From nurses to cleaners: how the May Decrees of the President are carried out in hospitals

The nurses were demoted to demote (in order to save on salaries), but no one canceled the duties of medical care to patients. Why is the hospital fictitiously cutting staff?

Yulia Suntsova

The doctors who have fallen under the redundancies believe that the administration is remaking the state fictitiously for the sake of saving money, because the need for rates, for the performance of their labor functions has not disappeared - the medical institution, as before, needs junior nurses.

The upcoming layoffs became known at the beginning of this summer. On June 29, the head physician Tatyana Shavrak signed Order No. 111 on the reduction of the staff of the junior staff of the Kolomna perinatal center. Immediately after, employees began to receive notifications of upcoming layoffs. Junior nurses and nurses were offered the following vacant positions: office cleaner of the 2nd grade, plasterer of the 4th grade of the general business service, the cloakroom attendant of the 1st grade of the general business service, the storekeeper of the 2nd grade of the general business service, the operator of electronic computers and computers of the 4th grade. All new positions had one thing in common: the salary is 2-3 times lower compared to what junior nurses receive now, while retaining the status of a medical worker.

Otherwise, as the nurses were "reassured", their work will not change, their job functions remain intact: " universal cleaners", as before, will take care of women in labor, babies, work with their biological fluids and watch for epidemiological well-being within the walls of the Center...

Since the opening of the Perinatal Center in Kolomna, the staff of junior nurses has been reduced by almost three times, the last three years have been cut continuously, and this year the management decided to completely get rid of all junior nurses. On paper, of course, because the work itself does not evaporate anywhere, say employees of the medical facility, who asked to keep their confidentiality.

- The perinatal center opened on September 25, 2017. Until September 7, 2019, everything was fine. There was a full staff. Each department had its own junior nurse with a daily schedule. There were about 56 younger [sisters] working. After the first layoff in 2019, 28 employees remain. In many departments, junior [sisters] began to work on a 2-day schedule every 2 days, combining them in several departments. In January 2021, another 6 people were removed. There are now 20 younger [sisters] of us. The salary for all this time has never increased, and the number of women in labor every year, on the contrary, only increases . one of the nurses explained to "Novye Izvestia".

The Kolomna Perinatal Center accepts women not only from the Moscow region, but also from neighboring regions. The flow of patients is large, medical personnel and premises for it are no longer sufficient. Some of the chambers are given over to commercial medicine. Free wards in the postnatal ward have been reformatted from single and double to double and triple, respectively. Epidemiological and sanitary standards suffer with increased flow. The management plans not only to transfer junior nurses to cleaners, but also to reduce the number of rates - from 25.75 rates for nurses to 14 cleaners and 4.75 castellans. Assistant nurses even now sometimes carry up to 8 posts on themselves and rush between three different divisions. At the same time, part of their work will go away, apparently, to the nursing staff, who are still overworked, and after October 1, they will finally whine.

With his order on the COMPLETE reduction of junior medical personnel, the head physician seems to say: pregnant women, women in labor and newborns in Kolomna are second-class people. They are not supposed to, like all other patients in the country, care provided by junior medical personnel, in accordance with the requirements of federal standards, the interlocutors argue.

Half of the nurses who are being fired immediately joined the interregional trade union of medical workers "Action" in order to protect their labor rights and defend the guarantees given by law.

On September 10, chief physician Tatyana Shavrak gathered the "rebels" and in an ultimatum told them: the fight against layoffs is pointless, there will be no younger sisters in the perinatal center, this decision is allegedly fully agreed with the Ministry of Health of the Moscow Region, the regional committee of the branch trade union and the State Labor Inspectorate! (audio recording of the meeting is at the disposal of the editors). The head physician told the female employees who joined the Action union that the union was an allegedly extremist organization, and its leader... had recently been arrested!

- This brazen and senseless slander from the mouth of an official intrigued me so much that I decided to personally coordinate our trade union campaign in Kolomna against the reduction of all junior medical personnel of the perinatal center announced by Ms. Shavrak, - said the organizing secretary of the trade union Andrey Konoval. - The aforementioned order to lay off all junior nurses grossly violates Federal Law No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation", licensing requirements for a medical organization, the procedure for providing medical care in the "obstetrics and gynecology" profile, approved by the Order of the Ministry of Health of Russia from October 20, 2020 No. 1130n).

“On a superficial examination”, we identified a number of other violations of the law that affect the quality of the institution's work.

The first (precautionary) step has already been taken - the chief physician of the KPTs Tatyana Shavrak was sent a demand to cancel order No. 111 as illegal and to withdraw notifications about the reduction of the positions of junior nurses within 1 week - in accordance with the norm of the Labor Code.

“In fact, this is a gesture of goodwill on our part, the last Chinese warning. If within 3 working days (until Tuesday) the head physician does not accept our proposal to start the negotiation process, we will start a tough protest campaign. Statements to supervisory and law enforcement agencies about the employer's illegal actions with detailed argumentation have already been prepared. - says the trade union leader.

The trade union recalls a similar situation with the dismissal in 2019 of junior nurses and midwives from the Anzhero-Sudzhensk city hospital named after A.A. Gorokhovsky. Then the head physician Olga Kozlova explained the reduction in rates by the results of some kind of actual analysis. So that analysis allegedly showed that the women of Anzhero-Sudzhensk give birth only in the daytime (?!), Which means that the medical staff at night may not work in full force!

In the end, the city hospital lost all claims to dismiss the nursing staff of the maternity hospital. Orders to change the staffing table and dismiss workers were declared illegal, and the midwives reinstated at work were paid salaries for the time they were forced to absenteeism and compensated for moral damage associated with violation of labor rights.

So that head doctor Kozlova, at least for show, left several nurses and orderlies in the state. What can not be said about the Kolomna perinatal center.

The reduction of junior staff, however, is not a novel by Mrs. Kozlova and Mrs. Shavrak, but rather an easy way out of the impasse. Are they being disingenuous by turning the arrows to the “top in health care”? After the "May decrees" set the task of bringing the salaries of junior medical personnel to the average level of salaries in the region and the accrual of additional benefits for this category of medical workers, many state medical institutions found themselves in a difficult situation. In the regions, municipalities were unable to find additional funds to improve the working conditions of workers and ... they simply liquidated the staffing units. No junior staff - no headache with their salaries, as they say. Original. But in the end, everyone suffers: first of all, patients.

Today, the trend of massive layoffs of junior hospital staff has spread throughout the country.

Junior medical personnel are an important link in the provision of medical care to the population. In 2013, out of 2.7 million medical workers, more than 687 thousand employees were referred to as junior medical personnel (for comparison: doctors - about 579 thousand employees).

Nursing staff include, in particular:

• Junior nurse (the main job function is medical care of patients - including those who are “lying down”, “heavy”, those who need constant help and personal care).
• Nurse (the main job function is sanitary and epidemiological measures in medical institutions: sanitary maintenance of wards, specialized rooms, moving medical waste, handling the body of a deceased person). In ambulance services, nurses are also involved in sanitizing the interior of an ambulance car, including contact with potentially dangerous biological fluids (blood, vomit, etc.).

The high assessment of the work of junior medical personnel was reflected in the "May decree" of the President of Russia No. 597 of May 7, 2021, which provided for an increase in the salary of this category of workers by 2018 to 100% of the average salary in the corresponding region (on a par with the average medical staff). In turn, the constituent entities of the Russian Federation, in agreement with the Ministry of Health of Russia, approved the corresponding regional "road maps" for increasing the salaries of medical workers, for which the state allocated substantial funds. Even today, in the payroll of nurses and junior nurses of many medical institutions, the lines appear: "Supplement according to the roadmap" or "Supplement according to decree 597".

This has paid off. The actual ratio of the average salary of junior medical personnel to the estimate of the average monthly income from labor activity in the whole of the Russian Federation (41,366.0 rubles) for 6 months of 2020 was 95% - 39,297.1 rubles.

The target indicators of the May Decrees have ensured a significant increase in the salaries of junior medical staff since 2013 - BUT NUANCE IN THIS PART OF EMPLOYEES WHICH RETAINED THIS STATUS IS NOW MINOR. After all, the lion's share was retrained as cleaners.

The salaries of cleaners in health care are significantly lower than the salaries of junior medical staff - sometimes 2-3 times. There are often cases when medical institutions, when calculating salaries, simply pull the cleaning women up to the minimum wage.

So, for example, the salary of a cleaner of office premises (X-ray room) in the GBUZ "Zverinogolovskaya Central District Hospital" in January 2021 amounted to 13,987.42 rubles. (before deducting personal income tax). Of these, the salary is 2,182.13 rubles; surcharge up to the minimum wage - 3132.83 rubles. The salary at the minimum wage level or a little more when working for 1 rate remained here throughout 2020, with the exception of the month of December, when a stimulating lump-sum payment of 15,000 rubles was paid to cleaners.

The monetary losses of one worker (cleaner), deprived of the status of junior medical staff, with the usual volume of workload for state medical institutions (1 - 1.5 rates) amount (only from taking him out of the area of effect of Decree No. 597) from about 120 to 240 thousand rubles. in year.

According to Rosstat data, in the period 2013 - 2018, set aside for the implementation of the "May decree" of the President of the Russian Federation No. 597, the number of junior medical personnel decreased from 687 thousand workers to 292.3 thousand, that is, the drop was 57.5%.

In 2019 - 2020 the reduction of nursing staff continued - to 267.6 thousand workers as of September 2020. Compared to 2013, the decline was 419.4 thousand people, or 61% (!).

The research project "Monitoring of pressing problems in the field of social and labor rights of health workers (September 2017 - November 2018)" shows that the main decrease in the number of employees did not take place in the form of complete dismissal of workers.

The main trend was the massive transfer of nurses and nurses (usually under threat of dismissal due to staff cuts) from the category of junior medical personnel to the category of auxiliary personnel - cleaners of office or industrial premises.

Sisters-hostesses were transferred to the positions of castellans or caretakers, nurses and junior nurses of boarding schools for disabled people - to nannies or nurses.

To a lesser extent, but still a noticeable phenomenon, in the process of reducing junior medical personnel, outsourcing has become - the transfer of the function of cleaning premises to an external contractor under a contract (the so-called cleaning ).

At the same time, in both scenarios, the workers transferred to non-medical positions retained completely (or to a greater extent) the former functionality of the junior medical staff!

In order to disguise violations of labor laws, federal regulations for the provision of medical care and licensing requirements for medical organizations, employers practice maintaining a small number of junior medical personnel in the staffing table, which are distributed among some of the cleaners (usually at 0.25 rates) through part-time or combination posts.

The main reason for the spread of this practice is the lack of funds to increase the average salary of medical workers in strict accordance with the Decree of the President of the Russian Federation No. 597. May decrees do not apply to the auxiliary personnel of health care institutions, therefore the transfer of nurses and junior nurses to cleaners was considered in the regions as the simplest a way to save social expenses. In the period under review, the salaries of cleaning ladies either did not increase, or rose slightly, or even decreased.

In fact, the initiative for such a solution to the problem of the shortage of funds came not from employers, but from the regional authorities. In particular, in many constituent entities of the Russian Federation, legal acts were issued by which the heads of institutions were obliged to take measures to optimize (reduce) the number of medical workers.

At the same time, the "federal center" (the Ministry of Health of Russia, federal supervisory agencies in the field of labor, health care) have taken and continue to take a passive position on this issue.

In essence, this measure directly contradicts not only the logic, but also the text of the Decree of the President of the Russian Federation No. 597. The decree was adopted "in order to preserve human resources, increase the prestige and attractiveness of professions in the budgetary sector of the economy". It is obvious that the reduction of nursing staff has nothing to do with strengthening the human resources of health care institutions.

• The transfer of medical workers to the category of household personnel leads to a decrease in the qualifications of persons whose duties include caring for patients and ensuring the sanitary condition of the premises in which patients stay (wards, offices, operating rooms, delivery rooms, etc.).
• Low wages for cleaning ladies, a decrease in the volume of social guarantees entail a decrease in professional motivation, an increase in staff turnover, an increase in the workload, and a drop in the level of professionalism in the difficult work of caring for patients.
• Another consequence is the disorganization of the work process while ensuring the conditions for the provision of medical care. "Cleaning ladies" often seek to "boycott" the performance of official duties related, in accordance with the regulatory framework, to the labor function of junior medical staff. In a situation of uncertainty, part of the duties of the junior medical staff is assigned to the shoulders of the nursing staff, and a significant amount of work is simply not performed. Especially negatively, this state of affairs affects the condition of hospitalized seriously ill patients, - they explain in the trade union.

The main reasons for the disbandment of the official staff of junior medical personnel, as already mentioned, are economic. And this is how it looks in numbers.

The junior nurse / nurse, nurse / orderly, deprived of the status of a medical worker, now do not apply not only to higher salaries, but also to a number of compensations and benefits. These include, for example, benefits for harmful working conditions, additional vacations, reduced working hours, early retirement, etc.

Workers who are deprived of nursing status are not affected by virtually any incentive, social, insurance and one-time payments for work in the context of the COVID-19 pandemic, although they bear their share of risk and additional workload due to the epidemic.

In particular, according to clause 10 of the Rules approved by Decree of the Government of the Russian Federation No. 415, during a pandemic, junior medical personnel who provide conditions for the provision of primary health care and specialized medical care in inpatient conditions were provided with payments of 20% and 3% of the average monthly income, respectively from work. Cleaning women are generally not allowed to work in the "red zones" (or are allowed, but without "covid" surcharges).

- In a pandemic, also junior medical personnel providing emergency medical care for mobile teams are paid 950 rubles for one standard shift;

- For the provision of specialized medical care in inpatient conditions and the conduct of pathological studies related to the new coronavirus infection (COVID-19) - 1215 rubles per one standard shift;

- For the provision of primary health care on an outpatient basis, or in contact with patients with an established diagnosis of a new coronavirus infection (COVID-19) while performing official duties - 600 rubles per one standard shift.

As we already understand, “universal office cleaners” are not covered by these payments.

How insurance payments do not apply to these “non-physicians” in the following cases:

- Deaths from COVID-19 during the performance of official duties (payment to relatives - 2,752,452 rubles in equal shares), -

- Persistent disability due to complications after COVID-19 (depending on the group of disability established as a result (Group I - 2,064,339 rubles; II group - 1,376,226 rubles; III group - 688,113 rubles).

PS:

On the eve of the publication of this publication, on September 14, it became known that the head physician of the Kolomna Perinatal Center, Tatyana Shavrak, canceled her order number 111 on the reduction of the staff of junior medical personnel, and also began to acquaint the employees with the order to cancel it, the employees are given letters of revocation of notifications of upcoming dismissals.

“The cancellation of the layoff is the result of the cohesion of half of the dismissed junior nurses who decided to resist the illegal decision and joined the Action trade union,” comments Andrei Konoval. “However, we must understand that in one form or another the employer may try once again to carry out the intended“ optimization”, so we, together with our trade union committee, will now continue legal work on this issue".