2017 Press Conference Press Release (2017/05/11)
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:
- 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.
- The National Health Insurance Administration shall make the nurse-to-patient ratio public and disclose the turnover and retention rate.
- 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.
Taiwan Nurses Union：Zxyyan Lu(0928718776)
Taiwan Labour Front Secretary-general：孫友聯 (0937059057)