Direct Request (CEACR) - adopted 1990, published 77th ILC session (1990)

Nursing Personnel Convention, 1977 (No. 149) - Portugal (Ratification: 1985)

The Committee has taken note of the detailed information and the documentation supplied by the Government in reply to earlier comments and to the allegations formulated by the General Confederation of Workers of Portugal (CGTP/IN) and by the Nursing Personnel Union of the southern district and of the autonomous region of the Azores. The Committee has also noted the comments formulated by the Portuguese Nurses' Union (SEP) on the Government's reply to these allegations. These comments were transmitted by the above-mentioned union confederation with its communication of 23 January 1990, a copy of which was sent on 6 February 1990 to the Government for its observations.

The Committee would also like to draw attention to the following:

Article 2, paragraphs 1 to 3, of the Convention. The Government refers in its report to the efforts undertaken, and to the legislative and other measures adopted, to improve working conditions, hours of work, remuneration and career prospects of nursing personnel, notably by Legislative Decree No. 134/87. It indicates, on the basis of the statistical data supplied, that during the period covered by the report, membership of this profession had increased (from 22,084 in 1987 to 23,641 in 1988), that the vast majority (about 90 per cent) are employed in the public sector and that the employers' and workers' organisations concerned are consulted on the formulation and adoption of the policy concerning nursing services and nursing personnel. With regard to the private sector, the Government states that conditions of employment in this sector are determined by collective agreements which stipulate standards comparable to those that apply in the public sector. The comments of the above-mentioned organisations, however, indicate that Legislative Decree No. 134/87 has not been applied in an equal fashion to nursing personnel assigned to the various ministries or to all categories of this personnel, and that the geographical distribution of nursing personnel has deteriorated owing to the lack of measures designed to encourage the assignment of this personnel to rural and peripheral regions. The Government admits that it is indeed difficult to engage nursing personnel in certain districts of the country, but it indicates that measures are being studied with a view to remedying the situation. As regards nurses engaged under contract ("tareifeiros"), as a result of the freeze on recruitment to the public sector (introduced by Legislative Decree No. 41/84) despite the shortage of nursing personnel - a question also referred to in the comments from the trade union organisations - the Government admits that the number of these nurses has increased from 2,380 on 31.12.87 to 2,656 on 31.12.88, but it indicates that legislative provisions are being formulated with a view to putting these workers on the same footing as public servants so as to improve the situation. The Committee notes these indications and the efforts being made by the Government. It hopes, however, that the necessary measures will be adopted within the framework of a general health programme with a view to improving the quantity and quality of nursing care in accordance with the Convention, by providing appropriate education and training, employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it. (In this respect, the Committee notes that according to the comments of the trade union organisations the number of persons leaving the profession is still fairly high.) The Committee would be grateful if the Government would indicate all progress made in this respect, and especially with regard to improving the status of nurses engaged under contract, the measures adopted to attract nursing personnel to the rural and peripheral regions and to increase the number of nurses assigned to primary health care, a category of personnel which appears to be lacking in certain hospitals, according to the above-mentioned comments from the trade union organisations.

Article 2, paragraph 4. The Committee again requests the Government to indicate the measures introduced or planned to improve co-ordination between the various health institutions, and to co-ordinate the policy concerning nursing personnel with policies relating to other aspects of health care and to other workers in the field of health, in consultation with the employers' and workers' organisations concerned, in accordance with the above-mentioned provision of the Convention.

Articles 3 and 4. The Committee notes with interest the adoption of Legislative Decree No. 261/88 referred to in the report, which defines admission requirements for general nursing training, and the adoption of Legislative Decree No. 480/88 which provides for the integration of nursing training into the national education system and stipulates that this training shall be subject to control by the Ministry of Education and the Ministry of Health. The Government also indicates that an official course designed to train ancillary personnel was created by the Ministerial Decree No. 7/89, and that with regard to the comments of the employers' and workers' organisations, according to which certain courses intended for this personnel category are still being given without any inspection being carried out by the competent authorities, or that they are being given by unqualified persons, these comments had been reported to the governing bodies of the hospitals concerned so that they may take the necessary steps. The Government adds that a Circular from the Department of Human Resources for Health (No. 12/89) has been sent to all hospital establishments within the jurisdiction of the Ministry of Health to ensure that ancillary personnel are assigned exclusively to tasks for which they had been trained.

The Committee notes this information and would be grateful if the Government would supply details on the results of these reforms, and hopes that measures may also be adopted to increase the number and improve the situation of nursing personnel training instructors, as referred to in the comments of the above-mentioned trade union organisations.

Article 5, paragraph 1. In its previous comments, the Committee had referred to observations by the Nursing Personnel Union indicating that nursing personnel were not sufficiently consulted on decisions concerning them. It had therefore requested the Government to indicate the measures introduced or planned to promote better possibilities of consultation with the personnel in question on decisions concerning them. In its latest report the Government supplied certain information on consultations which are taking place at various levels with members of the personnel and indicated its intention of involving representatives of the nurses' unions in the consultations due to take place with a view to modifying the legislation in force on the practice of the nursing profession. The Government also referred to the participation of these representatives in working groups organised by regional and international agencies.

The Committee takes note of this informnation and hopes that the Government will make every effort to encourage the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them at national level, as well as at the level of the hospital establishments where they work.

Article 6. The Committee notes that, according to the information supplied by the Government on the subject of hours of work, weekly rest time, paid annual holidays and educational leave of nursing personnel in the public sector, conditions are the same as those that apply to public servants. With regard to the private sector, the Committee notes that the above questions are dealt with in the collective agreements, in particular, in the agreement which came into effect on 1 May 1988 between the Portuguese Association of Private Hospitals and the Portuguese Nursing Personnel Union. The Committee would be grateful if the Government would supply a copy of this Convention, bearing in mind that the copy attached to the report dates from 1986.

The Committee would also be grateful if the Government would indicate the provisions that ensure the application of sub-paragraphs (e), (f) and (g) of the Convention concerning maternity leave, sick leave and social security in the case of nursing personnel employed in the public sector.

Article 7. The Committee notes with interest the information supplied by the Government on the extension of occupational health and safety legislation to commercial establishments, offices and services including nursing personnel under the jurisdiction of the Ministry of Health. It would be grateful if the Government would keep it informed of all further developments in this respect and especially of all the provisions introduced to adapt this legislation to the special nature of nursing work and of the environment in which it is carried out.