Direct Request (CEACR) - adopted 2010, published 100th ILC session (2011)

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

Article 2 of the Convention. Measures to attract nursing personnel to the profession and to retain them. The Committee notes the Government’s indications that the admission quotas for nursing schools increased from 19,400 in 2000 to 30,000 in 2003 and have since remained at this level. It notes that, according to demographic forecasts, there will be around 650,000 nurses in 2025, that is 45 per cent more than in 2005. However, the Committee understands that around 10 per cent of the places available in nursing training institutes (IFSI) are not filled and that just over 20 per cent of the students enrolled in the first year do not complete their training. The Committee requests the Government to provide further information on this matter and on the measures taken to remedy this situation. The Committee also notes with interest the launch in 2008 of the campaign entitled “Your Hospital Needs You”, which aims to promote all hospital jobs, including the nursing profession, with a view to filling 200,000 posts over a period of five years. It notes that a regional nursing plan was drawn up in the
Île-de-France region covering the period 2003–06 and then updated to cover the period 2008–13. The three themes of the plan are attractiveness, training and staff retention. The Committee requests the Government to indicate the results of these campaigns and to provide information on any similar initiatives adopted in other regions. In general, the Committee requests the Government to provide information on any regional disparities in terms of the number of nursing personnel in relation to the total population and, if applicable, on the measures taken to improve the distribution of nursing personnel across the national territory and the impact of these measures.

The Committee also requests the Government to provide information on any programmes implemented relating to the recruitment of nursing personnel from abroad. In this regard, it refers to the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted on 21 May 2010, which lays down the ethical principles governing international recruitment and aims to strengthen the health systems of developing countries, countries in transition and small island States.

Furthermore, the Committee notes the adoption of the Act of 21 July 2009 introducing hospital reforms and concerning patients, health and territories, which provides for the creation of regional health agencies and substantially reforms the governance of hospitals, including the conclusion of long-term agreements on objectives and means. It also understands that a large number of job losses is envisaged in public hospitals. The Committee requests the Government to provide further information on the impact of this reform on the working conditions of nursing personnel and on the reductions in nursing personnel envisaged in the public sector.

The Committee also notes the draft agreement concluded on 2 February 2010 between the Health and Sports Minister and five trade union organizations concerning the inclusion of nurses who graduate from IFSI in category A of the hospital civil service, resulting in a pay increase for the personnel concerned. It also notes that, under section 37 of Act No. 2010-751 of 5 July 2010 reforming social dialogue and containing various provisions relating to the civil service, nurses and paramedical staff having the status of civil servants in category A are no longer grouped in the active category of the civil service, which previously allowed them to retire at 55 years of age instead of at 60 years of age due to the difficult nature of their work. It notes that, during a six-month period starting on 1 September 2010, civil servants currently in employment may choose to remain in category B and benefit from a limited pay increase while retaining the right to retire earlier, or be moved to category A and renounce this right. The Committee understands that the new provisions applicable, in particular the major concessions that have to be made in terms of retirement rights in order to move into category A, have been very controversial among nursing personnel. It requests the Government to provide further information on this reform and its expected impact on the attractiveness of the nursing profession, as well as on the way in which this reform relates to the current debate concerning the plans to raise the retirement age.

Article 3. Training. The Committee notes the adoption of the Order of 31 July 2009 concerning the state nursing diploma. It understands that this text has given rise to some fears among the nursing personnel concerning the duration of the training reduced from 38 to 34 months, the number of hours of study, from 4,760 to 4,200 (the number of hours allocated to individual work has in turn been increased) and the duration of placements, from 68 weeks to 60 weeks. The Committee requests the Government to provide any information it has available in reply to the concerns expressed.

Article 5. Consultation of nursing personnel on decisions concerning them. The Committee notes the adoption of Act No. 2006-1668 of 21 December 2006 creating a National Association of Nurses which is intended to replace the Central Council for the Paramedical Professions with an interdisciplinary body designed to create the necessary links between all health system stakeholders. It notes the organization of the first elections of the departmental and regional councils, as well as those of the national council, which were held in 2008. It notes that the Association is entrusted with the task of ensuring the monitoring of the number of staff in the profession and defending the profession or professionals and that it should be consulted on legislative texts and regulations concerning the nursing profession. The Committee requests the Government to provide information on the functioning of the National Association of Nurses in practice and on the role that it plays in improving the working conditions of nursing personnel in France.

Article 7. Occupational health and safety. The Committee notes that the above draft agreement of 2 February 2010 provides for the continuation of local agreements on improved working conditions by placing greater emphasis on actions relating to the prevention of occupational hazards and improved organization of the work. It requests the Government to provide more detailed information on the measures taken with a view to adapting the occupational safety and health regulations to the specific characteristics of the work of nursing personnel. In this regard, the Committee draws the Government’s attention to the HIV and AIDS Recommendation, 2010 (No. 200), which was adopted by the International Labour Conference in June 2010, and in particular to Paragraph 31 of that Recommendation, which provides that “Safety and health measures to prevent workers’ exposure to HIV at work should include universal precautions, accident and hazard prevention measures …, environmental control measures and post-exposure prophylaxis and other safety measures to minimize the risk of contracting HIV and tuberculosis, especially in occupations most at risk, including in the health-care sector”.

Part V of the report form. Application in practice. The Committee would be grateful if the Government would continue providing general information on the manner in which the Convention is applied in practice, in particular in overseas departments and collectivities, including, for example, statistics relating to the number of nursing personnel, disaggregated, if possible, by level of training and function, gender and age, the nurse-to-population ratio, the number of persons joining and leaving the profession each year, copies of official reports or studies concerning nursing services, as well as information concerning any difficulties encountered in practice in implementing the Convention.