Several hundred health workers from the trade union Nurses United, held a protest on 23 September this year in Zagreb, Croatia, calling on the government to improve their working conditions. The rally was the first significant public action in the healthcare sector after a large protest in 2019, when over 2,000 nurses, ambulance drivers, and other health workers protested exhausting working hours and worsening rights in the workplace.
In addition to the unresolved issue of overtime work, the nurses’ requests expanded to more employment in public health facilities and a reversal of mandatory COVID-19 passes for health workers that were introduced in October. Although a small anti-vax group tried to take over the event, the organizers made a point of showing that the protest was organized to improve working conditions and push the government to take responsibility for the instability of the health system.
For the past few months, the ministry of health has tried to shift the responsibility of a slow pandemic response and vaccination drive on health workers, and nurses in particular. According to the Croatian Nursing Council (CNC), to date, 72% of nurses in Croatia have been vaccinated against COVID-19, while 90% of physicians have been vaccinated. The government however, has argued that the remaining 28% of nurses will be to blame if the infection rates remain high ahead of the flu season.
Drowning in work
At the same time, however, the ministry remains silent on issues that have plagued the system long before the pandemic, one of them being a severe shortage of nurses. One of the nurses that took the floor during the protest pointed out that the shortage of nurses in the hospital system alone is 4000. “And then there’s all the other institutions where nurses work, primary health care centers, kindergartens, homes for the elderly…The total deficit is much, much higher,” she said in her speech.
The official estimate of the shortage as reported by the CNC, is 10,000 nurses. Previous estimates by trade unions went even higher, to 12 thousand. Although the deficit is hardly news anymore, the situation has been deteriorating even more since the beginning of the pandemic.
In the first period of COVID-19, nurses reported having inadequate access to personal protective equipment (PPE) and as a result many were infected in the workplace. CNC reports that at least one quarter of the whole nursing workforce had been infected by May 2021. This meant extra shifts for those who remained COVID-19 free. It also meant a lot of shifting among hospital departments, being unable to see family, or to get proper rest. Although access to PPE has been stabilized, there has been little to no recognition by the Ministry of Health for the nurses’ work. Requests that trade unions have tabled years ago – including better staffing – remain unresolved.
From 2013 until mid-2020, a cap on employment in the public sector meant that there have been very few job openings in public health institutions. The cap was perceived as the main obstacle to the employment of nurses, but once it was relaxed last year, the situation hardly changed. Today, although hospitals publish calls for nurses on a regular basis, there seem to be few workers willing to take the job.
This summer, the central hospital in Split, the country’s second-largest city, issued a call for 48 nurses. According to health workers at the hospital, less than 10 people applied. The same thing is happening in other parts of Croatia, and the newly employed nurses are surpassed in number by those leaving.
According to Brankica Grgurić from the Croatian Trade Union of Nurses, it boils down to working conditions. “All of our nurse trainees do their training at these hospitals, and they see nurses drowning in work and without appreciation for what they do. Can you blame them for not wanting to experience this every day?,” she asks.
Radmila Čahut Jurišić from the Trade Union of Healthcare echoes her concerns. Earlier in September, Čahut Jurišić shared information about working conditions at Rijeka University Hospital. She warned that the nurses’ mental and physical health was in danger because of the amount of work they are facing, citing that many of the nurses work more than 230 hours overtime in less than 6 months. Čahut Jurišić said: “They are often not remunerated for this additional work, nor are they granted additional leave to recuperate, so it is no surprise that they are now at the very limit of their strength.”
No action taken by the ministry of health
Although the unions have repeatedly asked the ministry to offer concrete solutions, their warnings have been overlooked. At best, there was an increase of quotas in nursing schools, which in Croatia exist on the level of secondary and tertiary education.
Unfortunately, this will not have the desired effect, says Adriano Friganović from the Croatian National Nurses Federation. “It’s not even a short-term solution. It doesn’t address the key issues that lead the nurses to leave their job or the country, it makes one believe that what we’re facing is only a deficit of nursing experts. But the truth is that many of the nurses who finish school or college choose to emigrate as soon as they graduate because they know the working conditions are extremely bad”, he says.
Meanwhile, there are no improvements to the working conditions, so the system is stuck in a circle where it educates a fair bit of nurses, but is deprived of their contribution. “Right now, countries of the Central and West EU have probably had more benefit from our nursing education system than the local healthcare service,” explains Friganović.
The working conditions in other EU countries are much better, and they need all the nurses they can get because they are not educating enough themselves. “But this means that the public resources we invest in the education of nurses actually benefit richer countries, and our own health system is left struggling – it’s hardly a sustainable situation,” he says.
That feeling is shared by all the trade unionists, but apparently not by those in charge of workforce planning. If this doesn’t change soon, warned the nurses at the protest, the ministry could soon face even bigger recruitment issues.
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