Izabella Main reports about the situation of nurses in Poland during the Covid-19 pandemic, the increasing shortage of nurses, and possible solutions through migration of nurses.
By Izabella Main
There is not enough of us. For the superhuman effort to protect the highest good, which is the health and life of fellow citizens, a fair payment must be made. Not rewards or allowances, but fair wages for counteracting the epidemic – the nurses blame the government and shout for help. (The Association of Digital Nurses)
The Covid-19 pandemic, which started in early 2020 in Wuhan, China and quickly spread globally, has reached the second wave in the Fall of 2020. Skilled healthcare workers are essential to the smooth operation of any healthcare system at any time. However, the need for an appropriate number of health personnel is especially important during a pandemic.
Increased importance of migrant healthcare workers
The current COVID‑19 pandemic highlights the importance and dedication of frontline responders as well as the challenges stemming from staff shortages. In many OECD countries migrant doctors and nurses makeup a significant proportion of healthcare personnel. Across the OECD countries, “nearly one‑quarter of all doctors are born abroad and close to one‑fifth are trained abroad. Among nurses, nearly 16% are foreign-born and more than 7% are foreign-trained” (OECD (oecd.org)). Nurses working in OECD countries hail from many countries, the top being the Philippines and India. But Polish nurses are not far behind: 70 323 nurses born in Poland worked abroad in 2015 and 2016.
While many Polish nurses work abroad, Poland has one of the lowest percentages of foreign-born and foreign-trained (0.1 percent) nurses working in the country, according to OECD data (oecd.org). Norway is on the other end of the spectrum. In Norway foreign-born and foreign-trained nurses constitute 12.1 and 8.7 percent, respectively. In response to the pandemic, many countries have implemented special regulations allowing migrant healthcare workers to extend their work permits or enter the healthcare labor market for the first time. In the USA the update on Visas for medical professionals (travel.state.org) was published on April 8, stating that medical professionals with approved visas could request emergency visa appointment while those already in the USA could extend their stay. The European Commission also issued Guidelines (pdf) (ec.europa.eu) on emergency assistance and cross-border cooperation in healthcare.
Shortage of nurses in Poland
Many publications and reports emphasize the shortage of nurses in Poland. Nurse emigration is not the only cause of this deficiency. Other reasons include an insufficient number of nursing students and a significant portion of nursing graduates not entering the profession. In 2019, only 20 percent of nursing program graduates actually worked as nurses in Poland (Rozwadowska 2020 (wyborcza.pl)). Another contributing factor is a de facto closure of the healthcare labor market to foreign-born and foreign-trained nurses. It is very difficult to estimate the number of foreign nurses working in Poland – the available statistics (alebank.pl) only show the number of nurses who received work permits, not the number of nurses actually employed in the Polish healthcare system. In the first half of 2020, only nine nurses from the Ukraine received work permits! Probably many more nurses born in the Ukraine work in Poland. However, they might have other permits allowing them to work and stay in Poland, including Polish citizenship or Pole’s Card (en.wikipedia.org), but data on these types of authorizations are hard to find.
The process of authorization (nipip.pl) is costly and time-consuming: one needs to submit documents about their nursing degree and professional experience in their home country and pass a Polish language test in order to intern in a healthcare facility for half a year. Only after the internship and another language exam do the nurses receive a work permit to be employed in Poland.
There have been attempts to shorten this process: a group of Ukrainian medical high school graduates was invited to study in Kalisz for a BA in nursing and to work in a hospital in Poznań, Poland upon graduation. However, they faced difficulties in receiving their diplomas because the District Council of Nurses and Midwives in Poznań refused to issue the permits, arguing that the “bridge” BA programs, created in 2004, were only for Polish nurses without BA degrees. In the past, a university degree was not required to work as a nurse, but EU regulations required them to have it. Local media reported on this situation (pulshr.pl). According to the journalistic accounts, migrant nurses would not solve the staffing problem. A number of articles (wyborcza.pl) also raise the issue of aging of nurses and resulting staff deficits. Gazeta Wyborcza, the National Council of Nurses and Midwives, as well as a few companies (ARJO, Skamex and Novamed) distributing medical devices, are trying to “discuss and find solutions to change the social perception of the nursing profession, promote the profession of nurses and midwives, improve working conditions as well as enhance working relations with doctors and patients.”
The impact of COVID
The Covid-19 pandemic exacerbated the situation of nursing personnel. The government proposed additional rewards for medical personnel working “on the Covid-19 front lines.” However, it soon became apparent that it was a mistake to offer additional incentives because there was no money in the state budget. In a recent interview (wyborcza.pl), Krystyna Ptok, the Chairman of the National Unions of Nurses and Midwives, criticized the government for their lack of preparation for the second wave of Covid-19 infections. She also mentioned the physical and mental exhaustion of nurses stemming from being overworked due to staff shortages. The government is currently fast-tracking special regulations for doctors from abroad (gazetawroclawska.pl) to work in Poland in order to mitigate the additional pressures of the pandemic. However, these regulations do not concern nurses. The mortality among nurses due to Covid-19 is rising and no solutions are offered. The media reported that (wyborcza.pl) the labor unions entered into discussions with the management of healthcare facilities on behalf of the bargaining union membership. If their demands are not met, the unions are considering a general strike in the Spring. The unions also blame the media for manipulating society’s perception of the situation of nurses and other medical professionals. The Association of Digital Nurses announced “the death of nursing in Poland” (oko.press).