in specialties relevant to healthcare account for 38.9 per cent of the total participants. Of this 38.9 per cent, 6.4 per cent were nurses and 11.9 per cent were assistant nurses. The Committee requests the Government to provide information on developments in relation to the adoption of a national health strategy as well as reforms to primary healthcare. It further requests the Government to provide information on any legislative amendments introduced relating to the operation of public and private health services and, if applicable, to supply copies of any relevant legislative texts. It also requests the Government to provide information concerning measures taken in order to prevent or address the shortage of qualified nurses, indicating the measures taken in relation to education and training as well as in relation to employment and working conditions, including career prospects and remuneration, with the aim of attracting men and women to the profession and retaining them in it. In the context of the global COVID-19 pandemic, the Committee invites the Government to provide updated information on the implementation of the measures taken to strengthen the health system and to address the increasing demand for qualified nurses.

“Exclusive” nurses. In its previous comments, the Committee noted that the shortage in qualified nursing personnel led to specific practices, including recourse to so called “exclusive” nurses, namely female migrant workers employed in a quasi-nursing capacity and even informal hospital services provided by patients’ families, which are increasingly tolerated by public establishments. In response to the Committee’s previous request for information on “exclusive” nurses, the Government provides data from the different regions in the country regarding the employment of this category of nurses. In its observations, the GSEE expresses its concern with respect to this form of atypical work. The Committee requests the Government to supply detailed information in its next report on the conditions of recruitment and work of foreign nurses and “exclusive” nurse, as well as measures taken to regulate their activities. The Committee requests the Government to provide its comments in respect of the observation of the GSEE.

Article 5(2) and (3). Determination of conditions of employment and work. The Government indicates that there is no collective agreement in force covering the country’s nursing personnel. It nevertheless refers to the 19 September 2014 Collective Labour Agreement “on the regulation of the conditions of remuneration and employment of workers, members of primary associations of the Federation of Greek Healthcare Institution Unions (OSNIE) employed at private clinics that are members of the Association of Greek Clinics (SEK) across the country”. The Government adds that legal disputes arising between nursing employees and their employers can be submitted to conciliation, mediation or arbitration procedures. The Committee notes that, each year, the competent department of the Ministry of Labour registers a relatively small number of cases of dispute resolution involving parties from trade union organizations of workers covering hospital staff and employer-operators of health service providers. In particular, the Government indicates that, from 1 June 2019 until 15 July 2020, the Ministry’s relevant Department has not handled any cases involving resolution of disputes between nursing employees and their employers through conciliation. The Committee takes note of a series of arbitration awards referred to by the Government. On the other hand, the GSEE observes that there are important difficulties concerning the procedure for collective bargaining and the conclusion of new sectoral collective agreements, which were aggravated by the expiry of former collective agreements enabling employers to pay nursing personnel in private hospitals on the basis of the minimum wage. The Committee requests the Government to provide information on the progress and results of collective negotiations to determine employment and working conditions of nursing personnel.

Article 6. Employment conditions of nursing personnel. Social security. Hours of work. The Government indicates that nursing personnel in the public and private sectors enjoy insurance coverage against risks of old age, disability, death, illness, maternity and unemployment. In its supplementary information, the Government indicates that the relevant Department of the Ministry of Labour and Social Affairs is considering including nurses who fall under the pension protection of the former Public Sector Fund, in the pension scheme for Heavy and Arduous Occupations. In response to the Committee’s previous request regarding the List of Arduous and Unhealthy Occupations set out in Law No. 3863/2010, the Government reports that a new List was finalized after consultation with the social partners through the Social Security Council. In this regard, the conclusions of the Standing Committee on Arduous and Unhealthy Occupations, in which representatives of the social partners, experts from the Ministry of Labour and Social Security (formerly IKA ETAM, now known as EFKA) and representatives of scientific institutions participated. The Government indicates that the new List attempted to rationalize and modernize the old one, taking into account the technological developments and their consequences in current labour data. It also indicates that, under Law No. 3863/2010, employees excluded from the prior List continued to be covered under the pension scheme until the end of 2015, with a view to ensuring their protection. In particular, the Committee notes that the new List stipulates, inter alia, that, male and female nurses working under fixed-term or indefinite contracts in nursing institutions, clinics, microbiological and biochemical laboratories and health insurance institutions are covered under the Regulation on Arduous and Unhealthy Occupations, with the exception of those employed in health centres within the framework of rationalization and modernization of the Regulation on Arduous and Unhealthy Occupations. In its observations, the GSEE expresses concern with regard to the difficult working conditions of nursing personnel, which are aggravated by the understaffing of hospitals and the imposed working hours schedule. The GSEE maintains that, under the current legislation nursing staff in hospitals works in three consecutive 8-hour shifts. The Committee requests the Government to supply a copy of the Regulation on Arduous and Unhealthy Occupations. In addition, it reiterates its request that the Government provide information on whether and to what extent this exclusion impacts on social security protection for nursing personnel. Recalling that this Article of the Convention aims to ensure that nursing personnel – as any other worker – are entitled to sufficient rest and leisure in order to avoid fatigue, the Committee requests the Government to address GSEE’s observations regarding the legal provisions allowing for 3 consecutive 8-hour shifts and to provide information on the provisions or other measures taken guaranteeing that nursing personnel enjoy conditions of employment and work at least equivalent to those of other workers in relation to hours of work, including regulation and compensation of overtime, inconvenient hours and shift work.

Article 7. Occupational safety and health. In response to the Committee’s previous comments, the Government indicates that the National Strategy for Health and Safety at Work (2016–20) was adopted following consultations with the social partners in the Health and Safety at Work Council of the Supreme Labour Council. In its observations, the GSEE comments that the poor health and safety conditions under which nursing personnel work expose them to exhaustion and burn out. The GSEE refers to a series of studies, which show that irregular shifts in combination with the very small number of nurses working during each shift place a heavy burden on these workers, making the performance of their duties extremely difficult. In particular, the GSEE indicates that the morning shift is usually served by two to four nurses but the afternoon and night shifts by only one nurse. The Committee notes that, in the context of the COVID-19 pandemic, the need for nursing personnel has increased, which may aggravate these phenomena. The Committee requests the Government to provide a copy of the National Strategy in force and reiterates its request that the Government provide information on progress made and results achieved with respect to occupational safety and health for nursing personnel, including with respect to ensuring adequate staffing on all shifts during the COVID-19 pandemic. The Committee also requests the Government to provide information on the measures implemented to prevent and reduce psychosocial risks, and promote mental health and well-being, in addition to preventing the risk of long-term effects on nurses’ well-being, particularly in the context of the pandemic.

Exposure to special risks. The Committee notes that according to “ILO: Country policy responses, COVID-19 and the world of work”, the Government has allocated €85 million to the Ministry of Health to support the purchase of sanitary equipment and the hiring of 2,000 health professionals. The Committee draws the attention of the Government to Paragraph 49 of Recommendation No. 157, which provides that: “(1) all possible steps should be taken to ensure that nursing personnel are not exposed to special risks. Where exposure to special risks is unavoidable, measures should be taken to minimise it; (2) measures such as the provision and use of protective clothing, immunisation, shorter hours, more frequent rest breaks, temporary removal from the risk or longer annual holidays should be provided for in respect to nursing personnel regularly assigned to duties involving special risks so as to reduce their exposure to these risks; (3) In addition, nursing personnel who are exposed to special risks should receive financial compensation.” The Committee also draws the Government’s attention to the ILO Guidelines on decent work in public emergency services, 2018, which recognize the need to protect public emergency workers, including emergency health workers, from exposure to communicable diseases. In particular, paragraphs 50 and 51 of the Guidelines stress that suitable and sufficient personal protective equipment (PPE) should be provided as protection against exposure to hazardous conditions for public emergency services (PES) workers and that workers and/or their representatives should be consulted and participate in relation to the selection and correct use of PPE. Noting that nursing personnel are at high risk of being infected while treating patients with suspected or confirmed COVID-19, particularly when infection control precautions including use of personal protective equipment (PPE) are not strictly practiced, the Committee requests the Government to provide detailed updated information on the safety measures adopted or envisaged including the provision of PPE and training in its use, as well as provision of adequate rest breaks during workers’ shifts and limitations on excessive hours wherever possible, with a view to protecting the health and wellbeing of nurses and limiting as much as possible their risk of contracting COVID 19.

Part V of the report form. Practical application. The Committee notes the data provided on the number of registered nursing students for the 2017–18 academic year, as well as statistics on the number of nursing students enrolled from for the academic years from 2013 to 2018. The Committee also takes note of the detailed information on persons practising in the nursing profession per level of training and field in the public and private sector based on the estimates, according to which 135,361 doctors and 55,963 nurses and midwives were employed in the beginning of 2020. The Committee notes a pronounced imbalance in the availability of doctors compared to nurses in Greece and observes that, according to the European Commission 2019 Country Health Profile on Greece, the country has the highest number of doctors but the lowest number of nurses per 1,000 population of any country in the European Union. The Committee requests the Government to provide detailed information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, including the nurse-population ratio, the number of nursing personnel broken down by public and private healthcare establishments, the number of students who graduate from nursing colleges annually and the number of institutions offering nursing education and training, 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 Greek health sector, including those that might have been developed in the context of the COVID-19 pandemic.

Direct Request (CEACR) - adopted 2019, published 109th ILC session (2021)

Article 2 of the Convention. Formulation and implementation of a nursing services and personnel policy. The Committee notes the Government’s report received on 21 November 2019, as well as the detailed information supplied in the Government’s 2018 report and annexes. The Committee recalls that, in its previous report, the Government had indicated that a national health strategy was being developed and that a bill concerning a reform to primary health care had been submitted to the Parliament. The Government reports on a series of labour law provisions adopted since 2013, indicating that these provisions apply to workers in dependent employment relationships in the private sector, including to nursing personnel. The Committee notes that amendments were introduced to Law No. 1579/1985 that define nursing specialties in Pathology, Surgery, Pediatrics and Mental Health. In addition, Ministerial Decision No. A4/203/1988 established the requirements for obtaining a special nursing certificate. The Committee further notes that, pursuant to Law No. 2519/1997, graduates of the Technological Educational Institutes (TEI) Departments of Health Visitors can obtain a nursing specialty in mental health. The National Council for the Professional Development of Nursing defined other nursing specialities through the promulgation of section 45 of Law No. 4486/2017. The Government reports that, according to data compiled by the Nursing Directorate, as of November 2018, 1,550 nurses had acquired a specialty in pathology, 1,953 nurses in surgery, 920 nurses in pediatrics and 945 nurses and health visitors in mental health. In response to the Committee’s previous request for information on “exclusive” nurses, the Government provides data from the different regions in the country regarding the employment of this category of nurses. In respect of the education and training policy for nursing personnel, the Government indicates that substitute teachers in the relevant specialties are recruited through a call for candidates issued by Ministerial Decision, whereas school nurses are recruited by the Regional Directorates of Education. The Committee notes that, in the field of higher education, during the reference period, two Higher Educational Institutes (AEI) and seven TEI provided first cycle programmes of studies in nursing. The Committee notes the data provided on the number of registered nursing students for the 2017–18 academic year, as well as statistics on the number of nursing students enrolled from for the academic years from 2013 to 2018. The Committee requests the Government to provide information on developments in relation to the adoption of a national health strategy as well as reforms to primary healthcare. It further requests the Government to provide information on any legislative amendments introduced relating to the operation of public and private health services and, if applicable, to supply copies of any relevant legislative texts. The government is also requested to provide information concerning the current composition of nursing staff, disaggregated by sex and age, including the number of graduates from the technological educational institutes who enter the nursing profession each year, the number of nursing personnel, broken down by those working at public and private healthcare establishments and “exclusive” nurses, the qualification or licences held by each of these categories, the number of persons treated, as well as the number of those who leave the profession each year. It also requests the Government to provide information concerning measures taken in order to prevent or address the shortage of qualified nurses, indicating the measures taken in relation to education and training as well as in relation to employment and working conditions, including career prospects and remuneration, with the aim of attracting men and women to the profession and retaining them in it.

Article 5(2) and (3). Determination of conditions of employment and work. The Government indicates that there is no collective agreement in force covering the country’s nursing personnel. It nevertheless refers to the 19 September 2014 Collective Labour Agreement “on the regulation of the conditions of remuneration and employment of workers, members of primary associations of the Federation of Greek Healthcare Institution Unions (OSNIE) employed at private clinics that are members of the Association of Greek Clinics (SEK) across the country”. The Government adds that legal disputes arising between nursing employees and their employers can be submitted to conciliation, mediation or arbitration procedures. The Committee notes that, each year, the competent department of the Ministry of Labour registers a relatively small number of cases of dispute resolution involving parties from trade union organizations of workers covering hospital staff and employer-operators of health service providers. The Committee also takes note of a series of arbitration awards referred to by the Government. The Committee requests the Government to provide information on the progress and results of collective negotiations to determine employment and working conditions of nursing personnel.

Article 6(g). Social security. The Government indicates that the nursing personnel in the public and private sectors enjoy insurance coverage against risks of old age, disability, death, illness, maternity and unemployment. In response to the Committee’s previous request regarding the List of Arduous and Unhealthy Occupations set out in Law No. 3863/2010, the Government reports that a new List was finalized after consultation with the social partners through the Social Security Council. In this regard, the conclusions of the Standing Committee on Arduous and Unhealthy Occupations, in which representatives of the social partners, experts from the Ministry of Labour and Social Security, former IKA ETAM (current EFKA) and representatives of scientific institutions participated. The Government indicates that the new List attempted to rationalize and modernize the old one, taking into account the technological developments and their consequences in today’s labour data. It also indicates that, under Law No. 3863/2010, employees excluded from the prior List continued to be covered under the pension scheme until the end of 2015, with a view to ensuring their protection. In particular, the Committee notes that the new List stipulates, inter alia, that, male and female nurses working under fixed-term or indefinite contracts in nursing institutions, clinics, microbiological and biochemical laboratories and health insurance institutions are covered under the Regulation on Arduous and Unhealthy Occupations, with the exception of those employed in health centers within the framework of rationalization and modernization of the Regulation on Arduous and Unhealthy Occupations. The Committee requests the Government to supply a copy of the Regulation on Arduous and Unhealthy Occupations. In addition, it reiterates its request that the Government provide information on whether and to what extent this exclusion impacts on social security protection for nursing personnel.

Article 7. Occupational safety and health. In response to the Committee’s previous comments, the Government indicates that the National Strategy for Health and Safety at Work (2016–20) was adopted following consultations with the social partners in the Health and Safety at Work Council of the Supreme Labour Council. The Committee requests the Government to provide a copy of the National Strategy in force. It also reiterates its request that the Government provide information on progress made and results achieved with respect to occupational safety and health for nursing personnel, including in relation to the prevention and treatment of HIV and AIDS.

Direct Request (CEACR) - adopted 2014, published 104th ILC session (2015)

Article 2 of the Convention. Formulation and implementation of policy on nursing service and personnel. The Committee understands that in the context of ongoing austerity measures, various measures are contemplated or have been taken in the health-care sector. It notes that the Government signed an agreement last year with the World Health Organization to implement the health reform support programme for 2013–15, aimed at the realization of, among others, a sustainable and equitable health system and quality care, especially primary health care. It also understands that a national health strategy is being developed. The Committee requests the Government to provide details on these developments, in particular information on the measures taken and results achieved with respect to the components of the abovementioned health reform support programme 2013–15. It also requests the Government to provide a copy of the national health strategy once it is adopted, and to provide information on the activities for nursing personnel and their results. The Committee also understands that a bill concerning a reform in primary health care was submitted to the Parliament, which includes the reform of the National Organization for Health Care (EOPYY). The Committee requests the Government to provide information on the contents of this bill and on any developments made in its adoption and its implementation, especially with respect to nursing personnel.

More generally, the Committee requests the Government to explain how these policies and programmes are formulated in consultation and coordination with relevant employers’ and workers’ organizations and professional associations, as required under paragraphs 3 and 4 of this Article of the Convention.

As regards the issue of shortage of qualified nurses, the Committee notes the information provided by the Government concerning “exclusive” nurses, in particular its reference to the Decision of the Minister of Health and Social Solidarity No. Y4a/oik.37804/25-4-2013 concerning the selection and management of private, including “exclusive”, nurses, and to the Decision of the Minister of Economy and Finance and the Minister of Employment of Social Protection No. 49556/2374/2008 providing for the minimum wages for private nurses. The Committee is of the view that in the context of continuing shortage of nurses in Greece, it is essential to maintain fair and transparent recruiting processes of nursing personnel, and the system of education and training and employment and working conditions for nurses, which are likely to attract persons to the profession and retain them in it, as provided in paragraph 2 of this Article of the Convention. The Committee requests the Government to provide information concerning the current composition of the nursing staff, including the number of graduates in nursing of the technological educational institutes who enter the nursing profession each year, and the number of nursing personnel broken down by those working at public and private health-care establishments and “exclusive” nurses, and the number of those who leave the profession. It also requests the Government to provide information concerning measures taken in order to address the issue of shortage of qualified nurses.

Article 5(2). Determination of conditions of employment and work. The Committee requests the Government to provide information on the progress and results of collective negotiations to determine employment and working conditions of nursing personnel. In particular, please provide a copy of the Collective Labour Agreement currently in force.

Article 6(g). Social security. The Committee notes the information provided by the Government concerning section 17 of Act No. 3863/2010 which provides for a List of Arduous and Unhealthy Occupations, the latest of which was published by Decision of the Minister of Labour and Social Security No. F10221/oik.26816/929/2011. According to the Government, Regulation on Arduous and Unhealthy Occupations (KVAE) does not cover health-care centres, including health-care stations. The Committee requests the Government to provide a copy of this Regulation, and to explain whether this exclusion may impact the social security protection for nursing personnel.

Article 7. Occupational safety and health. The Committee notes the Government’s reference to the National Strategy on Health and Safety at Work 2010–13. The Committee requests the Government to provide information on the preparation of a new National Strategy for 2014 and onwards, and to send a copy once it is adopted. Please also provide information on the progress made and results achieved with respect to the areas related to occupational safety and health of nursing personnel, including the prevention and treatment of HIV/AIDS infections.

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

Article 2, paragraphs 1 and 3, of the Convention. Formulation and implementation of a nursing services and personnel policy in consultation with the employers’ and workers’ organizations concerned. The Committee notes the detailed information supplied in the Government’s report and also the attached documentation. It notes the modifications made to the national health system, in particular the adoption of the “Health and well-being” programme in the context of the third community aid plan. The Committee also notes that one of the aims of this plan is to improve the quality and effectiveness of health services. With regard to the steps taken to implement the abovementioned programme, in particular its priority component concerning human resources, the Committee notes that these measures will enable new services to be created, health personnel to be trained and new staff to be recruited for the newly created units and services. The Committee requests the Government to continue supplying information on the implementation of the abovementioned programme, the results achieved and its impact on the conditions of work of nursing personnel. It also requests the Government to keep the Office informed of any legislative amendments relating to the operation of health services in the public and private sectors and, if applicable, to supply copies of any relevant legislative texts.

Furthermore, the Committee notes that, according to numerous information sources, the country is experiencing a shortage in qualified nursing personnel, to the extent that unusual practices have developed, including the recourse to so‑called “exclusive” nurses, namely female migrant workers employed in a quasi-nursing capacity and even informal hospital services provided by patients’ families which are increasingly tolerated by public establishments. As the Committee understands it, Greece is, along with Italy, the only European Union country in which the number of doctors exceeds the number of nursing personnel in public hospitals. The Committee requests the Government to supply detailed information in its next report on the phenomenon of understaffing in the nursing sector, the conditions of recruitment and work of foreign nurses and “exclusive” nurses – which would appear to constitute a grey area between regular and irregular work – and also the steps taken or contemplated to tackle the shortage in nursing personnel and to provide employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it.

Article 5, paragraph 2. Determination of conditions of employment and work by collective negotiation. Further to its previous comment, the Committee notes the copies of collective agreements supplied by the Government governing the questions of remuneration and conditions of work of nursing personnel employed in public and private hospitals, nursing homes and medical centres. As regards nursing personnel employed on private contracts in the public sector, the Committee notes that remuneration is currently determined on the basis of the uniform salary scale valid for all public service employees. Moreover, as regards conditions of work and pay of nursing personnel employed on a voluntary basis by private associations, the Committee notes the joint ministerial decision of the Minister of Economic and Financial Affairs and the Under-Secretary for Employment and Social Protection. The Committee requests the Government to continue supplying information on the collective agreements in force and on any alteration in the methods of determining conditions of employment and work of nursing personnel.

Article 7. Occupational safety and health. The Committee notes the Government’s statement to the effect that, on the occasion of the World Day for Safety and Health at Work 2006, an information campaign took place concerning biological agents and HIV/AIDS. In this regard, the Committee wishes to draw the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to helping health services to strengthen their capacity for providing workers with a healthy and decent working environment, this being the most effective means of reducing the transmission of HIV and improving the provision of care for patients. The Committee would also like to refer to the discussion held at the June 2009 session of the International Labour Conference on “HIV/AIDS and the world of work”, with a view to the adoption of an international labour recommendation, in particular paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310), which states 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. The Committee requests the Government to keep the Office informed of any new measure taken or contemplated in order to improve the protection of nursing personnel against infectious diseases, including HIV/AIDS.

Part V of the report form. Practical application. The Committee notes the statistics supplied by the Government concerning the number of qualified auxiliary nurses and also the number of persons who took a training course during the 2002–08 period. The Committee requests the Government to continue supplying information on the application of the Convention in practice, including, for example, statistics on the number of nursing personnel – by sectors of activity and by levels of training and functions, if possible – the number of persons entering and leaving the profession each year, the number of students enrolled in various nursing schools, copies of reports or official studies, and information on any practical difficulties encountered in the implementation of the Convention, etc.

Direct Request (CEACR) - adopted 2004, published 93rd ILC session (2005)

The Committee takes note of the information provided by the Government in its report.

Article 2, paragraphs 1 and 3, of the Convention. In light of current challenges facing health-care systems in general, such as rising costs and restructuring of health services, advances in medical technology and work reorganization, or growing workload and stress, the Committee requests the Government to outline the objectives and priorities of its policy concerning nursing services and to elaborate on any time-bound action plan, programme or initiative aiming at improving the quality of nursing care, promoting knowledge and skill enhancement for nursing personnel and ensuring sufficiently rewarding working conditions for the practice of the nursing profession.

Article 5, paragraph 2. The Committee would thank the Government for transmitting, together with its next report, copies of all labour collective agreements currently in effect regulating remuneration and working conditions of nursing personnel employed in public or private hospitals, nursing homes and medical centres.

Article 7. The Committee notes that Presidential Decree No. 186/1995 on the protection of workers from risks related to exposure to biological agents at work in compliance with Council Directives 90/679/EEC and 93/88/EEC, which has last been amended by Presidential Decrees Nos. 174/1997 and 15/1999, makes reference to the human immunodeficiency virus (HIV) in conformity with the provisions of Commission Directives 97/59/EC and 97/65/EC. The Committee would appreciate receiving copies of the latest amendments and requests the Government to keep it informed of any new measures or initiatives, legislative or others, on these matters, especially as regards the occupational health and safety situation of nursing personnel.

Part V of the report form. The Committee notes that according to the statistical information supplied by the Government there were approximately 36,000 nurses and midwives employed across the country in 1998-99. The Committee would be grateful if the Government would continue to supply information on the application of the Convention in practice, including for instance statistics on the nurse-to-population ratio, the number of students attending nursing schools and the number of nurses leaving or joining the profession, copies of official reports (e.g. annual reports of the National Council for the Development of Nursing Care and Nursing Services (ESAN)) addressing labour and employment issues concerning nursing services and nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

Article 7 of the Convention. The Committee takes note of the information provided by the Government in its report on the adoption of Presidential Decree No. 186/1995 respecting the protection of workers against the risk of exposure to biological agents in places of employment, in compliance with the Council Directives Nos. 90/679/EEC and 93/88/EEC. In addition, and reiterating its previous comments, the Committee would be pleased to receive information with the Government's next report on the measures taken or contemplated, in consultation with the employers' and workers' organizations concerned, with regard to the maintenance of the employment relationship of nursing personnel infected or considered to be infected with HIV, such as confidentiality of test results, recognition that the cause of infection was occupational, longer annual holidays, financial compensation, more frequent rest breaks, etc.

Part V of the report form. The Committee hopes that the Government will supply information on the manner in which the Convention is applied in practice, including statistics on the numbers of nursing personnel and their relation to population, and eventually data on the number of persons leaving the profession. Please also report any difficulties encountered in practice in the implementation of the Convention.

Direct Request (CEACR) - adopted 1995, published 82nd ILC session (1995)

The Committee takes due note of the detailed information supplied by the Government in reply to its previous direct request.

Article 7 of the Convention. The Committee requests the Government to indicate the measures which have been taken or are envisaged to improve existing laws and regulations on occupational health and safety by adapting them to the special nature of nursing work and of the environment in which it is carried out. Furthermore, with reference to its general observation of 1990, which it reiterated in 1994, the Committee requests the Government to indicate the measures which have been taken or are envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, the arrangement of conditions of work, confidentiality of test results, recognition that the cause of infection was occupational, etc.

Point V of the report form. The Committee notes the statistics supplied by the Government in its last report. It hopes that the Government will continue to supply such statistics, and that it will provide information on the number of persons leaving the occupation. Please also report any difficulties encountered in practice in the implementation of the Convention.