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

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

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.