Nursing advocates warn of critical staff shortage, underfunding of nursing care services
Ukraine's healthcare system is facing a critical shortage of nursing staff and underfunding of nurses' work, which is significantly worsening the provision of medical care, nursing advocates said at a press conference at Interfax-Ukraine on Thursday.
Secretary of the Council of the NGO Medical Movement "Be Like Us" Ruslana Mazurenok said a number of studies and surveys on the situation in the sector had shown that "nursing today is being destroyed by staff shortages, overload and financial injustice," while the state is not paying proper attention to this area.
"Medical reform is designed in such a way that the role of nurses in the system has effectively fallen outside the focus of state policy. The NHSU packages of medical services regulate the availability of specialist doctors and equipment, but say almost nothing about requirements for the presence of nurses, their number and qualification level. No one counts the hard daily work of a nurse. For the system, it is as if it is a free add-on that does not need to be paid for separately," she said.
Mazurenok also said that nurses' work "is not legally or financially identified as a separate valuable service, which automatically devalues the profession; we are transferred to part-time positions, one person is forced to do the work of three, and it is easiest to save money on us."
She said studies and surveys conducted by the public organization had shown "critical staff overload, non-transparent mechanisms for calculating wages, instability of near-frontline bonuses, and a widespread feeling of professional burnout among healthcare workers."
"During these studies, we identified three levels of obstacles to receiving these near-frontline bonuses. The first is the level of the Ministry for Communities and Territories Development, the second level is the NHSU, because the status of an institution does not guarantee funding, and the NHSU constantly changes the rules, and the third is the level of the medical institution itself, because administrations manually approve how much each person should be paid. This is mainly due to the fact that all our salaries and bonuses are tied to collective agreements, which were mostly concluded before the war and contained nothing about bonuses or frontline payments," she said.
According to Mazurenok, the government's declarative guarantees regarding basic salaries are undermined by the reality of hospital underfunding.
"I will give a typical example from experience: there is a department where, based on real needs and the number of patients, a nurse should work full-time. However, due to an artificial shortage in the wage fund, she is legally transferred to 0.75 or 0.5 of a full-time position. What happens in practice? The number of beds does not decrease, while the nurse receives a reduced salary, from which incentive allowances are also removed," she said.
"Clear indicators on the provision of nursing staff must be included in the conditions for purchasing medical services," Mazurenok said.
For his part, auditor of the Council of the NGO Medical Movement "Be Like Us" and a surgeon Oleksiy Chupryna believes that "in order for a nurse to become a fully recognized actor, she must become a user of electronic medical systems."
"This means that the hospital has to pay for her, because payment is made for all doctors who enter information into the NHSU. And that is why I think the vast majority of directors try to bypass this issue, because it means additional costs," he said.
Psychiatric nurse Halyna Stepaniuk, for her part, described low wages as the biggest problem both in psychiatry and in nursing in general.
"We try to help patients, but when you catch yourself thinking that your take-home salary is UAH 10,400 and it has not improved in any way, it has not changed. On the contrary, earlier we received UAH 10,800 net, then the military levy appeared and we started receiving UAH 10,400. Many staff are leaving medicine, looking for better-paid work in another sector or going abroad because they no longer see prospects in Ukraine," she said.
In addition, Stepaniuk said the number of patients had increased because of the war, as had the number of women who had lost a son or husband in the war, or whose relatives had gone missing.
"Patients are appearing who develop mental disorders against the background of these stressful events. And as people, we cannot fail to sympathize with them. This also affects our mental health, but it is not reflected in salaries in any way. In addition, departments that should, on the contrary, be expanded according to specialization are being reduced, for example, departments for schizophrenia or separate departments for depressive disorders. In addition, procedural nurses are being cut, and now all the work falls on the shoulders of the duty nurse, but no one takes this into account," she said.
For her part, Head of the Council of the NGO Medical Movement "Be Like Us" and a pediatric nurse Oksana Slobodiana, answering an Interfax-Ukraine question about the level of nurses' pay in the private sector, said an analysis of market vacancies for nurses showed that salaries in the private sector "fluctuate at around UAH 20,000, from dentistry to ophthalmology, and if it is a more complex profession, for example operating room anesthetist nurses, then it is around UAH 25,000."
"I must say that if earlier they wanted only younger nurses, now they hire nurses aged 50 and 50+. In other words, the main thing is that there is a workforce," she said.
"In 2023, we predicted that critical problems in nursing would begin in 2026. These problems have already begun in a catastrophically serious way and have started in all regions of Ukraine. We see that across the country there is a staff shortage specifically among mid-level medical personnel, that is, nurses," Slobodiana said.