Nursing Personnel Convention, 1977 (No. 149) - Lithuania (Ratification: 2007)

Direct Request (CEACR) - adopted 2024, published 113rd ILC session (2025)

Articles 2 and 5(1) of the Convention. National policy concerning nursing services and nursing personnel. Consultations. The Committee notes the information provided by the Government regarding the set of measures adopted to attract persons to the nursing profession and retain them in it. In this respect, the Government refers to the adoption in 2019 of the updated Lithuanian Health Strategy (LHS) for 2014–2025. The Strategy’s goals include reducing health inequities and social deprivation and guaranteeing high-quality, effective health care focused on the population’s needs. Moreover, a supervisory committee was established aimed at monitoring the implementation of the guidelines for the National Nursing Policy for 2016–2025. This committee is composed of 18 members, including hospital nurses, representatives of nurses’ unions and representatives of universities. The Government indicates that the activities of the supervisory committee will focus on the revision of the qualification and licensing system, changes in the qualification system, assessment of competencies and improvement of working conditions. The Government adds that the supervisory committee will also seek to develop a national nursing policy aimed at raising the prestige of the nursing profession and improve nursing services. In 2022, the Ministry of Health elaborated a draft plan for attracting healthcare professionals, including nurses and nurses’ assistants. In this framework, an indicator of the minimum duration of professional practice was established, the role of the mentor was introduced and the processes for attracting future healthcare professionals to medical institutions were simplified. Furthermore, €14 million from the 2021–2027 European Union (EU) funds investment programme have been allocated to additional measures to attract and retain health professionals in health care institutions, increase the prestige of the most missing professional qualifications and specialisations, and vocational guidance on nursing. In addition, the Ministry of Health, after consulting health care institutions on possible incentives, prepared a list of proposed incentives with the objective of providing detailed and structured information to students and residents in the health sector to help them to decide on the conclusion of a contract with a healthcare institution. The Committee also notes that the Government refers to the adoption of a set of measures to increase and improve the provision of long-term care services, including the adoption in 2023 of the Order on long-term care services with the objective of transforming currently fragmented health and social services into high-quality, timely and continuous complex care; the development of qualification programmes for upgrading nurses’ qualifications; and the training of 4,000 care specialist on long-term care services. Moreover, more than €100 million will be spent on the development of these services, mainly for improving infrastructure and upgrading the qualifications of healthcare specialists. Lastly, the Committee notes the detailed information provided by the Government on the measures taken to improve the planning of the needs of health workers in the country, including nursing personnel. In 2022, a broader circle of stakeholders was included in the planning of the needs for nursing personnel. On 1 February 2023, the Ministry of Health joined the EU4HEALTH international project HEROES, which was adopted as a response to the COVID-19 pandemic and to reinforce crisis preparedness in the EU, including by improving the forecasting and planning of health professionals in Europe. The Government further indicates that the launching of the “Lithuanian Healthcare Professionals Competence Platform” is expected in 2024, as a tool to identify the need for professional development of healthcare professionals and monitor compliance with licensing conditions. The Government adds that the Platform will contribute to a more effective cooperation between the State, education providers, and healthcare institutions, and will allow the assessment of the improvements regarding professional development in the healthcare sector and identify the need for improvement of competences.

At the same time, the Committee observes that despite the implementation of the abovementioned measures, nurses’ shortages remain - according to the OECD Country Health Profile 2023, in 2021, there were 7.9 nurses per 1,000 population, which is below the EU average of 8.5; a predicted shortage of over 3,000 nurses is estimated by 2030. The Committee requests the Government to provide updated detailed information on the nature and the impact of the measures taken or envisaged to achieve the objective of providing the quantity and quality of nursing care necessary for attaining the highest possible level of health for the population as per Article 2(1) of the Convention. The Committee also requests the Government to indicate the impact of the measures taken to anticipate and prevent the shortage of qualified nurses, including those adopted in the framework of the Lithuanian Health Strategy for 2014–2025, the 2022 Plan for attracting healthcare professionals and the 2023 Order on long-term care services. It also requests the Government to provide updated information on the status of the development of the national nursing policy by the supervisory committee. Moreover, while noting that the Government does not provide information on nursing migration trends, the Committee reiterates its requests to the Government to provide detailed updated information on current trends concerning nursing migration from Lithuania and any measures taken or envisaged to retain nursing personnel, including measures in relation to education, vocational guidance, training, working conditions, career prospects and remuneration.

Article 5(2). Negotiated determination of conditions of employment of nursing personnel. The Committee notes the Government’s indication that a new Lithuanian National Health System (LNHS) Sector Collective Agreement was signed on 15 November 2021 by the Minister of Health and nine trade union organisations representing health workers, including nursing personnel. The collective agreement ensures social guarantees, stable wage increases, and additional guarantees for all trade union members, including employees of the LNHS institutions. The Government indicates, that following the signing of amendments to the collective agreement in 2022, the minimum coefficients of the fixed share of the basic salary were increased as of 1 January 2023. As a result, the salaries of the LNHS employees - members of the trade unions that signed the collective agreement, have increased on average by approximately 14 per cent. The Government indicates that the average wage growth of health carers in 2023 was between 85 euro and 100 euro compared to 2022. In addition, the fixed part of the basic salary of nurses and midwives with higher university education was increased by 10 per cent. Finally, the Government indicates that the renewed collective agreement also expressly states that on-call duty, where an employee is required to be at the workplace, to be available to the employer and, if necessary, to perform their duties immediately, is to be regarded as working time and should be remunerated. The Committee requests the Government to provide detailed updated information on the implementation in practice of the 2021National Health System Sector Collective Agreement and its impact on attracting and keeping an adequate number of motivated qualified nursing personnel in the profession.

Application in practice. The Committee notes the information provided by the Government about the number of nurses and midwives disaggregated by county, which shows that Vilnius County has the highest number of nurses and midwives (6,846) followed by Kaunas County (4,820). The region with the least number of nursing personnel is Tauragé (530). In addition, the Committee notes the uneven distribution of practising nurses and midwives per 10,000 population in different counties (Klaipeda County has the highest number – 90, followed by the capital region and Vilnius County – 80.7 and the lowest number of 51.3 in Marijampolé county). The Committee observes, nonetheless, that the Government does not indicate the number of nurses working in the public and private sectors, neither the number of those leaving the profession each year. The Committee therefore reiterates its requests to the Government to continue to provide detailed updated information, disaggregated by age and sex, concerning the implementation of the Convention and to supply the previously requested information on the situation of nursing personnel and midwives – including the number of nursing personnel broken down by those working at public and private healthcare establishments and the number of those who leave the profession each year. It also requests the Government to provide copies of any recent reports, studies, or surveys relevant to the matters covered under the Convention.

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

Articles 2 and 5 of the Convention. National policy concerning nursing services and nursing personnel. Consultations. The Committee takes note of the Government’s report, much of which reiterates information provided in its previous report. The Committee understands that, according to the OECD Reviews of Health Systems: Lithuania 2018 (the 2018 OECD Review), Lithuania has achieved a profound transformation of its health system after declaring independence in the early 1990s. The 2018 OECD Review indicates that the organization and governance of the system is typical of many European countries and has remained stable over the past two decades, with an appropriate set of policy directions having been consistently pursued over time. Health is a prominent inter-sectoral priority that cuts across Lithuania’s main strategic planning documents; for example, the objective of “Health for All” is one of three horizontal priorities established in the country’s national development strategy: “Lithuania 2030”. Its implementation is governed by a specific inter-sectoral action plan coordinated by the Ministry of Health. In its previous comments, the Committee noted the establishment of a new Health Programme 2011–20 and requested the Government to provide information on its implementation and impact, particularly on the quality of nursing services and the employment conditions of nursing personnel. The Review notes that overall, no systematic tools are in place to assess future needs and gaps, or to evaluate the impact of future policies. The Government reports on indirect measures that, in its view, have had a positive impact on improving the quality of nursing care services. In this respect, the Government refers to the annex that forms part of the Collective Agreement of the National Health System of Lithuania, 31 August 2018, No. 2/S-133, which provides for the allocation of €100 million to increase wages for healthcare professionals as of May 2018. It adds that, depending on educational level, the fixed portion of the basic salary for nursing personnel may not be less than 60–70 per cent of the fixed portion of the basic salary for physicians. The Government also refers to the annex that forms part of the Collective Agreement of the National Health System of Lithuania, which entered into force in January 2019 and focuses on improving the working conditions of healthcare specialists. It takes note of the report on the State of Health in the EU Country Health Profile 2017 on Lithuania (2017 Health Status Profile), prepared by the OECD and the European Observatory on Health Systems and Policies, and available on the website of the European Commission. According to the 2017 Health Status Profile, despite the large emigration of health workers since it joined the EU in 2004, Lithuania has retained a higher number of physicians per capita than the EU average (4.3 per 1000 population compared to 3.6), mainly by increasing the number of graduates. On the other hand, the ratio of nurses to the population (7.7), is below the EU average of 8.4. Main health system challenges include the uneven distribution of physicians across the country, the aging of the health workforce and emigration. The 2017 Health Status Profile indicates that a number of new policies have been put in place to increase the number of nurses and strengthen their role in health services, especially in primary care. Specialist nurse training has been initiated, for example in diabetes and cardiology, where new positions for chronic patient groups have been introduced. The Government indicates that measures aimed at regulating the provision of personal healthcare services are designed to regulate the workload of healthcare professionals with the aim of achieving a 1:2 ratio of doctors to nurses. The Committee also notes that, according to the 2017 OECD Profile, since joining the EU in 2004, Lithuania has experienced large migration outflows of health workers, particularly of nursing personnel, who emigrate abroad in search of better pay and working conditions. It notes that this situation remains a challenge for the country and understands that according to the OECD STAT database, 26,078 nurses migrated abroad in 2018. The Committee requests the Government to provide up to-date information on the implementation and impact of the national Health Programme 2011–20, particularly with respect to improving the quality of nursing services and the employment conditions of nursing personnel. It also requests the Government to provide information on the content, status and impact of the inter-sectoral action plan coordinated by the Ministry of Health, as well as on the allocation of €100 million to increase wages for healthcare professionals pursuant to the Collective Agreement of the National Health System of Lithuania. It reiterates its request that the Government provide detailed, updated information concerning current trends in respect of nursing migration from Lithuania and any measures taken or envisaged to retain nursing personnel, measures in relation to education, vocational guidance and training, as well as in relation to working conditions, including career prospects and remuneration. The Committee also requests the Government to provide information on measures taken or envisaged to ensure the active participation of nursing personnel in the development, implementation and monitoring of policies and general principles regarding the nursing profession.

Part V of the Report Form. Application in practice. The Committee requests the Government to provide detailed updated information, disaggregated by age, sex and region, concerning the situation of nursing personnel in the country, the nurse-population ratio, the number of nursing personnel broken down by those working at public and private healthcare establishments, and the number of those who leave the profession each year and to provide copies of any recent reports or studies addressing nursing-related issues.

Direct Request (CEACR) - adopted 2013, published 103rd ILC session (2014)

Article 2(1) of the Convention. National policy concerning nursing services and nursing personnel. The Committee understands that a new Health Programme 2011–20 has been established and that Lithuania has entered into a biennial collaborative agreement 2012–13 with the WHO/Europe, which aims to raise the level of health. The Committee requests the Government to provide up to-date information on the implementation of these programmes, particularly as regards their impact on the quality of nursing services and the employment conditions of nursing personnel. Moreover, the Committee recalls its previous comment in which it noted the persistent challenges of nursing migration and requested the Government to indicate any measures or initiatives to reverse the emigration trend. The Committee understands that the emigration of nurses and doctors – basically in the search of better pay conditions – continues unabated, mainly towards European countries such as Denmark, the United Kingdom, Norway, Germany and Sweden. It also understands that, in some cases, nurses do not formally emigrate but travel to neighbouring countries to work for four weeks before returning home for two weeks off. The Committee further understands that there are serious limitations regarding migration statistics and that the use of the number of certificates of competency as an indication of the scale of the outflow is not a reliable tool. Realizing that in the long run migration of qualified nurses puts the national health care system at risk, and that this question calls for coordinated action both by countries of origin and host countries, the Committee requests the Government to provide up-to-date information – including all available statistics – on the situation of nursing migration and any policies or projects implemented in this area.

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

The Committee notes the Government’s first report on the application of the Convention and wishes to draw its attention to the following points.

Article 2, paragraph 1, of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes that under sections 67 and 68 of the Law amending the Law on the health system (Act No. VIII-946 of 1 December 1998), the formulation of national health policies is carried out primarily by two bodies, namely, the National Health Board, which acts as an advisory body for the Parliament and the Government, and the State Health Commission, which acts as a coordinating body among government entities for the formulation of policy measures and the implementation of relevant legislation. It understands that the Parliament has adopted the Lithuanian Health Programme 1997–2010 while the Government has adopted the Implementation Strategy of Health Care Reform’s Aims and Objectives. This strategy, however, does not appear to contain any policies, programmes or activities specifically targeted to nursing personnel. The Committee therefore requests the Government to provide a copy of the Health Programme 1997–2010 and to elaborate on its implementation and the results achieved with respect to nursing personnel. It also asks the Government to explain how the ongoing health-care reform is expected to affect the quality and quantity of nursing care.

Article 2, paragraph 2. Employment and working conditions of nursing personnel. The Committee notes the Government’s indication that working hours, working conditions, remuneration levels, job descriptions and internal procedures for nurses are regulated by internal rules approved by the heads of health-care institutions in consultation with the employers’ and workers’ organizations concerned, such as the Union of Lithuanian Nursing Managers (ULNM) and the Lithuanian Nursing Specialists Organization (LNSO). Recalling that the Convention calls for measures designed to render the nursing profession attractive, including reasonable career prospects and levels of remuneration that take account of the constraints and hazards inherent in the profession, the Committee would appreciate receiving the Government’s views as to whether nursing personnel is currently offered employment and working conditions (including possibilities of professional advancement and financial benefits) that are likely to incite young persons to join the profession or retain qualified nurses in it. It would also request the Government to provide sample copies of internal rules regulating the working conditions in health establishments.

Article 2, paragraph 3. Consultations with social partners. The Committee notes the Government’s indication that representatives of the ULNM and the LNSO are included in the panel of the Ministry of Health and a standing working group on nursing issues, both set up in 2009, for the examination of questions such as the draft Law on nursing practice, licensing, skill development, safe working environment, workload and trade union representation. It would be grateful if the Government would provide more detailed information on the organization and activities of the panel as well as on the operation of the standing working group and any practical results obtained so far.

Article 5, paragraph 1. Participation of nursing personnel in planning. The Committee notes the Government’s reference to section 47 of the Labour Code (Act No. IX-926 of 4 June 2002) generally providing for the employee’s right to information and consultation. According to the Government’s explanations, the information and consultation processes deal with issues related to the internal administration of an enterprise, including, for instance, its current and future activities and important decisions concerning financial and labour matters. Recalling that the Convention requires that nursing personnel be not merely kept informed but rather actively involved in the elaboration and application of policies and general principles regarding the nursing profession, the Committee requests the Government to provide additional information on any specific measures to this effect.

Part V of the report form. Application in practice. The Committee understands that the country experiences a serious problem of nurse migration with 45 per cent of all licensed nurses being reportedly registered in other countries, mainly in Western Europe. The Committee would be grateful if the Government would provide in its next report up to date information on the manner in which the Convention is applied in practice, including for instance statistics on the number of students entering or graduating from nursing schools, the number of nurses registered with the State Health-care Accreditation Agency (VASPVT), the nurse–population ratio, copies of any relevant collective agreements, measures or initiatives to contain or reverse the nurse migration trend, etc.