Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

1. The Committee takes note of the information and legal texts (laws, decrees, regulations and collective bargaining agreements) communicated by the Government in its report concerning Article 1, paragraph 2 (scope of application), Article 1, paragraph 3 (nursing care and services on a voluntary basis), Article 2, paragraph 1 (policy concerning nursing services), Article 2, paragraph 2(a)(b) (education and training and remuneration), Article 2, paragraph 3 (consultation with the employers' and workers' organizations), Article 3, paragraph 1 (nursing education and training), Article 4 (requirements for the practice of nursing), Article 5, paragraph 3 (settlement of disputes) and Article 6 (working conditions).

2. The Committee refers to its previous comments on the following provisions:

Article 2, paragraph 2. The Committee takes note of the information of the Government that:

-- career opportunities in the clinical area and management are scarce;

-- in the next five years demand for nursing personnel will exceed supply by at least 40 per cent; and

-- representatives of professional nurses consider that remunerations are inadequate, especially in relation to the responsibilities borne by middle and senior management.

The Committee recalls that according to this provision measures should be adopted to provide the quantity and quality of nursing care necessary for attaining the highest possible level of health for the population. The Committee therefore requests the Government to continue supplying information on the education and training courses, employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it.

Article 2, paragraph 3. The Committee takes note of Legislative Decree No. 115 of 31 March 1998 regulating the organization of the Agency for Regional Sanitary Services and of the information of the Government according to which:

-- the drafting of a national law to ratify the organizational arrangements already implemented in many Italian regions that have autonomous legislative powers with regard to health;

-- nursing services have been set up under this regional legislation which provide for an organizational structure headed by a nurse with management functions; and

-- the bodies responsible for developing and implementing these policies are: (a) for general policies: the Ministry of Health in concert with other ministries concerned as directed by the Council of Ministers; (b) for regional policies: health councils following the same pattern as central government; and (c) for local policies: management boards of individual health institutions.

The Committee hopes that the Government's next report will state that the abovementioned national law has been adopted and that a copy of this text will be communicated.

Article 5. The Committee takes note of the information supplied in the Government's report according to which participation of nursing personnel at the National Health Service level is not regulated yet by the State. However, the Committee recalls that the Government has informed in its previous report that a National Committee was established by decree of the Ministry of Health of 7 November 1991, for verifying and revising the quality of services at the national level, and that nursing personnel were represented by three members from the National Federation (IPASVI). The Committee therefore requests the Government to provide a clarification on this issue. The Committee takes note also of the information contained in the report that some regions have passed legislation on nursing service planning. It requests the Government to communicate copies of this legislation. The Committee recalls that in its previous comments it has requested the Government to provide information on the measures planned or taken to establish working groups to promote the quality of health care at the level of the individual hospitals, in accordance with section 2, subsection 2, of the decree of 13 September 1988. The Committee hopes that the Government will provide information on this issue.

3. Article 7. The Committee takes note with interest of the information provided by the Government in its report according to which in matters of occupational safety and health in general, and, with particular reference to biological risks and the risk of accidental exposure to the HIV virus, the Government and the regional and local authorities may take primary prevention measures, run information campaigns and issue specific regulations to safeguard, as far as possible, the work of nursing personnel. It also takes note of the various texts communicated by the Government with its report on this matter such as the informative brochure on biological risks for nursing personnel; Act No. 5 of 5 June 1990 approving the programme of urgent intervention on prevention and measures to combat AIDS, and Decree No. 235 of the Ministry of Health of 28 September 1990 on protection against occupational exposure to HIV within the structure of the Health Service in both the public and private sectors. In relation to its general observation of 1990, reiterated in 1994, the Committee requests the Government to continue providing information on the measures taken or contemplated regarding the working conditions of the nursing personnel who are infected or considered to be infected by HIV.