台灣護理產業工會

Do Nursing Staff Really Benefit from the One Fixed Day Off and One Flexible Rest Day Policy? 2017 Taiwan Nurse Workplace Investigation(2017年記者會新聞稿/Press Conference Press Release)

2017 Press Conference Press Release (2017/05/11)

Taiwan Nurses Union Chairman Zxyyan Lu and Taiwan Labor Front Secretary-General advocated for Labor Standards Act and urged the Ministry of Health and Welfare to take on an increasingly active role in policy making regarding these issues in the press conference .

 

 

In order to shorten working hours, the Labor Standards Act — One Fixed Day Off and One Flexible Rest Day Policy — was officially set in motion on the 1st of January this year. Both before and after its implementation, managerial groups had repeatedly accused, through the media, that the policy substantially increased costs, especially the newly implemented “Rest Day” overtime pay. Management of healthcare services to which the Labor Standards Act applies to also have expressed disapproval, believing that this act will severely impact the operation of these medical institutions. Taiwan Nurses Union noted that Taiwan’s nursing workplace has long been known for its harsh working conditions, so what form exactly will working hours and scheduling take after the implementation of the One Fixed Day Off and One Flexible Rest Day Policy? From March 1st to April 25th, the Taiwan Nurses Union investigated the working hours and environment of nursing staff, in hopes of showing actual working conditions. A total of 600 questionnaires were collected, and the nurses surveyed had an average working experience of 8.3 years (+8.1), while 33% worked in medical centers, 39% in regional hospitals and 19% in district hospitals.

Since 1998, nursing has been incorporated into the domain of the Labor Standards Act for almost twenty years. However, the labor administration has found via annual labor inspections that violations of the Labor Standards Act are common among many medical institutions. According to the Labor Inspection conducted by the Department of Labor in 2015, cases of violation were as high as 100%. In other words, every single hospital that was inspected had violated the Labor Standards Act. Article 24 of the act, regarding overtime labor regulations, was violated the most with a rate of 88.9%. Following close behind, with a violation rate of 72.2%, was Article 83, which states that a labor-management conference must be held to promote worker-employer cooperation and increase work efficiency. This demonstrates that hospital treatment towards nurses in regards to long working hours, excessive workload, and the right to rest is still severely inadequate. In addition, according to the survey conducted by the Union of Nurses Association, the turnover rate for nurses in December 31st of 2005 is 12.15% (while it is 18.82% within a year of working among new graduates ). To some extent, this is due to the adverse work environment in the field of nursing, which is the motivation behind the Nurses Union’s relentless advocacy for labor inspections in accordance to the Labor Standards Act, in order to ensure that it is observed after its implementation.

The purpose of the questionnaire given by the Union is to investigate whether or not the One Fixed Day Off and One Flexible Rest Day Policy actually improved the working environment of nursing staff, especially in regards to changes in working hours, overtime pay, and days off. Survey results show that even though the average daily working hours have slightly decreased, with day shifts now being 9.96 hours (from 10.36 hours before the implementation of the law), early night shifts being 9.34 hours (from 9.45 hours), and long night shifts being 9.4 hours (from 9.82 hours), nurses are still working overtime by 1.5 to 2.0 hours daily. However, because working hours among nurses and manpower are closely intertwined, and the main cause for overtime is that many hospitals are reluctant to increase manpower, the policy is no doubt a way to keep employers in check. While the survey showed that working hours have slightly decreased, problems associated with the nurse-patient ratio in medical centers and district hospitals continue to worsen. The nurse-patient ratio is 10.1 in medical centers (from 9.6 before implementation), 13.3 (13.1) for regional hospitals, and 15.7 (18.9) in district hospitals, the only area in which there was relative improvement.The nurse-patient ratio serves as an important index for gauging the nursing work environment and health care quality that the Nurses Union monitors long-term. According to hospital evaluation criteria, the nurse-to-patient ratios of medical centers, regional, and district hospitals are 9, 12 and 15 respectively. This means that medical centers and regional hospitals are clearly operating below the evaluation criteria, leading to the overworking of nursing staff and a sacrifice of patient care quality. Moreover, this current condition is completely against President Tsai’s pledge that, “all medical institutions should achieve reasonable nurse-to-patient ratios, as well as improve working hours and the treatment of workers in accordance to the Labor Standards Act.” (2016.03.09) The Union hopes that the Ministry of Health and Welfare will take an increasingly active role in policy making regarding these issues.

In addition, this investigation also looked into the working hours and scheduling of nurses after the implementation of the One Fixed Day Off and One Flexible Rest Day Policy. Among the cases investigated, up to 46% of nurses indicated that the policy was put into effect in terms of scheduling, while 31% adopted a four-week flextime schedule and 15% for a two-week flextime schedule. Although hosting a labor conference is a legal requirement for the implementation of flextime scheduling, up to 66% are unsure whether flextime scheduling was adopted by way of a labor conference. Moreover, 13% of respondents indicated that they adopted flextime scheduling without discussing it in a labor conference. Because it is common practice to shift rest days, fixed days off, and national holidays around, most nurses work a three-shift schedule. However, this type of work schedule allows employers to arbitrarily change shifts, make unreasonable deductions and depriving workers of resting time. Up to 68% of nurses reported that the nursing scheduling system does not adequately mark out rest days and holidays, causing holidays to be arbitrarily changed. 47% of nurses even indicated that their employers required them to work on their fixed day off.

Although, since January 1st, 2014, nurses have been exempted from the “responsibility system” (working hours based upon the number of patients and workload instead of a time based system) (Article 84, Section 1 of Labor Standards Act), problems associated with working overtime and the accumulation of leave days still exist. How is the accumulation of leave days dealt with after the implementation of the new policy? 38% of respondents indicated that their employers paid overtime according to the law, but only with an average hourly rate of NTD $164, with 23% receiving less than the legal overtime pay. Similarly, 23% reported being asked to make up the hours missed from their fixed off days and 11% were forced to give up their accumulation of leave days. Taiwan Nurses Union said that hospitals have long been maliciously garbling issues associated with the accumulation of leave days, as it is hard to distinguish the the exact hours of leave accumulation due to overtime working or being on-call. This problem is further exacerbated by the implementation of the Labor Standards Act that stipulates the necessity for overtime pay, as the vague and unclear methodology used to document leave accumulation makes it difficult to distribute the correct payment.Thus, labor authorities should strengthen advocacy efforts.

        In addition, special leave has been an option nominally, but not actually, available to nurses in the past. While the new policy hopes to give nurses control over their leave days, up to 44% of nurses responded that their employers decided their special leave days. Only 21% were allowed to arrange it themselves, while 34% were able to schedule their leave days after discussing with colleagues. 15% indicated that when they were unable to go on special leave, their employers paid them at a lower hourly rate than usual, and another 15% were forced give up their legal right to special leave. In regards to national holidays, 56% were given compensatory leave as promised, and only 18% received overtime pay. An alarming 26% said that they were forced to give up their legal right to holiday leave. As a result, Taiwan Nurses Union calls for the inclusion of the special leave and national holidays into the checklist for labor inspection, so that there is de facto implementation of the good intentions of the policy makers.

        Taiwan Nurses Union indicated that the One Fixed Day Off and One Flexible Rest Day Policy is no doubt a way to keep employers in check, forcing all acts suppressing labor rights to surface. Ever since the policy was set in motion, employers have been complaining that there is little flexibility in hiring and managing employees, but these grievances are simply a vocalization of their anger from being caught for exploitation. The cost of not hiring enough nurses to match the legal standard and overworking them is a sacrifice in patient care quality and a continued loss of nursing staff. In a rapidly aging society, where long-term care is an urgent need with rising demand, should the people of Taiwan not be worried? Only by actively monitoring the government and healthcare institutions, while asserting the need to implement the Labor Standards Act and to lower the nurse-to-patient ratio will ensure a higher quality of patient care. In fact, according to a study by the European Union (2016, 2017), the best solution to battle the continued decrease in number of nurses is to improve working conditions. This include decreasing working hours to 39 to 30 hours per week, increasing rest time, as well as reducing the workload and work-related stress. Well-rested and healthy nurses translate to a lower turnover and sick leave rate.

According to this investigation, little improvement was made on nurses’ labor conditions. Hospitals may have made slight adjustments after the implementation of the Labor Standards Act, but the workload of nurses in fact increased. Thus, we object and demand the following:

  1. The Ministry of Labor shall strengthen labor inspection, with a particular focus on the implementation of special leave and allow Union workers as inspectors for in-depth work environment supervision.
  2. The National Health Insurance Administration shall make the nurse-to-patient ratio public and disclose the turnover and retention rate.
  3. The Ministry of Health and Welfare shall change the nurse-to-patient ratio from the entire nursing staff and patient number to the actual number of patients each nurse cares for in each unit.

Contact:

Taiwan Nurses Union:Zxyyan Lu(0928718776)

Taiwan Labour Front  Secretary-general:孫友聯 (0937059057)

閱讀更多...

護理人員「一例一休」了嗎? 2017年台灣護理人員職場一例一休大調查(2017記者會新聞稿)

2017護師節記者會新聞稿(記者會日期:2017/05/11)

以縮短工時為目的的勞基法「一例一休」工時修法,在今年1月1日正式上路。實施前後,資方團體一再透過媒體控訴將大幅提高成本,尤其是新增的「休息日」加班費,適用勞基法的醫療保健服務業也不例外,認為將會嚴重衝擊醫療院所的經營。臺灣護理產業工會表示,臺灣護理職場環境長期以來以血汗、過勞著稱,而工時和排班(尤其是花花班),在一例一休上路以後呈現怎樣的面貌?臺灣護理產業工會於3月1日至4月15日,對護理人員的工時狀況進行調查,希望更能呈現護理人員的實際工時狀況,問卷共回收有效問卷共600份,平均年資8.3年(+8.1),工作職場於醫學中心者33%、區域醫院39%、地區醫院19%。
護理職業於民國87年納入勞基法的適用範圍,迄今已近20年。但從勞工主管機關每年例常性勞動檢查中發現,各醫療院所違法勞基法工時的情況相當普遍。以2015年台北市勞工局由陪鑑人員參與的勞動檢查為例,違法單位更高達100%,也就是說每一家受檢的醫院都有違法情況,無一倖免。其中以違反第24條延長工時規定的情況最多,高達88.9%;而違反第83條未依法召開勞資會議者,也有72.2%,顯示醫院對於護理師工時過長、工作負荷過大,以及休息權保障不足的問題仍然嚴重。(http://bola.gov.taipei/public/Attachment/611115532460.pdf)。另外,根據護理師公會的調查,105 年 12 月 31 日離職率是12.15%(新畢業生一年內則是18.82%,已排除任職三個月內離職者),某種程度上和護理師惡劣的勞動環境有關,因此本會長年呼籲各級政府勞工主管機關應針對勞基法加強勞檢,以確保勞基法勞動條件保障的落實。
本次的問題調查,主要是針對「一例一休」的實施是否提升護理人員的勞動環境,尤其是在工時、加班費、休假等的變化。調查結果發現,「一例一休」的實施,雖然護理師每日平均工時有些微下降,其中白班為9.96(實施前10.36)、小夜班為9.34(9.45)、大夜班則為9.4(9.82),但每天幾乎仍超時工作1.5-2.0小時。然而,護理工時和人力息息相關,醫院不願意增加人力是讓護理師工時過長的主要原因,而一例一休的上路,無疑是資方剝削勞工的「照妖鏡」,這次調查發現雖然工時微降,但護病比的問題在醫學中心和區域醫院的層級持續惡化,其中醫學中心為10.1(實施前為9.6)、區域醫院為13.3(13.1),在地區醫院的部份則有改善15.7(18.9)。護理比問題是本會長期監查護理勞動環境和醫療品質的重要指標,而根據醫院評鑑標準,醫學中心、區域醫院、地區醫院護病比分別為9、12、15,也就是說,醫學中心及區域醫院明顯的在低於評鑑標準的人力下運作不僅加重護理師工作負荷、犧牲民眾照護品質,更和蔡英文總統:「在醫療機構內,要達到合理護病比,改善工時及待遇的勞動條件」(2016.03.09)的宣示,背道而馳,就此,工會希望衛生福利部應有更積極的政策作為。

此外,本次調查也針對一例一休實施後護理師工時和排班情況進行瞭解,其中,高達46%護理師表示其排班有落實一例一休,而31%採四周變形工時,採二周變形工時則有15%。然而,召開勞資會議是勞資約定採用變形工時的法律要件,但卻高達66%不清楚其變形工時是否有經勞資會議通過,更有13%的受訪者表示並未經勞資會議討論。護理師多為三班輪班型態,因為休息日、例假日或者國定假日之挪移的情形相當普遍,然而,這樣的工時型態卻成了資方隨意調動、恣意剋扣、甚至剝奪休息時間的依據,高達68%護理師反映班表上無法明確標示休息日和例假日,進而導致例假日被任意更動,而更有47%反映雇主違法要求於例假日出勤。
護理師早於103年一月一日被排除於勞基法84-1條責任制外,但是工時過長無法休息,以及護理職場累積時數(積假)的問題仍然存在。新法實施以後,累積時數如何被處理?有38%受訪者表示雇主依法給付加班費,但平均每小時只有164元,而23%違法給付不足額的加班費,而同樣有23%要求擇期補休,但有11% 的受訪者被強迫「自動放棄」。臺灣護理產業工會表示,長期以來累積時數的問題往往被醫院惡意混淆,也就是說,勞工無法釐清累積時數是來自平常日的加班或者是on-call,新法上路後更有休息日出勤的加班給付,因此也就完全無法爭取符合法律的「正確給付」,勞工主管機關應加強宣導。
此外,在特休假部份,過去看得到用不到的情形非常普遍,此次修法希望勞方有休假主導權,但仍有高達44%護理師反映其特休假並未被徵詢,而由主管排定公布,由自己自主排定者只有21%,而自己與同事協商排定的則有34%。耐人尋味的,有15%的受訪者反映特休假無法休假時,雇主以低於時薪的方式結清,而有15%護理師被迫自行放棄其法定權益。而在國定假日出勤部份,以約定補休的方式為56%,僅有18%的受訪者表示有發加班費,值得注意的是竟有26%的受訪者回答「被迫自行放棄法定權益。因此,臺灣護理產業工會呼籲應將特休假及國定假日出勤列入下一次勞動檢查的重點項目,以確保修法的美意得以落實。
臺灣護理產業工會表示,此次「一例一休」的修法,無疑是一面照妖鏡,讓過去慣老闆的各種違法行為一一浮上水面,一例一休上路後老闆們持續抱怨『運用人力更沒有彈性』,其實都是狐狸尾巴被踩到,發出的哀嚎,醫院以低於評鑑標準的護理人力,壓榨護理人員,犧牲的是病患照護品質的下降,護理師持續流失,對於老化社會,長照需求倍數成長的情形,民眾難道不擔心,民眾積極監督政府及醫院,強力要求落實勞基法以及降低護病比,才能對照護品質把關。事實上,根據歐盟(2016,2017)研究顯示,在護理人力持續流失的情況下,改善勞動職場條件,包括降低工時,3930小時/周,增加休息時間,降低工作壓力,包括降低照顧負荷,是留住人才最好的良藥,護理師身心得到休息,更健康,離職率下降,病假率也下降。
針對本工會這次的調查結果,顯示台灣的護理勞動條件未見改善,而醫院因應這次有利於勞工的修法,表面上稍微調整工時,卻增加護理師工作負荷,就此,我們要嚴重提出抗議,並提出以下的訴求:
一、 勞動部加強勞動檢查,特休假之實施也是重點,並以工會成員作陪鑑員,深入監督職場實務工作;
二、 健保署公布護病比,同時應公布離職率及留任率;
三、 衛福部醫院評鑑檢視護病比,應改為各單位每位護理師直接照護人數,而非全院護理人員數及病人數。

新聞聯絡人:

臺灣護理產業工會理事長 盧孳艷 0928718776
勞陣秘書長 孫友聯 0937059057

閱讀更多...
Top of Page