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

Nursing Personnel Convention, 1977 (No. 149) - Russian Federation (Ratification: 1979)

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Article 2(b) and 5 of the Convention. National policy concerning nursing services and nursing personnel. Working conditions. Working time and remuneration. The Government indicates that in order to eliminate staff imbalances in medical organizations and their units located in rural areas or in workers’ settlements, urban-type settlements and cities with a population of up to 50,000 persons, since 2018 the Government has co-financed the expenses of medical workers, including nursing staff (paramedics), posted from cities to rural areas, through one-off compensation payments with the aim of retaining these medical workers on a permanent basis. The Government further indicates that current legislation provides for the differentiation of five levels of remuneration for nursing staff based on the qualifications, complexity and specificity of the professional activity. Moreover, an assessment of the development of workers’ skills is carried out as part of their certification for qualification categories, with a corresponding increase in the level of salaries. The Government also reports that obtaining a qualification category or recognition of a high level of specialist training grants a slight increase in salary, but not greater clinical powers. At the federal level, the average salary for nursing staff in each healthcare organization must be at least 100 percent of the average monthly labour income in the region. According to the Government, specific remuneration agreements have been established at the medical organization level. Furthermore, the Government reports that all health care workers have a reduced working time of 39 hours per week (as opposed to 40 hours per week in other sectors). Depending on the complexity of the work, additional social benefits are granted in the form of reduced working hours by a percentage (36, 33, 30, 24 hours per week) and, in the case of employees working under harmful conditions, they are granted increased paid annual leave. As for shift work, it is regulated by collective agreement in a medical organization and is usually for periods of 12 or 24 hours. The Government further states that the health care system has a unified nomenclature of specialties, which provides for differentiation of nurses and other comparable staff in terms of qualification level in various areas of health care with limited access to employment based on educational background. According to the Government, consultations are currently underway between the federal health authority and the social partners, including the professional nursing association to decide whether this nomenclature needs updating. The Committee requests the Government to continue to provide detailed updated information on the nature and impact of the measures taken to provide nursing personnel with employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it, particularly in rural and remote areas of the country. In addition, the Committee requests the Government to supply information regarding wages, benefits and career prospects for nurses as compared to other similar occupations in all regions. The Committee also requests the Government to provide up-to-date information on the consultations carried out with the employers’ and workers’ organizations concerned, with regard to such measures, including the results of the consultations on the updating of the unified nomenclature of specialties.

Article 2(2)(a) and (3). Education and training. The Government indicates that, under the 2018 Healthcare National Project, the Federal Project “Providing health system medical organizations with qualified personnel”, provides for the implementation of a set of measures in the area of education and training aimed at increasing the number of nurses, included those whose training is financed from the state and municipal budgets; and developing specific training to prepare a professional for a known job position in advance, with additional benefits and social support during the training period. The Government further indicates that there is a unique bachelor’s degree programme in nursing which offers the same conditions and the same programme to medical graduates and nursing graduates from medical schools, including those with specialized work experience. Moreover, in order to increase the number of doctors and nurses, Decree No. 1304 of 9 October 2019 on the “Principles of modernization” of primary health care was issued, which ordered the increase of the number of students in professional educational organizations by at least 30 percent annually due to the existing shortage of specialists (section 1.4.7), by training specialists with secondary medical education, starting 2020/21. In 2021–22, it was envisaged to increase the total number of admissions for specialty, bachelor’s and master’s degree programmes by 7.8 per cent compared to previous year. On the other hand, the Government indicates that in order to support the employment of nurses in rural areas and remote settlements it attracts school-leavers living in these places with accommodation and social support measures for the duration of their studies; and establish a network of college branches in isolated areas. The Committee requests the Government to provide information on the nature and the impact of the measures implemented in the framework of the Decree No. 1304 of 9 October 2019 on the “Principles of modernization” of primary health with regards to the increase of the number of nurses, as well as on any measures taken or envisaged to ensure that nursing personnel are provided with education and training appropriate to the exercise of their functions. It further requests the Government to continue to provide statistical information, disaggregated by sex, age and region, on the number of persons enrolled in nursing schools and the number of female and male nurses who enter and leave the profession each year, including in rural and remote areas of the country.

Article 7. Occupational safety and health. The Government indicates that Federal Law No. 426-FZ of 28 December 2013 on the special assessment of working conditions provides that the assessment of risks in the workplace of nurses is carried out through a special procedure that takes into account the hazard class. In case of working in harmful and/or dangerous working conditions, medical workers, including nurses, receive additional salary and holidays. The Committee welcomes the information that negotiations between the federal health authority and professional nursing associations take place regularly to ensure effective protection of the occupational safety and health at work of nurses. Recalling the recent recognition of the right to a safe and healthy working environment as a fundamental principle and right at work, the Committee requests the Government to provide copies of collective agreements that have been concluded between the federal health authority and professional nursing associations regarding the occupational safety and health at work of nurses. It also requests the Government to provide information on any safety measures taken or envisaged to improve working conditions in respect of safety, health and security for nursing personnel.

Application in practice. The Committee notes that, according to the latest accessible OECD data, in 2019 there were 8.5 nurses per 1,000 inhabitants. The Committee requests the Government to provide information, including updated statistics, on how access to healthcare in both rural and urban areas has evolved over the last 10 years. The Government is also asked to supply copies ofreports by inspection services as regards compliance with the labour law framework in the healthcare sector. It also 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 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.