Direct Request (CEACR) - adopted 2018, published 108th ILC session (2019)

Direct Request (CEACR) - adopted 2013, published 103rd ILC session (2014)

Observation (CEACR) - adopted 2013, published 103rd ILC session (2014)

Direct Request (CEACR) - adopted 2009, published 99th ILC session (2010)

Article 2, paragraphs 1 and 2, of the Convention. National policy for nursing services and nursing personnel. The Committee notes the Government’s indication that the health sector has undergone comprehensive change since the end of 2007, particularly because of the new integrated national health system, under which the State has become a provider of health services and has enabled the private sector to extend its coverage. It also notes the Government’s reference to a draft Act concerning nursing personnel, which has been before Parliament for some time. It hopes that the Government will adopt this draft Act in the near future and will take account of the comments which the Committee has been making for a number of years. The Committee therefore requests the Government to provide further details concerning the principal components, priorities and objectives fixed by the new integrated national health system, particularly concerning its impact on the conditions of work of nursing personnel, and to supply a copy of the Act concerning nursing personnel, once it has been adopted.

Furthermore, the Committee notes that, on average, there are between ten and 11 nurses per 10,000 population and nursing personnel are leaving the country in order to obtain better conditions of work. It also notes that Uruguay has the lowest number of qualified nurses in the whole of Latin America, with a figure of only 12.2 per cent for nursing personnel and, consequently, the highest figure for auxiliary nurses (87.8 per cent). This phenomenon is accentuated by the fact the MERCOSUR provides for the free movement of workers between its member States (Brazil, Argentina, Paraguay and Uruguay) and, in particular, since the treaty of Asunción signed in 1991 which provides for the possibility of sectoral agreements, especially in the health sphere. In this regard, the Committee wishes to refer to the draft WHO code of practice concerning the international recruitment of health personnel, currently under discussion, which encourages member States to conclude bilateral and multilateral agreements to promote cooperation and coordination relating to migrant health personnel in the recruitment process, in order to optimize the advantages and reduce the potentially negative impact of the international recruitment of health personnel, and also calls for measures to conserve and maintain a qualified national workforce of health personnel by improving their economic and social situation, living and working conditions, possibilities of employment and career prospects. The Committee therefore requests the Government to supply detailed information on any developments in the situation and on any additional measures taken or contemplated in order to contain the phenomenon of the migration of qualified nursing personnel abroad.

Article 2, paragraph 2(b). Remuneration for nursing personnel. Further to its previous comment, the Committee notes the Government’s indication that, since 2005, the policy of collective bargaining within the Wage Council has brought new developments with regard to the wages of nursing personnel, in both the public and private sectors. It notes that wages for nursing personnel increased by 40 per cent between 2005 and 2009. The Committee also notes that the Government has not supplied any information concerning the specific points raised in its previous comment and requests it once again to indicate: (i) the reasons for nursing personnel leaving the profession or working abroad; (ii) any difficulties still encountered by nursing personnel in the public or private sector, such as redundancies, wage cuts or delays in the payment of wages; and (iii) any measures taken or contemplated, such as the introduction of an incentive bonus system, to remedy this situation in the short term.

Article 3, paragraph 2. Need to coordinate nursing education and training with education and training for other workers in the health sphere. The Committee notes the information supplied by the Government concerning subjects taught at the University of the Republic in the health sphere, particularly with regard to occupational health. However, it notes the Government’s indication that there is still no specific coordination between nursing education and training and the education and training given to other workers in the health sphere. The Committee requests the Government to indicate, in accordance with this provision of the Convention, the measures taken or contemplated to ensure the coordination of education and training for workers in the health sphere.

Article 5. Participation of nursing personnel in the planning of nursing services – determination of conditions of employment and work by negotiation between employers’ and workers’ organizations concerned. Further to its previous comments on this point, the Committee notes the Government’s indication that the restructuring of the Ministry of Public Health, mentioned in its previous report, is going ahead. It notes that the Government does not supply any information concerning the impact of the closure of the Central Nursing Department on the active participation of nursing personnel in the planning of nursing services. The Committee further notes that no progress has been made with regard to the national plan for nursing services, which was due to be drawn up by the Nursing Services Technical Committee. Bearing in mind that it has been raising the question of the participation of nursing personnel in the planning of nursing services for many years, the Committee requests the Government to take the necessary steps without delay to ensure, in accordance with this Article of the Convention, the real and effective participation of nursing personnel in the planning of nursing services and the consultation of such personnel on decisions concerning them. It also requests the Government to indicate whether, since 1999, there has been an agency or service which exercises the tasks for which the Central Nursing Department was responsible, and to keep the Office informed of any developments with regard to the national plan for nursing services.

Article 7. Specific legislation on occupational health and safety adapted to the special nature of nursing work and of the environment in which it is carried out. The Committee notes the Government’s indication to the effect that no particular measure has been adopted with a view to adapting occupational safety and health laws and regulations to the specific nature of nursing work, in accordance with this Article of the Convention. It also notes that the Government does not supply any information concerning any follow-up measures taken in the event of occupational accidents, particularly in cases of contamination by HIV/AIDS. The Committee therefore requests the Government once again to supply information on the conditions of work of nursing personnel and the risks of accidental contamination, on the confidential nature of HIV/AIDS test results, and to indicate whether HIV infection contracted in the course of duty is recognized as an occupational disease. It also requests the Government to send a copy of the revised bio-security standards mentioned in its previous report.

Furthermore, the Committee wishes to draw the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to helping health services to strengthen their capacity for providing workers with a healthy and decent working environment, this being the most effective means of reducing the transmission of HIV and improving the provision of care for patients. The Committee would also like to refer to the discussion at the June 2009 session of the International Labour Conference on “HIV/AIDS and the world of work”, with a view to the adoption of an international labour recommendation, in particular paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310), which states that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS.

Part V of the report form. Practical application. The Committee requests the Government to continue supplying general information on the manner in which the Convention is applied in practice, including, for example, statistics on the numbers of nursing personnel (by sectors of activity and by levels of training and functions, if possible), the number of persons entering and leaving the profession each year, the number of students enrolled in various nursing schools, copies of official reports or studies on nursing services, copies of branch or establishment collective agreements covering nursing personnel, and information on any practical difficulties encountered in the implementation of the Convention.

Direct Request (CEACR) - adopted 2005, published 95th ILC session (2006)

The Committee notes the information contained in the Government’s last report and the attached documentation.

Article 2, paragraph 2(b), of the Convention. Further to its previous comment regarding remuneration levels for nursing personnel in the public sector, the Committee notes the Government’s statement that the economic policy tending to reduce public expenditure affects the income of nursing personnel, and that consequently it has not been possible to take any measures to increase the wages of nursing personnel and maintain their purchasing power.

In this connection, the Committee requests the Government to provide more detailed information, including copies of collective agreements, on the remuneration levels practiced in both the public and the private sectors. It further asks the Government: (i) to specify whether low salaries of nursing staff employed in public health care institutions have an impact on the number of nurses leaving the profession or even migrating to other countries; (ii) to indicate any other difficulties (e.g. redundancies, salary reductions, delayed payment of wages) which may be experienced by nurses in the public or private sector; and (iii) to outline any measures taken or envisaged to remedy this situation in the short term.

Article 3, paragraph 2. With reference to its previous comment concerning the need for coordination of nursing education with the education and training of other health workers, the Committee notes the Government’s statement that the Universidad de la República has undertaken the initiative to create a "health area" composed of all the schools and institutes in order to unify the different teaching faculties related to health care professions, including the nursing profession. The Committee would appreciate receiving further information on any concrete steps taken to put this initiative into practice.

Article 5. The Committee notes that, according to the information provided by the Government, the Technical Nursing Committee has prepared health care guides for patients with emerging diseases and is currently in the process of formulating a national plan for nursing services, whereas the advisory commission for the planning of nursing services has never become effective. The Committee requests the Government to keep it informed of the progress made in the preparation of the national plan and to communicate a copy of the text once it is finalized. Moreover, the Committee notes the Government’s indication that, due to the restructuring of the Ministry of Public Health, the Nursing Central Department ceased its functions at the end of 1999. In this regard, the Committee requests the Government to specify the agency or service, if any, responsible for the tasks previously entrusted to the Nursing Central Department and also to clarify whether the abolition of that Department has had an impact on the process of active participation of nursing personnel in the planning of nursing services and full consultation with such personnel on decisions affecting the terms and conditions of their employment.

Article 6. The Committee notes with interest Decision No. 12.537 of the Labour Court of Appeals, which makes express reference to ILO Convention No. 149 and its impact on domestic legislation.

Article 7. The Committee notes the Government’s statement that the existing bio-security standards were last updated in 2002 and that they were distributed to health personnel both in the public and the private sectors. The Committee would appreciate receiving a copy of the revised bio-security standards. In addition, the Committee notes the Government’s statement that in 2003 the need for a quick HIV test for occupational accident prevention was raised with the competent authorities. The Committee requests the Government to provide information on any follow-up action in this respect and also to report on measures taken with respect to the working conditions of nursing personnel in relation to the risks of accidental infection, the confidentiality test results, recognition of the occupational nature of the HIV disease contracted during the course of work, etc.

Part V of the report form. While recalling that statistical information on nursing personnel was transmitted for the last time in 1993, the Committee would be grateful if the Government would supply in its next report all available data including, for instance, statistics on the evolution of the nursing workforce both in rural and urban areas, the number of students enrolled or graduating from nursing schools, as well as the number of persons leaving the nursing profession every year, copies of official reports or recent studies examining the employment and working conditions of nursing personnel, etc.

Direct Request (CEACR) - adopted 2001, published 90th ILC session (2002)

Article 2 of the Convention. The Committee notes the detailed information provided by the Government concerning the training policy for nursing personnel as well as the measures adopted in relation to the employment and working conditions of the above personnel. In this respect, the Committee notes that, according to the information provided by the Government, the remuneration of nursing personnel differs widely depending on whether it is a question of the public or the private sector. In the latter sector, nursing personnel have benefited from the introduction of wage incentives, through collective agreements, between 1987 and 1992. As from this latter date, collective agreements were confined to establishing percentages of wage increases. However, the Committee notes with concern that in the public sector the income of nursing personnel has been affected by the measures taken to reduce costs. The Committee therefore asks the Government to take all the necessary measures to ensure that the wages of nursing personnel are respected and adjusted to maintain their purchasing power with a view to attracting persons to the profession and retaining them in it.

Article 3, paragraph 2. The Committee notes the Government’s statement to the effect that nursing education and training are not coordinated with the education provided to other workers in the field of health. The Committee draws the Government’s attention to the importance of such coordination and hopes that the Government will take the necessary measures to ensure such coordination, as envisaged in this provision of the Convention.

Article 5. With reference to its previous comments, the Committee recalls that it asked the Government to indicate which decisions had been adopted by the Technical Nursing Committee which may affect the working conditions of nursing personnel. While noting the composition of the above committee, it also registers the establishment of the advisory commission for the planning of nursing services. The Committee notes that, according to the information provided by the Government, the procedures by which the conditions of employment and work of nursing personnel are determined are, in the public sector, the five-year budgets and, in the private sector, collective agreements. The Government adds that the participation of nursing personnel in the planning of nursing services depends on the policies of both the public and private institutions concerned. It indicates that machinery has been established in certain institutions for active participation in the planning of their services but that, when decisions are taken at the higher level of the organization of the institution on the planning of health services, of which one of the components is nursing services, participation is rare or non-existent. The Committee recalls that, in accordance with this provision of the Convention, measures shall be taken to promote the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them. The Committee therefore urges the Government to take the necessary measures to promote the participation and consultation of nursing personnel in accordance with this provision of the Convention and to provide the relevant information concerning the measures adopted.

Article 7. With reference to its previous comments, the Committee notes that since 1997 the Ministry of Public Health, through its national AIDS programme, has been revising the existing bio-security standards for the prevention of accidents through exposure to blood and body fluids. The Committee urges the Government to continue providing information on this subject and, in particular, on the results of the application of the measures relating to nursing personnel proposed under the above national programme. It also requests the Government to indicate the measures which have been adopted, for example, with respect to the working conditions of nursing personnel in relation to the risks of accidental infection, the confidentiality of test results, recognition of the occupational nature of diseases caused by human immunodeficiency virus (HIV) contracted during the course of work, etc.

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

The Committee notes with regret that the Government's report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

The Committee notes the detailed information supplied by the Government in answer to its previous comments.

Article 5 of the Convention. The Committee notes with interest the Government's statement that there is a technical nursing committee which enables nursing personnel to participate in decision-making that concerns them. It asks the Government to continue to supply information on any decisions taken in the context of the above committee or any agreement concerning the conditions of work of nursing personnel.

Article 7. The Committee asks the Government to indicate the measures taken or envisaged to improve the existing provisions of the law on occupational safety and health, so that they are adapted to the particular characteristics of the work of nursing personnel and their working environment. Furthermore, referring to its general observation of 1990, which it repeated in 1994, the Committee asks the Government to indicate the measures taken or envisaged, in consultation with the employers' and workers' organizations concerned, to take account of the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, working conditions, confidentiality of test results, acknowledgement that the cause of infection is occupational, etc.

Part V of the report form. The Committee notes the statistical information supplied by the Government in its last report. It hopes that the Government will continue to provide such statistics and that it will send data on the number of people leaving the profession. Please also report any difficulties encountered in the practical application of the Convention.

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

The Committee notes that the Government's report has not been received. It must therefore repeat its previous observation which read as follows:

In its previous comments the Committee noted the observations made by the Association of Nursing Personnel of Uruguay to the effect that regulations establishing a nursing diploma had been adopted without those concerned having been consulted. It noted that the detailed explanations in the Government's report gave no information on the existence and results of the consultations provided for in Articles 2 and 5 of the Convention. The Committee notes the detailed information supplied by the Government. The latter refers in particular to a technical nursing committee on which the Association of Nursing Personnel of Uruguay is represented. The Committee asks the Government to provide detailed information on the composition and functions of the technical nursing committee including the texts regulating such committees. The Committee is also addressing a request directly to the Government concerning certain other points.

The Committee hopes that the Government will make every effort to take the necessary action in the very near future.

Direct Request (CEACR) - adopted 1995, published 82nd ILC session (1995)

The Committee notes the detailed information supplied by the Government in answer to its previous comments.

Article 5 of the Convention. The Committee notes with interest the Government's statement that there is a technical nursing committee which enables nursing personnel to participate in decision-making that concerns them. It asks the Government to continue to supply information on any decisions taken in the context of the above committee or any agreement concerning the conditions of work of nursing personnel.

Article 7. The Committee asks the Government to indicate the measures taken or envisaged to improve the existing provisions of the law on occupational safety and health, so that they are adapted to the particular characteristics of the work of nursing personnel and their working environment. Furthermore, referring to its general observation of 1990, which it repeated in 1994, the Committee asks the Government to indicate the measures taken or envisaged, in consultation with the employers' and workers' organizations concerned, to take account of the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel: for example, working conditions, confidentiality of test results, acknowledgement that the cause of infection is occupational, etc.

Point V of the report form. The Committee notes the statistical information supplied by the Government in its last report. It hopes that the Government will continue to provide such statistics and that it will send data on the number of people leaving the profession. Please also report any difficulties encountered in the practical application of the Convention.

Observation (CEACR) - adopted 1995, published 82nd ILC session (1995)

In its previous comments the Committee noted the observations made by the Association of Nursing Personnel of Uruguay to the effect that regulations establishing a nursing diploma had been adopted without those concerned having been consulted. It noted that the detailed explanations in the Government's report gave no information on the existence and results of the consultations provided for in Articles 2 and 5, of the Convention.

The Committee notes the detailed information supplied by the Government. The latter refers in particular to a technical nursing committee on which the Association of Nursing Personnel of Uruguay is represented.

The Committee asks the Government to provide detailed information on the composition and functions of the technical nursing committee including the texts regulating such committees.

The Committee is also addressing a request directly to the Government concerning certain other points.

Direct Request (CEACR) - adopted 1993, published 80th ILC session (1993)

The Committee takes note of the information supplied by the Government concerning the training of nursing personnel. It asks the Government to indicate the measures taken or contemplated to provide nursing personnel with employment conditions and remuneration which are likely to attract persons to the profession and retain them in it, in accordance with Article 2, paragraph 2(b), of the Convention.

Observation (CEACR) - adopted 1993, published 80th ILC session (1993)

In its previous comments, the Committee noted the allegations made by the Nurses' Association of Uruguay that Decree No. 310/991 of 27 November 1991, establishing a nurse's diploma issued by the School of Health of the Ministry of Public Health, was adopted without the persons concerned being consulted and does not solve the problem of the lack of professional nurses, the main causes of which are low wages and hard working conditions.

The Committee takes note of the detailed information supplied by the Government. It notes that Decree No. 310/991 establishes a "degree in nursing care" which can be obtained in four years by persons who have completed their secondary education (sections 1 and 2) and an intermediate diploma in technical assistance in nursing which can be obtained in two years (section 3). The Decree defines the tasks which may be carried out by nurses and technical assistants (sections 4 and 5). It also establishes, provisionally and exceptionally, further training and refresher courses for auxiliary nurses who have qualified at the School of Health and who have practised for ten years. These courses last 18 months and lead to a "degree in nursing care" (sections 6, 7 and 8). Persons who have obtained their qualifications at the School of Health will be given preference in the competitive examinations for entry to the Ministry of Public Health (section 12). Lastly, the education provided by the School of Health shall be coordinated with and complementary to that provided by the University and other institutions pursuing the same ends (section 13).

The Committee notes that the provisions of Decree No. 310/991 give effect to Articles 2, paragraph 2(a) and 3 of the Convention. The Committee recalls, however, that under Article 2 of the Convention, the policy concerning nursing services and nursing personnel which must include the necessary measures to provide nursing personnel with education and training appropriate to the exercise of their functions shall be formulated in consultation with the employers' and workers' organizations concerned. The Committee notes that in its detailed explanations the Government does not indicate whether such consultations were held prior to the adoption of Decree No. 310/991 or refer to the results thereof.

The Committee asks the Government to indicate the measures that have been taken to ensure that the employers' and workers' organizations concerned are consulted, in accordance with the provisions of the Convention, particularly with regard to Article 2, paragraphs 3 and 4 and Article 5, paragraph 1, of the Convention.

The Committee raises another question concerning the application of Article 2, paragraph 2(b), in a request addressed directly to the Government.

Direct Request (CEACR) - adopted 1992, published 79th ILC session (1992)

The Committee requests the Government to supply additional information in its report on the following points:

Article 2, paragraph 2(a) and (b). The Committee requests the Government to continue supplying information on the progress achieved as regards education and training that is appropriate to the exercise of nursing functions.

The Committee trusts that the Government will make every effort to take the necessary measures to improve the levels of remuneration and the conditions of employment and work (including career prospects) of nursing personnel in general and of those in the public sector in particular in order to attract persons to the profession and retain them in it, in accordance with the above provision of the Convention.

Article 5, paragraph 2. The Committee requests the Government to keep it informed of the outcome of the work undertaken by the Technical Committee and the Nurses' Association to update the existing standards and to formulate draft legislation and regulations that are specifically applicable to nursing personnel.

Point V of the report form. The Committee trusts that, despite the difficulties to which it refers, it will be possible for it to supply information on the effect given to the Convention in practice, including statistical data on the numbers of nursing personnel in general, and in relation to the population and to the numbers of other workers in the health sector.

Observation (CEACR) - adopted 1992, published 79th ILC session (1992)

The Committee notes a communication from the Nurses' Association of Uruguay, dated 18 December 1991, a copy of which has been transmitted to the Government by a letter dated 21 January 1992. The Nurses' Association alleges that effect is not given to the provisions of the Convention concerning consultation with the professional organisations of the Government's measures in respect of education and nursing training. Consequently, it would be grateful if the Government would make its own observations on these allegations so that the Committee can examine the substance of the question at its next session.

In addition, the Committee has referred to other questions related to Article 2, paragraph 2(a) and (b), and Article 5, paragraph 2, in a direct request.

Direct Request (CEACR) - adopted 1990, published 77th ILC session (1990)

1. With reference to its previous comments, the Committee notes the information supplied by the Government, particularly as regards the application, in the public sector, of Article 5, paragraph 3, of the Convention (settlement of disputes through negotiations between the parties or through independent and impartial machinery).

2. The Committee requests the Government to supply additional information in its report on the following points:

Article 2, paragraph 2(a) and (b). In reply to its previous comments, the Government indicates that measures have been taken to change the study programme of the University Nursing School and to award diplomas in this subject to those who are about to finish their courses there. It adds that the shortage of nurses has also led the above School to establish a programme of supplementary studies, intended to train nursing auxiliaries who have attained the required standard of pre-university education, so that they can gain a nursing diploma in a short time and thereby raise the number of persons with diplomas in this subject. The Committee notes with interest the indications supplied by the Government and requests it to continue supplying information on the progress achieved as regards education and training that is appropriate to the exercise of nursing functions.

As regards their conditions of employment and work, the Government indicates that levels of remuneration continue to be inadequate, particularly in the public sector, and that this frequently results in nursing personnel taking on a second job. The Committee trusts that the Government will make every effort to take the necessary measures to improve the levels of remuneration and the conditions of employment and work (including career prospects) of nursing personnel in general and of those in the public sector in particular in order to attract persons to the profession and retain them in it, in accordance with the above provision of the Convention.

Article 5, paragraph 2. In reply to the Committee's comments, the Government indicates that the Committee set up to formulate a preliminary text of the Conditions of Service of Health Personnel, has suspended its meetings due to the withdrawal of the representatives of the Medical Union of Uruguay, the Uruguay Health Federation and the Mutual Benefit Societies of the Interior. The Committee hopes that it will be possible to recommence negotiations between the Government and the trade union organisations concerned in the near future in order to determine the conditions of employment and work of nursing personnel, both in the public and private sectors, and that the Government will indicate the progress achieved in this respect. The Committee also notes with interest the creation, within the Ministry of Health, according to the Government's report, of a Technical Nursing Committee in which representatives of the personnel of "Hospital de Clínicas", and the Nurses' Association participate on an equal footing, and it notes that this Committee has been given the task of updating the existing standards in this sector in the specific field of nursing. The Committee also notes the initiative taken by the Nurses' Association to formulate, with the participation of the representatives of all the health services at the national level, draft legislation and regulations that are specifically applicable to nursing personnel. The Committee requests the Government to keep it informed of the outcome of the work undertaken by the Technical Committee and the Nurses' Association.

3. Point V of the report form. The Committee notes the Government's explantions and trusts that, despite the difficulties to which it refers, it will be possible for it to supply information on the effect given to the Convention in practice, including statistical data on the numbers of nursing personnel in general and in relation to the population and to the numbers of other workers in the health sector.