“If you don’t like it – quit.”
Why the nurses in Kolomna declared a hunger strike.
In the city of Kolomna, Moscow Region, nurses at a local perinatal center have announced a hunger strike. The Moscow Region Ministry of Health is conducting an investigation. One nurse will join the hunger strike every five days. They are dissatisfied with the working conditions at the center and with the administration’s attempts to reduce their positions by transferring them to cleaning staff. This is part of a reform that has taken place in Russia in recent years and has already led to protests by medical personnel.
“Considering the experience of my body, not eating for two days during work, I think maybe it will be easier for me,” says Natalia Trukhina, a junior nurse at the Kolomna Perinatal Center, in a conversation with the BBC. Trukhina became the first nurse at the Kolomna Perinatal Center to start a hunger strike on February 2. On that day, she went to work at 8 a.m. for a 12-hour shift and began fasting in the morning. She published a bulletin about her hunger strike – she measures her health indicators (blood pressure, weight, blood sugar) herself. According to Natalia, two employees of the center followed her and recorded and photographed her actions. “After a while I even felt sorry for the supervisors. Not everywhere there are sofas to sit on, so they stood and waited while I finished my work in this room. They also asked me for a training document. Why do they need it? It’s unclear,” she wrote in another post about the first day of the hunger strike. Her colleagues, five employees of the center, plan to join the hunger strike in five-day intervals. At the same time, the nurses, like Trukhina, plan to continue working.
Nurse Natalia Trukhina has been on hunger strike since February 2. The hunger strike statement was released on January 25 by the Interregional Trade Union of Healthcare Workers “Action” – an independent organization that advocates for the rights of medical professionals, including in cases of layoffs of junior medical staff. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. Episodes End of story podcast advertisement In recent years, a peculiar reorganization has been taking place in Russian hospitals: management is cutting the positions of sanitary workers and junior nurses, and instead offering employees lower positions, such as cleaners or storekeepers. The number of offers is supposed to remain the same. The BBC wrote extensively about the situation in the city of Anzhero-Sudzhensk, Kemerovo region: in 2019, the cleaners of the local hospital announced a hunger strike because the management was trying to reduce their positions and transfer them to janitors. The hunger strike itself lasted two days, after which many cleaners were fired and then spent months fighting their cases in court. The hospital management and the BBC interviewer at the Kemerovo Regional Ministry of Health explained that these plans are related to the need to increase cost efficiency. This is connected with the “May decrees” – they were issued by Vladimir Putin in 2012, when he became the president of Russia again. According to the decrees, the salaries of average and junior medical personnel should reach the average salary level in the region. The “Deystviye” trade union and various experts said at the time that this was a significant burden for hospitals.
Trukhina announced her hunger strike on social media. Another reason for a reduction could be changes in the qualification requirements for medical personnel. The situation at the Kolomenskoye Perinatal Center has become a continuation of this trend. Especially since the burden on the health care system has increased in recent years due to the coronavirus pandemic. “There are only 22 junior nurses left. All maternity wards have been closed, some have been reassigned to disinfection work, and others have been reprofiled for COVID-19. And all the workload has fallen on us,” says Natalya Trukhina, describing the current situation at the Perinatal Center. According to her words, difficulties arose as early as September 2019, when the number of junior medical staff was reduced by about half, but there was no salary increase. According to the answer given by the Ministry of Health to the trade union “Deystviye”, the reduction of sanitary workers in 2019 was carried out due to the lack of professional education of employees in the position of “sanitary” in accordance with the professional standard adopted in 2016. According to the Ministry of Health, since “cleaning the premises” was the main activity of the sanitary workers, this function was outsourced to a cleaning company. And a large part of the junior medical staff, after training, has moved on to positions as junior nurses for patient care. For example, according to the Department of Health, the 2019 measures “did not result in an increased workload for junior medical staff.” But some of the staff at the perinatal center disagree. “Today, in the huge (6-storey) perinatal center in Kolomna, instead of the 160 junior nurses and sanitarians provided for by the staffing norms of the Russian Ministry of Health, there are only 22 junior nurses and about 20 cleaners of an individual entrepreneur… Due to the enormous workload, during the entire 12-hour shift a junior nurse has only 7-10 minutes to eat a quick meal,” the statement published on January 25 said. As of October 1, 2021, according to Natalia Trukhina, a new change was planned – the position of junior nurse was to be abolished. Those who wanted to stay at the center were offered to transfer to a junior technical staff position with a salary of about 8,000 rubles – as a janitor, storekeeper, plasterer. Trukhina and other hunger strikers did not sign the letter. Later, with the help of the “Deystvie” staff, this reduction was challenged and the order was canceled – but the working conditions remained unchanged. The reason for the hunger strike was not only the threat of job cuts or transfer to janitors, but also the excessive workload of the nurses. The authors of the appeal demand to increase the number of junior nurses in the center by more than two times (up to 60) and to hire 21 sanitary workers – currently, as the appeal states, there are none. Among the demands of the participants is to remove the duties of the sanitary workers from the nurses and to pay them extra for working in several departments. They also ask for rest and meal breaks. “One of the duties of a junior nurse is to take care of patients. In my case, that means helping a woman wash herself. Changing bed linen, accompanying patients and taking them to specialists. We also have sanitary duties, which include cleaning the wards. In my case, I clean the intensive care unit of the premature infants’ ward,” says Trukhina. “I work on the third floor, which includes three departments – the postnatal department for women, the postnatal department for children, and the department for newborns and premature babies. These are three different departments, and by transferring us to the general staff, the management separated us from a specific department and forced us to run everywhere without any extra pay. So in the morning we rush to one department, then to another, and then to the third,” says Natalia Trukhina. The response from the Ministry of Health states that junior nurses are part of the “general staff of the institution” – meaning that they should work in several departments at the same time. In the statement, released on January 25, the nurses cite examples of how working in multiple departments can potentially harm patients. For example, only one junior nurse works in two intensive care units at the center – one for women and one for children. “Pediatric resuscitation is considered a sterile area. There should be a resident assigned to it. But at the moment, there is only one junior specialist who goes from one department to another. In the women’s resuscitation department, there are sometimes mothers with hepatitis or HIV infection. Meanwhile, in the children’s department, they simply put on a disposable gown on top, because there is no opportunity to change clothes each time they run from one department to another, and the employer has not provided the necessary number of specialized suits for this,” – stated in the appeal. After our appeals to the prosecutor’s office in September 2021, the authors of the document continue, they were issued two special suits each, but this is not enough for work – as a suit, according to SanPiN requirements, should be washed after each shift worked.
This is not the first time that perinatal center workers have tried to improve their working conditions. “During our meetings we kept talking about how physically difficult it was for us, but the management did not listen to us. The trade union (not Deystviye, but the trade union of the Kolomna Perinatal Center – BBC) did not support us and always sided with the administration. At every meeting it was said that we were legally correct, that the administration was acting correctly, and those who didn’t like it could resign,” says Natalya Trukhina. According to her, the hospital’s management cited orders from the Ministry of Health to reduce staff. Since January 25, when the appeal was published, the perinatal center has been inspected by various agencies, including the Ministry of Health, Rospotrebnadzor (the Russian Federal Service for Surveillance of Consumer Rights and Human Well-being), the State Labor Inspection, and the Prosecutor’s Office. However, she describes these inspections calmly: “They just came and talked to the employees. As reported by the BBC in the Ministry of Health of the Moscow region, the department is currently conducting an official inspection at the Kolomna Perinatal Center, “based on the results of which appropriate measures and decisions will be taken”. The BBC expects a response from the Russian Ministry of Health, the Moscow Regional Prosecutor’s Office, Roszdravnadzor and the State Labor Inspectorate. Historically, in the vast majority of state hospitals, the functions of sanitation workers and junior nurses have been virtually indistinguishable, explains the Action trade union. With the introduction of the “Junior Medical Staff” professional standard in 2016, the division between orderlies and junior nurses has become stricter, and the need for specialized training in each of these professions has emerged. In fact, the combination of functions remained even after the introduction of the professional standard. According to Rosstat, cited by the trade union “Action”, from 2013 to September 2020, the number of junior medical personnel (MCS) decreased from 687 thousand to 267.6 thousand workers. Compared to 2013, the number decreased by 419.4 thousand or 61%. At the same time, the main reduction in the number of junior nurses did not take the form of outright layoffs (although such reductions did take place). “The main trend has become the mass transfer of sanitary workers and junior nurses (usually under the threat of dismissal due to staff reduction) from the category of medical and social workers to the category of auxiliary staff – janitors of office (or production) premises (hereinafter referred to as janitors),” said “Deyistviye” in its analytical note in May 2021. The main reason for the spread of such practice is the lack of funds to increase the average wages of medical workers in strict accordance with the Decree of the President of the Russian Federation ¹ 5972 – the so-called “May Decree” of 2012. “The May decrees do not apply to the auxiliary staff of health care institutions, so the transfer of health care assistants and junior nurses to janitors was seen in the regions as the easiest way to save on social spending. The salaries of janitors either did not increase or increased insignificantly or even decreased during the period under review,” the union said. The problem of translating nurses into orderlies has become so widespread that information on how to do this has appeared on regional union websites. Clarification on how to format such a translation has been provided by the Ministry of Health. Nurses at the Kolomna Perinatal Center are currently trying to keep their jobs. “I cannot go from one job to another every time the management interferes with my pocket. It’s wrong, it’s abnormal,” says Trukhina. This is how she described her feelings after the first day of fasting: “Do I feel like eating? I don’t even know. Before lunch I felt a little hungry, then it went away. I feel like drinking all the time, today I drank 1.5-2 liters. I don’t feel dizzy, nothing hurts. We’ll see what tomorrow brings. Tomorrow I have another 12-hour shift starting at eight.”