"You don't know our competence". Nurses and midwives protest against change in employment standards

Nurses and midwives disagree with changes to minimum staffing standards proposed by the Executive Board of the National Union of Provinces. In their joint position of October 10, 2025, the four key professional organizations - the Supreme Chamber of Nurses and Midwives (NIPN), the All-Poland Professional Union of Nurses and Midwives (OZPIP), the Polish Nursing Association (PTP) and the Polish Midwives Association (PTPoł) - call for the immediate withdrawal of the proposed changes.

The organizations warn that a reduction in standards could directly translate into a deterioration in patient safety and an even greater burden on medical staff. They also call on the Health Minister to strengthen oversight of facilities run by provincial governments, which, they stressed, do not always comply with current regulations and do not have full knowledge of the competencies of the medical profession.

"The current standards are an integral part of the Agreement concluded on July 9, 2018 between the National Trade Union of Nurses and Midwives, the Supreme Chamber of Nurses and Midwives and the Ministry of Health and the National Health Fund. The standards and the timetable for their implementation in various areas of treatment is an integral part of the 'Long-term State Policy for Nursing and Midwifery in Poland'." - recalls Krystyna Ptok, chairwoman of the OZZPiP.

The standards setting minimum nursing staffing levels (0.6 FTEs in conservative wards and 0.7 FTEs in surgical wards), the organizations stress, are already limits that cannot be lowered without compromising patient safety. The calculations take into account an average bed occupancy rate of 80-85% and are intended to ensure continuity of care even during periods of increased patient influx.

Nevertheless, as the nurses point out, the applicable standards are often violated, and the institutions responsible for control - such as the National Health Fund, the Patient Ombudsman, governors or founding bodies - do not react firmly enough. In this situation, according to the environment, the proposal to lower them further is unjustified and dangerous.

The joint position also draws attention to the risk of nurses and midwives being replaced by medical caregivers or paramedics.

"I constantly encounter discussions about the competence of nurses and midwives. The controversy usually stems from insufficient knowledge. Failure to recognize competence, discussions that all nurses and midwives do the same thing, that all in all it's injections, administration of medicines - these are deeply rooted stereotypes. Today, competently, nurses and midwives perform a very wide range of tasks, which is why we are working to make Advanced Practice Nursing more realistic. It is worrying that also in the communities that influence the functioning of health care, we have a low level of knowledge about the competencies of the various health professions," stresses Mariola Lodzinska, president of NIPIP.

According to the Law on Nursing and Midwifery Professions, these professions are responsible for providing health services that require specialized knowledge and skills, including planning care, recognizing patient needs and making independent decisions within the scope of professional competence.

In contrast:

• A paramedic works mainly in emergency situations, as part of the National Emergency Medical Service system,
• The medical caregiver performs supportive activities - providing hygiene, comfort and basic support to the patient.

Neither of these professions can therefore replace a nurse or midwife in medical services or be counted in the applicable employment standards.

"In the case of de facto midwives, no other profession has similar competencies. The unique competencies of midwives cover a wide range of activities - from managing physiological pregnancy and receiving deliveries, to caring for the mother and newborn, to counseling and preventive health care," reminds Agnieszka Bień, president of the Polish Midwifery Association.

The nursing community points out that the hiring of medical caregivers should only be a complement to the team, not a substitute for specialized staff.

"Research indicates that from the perspective of health policy and hospital economics, the savings achieved by replacing nurses with less qualified staff are apparent - the costs of complications, hospitalizations, longer stays and staff turnover outweigh the accounting 'gain'." - emphasizes Grażyna Wojcik, president of the Polish Nursing Association.

The organizations appealed to the Minister of Health to strengthen substantive supervision of hospitals run by provincial governments - both in terms of compliance with employment standards and proper use of the professional competence of staff. They also announced an official request to the Board of Directors of the Union of Provincial Governments to withdraw the October 10, 2025 position.