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)

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護理職場暴力大公開

 

 台灣護理產業工會聲明稿 2014509


      

醫療人員在職場上遭暴力脅迫事件,在新聞媒體上屢見不鮮,雖然今年一月十四日立法院已三讀通過《醫療法》
修正案(俗稱王貴芬條款),未來任何人若以強暴、脅迫等暴行妨害醫事人員執行業務,將比照《刑法》妨害公務罪,

最重判三年有期徒刑,若導致醫事人員死亡,更可處無期徒刑。但法令修正至今相關暴力案件仍層出不窮,顯見醫
療人員的職場暴力問題相當嚴重。根據衛生福利部統計,前年全國急診室暴力共五百九十一件,平均每天近兩件,
顯示第一線服務民眾的護理人員在職場上面臨的危險隨時存在,護理人員除了過勞外,職場暴力問題已成為另一個
危害健康的風險。因此台灣護理產業工會、台灣勞工陣線、台灣職業安全健康連線與立委林淑芬於國際護師節前夕,
公佈護理職場暴力調查,共同呼籲醫療院所應有效預防職場暴力,提供護理人員友善安全的工作環境。

 

五成六的護理人員在過去一年內曾遭遇暴力事件 
          台灣護理產業工會為瞭解護理職場暴力之真實現象,於今年在各醫療院所進行調查,結果發現高達56%表示
在過去
一年內親身經歷過暴力,其中在一個月內發生的有42%;暴力的型態排行榜依次為言語辱罵(443人次)、
毆打(180)、
推擠(144)、丟東西(119)、工作安排不公(107)、霸凌(78)、咬(73)、惡意調配工作(56)、撞擊(53)、
性別歧視(27)。
而暴力來源最主要來自於病患(362)、家屬(343)、醫師(74)、護理主管(70)、護理同事(69)。
這項結果顯示主管及同事
也是職場暴力來源,醫療體系內部權力關係成為職場霸凌的重要因素。

 

人力不足成為遭遇暴力事件的重要原因
     暴力事件發生的原因主要為醫護人員無法緩和病患或家屬的情緒(431人次)、醫護人力不足(366)、有酒精濫用或

精神病史(204、235 )、等候處置太久或病情解釋不清楚( 208、169)。台灣職業安全健康連線指出,此一結果可以
發現,
許多的暴力事件發生,最重要的因素還是在於護理人員人力不足,長期超時工作、過重的工作負荷,導致無法
充足的時間與精力向病人或家屬充分溝通及說明,造成醫病關係的不信任與對立,致使護理職場暴力事件的發生率

大幅增加。

 

醫療院所針對暴力事件未積極預防與處置
     進一步調查職場對暴力事件之處置情形,卻發現有高達72%的護理人員在遭遇暴力事件後,被要求當作沒事繼續

上班。原因是主管認為承受暴力是必然的(247);為了保有工作(229),或主管要求(211)。醫院顯然並未選擇站在護
理人
員這一方積極協助,常常是請護理人員做成因分析(206),或只做紀錄並未呈報(119),醫療院所也沒有積極發展
軟硬體
預防措施,且幾乎都未有演習及訓練課程、人員配置未依規定(包括護病比持續低於評鑑標準),人員動線管制不
良包
括急診門禁管制及暴力逃生動線等。台灣勞工陣線表示,雖然新修正的醫療法課予醫療院所防治之責任,但未有罰
與監督機制,形同虛設,而職業安全衛生法雖有規定雇主應積極預防職場暴力的發生,但法令通過至今尚未施行,使

得雇主在預防責任上消極不作為。

 

職場暴力將使護理人力不足問題更加惡化
         研究醫院職場暴力的專家Roxanne Nelson指出:醫療職場暴力是全球性的問題,包括開發及未開發國家,

它是其他職業暴力的4倍,研究顯示至少1/3護理人員都遭遇暴力事件包括言語威脅、毆打、強暴、刺傷等,然而,
卻有高達70-80%的案件都未通報。根據台灣職業安全健康連線理事長鄭雅文教授日前進行的研究報告顯示,
受暴
勞工出現睡眠品質不佳、情緒困擾等問題的風險高出兩倍以上。立委林淑芬則表示:職場暴力的後果是嚴重的,

了因暴力導致的外傷外,更可能面臨「創傷症候群」的問題,此外,工作人員生產力恐將明顯降低、員工持續流失,

這些種種在台灣護理人員極度短缺之時,更是雪上加霜!

 

  台灣醫療職場暴力近年來經常占據媒體報導的巨大版面,身為急診專科醫師的衛福部部長,應該是最能理解護
理人員面對的威脅,然而至今無法有積極作為,並未制定相關政策,也未督促醫院發展策略及培訓方案。因此我們
提出以下訴求:

 

一、醫療院所應依法負起職場防暴責任,建立防暴機制,改善軟硬體設施,包括就醫硬體動線改良、合理三班護病比。

二、勞動部應盡速落實職業安全衛生法,並針對職場暴力高風險的工作進行宣導與監督。

三、醫療院所應針對職場暴力預防進行教育訓練課程,培養更好技能並定時演習一方面作培力訓練,另一方面藉由實際

      案例學習處理暴力事件之技巧。


新聞聯絡人:

台灣護理產業工會理事長盧孳艷 0928718776

 

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台灣醫界、公衛界聯合「反服貿與反醫療商品化運動」的立場與宣示

 台灣護理產業工會聲明稿 2014408


 
陽明大學臨床暨社區護理所教授、台灣護理產業工會理事長 盧孳艷發言稿

"服貿"及自由經濟區將"健康"商品化以及讓台灣醫療人員被剝削的情形更嚴重,

這次「反服貿運動」還必須對抗威脅台灣未來主體性及國家社會福利發展的因素

因為"成本"是商品化最大考量,所以"私有化"醫療體系是與世界潮流將"醫療體系"公共化背道而馳,尤其是護理人員在成本考量下,工時無限加長,薪資降低,護理人員的勞動條件被操弄為"個人能力不足",而不願意負起培育人才及能力的責任,壓低醫療成本,將人力成本控制在最低,直接反映的是”照顧品質”的低落,醫療照顧是人力密集的服務,需要面對面直接接觸,需要的是完善的培育及持續性在職教育,才能應付突飛猛進的科技發展,商品化卻是背道而馳,人力包括醫護人員如果只是”賺錢工具”,效率、體力、勞力就不段的要被壓榨出來,而非腦力、能力,台灣醫療人員的競爭力逐漸喪失。
重點是追求的"利潤"誰擁有?老闆,那些1%的人,他們的財富是我們這些99%的人剝削而來呀!!!護理人員目前的薪資在亞洲國家敬陪末座。昨天北市勞動局才公布的執業場所違反勞基法被罰的包括馬偕,和信,都是超時工作,甚至13小時,而且加班為給加班費,卻只罰2萬元。
這樣的勞動條件在簽服貿後,會有何改變?商品化是惡化”利潤’的追求,財團希望服貿盡快簽訂,讓它們更有機會賺更多錢,自由經濟示範區,更打破許多規範,醫療院所脫離”非營利”組織之規範,衛福部更將需要保障及密集培植的醫療體系包括人員、組織管理及運作機制的台灣優勢作為”餌”,成為吸引觀光客的資產,而觀光客前來進行”醫美”及一些非急迫性手術(高階健康檢查與美容醫學等項目外,許多非急迫性之選擇性手術(衛福部網頁http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=4260&doc_no=42756).讓台灣繼藉由"廉價女工”輸出低廉"紡織品賺取外匯後,醫療人員也溣落到成了同樣的處境,實在可悲!我們知道自由經濟示範區所執行的醫療處置並未能提升"台灣醫療科技",(衛福部宣稱生醫科技及周邊產業會形成群聚效應,共同研發創新並帶動產業發展),簡單的醫美及手術所使用的產品,如何能刺激生醫科技的提升,所以我們要問「消費完這些醫護人員之後我們的醫療還剩下甚麼」?
 

新聞聯絡人:

台灣護理產業工會理事長盧孳艷 0928718776

 

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