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

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

The Committee notes the observations of the Central Organization of the Finnish Trade Unions (SAK), the Confederation of Unions for Professional and Managerial Staff in Finland (AKAVA) and the Finnish Confederation of Professionals (STTK), received on 30 August 2018.

Article 3(1) of the Convention. Education and training of nursing personnel. In their observations, the workers’ organizations indicate that a vocational education reform entered into force at the beginning of 2018, which will fundamentally modify vocational education and training, including the training of basic nurses. The Committee requests the Government to provide its comments in this respect.

Article 7. Occupational safety and health. In their observations, the workers’ organizations refer to an amendment to the Communicable Diseases Act, which entered into force on 1 March 2018. They indicate that the amendment requires all nursing staff to receive certain vaccinations to promote patient safety, observing that employers have interpreted the amendment to mean that, if an employee refuses to be vaccinated, the employer may terminate the employee. Furthermore, the workers’ organizations allege that much of the healthcare sector implements a three-shift system, including night work. However, the possibility of reducing negative effects of night work with shift arrangements has not been utilized in a comprehensive manner in the healthcare sector. The Committee notes the concerns expressed by the workers’ organizations in respect of the working conditions of employees in the healthcare sector. They indicate that, according to a public sector survey on well-being at work (2016), 71 per cent of employees in the health sector found their work to be mentally taxing, 51 per cent found it physically taxing and 49 per cent had experienced violence or threat of violence, primarily in centralized hospital emergency units. The workers’ organizations call for more specific legislation to protect employees from these risks. In its report, the Government indicates in response to the Committee’s previous comments that occupational safety and health enforcement has targeted the healthcare sector and that reduction of physical and psychosocial load borne by healthcare sector workers, and preparing such workers for the possibility of the threats of violence were identified as key development areas for the sector. The Committee notes the Government’s indication that occupational safety and health activities in the healthcare sector have proved challenging, since the rapid pace of change in the service structure also requires reforms to safety management. The Committee requests the Government to provide its comments with respect to the observations of the SAK, the AKAVA and the STTK and to provide information on the measures taken or envisaged to ensure the health and safety of nursing personnel.

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

Article 2, paragraphs 1 and 3, of the Convention. National policy on nursing services and nursing personnel. The Committee notes the Government’s explanations concerning the aims and implementation of the Target and Action Plan for Social Welfare and Health Care 2000–03 and the Development Project for Social Services 2003–07. It also notes that the National Development Programme for Social Services and Health Care, which started in 2008, is expected to continue the development work while the Health 2015 programme has identified eight targets for public health emphasizing, among others, the need to take health promotion into account in the training of all health professionals. The Committee would be grateful if the Government would provide in its next report up to date information on the application of the new programmes and also describe how these programmes are expected to impact on the quality of nursing services and the employment and working conditions of nursing staff. To the extent that the above general health programmes determine or directly affect the national policy for nursing services and nursing personnel, the Committee would appreciate if the Government would specify whether and how the employers’ and workers’ organizations concerned have participated in the formulation of these programmes, as prescribed by this Article of the Convention.

Article 3. Nursing education and training. The Committee notes the Government’s indications about the projected labour needs and openings in the field of health and social services. It notes in particular that, even though the number of nurses working in municipal social and health care has increased by 40 per cent between 2000 and 2006, the shortage of nursing personnel has also increased and amounted to 4.7 per cent in 2008 as compared to 2.4 per cent in 2005. The Committee understands that initiatives in recent years to encourage the return of Finnish nurses working abroad, mainly in Norway and the United Kingdom, produced little result. It also understands that, in one of the latest developments in efforts to tackle the growing shortage of health professionals, private health-care companies have proceeded with plans to hire nurses from the Philippines, while the Government is reportedly negotiating a bilateral labour agreement with the Government of Philippines to the same effect.

In this respect, the Committee wishes to refer to the draft WHO code of practice on the international recruitment of health personnel, currently under consideration, which urges member States to enter into bilateral and multilateral arrangements to promote cooperation and coordination on migrant health personnel recruitment processes in order to maximize the benefits and mitigate the potential negative impact of international recruitment of health personnel, and also calls for measures in order to retain and sustain a skilled domestic health workforce by improving their social and economic status, their living and working conditions, their opportunities for employment and their career prospects. The Committee requests the Government to continue supplying detailed information on the evolution of the situation and on any additional measures to address the problem of shortage of qualified nurses having due regard to fair and ethical recruitment practices.

Article 7. Occupational safety and health. The Committee notes that the National Public Health Institute and the Finnish Institute of Occupational Health have published guides that are particularly useful for nursing personnel, including a guide on blood contamination at work and a revised guide on needle pricks and other injuries. It also notes the information on the working group on the protection of nursing personnel in the event of a pandemic and the occupational safety monitoring scheme for health care. The Committee requests the Government to continue providing full particulars on any measures, legislative, administrative or others, seeking to improve the occupational safety and health standards applicable to health-care workers.

In this respect, the Committee draws the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to assisting health services in building their capacities to provide their workers with a safe, healthy and decent working environment as the most effective way both to reduce transmission of HIV and to improve the delivery of care to patients. The Committee wishes also to refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides 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.

Part V of the report form. Application in practice. The Committee notes the statistical information provided by the Government in its report according to which 85 per cent of all registered nurses are employed in the public sector, the nurse-to-population ratio stands at ten nurses for every 1,000 people, and the number of students attending nursing schools has increased from 11,000 in 2004 to almost 14,000 in 2007. The Committee would be grateful if the Government would continue transmitting all available information on the manner in which the Convention is applied in practice, including, for instance, statistics on the overall nurse workforce, the number of nurses leaving or joining the profession, any measures or initiatives to further improve the conditions of employment of nursing personnel (for instance, organization of hours of work with due regard for health workers’ preferences and work–family balance, pay incentives, training scholarships, etc.).

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

Article 5, paragraph 3, of the Convention. Settlement of disputes. The Committee notes the observations made by the Commission of Local Authority Employers (KT) concerning the industrial action taken by the Union of Health Professionals (TEHY) during the collective negotiations held in autumn 2007. According to these observations, the TEHY attempted to force a 25 per cent pay increase by undertaking a mass resignation that directly and critically threatened the life and health of patients. TEHY action allegedly affected emergency units and operations in complete disregard of ministerial directives and established labour practices. The Committee requests the Government to transmit any comments it may wish to make in reaction to the observations of KT, especially in light of Article 5(3) of the Convention which requires the settlement of collective labour disputes through independent and impartial procedures such as mediation, conciliation and voluntary arbitration with a view to making it unnecessary for the organizations of nursing personnel to have recourse to industrial action which may be disruptive of sensitive health-care operations.

The Committee is raising other points in a request addressed directly to the Government.

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

The Committee takes note of the information provided in the Government’s detailed report and the attached documentation.

Article 2, paragraphs 1 and 3, of the Convention. The Committee notes with interest the information concerning the four-year target and action programmes for social welfare and health care aiming at guiding the way social welfare and health care are organized by municipalities and issuing the necessary recommendations for action. The Government indicates that upon the completion of the first programme covering the period 2000-03, the Ministry of Social Affairs and Health is currently working on the next target and action programme for 2004-07. The Committee requests the Government to provide additional information on the implementation in practice of the 2000-03 programme and the priorities and objectives fixed for the new action plan.

In addition, the Committee notes with interest the information concerning the formulation of the "Health 2015" public health programme which sets out the national health policy for the next 15 years based on the WHO’s "Health for All" programme. It also notes the adoption of the 2002 Government resolution on securing the future of health care which draws special attention to the need for ensuring the availability of skilled personnel and provides for training and skill enhancement measures for health-care professionals. The Committee would be particularly interested in receiving information on concrete measures implementing the above policies and resolutions and the practical results obtained in terms of nursing staff trained, professional advancement and quality of nursing care. It would also be grateful if the Government would communicate information of any future action or policy decision on these matters, especially in the light of the Munich Declaration of June 2000 regarding nursing and midwifery and the WHO European Strategy for Nursing and Midwifery Education.

Article 3. The Committee notes that according to the Government’s forecast for 2001-10, an additional 6,300 employees are needed to remedy the present shortfall in nursing staff. Altogether 12,000 persons will be needed in social and health services during that period when 49,000 to 55,000 employees are expected to retire. The Government reports that some 330 new first-year places were created at polytechnics in 2002-03 while provision is made for some 250 additional places in 2004. With regard to continuing training for practicing nurses, the Government indicates that changes are scheduled to take effect in 2004 aiming at making the sector more interesting through long-term supplementary training so as to ensure the continuous vocational development of nursing staff in line with changing demands in health-care and medical technologies. The Committee requests the Government to keep it informed of the evolution of the situation as regards the shortage of nursing personnel and to elaborate on the new training arrangements in health care.

Articles 5 and 6. While noting the information supplied by the Government concerning the participation of nursing personnel in work planning and the latest amendments to the legislation on working time, the Committee requests the Government to transmit together with its next report copies of all collective agreements currently in force regulating employment terms and working conditions of nursing personnel employed in public or private hospitals, nursing homes and medical centres.

Article 7. The Committee notes with interest the adoption of the new Occupational Safety and Health Act (738/2002) which contains some new provisions on health risk factors of particular relevance to the health care sector such as excessive strain, harassment, exposure to biological and chemical agents and violence. It also notes the adoption of the Occupational Health Care Act (1383/2002) and the implementing Government Decrees (1484/2001 and 1485/2001) which include abnormal temperatures, night work and threat of work-related violence among the examples of work causing special risk and may therefore be of importance in certain nursing professions. Moreover, the Committee notes the Government’s indication that to date there have been no reported cases of work-related HIV infection. The Government adds that the Occupational Diseases Decree has been amended to include hepatitis C to the list of communicable blood-borne occupational diseases and that a revised handbook on communicable blood-borne diseases intended for health workers is under preparation. The Committee requests the Government to keep it informed of any new measures or initiatives regarding the adaptation of existing laws and regulations on occupational safety and health to the special nature of nursing work.

Part V of the report form. The Committee would be grateful to the Government for supplying detailed information on the practical application of the Convention, including for instance up-to-date statistics on the number of nurses employed in the public and private sectors, the nurse-to-population ratio, the number of students attending nursing schools, the number of nurses prematurely leaving the profession, copies of official reports or studies addressing labour and employment issues concerning nursing services and nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

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

The Committee notes the Government’s reply to the comments made earlier by the Union of Health Professionals (TEHY) alleging subordination of nursing services to medical activity, insufficient wages, non-equality of payment between men and women, lay-offs and retrenchments within the health-care system and the negative impact these factors produce in the employment relationships of the nursing sector. The Government recognizes that the proportion of personnel that find their work somewhat or entirely stressful is higher in the nursing sector than in other sectors and refers in this respect to the higher number of sick leave days per year observed in the municipal sector in general. The Government indicates, however, that efforts are made to help personnel in the municipal sector cope with their work such as the preparation of a handbook on municipality management and a brochure on coping at work designed specifically for health-care workers. In addition, the Government, while recognizing that there are in practice a large number of temporary substitutions in this sector arising from the fact that most personnel are women and use a lot of statutory childcare leave, job alternation leave and study leave, reports that fixed-term posts have been made permanent on a large scale especially in health care. Finally, the Government notes that there are no major differences between men’s and women’s pay levels in the sector unless what was meant by inequality of pay in TEHY’s comments was that men in male-dominated fields such as engineering may well earn more than nurses under the terms of their collective agreements. The Committee notes the Government’s explanations but wishes to receive more concrete information on the extent of lay-offs and retrenchments operated in health care, and the measures taken or envisaged to fight precariousness and promote employment stability of nursing personnel. In relation to the comments on alleged wage differentials between men and women in the sector, the Committee will examine this issue at its next session under Convention No. 100.

The Committee is also addressing a direct request to the Government on certain points.

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

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

Article 2, paragraph 1, of the Convention. The Committee takes note with interest of the information according to which:

-- a national plan was elaborated to make available social and health services to all citizens and to ensure the continuity of social and nursing services by increasing the number of permanent jobs;

-- the framework for developing the social and health services will be reformed this year to be replaced by a four-year target and an action programme which defines the essential development objectives of the social and health care sector and its follow-up, the measures needed to achieve these objectives and the persons responsible for their implementation;

-- a long-term plan will be drawn up for emphasizing the status of the personnel and identifying measures to counteract the exhaustion of the employees in the social and health care sector, improving their expertise and ensuring employment;

-- labour market organizations should revise the basis for wages in the social and health care sector to encourage them to make a more efficient performance than at present;

-- a plan called Health Care for the 2000s action was initiated in 1998 to --among other objectives -- develop nursing services;

-- in accordance with the Act on Health Care Professionals, the Council of State has appointed a consultative committee for health service professionals to propose motions for the education and professional activity of health care professionals;

-- a personnel programme for the municipal social and health sector is under preparation at the Ministry of Social Affairs and Health to improve the coping and expertise of the nursing personnel;

-- a document called The Trend of Nursing was published in 1997 to underline the fundamental role of nursing personnel;

-- the nursing occupations is one of the sectors covered by the Programme for Aging Workers (1998-2002) which attempts to improve working conditions.

The Committee requests the Government to report on any progress achieved in the development of the abovementioned programmes.

Article 4. The Committee takes note of the information of the Government in relation to the adoption of the Act concerning Health Care Professionals (559/1994) which promotes the recognition of conditions for vocational practice. The Committee requests the Government to supply a copy of the Act.

Article 6. The Government takes note of the information contained in the Government's report on the adoption of several Acts (e.g. the Working Hours Act (605/1996) and the Act to amend the Study Leave Act (58/1997)). The Committee requests the Government to supply further details on the provisions of these Acts related to each of the field of this Article of the Convention in relation to nursing personnel and to communicate copies of the relevant texts.

Article 7. The Committee takes note of the information of the Government according to which by virtue of the Council of State Decision (1409/1993) the Council Directive of 29 May 1990, 90/269/EEC on the minimum health and safety requirements for the manual handling of loads where there is a risk particularly of back injury to workers, has come into force on 1 January 1994. The Government informs that this directive also concerns nursing personnel who are exposed to the risk of back injuries when they lift or handle patients.

With reference to its general observation of 1990 which it repeated in 1994, the Committee notes the information that:

-- Work-related diseases transmitted by blood are recognized as occupational diseases in accordance with the Occupational Diseases Act (1343/1988).

-- The decision of the Council of State (1155/1993) on the protection of workers against hazard caused by biological factors provides for inspection visits by occupational health officers, instructions on working methods and personal protection, regular information services and, in the field of nursing, systematic registration of hazardous situations.

-- Employers' and workers' organizations, including professional health care organizations, and a number of hospital districts and health centres were consulted during the preparation of the above regulations.

-- No work-related HIV infections have been diagnosed in the country.

The Ministry of Social Affaires and Health published a guide on blood-transmitted diseases in occupational life in 1994 (updated in 1998) concerning prophylactics and measures following exposure. Physicians and nursing personnel of a hospital unit treating infectious diseases (including HIV/AIDS) were consulted before the final edition of the text. The Committee requests the Government to continue providing information on these issues and on the measures taken or contemplated with respect to nursing personnel who are infected or considered to be infected by HIV (e.g. adaptation of conditions of work, etc.).

Part V of the report form. The Committee takes note with interest of the tables attached to the report containing data on nursing personnel. The Committee notes the information that the number of unemployed in the nursing sector has remained more or less unchanged during 1994 to 1999, and that graduates from vocational nursing institutes have had difficulties in finding work in different parts of the country. The Committee notes that the social and health care personnel of the municipal sector, which decreased by 5 per cent during the early 1990s, started to increase during the last few years and decreased in 1998 to the same level it had at the beginning of the 1990s. Thus, the Committee requests the Government to continue to provide information on the variations of the number of nursing personnel leaving the profession.

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

The Committee notes the information provided by the Government in its report, as well as the observation made by the Union of Health Professionals (TEHY) alleging subordination of nursing services to medical activity, insufficient wages, non-equality of payment between men and women, lay-offs and retrenchments within the health care system and the negative impact these factors produce in the employment relationships of the nursing sector. The Committee requests the Government to provide a response to these comments made by the TEHY.

The Committee is also addressing a direct request to the Government on certain points.

Direct Request (CEACR) - adopted 1994, published 81st ILC session (1994)

With reference to the previous direct request, the Committee notes the information, in particular that on the application of Article 5, paragraph 1, of the Convention, and the copies of legislation as well as the comments made by the Union of Health Profesionals (TEHY), supplied by the Government with its report.

Article 2, paragraph 1. The Committee notes the information supplied by the Government indicating increased unemployment in the nursing sector, although at a lower rate than that for all sectors combined, in contrast with the shortage of health care personnel a few years ago. It also notes that TEHY points out in its comments that the number of health care posts and personnel is no longer monitored in the modified five-year plan approved by the Government, thus rendering it difficult to assess the training need. The Committee recalls that this provision of the Convention requires the adoption and application of a policy designed to provide the quality and quantity of nursing care necessary for attaining the highest level of health for the population. It requests the Government to indicate measures taken to ensure that the number of nursing posts provided is sufficient to offer the required level of nursing services to the population, and also measures taken to assess and fulfil the need for training an appropriate number of nursing personnel to fill up such posts. Please also supply such information as statistics of the numbers of nursing personnel in accordance with point V of the report form.

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

1. Referring to its previous comments the Committee notes the information provided by the Government in its report and in particular the information on the application of Article 2, paragraph 3, of the Convention, with regard to the consultation of employers' and workers' organisations concerned in the formulation of policies concerning nursing services and nursing personnel. It would be grateful if the Government would supply additional information on the following points:

2. Article 5, paragraph 1, of the Convention (participation of nursing personnel in the planning of nursing services and consultation of such personnel on decisions concerning them).

(a) With reference to its previous direct request, the Committee notes with interest from the Government's reply that the Act respecting the co-determination in state offices and agencies, No. 651 of 1988, came into effect on 1 October 1988 and that in accordance with that Act, the Ministry of Finance and the central employees' organisations have reached a joint agreement which includes, inter alia, provisions on the participation of health-care personnel in co-determination in state establishments and on the arrangement of internal information systems. The Government has also referred to a joint nation-wide recommendation issued in 1988 and revised in 1989 which provides increased possibilities for nursing personnel employed by municipalities and municipal federations to play a direct role in the improvement of health services and in decisions affecting staff in care communities. The Committee also notes that the nation-wide agreement on municipal staff training was revised in 1989 and that the revised text stresses the importance of staff training and covers the principles of career prospects. The Committee requests the Government to supply information on the practical application of the above Act and agreements and hopes that further efforts will be made to that effect since they appear to be necessary in the light of the comments from the Confederation of Salaried Employees (TVK) communicated with the Government's report.

(b) The Committee notes that the act on specialist health care and the act implementing it are being reinforced and that the revision will take effect at the beginning of 1991. It also notes the Government's statement that the employers' and workers' organisations have been widely consulted in the preparatory work. The Committee hopes that the Government will supply the text of the above revised legislation when adopted.

3. Number of nursing personnel (point V of the report form). Further to its earlier comments, the Committee notes from the Government's statement and from the statistical data supplied with the report that the number of nursing personnel and the number of nursing posts have been increased. The Government recognises, however, that in spite of the progress achieved, there are still staff shortages which according to the TVK are due to such changes as shortening of working week. The Committee hopes that additional measures will be taken to increase, in particular, the number of nursing posts, and that the Government will continue to provide the information called for under this point of the report form.