To improve the organization of patient care in hospitals, the positions of head nurses of hospitals and head sisters of departments have been introduced.

The elder sister is the direct assistant to the head of the department. This is the most qualified paramedical worker with long work experience. The elder sister should be the organizer of the medical and economic work of the department and is responsible to the head of the department and the chief doctor of the hospital for the sanitary condition of the department and for the implementation of the established regimen for patients and staff.

All household functions under the leadership of the senior sister of the department are carried out by the sister-hostess, barmaid, nurses, cleaners.

The work of nurses consists of a number of elements: fulfillment of medical appointments, sanitary and hygienic care, nutrition of patients, monitoring the condition of patients, communication with auxiliary departments. Almost all of the working time of a nurse is spent on fulfilling medical appointments.

The norms of load per sister are 20 patients in the therapeutic, neurological, oncological, orthopedic, urological, dental and rheumatological departments during the day and 30 patients at night.

The inpatient stay of patients in the hospital makes it necessary to ensure round-the-clock duty of medical personnel.

The work schedule of hospital staff should ensure, on the one hand, the greatest possible continuity in monitoring patients.

one and the same sister, on the other - improving the quality of patient care. The existing forms of shift work of personnel are reduced mainly to three groups: one-shift (daily) duty, two-shift and three-shift.

The work schedule with daily duty cannot be satisfactory due to the fact that with it the ward nurse works in the department once every 5 days and does not know her patients. This leads to the fact that, observing the dynamics of the disease unsystematically, she cannot provide proper care for the patient. The quality of the work of a nurse on duty for 24 hours, of course, cannot be high.

With a two-shift work schedule, the sister is on duty for 12 hours day and night, having one day off after daytime and 2 days off after night duty. At the same time, the sister during the day, that is, during the most responsible work of caring for the sick, is in the department once every 5 days. It also does not meet the requirements of continuous monitoring. In some hospitals, there is a three-shift system in which the same nurses work the internal and day shifts, while other nurses work at night.

This nursing schedule, in which there is a full-time “on-duty” nurse working in the morning hours and the rest of the nurses working on a 12-hour schedule, is carried out in most hospitals, and is especially recommended where there is no dedicated procedural nurse. This schedule is convenient both for the work of departments and for the sisters themselves.

One of the methods for improving the quality of medical care for patients in hospital departments is the organization of two-stage care for patients in a hospital. There are two patient care systems in hospital departments. One of them is called three-degree. According to this system, three groups of personnel take part in the direct service of patients: a doctor, a ward nurse and a nurse. The second service system is called two-degree. In this case, only two groups of personnel are involved in servicing patients: a doctor and a ward nurse.

Three-step service is most widely used in hospitals and has the advantage that the so-called dirty work is not done by the nurse on duty, but by the nurse on duty. This system requires the mandatory presence in the department of personnel providing food for patients.

The main task of the two-stage system of patient care is to bring the most qualified care closer to the patient by transferring his care only to the ward nurse. This is achieved by redistributing the budget of working time and responsibilities between the middle and junior medical personnel.

The restructuring of patient care on a two-tier system requires neither an increase in staffing nor additional appropriations. With a two-stage system of patient care in hospital wards, the care and maintenance of the patient is entrusted entirely to the sister, and the nurse performs only the functions of a cleaner.

Work of a hospital in the conditions of a five-day working week with two days off. In some cities (Perm, Zaporozhye, Kemerovo, Ivanovo, etc.) continuously operating medical institutions (hospital hospitals, maternity hospitals, dispensaries, stations and departments of emergency and emergency medical care, trauma centers, dairy kitchens and health centers), medical institutions serving workers and employees of continuously operating enterprises were not transferred to a five-day work week. Other health care institutions, as a rule, were transferred to the new mode of operation.

With the introduction of two days off a week, it is necessary to pay special attention to strengthening the units providing emergency and emergency medical care, both in hospitals and polyclinics. With low negotiability, the provision of outpatient care can be entrusted to hospital doctors working on weekends.

In hospitals, it is necessary to provide for work on one of the days off of the admissions department, clinical laboratory, physiotherapy room, physiotherapy room in volumes that ensure the admission and discharge of patients from the hospital and the release of all prescribed procedures to patients.

In hospitals that are entrusted with the provision of emergency medical care, it is inappropriate to provide work on a day off for X-ray diagnostic rooms, a functional diagnostics and electrocardiography room, and other support services that are not directly related to the admission and discharge of patients and the vacation of procedures. In hospitals that perform the functions of providing emergency medical care, the work of these offices on the second day off is provided for in the required volumes.

The mode of operation of individual structural units in hospitals on a day off should be built in such a way that on this day the remaining staff can receive planned and emergency patients and discharge patients from the hospital.

The fulfillment of these requirements is impossible without taking measures to improve the organization of work of medical personnel, improve their qualifications, and without the widespread introduction of best practices and scientific achievements into practice. The most important requirement is also the need to observe and improve labor protection and safety of workers.

With a five-day working week with two days off, a summarized accounting of working time is established for all categories of workers, both with a normal working day and with a working day reduced due to harmful, dangerous and special working conditions.

The accounting period is set depending on the mode of operation of the institution and the calendar of days off.

The most acceptable is the monthly accounting of working hours. Other accounting periods are also allowed. For example, if an institution has established a mode of operation in which one day off is set every eighth week, then the accounting period can be two calendar months.

When calculating working time, they proceed from the number of working days in the accounting period and the length of the working day established for a six-day working week. The length of the working day with a five-day working week, based on the length of working time with a 6-day working week, may be as follows (Table 4).

The length of working time on individual days is determined in the schedules of each employee, depending on the working conditions. Work with a five-day working week should be carried out according to schedules approved by the administration of the institution in agreement with the local trade union committee. The work schedule should be drawn up for each position, regardless of whether it is occupied by a permanent employee or part-time worker. Schedules, as a rule, should be drawn up for the entire accounting period and brought to the attention of each employee no later than 2 weeks before they are put into effect.

The work of doctors and paramedical personnel on weekends should be alternated so that each employee works on these days once in the accounting period.

In hospitals, with polyclinics, dispensaries and other institutions that have both outpatient and inpatient units, doctors who are on the staff of outpatient units should be involved in duty in the hospital.

In hospitals, senior nurses, housewives, pharmacy workers, auxiliary office staff and other employees not directly related to the continuous round-the-clock operation of the hospital are provided with two days of rest in a row. For example, Saturday - Sunday, Sunday - Monday.

CALCULATED DATA

The duration of the shift is 41 hours a week.

8 hours 12 minutes Duration of continuous

weekly rest - 63 h. 48 min.

Number of shifts - 1 (2)

Average monthly working days Duration * *

daily rest-15 hours 48 - 21.2

Number of days of weekly rest in min rt

average per month - 8.7

Days of the month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Working hours 8 12 8 12 8 12 8 12 0 0 8 12 8 12 8 12 8 12 8 12 0 0 8 12 0

Symbols: 0-day of rest, 8.12-shift duration 8 hours. 12 min.

Note. For workers and employees who have a 36-hour work week, a five-day work week with two days off for intermittent work can be established according to this schedule. At the same time, the duration of the work shift should be 1 hour less, i.e. instead of 8 hours 12 minutes. should be set to 7 hours 12 minutes.

CALCULATED DATA The actual duration of the working week on average per week is 41 hours.

Shift duration -8 hour

The average duration of continuous

jerky weekly rest-61h.

Number of shifts - 1 (2) G

Average monthly number of working days 21 7

Duration

daily rest - 16 hours.

Number of weekly rest days

average per month - 8.1

Symbols: 0 - rest day, 8 - shift duration (8 hours).

Note. Payment for additional days of work (every eighth Saturday) is made on a general basis.

Chart #3

Estimated data: Number of shifts - 3, number of teams - 3, duration of morning and evening shifts - 8 hours, duration of night shift - 7 hours, duration of daily rest - 16-17 hours, actual duration of the working week - 41 hours, the average duration of a weekly rest is 56 hours, the average monthly number of working days is 22.5, the number of days of weekly rest on average per month is 7.2.

Symbols: y, v, n - morning, evening and night shifts; o rest day.

Note: When applying this schedule for workers with a 36-hour work week, the duration of the morning and evening shift will be 7 hours, the night shift will be 6 hours and 30 minutes, the shift in the afternoon will be 6 hours.

To ensure normal work on the admission and discharge of patients, it is necessary to make preliminary preparation of all documents and patients to be discharged on a day off. Due to the reserve of working time formed by the doctors of the hospital, it is planned to increase the number of shifts for each position.

Organization of food for patients.

There are two systems for organizing food blocks: centralized and decentralized.

With a centralized system, there is a central hospital kitchen, from where prepared food is delivered to pantry rooms at hospital departments in a group transport container.

The decentralized system is based on the principle of dispensing ready-made meals to patients directly from the kitchen in individual dishes.

With a centralized system, the food unit includes: a) a kitchen-preparation with premises for warehouses in one of the hospital buildings with a complete technological process to provide patients with this building and the release of semi-finished products and raw products to the pre-cooking kitchens of the remaining buildings (dispense of prepared food to the pantry of this cases are produced in individual dishes from the kitchen - pavilion types of hospitals);

b) a kitchen with a complete technological process in the hospital building; at the same time, the release of prepared food from the kitchen to the pantry located in the same building is carried out in individual dishes (single-unit hospitals).

During breakfast and lunch, between lunch and dinner, vitamin drinks are provided to patients.

The hospital kitchen is managed by a dietitian working under the guidance of a physician. She is responsible for observing the sanitary-hygienic and technological process in the kitchen, for the correct release of food from the kitchen, and organizes the distribution of food in pantry.

Direct cooking is carried out under the guidance of a senior cook-foreman, who, like the rest of the production staff of the kitchen, works under the guidance of a dietitian. In hospitals where there are no dieticians, the organization of meals for patients is entrusted to the head nurse.

Compiled by: Associate Professor Okuneva GYu

Head Methodology room Yugai V.V.

Legal regulation of the work of health workers is carried out on the basis of unity and differentiation. Some norms apply to all health workers, special labor regulation rules are established depending on the type of medical care provided by workers, their working conditions and other circumstances. This takes into account the degree of risk to which the life and health of health workers are exposed in the provision of certain types of medical care, and the place of their activity.

Medical activity is understood as 1 the performance of medical work and services for the provision of pre-medical, outpatient, inpatient, high-tech, emergency and sanitary-resort medical care, including including the conduct of: medical examinations; laboratory diagnostics; works on clinical pharmacology; collection and storage of human organs and tissues for transplantation; etc.

The peculiarities of regulating the labor activity of medical workers are determined, in particular, by the healthcare system, within which the medical worker performs his labor functions.

Distinguish between state, municipal and private health care systems.

To public health system include the Ministry of Health and Social Development of the Russian Federation, the republics within the Russian Federation; health authorities of regions, districts, territories, cities; Russian Academy of Medical Sciences, which, within their competence, plan and implement measures to protect the health of citizens. It also includes state-owned and subordinated to the Ministry of Health and Social Development of the Russian Federation or the executive authorities of the subjects of the Federation in the field of healthcare, medical and preventive and research institutions, educational institutions, pharmaceutical enterprises and organizations, pharmacies, sanitary institutions, territorial bodies established in accordance with the established procedure for the implementation of sanitary and epidemiological supervision, institutions of forensic medical examination, logistics services, enterprises for the production of medical preparations and medical equipment and other enterprises, institutions and organizations.

AT municipal health system includes health authorities and municipally owned medical and preventive, research, pharmacy institutions, pharmaceutical enterprises and organizations, institutions.

To private healthcare system include medical and preventive, educational, pharmacy institutions, the property of which is in private ownership, persons engaged in private medical practice and pharmaceutical activities. The private healthcare system includes medical and other organizations created and financed by legal entities and individuals.

Features of the regulation of the work of medical workers are related to the nature of their professional activities.

The specificity of the labor activity of health workers is that the object of their work is the life and health of a person. This places a huge responsibility on the workers for the results of their work, and requires great psychological costs; and, as a result, the work of medical workers is associated with nervous fatigue.

The specifics of the labor activity of health workers can also include working conditions. By the nature of their activities, medical personnel may be in conditions that are harmful to health (for example, direct contact with sources of infections, ionizing radiation, work on X-ray machines). In some situations, health workers have to perform life-threatening work.

To conclude an employment contract for work as a medical worker, the candidate must have special labor capacity.

In accordance with Art. 54 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 No. 5487-1, persons who have received a higher or secondary medical education in the Russian Federation, who have a diploma and a special title, as well as a specialist certificate and a license to carry out medical activities, have the right to engage in medical activities.

A specialist certificate is issued on the basis of postgraduate professional education (postgraduate studies, residency), additional education (advanced training, specialization) or a screening test conducted by commissions of professional medical associations on the theory and practice of the chosen specialty, issues of legislation in the field of protecting the health of citizens.

During the period of training in institutions of the state or municipal health care system, doctors have the right to work in these institutions under the supervision of medical personnel responsible for their professional training. Students of higher and secondary medical educational institutions are allowed to participate in the provision of medical care to citizens in accordance with the training programs, also under the supervision of medical personnel responsible for their professional training.

Persons who do not have a completed higher medical education may be allowed to engage in medical activities in the positions of workers with a secondary medical education in the manner established by the federal executive body in the field of healthcare.

Doctors who have not worked in their specialty for more than five years may be admitted to practical medical activities only after undergoing retraining at the relevant educational institutions or on the basis of a screening test conducted by commissions of professional medical associations.

Workers with secondary medical education who have not worked in their specialty for more than five years may be admitted to practical medical activities after confirming their qualifications in the relevant institution of the state or municipal health care system or on the basis of a screening test conducted by commissions of professional medical associations.

Persons who have received medical education in foreign countries are allowed to practice medicine after an exam at the relevant educational institutions of the Russian Federation in the manner established by the Government of the Russian Federation, as well as after obtaining a license to carry out medical activities, unless otherwise provided by international treaties of the Russian Federation.

Persons illegally engaged in medical activities are subject to criminal liability.

Thus, taking into account the requirements of the law regarding the rights to engage in medical activities and in accordance with Art. 65 of the Labor Code of the Russian Federation, when hiring a medical worker, the employer must ask him for documents on education, qualifications or the availability of special knowledge.

It should be noted that when determining the type of activity of a medical worker in an employment contract, it is not enough to indicate only his position (resident, head of department, etc.). Specifying the labor function of a health worker, it is necessary to indicate his specialty (for example, therapist, ophthalmologist).

Working hours

As a general rule, for all medical workers, regardless of which healthcare system they work in, half-holiday. The introduction of reduced working hours in this case is explained by the specifics of the work, which is associated with responsibility for the health and life of a person, with labor that requires significant physical and psychological costs, and often - being in harmful or even life-threatening working conditions.

For medical workers, several types of reduced working hours are established. The reduced working day is differentiated depending on the type of medical institution, the category of medical workers, and the presence of harmful conditions.

In accordance with Art. 350 of the Labor Code of the Russian Federation, the working time of medical workers is no more than 39 hours per week. The duration of working hours for certain categories of medical workers is established by the Government of the Russian Federation and is determined depending on the position and (or) specialty, as well as the place of activity.

Decree of the Government of the Russian Federation of February 14, 2003 No. 101 2 contains lists of positions and specialties for which reduced working hours are set at 36, 33, 30 and 24 hours a week.

For medical workers of healthcare organizations living and working in rural areas and urban-type settlements, the duration of part-time work may be increased by a decision of the Government of the Russian Federation, adopted taking into account the opinion of the relevant all-Russian trade union and the all-Russian association of employers. Thus, the Decree of the Government of the Russian Federation of November 12, 2002 No. 813 3 for medical workers living and working in rural areas and urban-type settlements establishes the duration of part-time work no more than eight hours a day and 39 hours a week.

Salary

When determining the salary of medical workers of the system of the Ministry of Health of the Russian Federation, Regulations on the procedure for remuneration of healthcare workers of the Russian Federation, approved by the Order of the Ministry of Health of Russia dated October 15, 1999 No. 377 (hereinafter - Regulations on wages). This Regulation provides for the general principles of remuneration on the basis of the Unified Tariff Scale.

The tariff rate (salary) depends on the category of the Unified Tariff Scale established for medical workers. The discharge is subject to increase depending on the presence of certain factors, namely:

The factors that determine the increase in the salary of medical workers are work in dangerous and especially difficult conditions and the profile of the medical institution.

The list of departments, work in which gives employees the right to increase salaries in connection with hazardous to health and especially difficult working conditions, is defined in the Appendix to Regulations on wages. For example, salaries (rates) for employees of departments for the treatment of HIV-infected, mentally ill, and tuberculosis patients are being increased.

In addition to wages, on the basis of tariff rates (salaries), employees of health care institutions receive additional payments and allowances of a compensatory and incentive nature.

To compensation payments relate:

increase in salaries for work with harmful and dangerous working conditions; extra pay for night work; additional payment for performing the work of a temporarily absent employee without being released from his main job; additional payment to medical workers of sea and river vessels; additional payment for the provision of anti-tuberculosis care associated with the risk of infection with tuberculosis microbacteria.

Allowances are provided for the duration of continuous work, working conditions. In addition, there are incentive bonuses.

For example, depending on the duration of continuous work, general practitioners of shop medical districts, nursing staff of shop medical districts and nursing homes are given a bonus of 30% of their salary for the first three years and 10% of their salary for the next two years of continuous work.

The allowance should be paid for the main position on the basis of the salary (rate) established for the categories of the Unified Tariff Scale without taking into account increases in wages for work in hazardous to health and especially difficult working conditions, allowances and additional payments.

Incentive allowances are established for a certain period, but not more than one year, and are issued by order of the institution. Allowances are canceled in case of deterioration in performance or at the end of especially important or urgent work for which they were established.

The size and procedure for permanent payments are established by legislative and regulatory acts of the Russian Federation, subjects of the Federation, and local governments.

Public health care institutions, within the budget allocations allocated to them, have the right to independently determine the types and amounts of allowances, additional payments and other incentive payments. At the same time, it must be borne in mind that the salaries (rates) take into account the qualifications of employees and the complexity of the work they perform. In the private health care system, remuneration is made by agreement between the employee and the employer, but its amount cannot be lower than that established by law.

The Labor Code of the Russian Federation (Article 146) establishes the obligation of the employer, under conditions that deviate from normal, to pay higher wages. Organizations independently determine the amount of remuneration in such conditions, however, they cannot be lower than the amounts established by labor legislation and other regulatory legal acts containing labor law norms.

So, at an increased rate, wages are paid at night. Night time is considered from 22.00 to 06.00. For medical workers, additional payment for night work is made in the amount of 50% of the hourly tariff rate (official salary) for each hour of work at night.

Decree of the Ministry of Labor of Russia dated 08.06.92 No. 17 "On the size of allowances and additional payments for health workers and social protection of the population" medical personnel engaged in the provision of emergency, emergency and emergency medical care, field personnel and communication workers of stations of emergency and emergency medical care departments are provided with additional payments in the amount of 100% of the hourly tariff rate (salary) for each hour of work at night.

The remuneration of health workers working in rural areas has some peculiarities. For them, salaries (rates) increased by 25% are established in comparison with the salaries (rates) of specialists engaged in the same types of activities in urban conditions (clause 2.3 Pay Regulations).

Part-time work

The combination of positions and professions is often used by the employer in order to save money or due to lack of staff.

In accordance with sub. "a" clause 1 of the Resolution of the Ministry of Labor of Russia dated 06/30/2003 No. 41 "On the peculiarities of part-time work of pedagogical, medical, pharmaceutical workers and cultural workers" under part-time is understood as the performance by an employee of other regular paid work under the terms of an employment contract in time free from the main job at the place of their main job or in other organizations (including in a similar position, specialty, profession) and in cases where a reduced working time is established (for with the exception of works for which sanitary and hygienic restrictions are established by regulatory legal acts of the Russian Federation).

Part-time work can be performed by an employee both at the place of his main job, and with other employers. Moreover, the conclusion of labor contracts on part-time work is allowed with an unlimited number of employers.

When registering a part-time job, the employment contract must contain an indication that the work is a part-time job.

When deciding on the possibility of registering a part-time employee, it must be taken into account that the law prohibits part-time work in hard work, work with harmful and (or) dangerous working conditions, if the main work is associated with the same conditions (Article 282 of the Labor Code of the Russian Federation).

Article 284 of the Labor Code of the Russian Federation establishes a general rule for limiting the length of working time when working part-time - no more than four hours a day and 16 hours a week. However, different rules apply for healthcare workers.

In accordance with Art. 282 of the Labor Code of the Russian Federation Decree of the Ministry of Labor of Russia dated June 30, 2003 No. 41, the duration of part-time work for medical workers during the month is established by agreement between the employee and the employer and for each employment contract cannot exceed:

for medical workers - half of the monthly norm of working time, calculated from the established duration of the working week; for medical workers whose half of the monthly norm of working time for their main job is less than 16 hours per week - 16 hours of work per week; for doctors and paramedical personnel of cities, regions and other municipalities where there is a shortage of them - the monthly norm of working time, calculated from the established duration of the working week; for junior medical personnel - the monthly norm of working hours, calculated from the established duration of the working week.

Medical professionals often have to work part-time, but not every job will be considered a part-time job. In particular, notare part-time work on the implementation of consulting by highly qualified specialists in institutions and other organizations in the amount of not more than 300 hours per year; work without holding a full-time position in the same institution and other organization, including duty in excess of the monthly norm of working time according to the schedule; conducting a medical examination with a one-time payment. The performance of these works is allowed during the main working hours and does not require the conclusion of an employment contract.

Granting additional leave

In accordance with par. 3 art. 350 of the Labor Code of the Russian Federation, certain categories of medical workers may be granted additional annual paid leave, the duration of which is established by the Government of the Russian Federation.

In accordance with Decree of the Government of the Russian Federation of December 30, 1998 No. 1588 4 for general practitioners (family doctors) and nurses of general practitioners (family doctors) for continuous work in these positions for more than three years, an annual additional paid three-day vacation. When determining the duration of continuous work in the positions of general practitioners (family doctor) and nurses of general practitioners (family doctor), for the provision of such leave, the time immediately preceding continuous work in the positions of district therapists and district pediatricians of territorial areas and nurses of therapeutic and pediatric territorial areas. Expenses for payment of the specified holidays are carried out within the limits of the funds allocated to the healthcare institution in which the specified positions are introduced.

Employees of enterprises, institutions and organizations of the state healthcare system that diagnose and treat HIV-infected people, persons whose work is related to materials containing the human immunodeficiency virus 5 are also entitled to additional leave for work in especially dangerous and difficult working conditions. Decree of the Government of the Russian Federation of 03.04.96 No. 391 "On the procedure for granting benefits to employees exposed to the risk of infection with the human immunodeficiency virus in the performance of their official duties" such employees have an annual paid leave of 36 working days (taking into account the annual additional leave for working in hazardous working conditions).

Issuance of special clothing and footwear for medical workers

In the event that employees perform labor functions at work with harmful conditions and (or) dangerous working conditions (or associated with pollution), they must be issued with certified personal protective equipment that flushes and neutralizes agents in accordance with standard standards approved in the manner established by the Government of the Russian Federation ( article 221 of the Labor Code of the Russian Federation). Since such working conditions are typical for medical workers, the employer is obliged to provide them with special clothing and footwear.

The employer is obliged at his own expense to ensure the timely issuance of special clothing, special footwear and other personal protective equipment, as well as their storage, washing, drying, repair and replacement. Clothes and shoes are issued for a certain period and according to the norm.

Decree of the Ministry of Labor of Russia dated December 29, 1997 No. 68 6 approved standard norms for issuing clothing and footwear to employees of healthcare organizations and medical research institutes. In addition, special acts of the Ministry of Health and Social Development of Russia for medical workers of individual services establish special rules and norms for the issuance of special clothing and footwear, taking into account the specifics of their activities. The regulations provide a list of special clothing, the period of wearing it and the procedure for issuing it into operation.

Yes, in accordance with Regulations on the procedure for issuing special clothing and footwear to employees of the disaster medicine service of the Ministry of Health and Social Development of the Russian Federation 7 by decision of the administration, in return for lost items, special clothing and footwear that have already been in use and decommissioned, but which are in stock and fit for wear, may be issued. New items purchased at the expense of budgetary appropriations are not issued until the expiration of the wear period for previously received but lost items.

Social Security

Social security of health workers can be defined as a system of measures to prevent social risk situations that do not depend or depend little on the health worker and may lead to adverse consequences (disability, lower living standards, etc.) and compensation for costs in the event of adverse events. consequences.

All health workers are subject to compulsory health insurance. Employees of enterprises, institutions and organizations of the state healthcare system that diagnose and treat HIV-infected people, as well as persons whose work is related to materials containing the human immunodeficiency virus, are subject to compulsory insurance in case of harm to their health or death in the line of duty, as well as compulsory social insurance against industrial accidents and occupational diseases.

An analysis of the rules for regulating the labor of medical workers established by law allows us to conclude that the legal regulation of the labor of health workers is carried out on the basis of unity and differentiation. Unity means that some features of the legal regulation of the labor of medical workers apply to all medical workers, and differentiation implies the establishment of special rules for regulating labor depending on the type of medical care provided by medical workers, on their working conditions and other circumstances. When establishing the features of legal regulation, the degree of risk to which the life and health of medical workers are exposed in the provision of certain types of medical care, and the place of their activity are taken into account.

1 Regulations on the licensing of medical activities (approved by Decree of the Government of the Russian Federation of January 22, 2007 No. 30).
2 Decree of the Government of the Russian Federation of February 14, 2003 No. 101 "On the duration of the working hours of medical workers depending on their position and (or) specialty."
3 Decree of the Government of the Russian Federation of November 12, 2002 No. 813 “On the duration of part-time work in healthcare organizations for medical workers living and working in rural areas and in urban-type settlements.”
4 Decree of the Government of the Russian Federation No. 1588 of December 30, 1998 “On Establishing General Practitioners (Family Doctors) and Nurses of General Practitioners (Family Doctors) Annual Additional Paid 3-Day Leave for Continuous Work in These Positions.”
5 See: art. 22 of the Federal Law of March 30, 1995 No. 38-FZ “On Preventing the Spread in the Russian Federation of a Disease Caused by the Human Immunodeficiency Virus (HIV)”.
6 Decree of the Ministry of Labor of Russia dated December 29, 1997 No. 68 “On approval of standard industry norms for the free issue of special clothing, special footwear and other personal protective equipment to workers”.
7 Approved by the Order of the Ministry of Health and Social Development of the Russian Federation dated November 18, 2004 No. 201.
8 See: art. 22 of the Federal Law "On the Prevention of the Spread in the Russian Federation of a Disease Caused by the Human Immunodeficiency Virus (HIV)".

Introduction

The current stage of healthcare development raises questions of the quality of medical care provided to the population in a new way. The proper level of medical care can be achieved only with the appropriate staffing of health care institutions. The formation of the number of medical personnel, the establishment of labor standards, the rational placement and use of personnel are the most significant components of the labor rationing system in healthcare, which are based on industry-specific labor regulations. Currently, the regulatory framework developed by the Ministry of Health of the USSR in the late 80s is used. Normative documents on labor are not focused on the organizational and technical conditions for the operation of medical and preventive health care institutions, as well as the incidence of the population and the demographic situation that take place in Russia at the present time. The need to update the existing regulatory framework and develop modern labor regulations is quite obvious. First, the crisis in the economy and the deterioration of the environmental situation in recent years have significantly changed the nature of the pathology and the severity of the course of diseases of the population served, as well as the frequency of visits, the duration and intensity of treatment. In this regard, it became necessary to develop new modern norms and standards for labor and improve existing ones. Secondly, the staffing standards for most of the main types of institutions (regional, city hospitals, adult and children's city polyclinics, etc.), developed 25–30 years ago and corresponding to the technology of the treatment and diagnostic process adopted at that time, do not meet modern requirements and need to be revised. Thirdly, the rapid development of medical science, the introduction of new technologies and modern equipment in the treatment and diagnostic process, the improvement of instrumental research methods have significantly changed the nature and content of the doctor's work and also require a serious revision and updating of the regulatory framework in healthcare.

The purpose of this work is to consider the types of labor rationing methods, methods for studying the cost of working time and approximate calculations of labor rationing for middle and junior medical personnel.

The work uses various sources, publications, educational literature.

The work consists of several sections. The first section characterizes the concepts of labor standards, its types, defines the functions, tasks and principles of labor rationing, as well as the procedure for introducing, replacing and revising labor standards. The second section discusses the types of labor rationing, methods for studying the cost of working time. The third section provides calculations of labor rationing for middle and junior medical personnel of various departments of a medical institution.

In conclusion, conclusions about the work done and a list of references are given.

Theoretical aspects of labor rationing in health care

The essence of labor standards and its types

The labor norm is the amount of work established for the employee per hour, day (shift), week, month, year, which he is obliged to perform under normal working conditions. The employer is obliged to ensure normal working conditions: good condition of mechanisms, equipment, fixtures, timely provision of technical documentation, proper quality materials and tools for work, their timely supply, safe and healthy working conditions. Labor standards - the norms of output, time, service - are established in accordance with the achieved level of technology, technology, organization of labor and production, and if they change, they must be systematically reviewed. Labor standards are subject to mandatory replacement as well as the certification of workplaces, the introduction of new equipment, technology, technical re-equipment of production, ensuring an increase in labor productivity. The introduction, revision and replacement of labor standards is carried out by the employer, taking into account the opinion of the trade union committee, local regulations. Employees are notified of the introduction of new norms at least two months in advance.

There are the following types of labor standards: production standards; time norms; service standards; population norms; normalized tasks; enlarged and complex norms used in collective forms of organization and remuneration (in the production team). According to their scope, labor standards are single, standard, intersectoral, sectoral (departmental) and local. In practice, there are always local ones, which are developed on the basis of standard, sectoral and other centralized norms of a recommendatory nature.

The output rate is the amount of work established in units of production, work operations that an employee must perform per hour, day (shift), month, working year.

The norm of time is the amount of working time (in hours, minutes) for the production of a unit of output or a work operation, it is used to calculate, determine production rates and other labor standards.

Service rates are the volume of maintenance of production mechanisms, machine tools, and areas established per employee. Their variety is the norm of manageability - the number of workers in a given production, which must be managed by one leader (foreman, site manager, foreman, etc.). This is also a calculation norm for determining the staff of labor managers.

The norm of the number of employees is the established number of working personnel of a certain profession, qualifications for performing work at a given production site, for example, repair workers for servicing machine tools or all employees of a workshop, department, enterprise, institution, organization.

The norm of the number and the norm of service are interrelated, since the norm of the number is determined by the norm of service, and vice versa.

The enlarged and complex norms used in the collective work of the production team along a single line are calculated for the entire team of the team, that is, this is the amount of work that the team must perform per day, week, month.

With a piecework wage system, a piecework rate is applied - this is payment for a unit of a product (working operation) of good quality (without marriage). The piece-rate under a simple piece-rate system is always the same, no matter how much the worker produces; under the piece-progressive system, it is the same within the limits of production, and for products made in excess of the norm, it progressively increases (but this system is rarely used, since it is reflected in the cost of production). Piece rates are set by the administration and are also revised with the revision of labor standards.

The normalized task is the total amount of work per working day (shift) for an employee or team, established with a time-based wage system based on time standards and production standards, is used to improve the efficiency of workers with time wages. Depending on the time the task is set for, daily (shift) and monthly normalized tasks are distinguished. In essence, this is a special production rate used for time workers.

Functions, tasks, meaning and principles of labor rationing

The main functions of labor rationing are distribution according to work, scientific organization of labor and production, production planning, evaluation of the labor activity of individual workers and teams, which serves as the basis for moral and material encouragement and dissemination of best practices.

Labor regulation includes:

¾ study and analysis of working conditions and production opportunities at each workplace;

¾ study and analysis of production experience to eliminate deficiencies, identify reserves and reflect best practices in labor standards;

¾ designing a rational composition, method and sequence of performing elements of the labor process, taking into account technical, organizational, economic, physiological and social factors;

¾ establishment and implementation of labor standards;

¾ systematic analysis of the implementation of labor standards and revision of obsolete standards.

The main tasks of labor regulation are to:

¾ justify the necessary and sufficient value of the cost of working time per unit of production in specific conditions;

¾ design rational labor methods;

¾ systematically analyze the implementation of labor standards to reveal production reserves;

¾ constantly analyze the implementation of labor standards to reveal production reserves;

¾ constantly study, generalize and disseminate production experience, revise labor cost standards as working conditions change.

The solution of these problems will make it possible to facilitate the work of workers, increase labor productivity and increase the volume of production.

The regulation of labor is the basis of the scientific organization of labor. With the help of the methods used in the regulation of labor, losses and unproductive expenditures of working time are singled out. By studying labor movements, the most economical, productive and least tiring methods of work are developed. This contributes to the growth of labor productivity. Further improvement of the organization of labor is impossible without improving its rationing.

Also, the regulation of labor is the basis of the organization of wages. The establishment of labor standards aims to guarantee society a certain productivity of labor, and the worker a certain level of wages. According to the performance of labor standards, the labor activity of each employee is evaluated and his work is paid. Without labor rationing, it is impossible to implement the economic law of distribution according to work.

Labor rationing is an important means of organizing production. The organization of production is the management of the process of production of material goods, i.e. establishing interaction between the labor force and the means of production in order to achieve the maximum economic effect in specific conditions. Through the organization of labor, the influence of labor rationing on the organization of production is manifested.

Scientifically based labor standards make it possible to evaluate the results of the labor activity of each employee, each team and compare their results. Only by comparison are leaders and laggards revealed.

Scientifically substantiated labor standards, correctly reflecting specific conditions, ensure an increase in labor productivity. If labor standards are too low, they can give rise to complacency or pessimism, which negatively affects the results of productivity; if the standards are too high, they are not feasible. In both cases, the growth of labor productivity will be hampered. Thus, all changes in the organization of labor and production, equipment and technology of work are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise.

Labor rationing is the basis of labor planning. For long-term, current and operational planning, a whole system of norms is used: norms for the consumption of materials, fuel energy, norms for the productivity of machines, norms for the expenditure of working time. Thus, labor standards play an important role in the system of norms used in planning at the enterprise.

Drawing up a plan for labor and establishing labor costs in accordance with the volume of production is impossible without scientifically based labor standards. Greater independence of enterprises in matters of labor planning enhances the interest of teams in the implementation of scientifically based labor standards.

The following principles should form the basis of labor regulation:

¾ scientific validity of labor standards;

¾ equal intensity of labor standards at the same jobs in identical conditions;

¾ preservation of the main productive force of society - workers;

¾ participation of workers in the establishment of labor standards.

The labor norm acts not only as the value of the necessary expenditure of working time, but also as an expression of the labor duties of each participant in production.

The procedure for the introduction, replacement and revision of labor standards

According to Art. 160 of the Labor Code of the Russian Federation, labor standards should be established in accordance with the achieved level of technology, technology, organization of production and labor.

The introduction, as well as the replacement and revision of labor standards, are formalized by local regulatory acts of the organization (order, order, regulation on rationing, etc.) and taking into account the opinion of the representative body of workers (trade union body, labor collective council, etc.).

The most rational and preferred method for designing regulatory materials is the analytical and computational method, since it is the most perfect and cost-effective.

To develop labor standards, the following activities are organized and carried out:

1. Preparatory and organizational and methodological work.

In the course of the work, the goals and objectives of the development of regulatory materials for labor rationing are determined, the types of norms are specified, and the terms of reference are drawn up.

The terms of reference are developed by the executing organization of the regulatory research work and approved by the customer organization.

The current technology, instructions, regulations, organizational and technical conditions and methods of performing work at workplaces are studied, equipment passports are selected, the characteristics of the tools used, fixtures, raw materials, materials, equipment operating modes, the content of technological and labor processes; the possibility of developing normative materials using time standards, including microelement ones, using electronic computers for designing rational labor processes and calculating labor standards is established.

A methodological program of work on the development of a regulatory document is being developed, reflecting the following issues:

¾ selection of enterprises (institutions, organizations), their structural subdivisions, on the basis of the organization of production and labor of which progressive technological (labor) processes and rational organizational and technical conditions for their implementation, provided for in the design of labor cost standards, will be developed;

¾ use of existing regulatory materials for labor rationing, including microelement standards;

¾ determination of factors that affect the time spent in the performance of individual works and ensure the greatest accuracy of standards and norms with the least complexity and laboriousness of their development;

¾ instructing employees who monitor and analyze the cost of working time and design norms and standards, the use of devices, video equipment, computer equipment, statistical, operational and other reporting data for this work;

¾ verification of the draft regulatory materials in a production environment;

¾ design of the collection of normative materials as a whole.

2. The study of the cost of working time in the workplace.

Said works include:

¾ preparation for observations: performers are selected whose work will be monitored, the compliance of technology, organization of the workplace and its maintenance with those designed is clarified;

¾ carrying out direct measurements of working time (timekeeping, photographs of working time, video filming of labor processes, etc.) or momentary observations; at the same time, materials related to the establishment of labor costs at selected enterprises are used to the maximum;

¾ carrying out technical calculations, experimental and other research work, processing the collected materials.

3. Processing of collected materials.

These works include:

¾ analysis and generalization of the results of the study of the cost of working time, the development of standards (norms) of labor costs;

¾ clarification of the main factors affecting the amount of labor costs; conclusion of empirical (based on experience) formulas of dependencies between the values ​​of influencing factors and the values ​​of labor costs;

¾ preparation of a draft regulatory document in the first edition, as well as instructions on the procedure for its verification directly at the enterprise;

¾ identification of specific enterprises (institutions, organizations), their structural subdivisions for conducting verification of regulatory materials on them;

¾ sending a draft regulatory document with instructions on the procedure for its verification to selected enterprises (institutions, organizations), to their structural divisions.

4. Verification of normative materials in production conditions.

The purpose of the audit is to identify the nature of the clarifications and additions to be made to the project.

5. Preparation of the final version of regulatory materials.

The analysis and study of the results of checking the draft regulatory document in a production environment, summarizing the feedback, comments and suggestions received is carried out.

Established labor standards in accordance with Art. 160 of the Labor Code of the Russian Federation may be revised as new equipment, technology is improved or introduced, and organizational or other measures are taken to ensure the growth of labor productivity, as well as in the case of the use of physically and morally obsolete equipment.

It should be noted that the achievement of a high level of production (provision of services) by individual employees through the use of new methods of work and improvement of workplaces (that is, advanced methods and forms of labor organization) cannot be the basis for revising previously established standards.

The replacement and revision of uniform and standard norms is carried out by the bodies that approved them. The revised norms are drawn up by a local regulatory act of the organization and communicated to employees no later than two months before the introduction.

Verification of the labor standards in force at the enterprise (in the institution, organization) is carried out by attestation commissions approved by the heads of enterprises (institutions, organizations).

Based on the results of the check for each norm, a decision is made: to certify or not to certify. Technically substantiated norms corresponding to the achieved level of engineering and technology, organization of production and labor are recognized as certified.

Outdated and erroneously established norms are recognized as not certified and are subject to revision. Outdated, in particular, should be considered the norms in force at work, the labor intensity of which has decreased as a result of a general improvement in the organization of production and labor, the growth of professional skills and the improvement of the production skills of workers and employees. Norms may be considered erroneous if the organizational and technical conditions were incorrectly taken into account or inaccuracies were made in the application of normative materials or in the calculations.

When checking the norms of labor costs, the administration is obliged to ensure a thorough check of the implementation of the technology provided for by the norms in all operations of the labor process, the compliance of the actual amount of work performed with the volumes laid down in the calculation of the norms. At the same time, the administration, based on specific production conditions, is obliged to rationalize the technological processes of those operations, the conditions for which, provided for by the norms, do not correspond to the achieved level of organization of production and labor, best practices.

Revision of obsolete norms is carried out within the terms and in the amounts established by the management of the enterprise in agreement with the trade union committee. The revision of erroneous norms is carried out as they are revealed in agreement with the trade union committee.

The basis for the application of correction factors to the norms and standards may be the development of production capacities, new equipment, technology, new types of products or the discrepancy between the actual organizational and technical conditions of production provided for in the newly introduced norms and standards.

Labor rationing methods

Types of labor rationing methods

Improving medical care for the population requires not only building up the material and personnel base of health care, but also further improving the style and methods of work, organizational activities at all levels, taking into account the economic efficiency of the measures taken. One of the important tasks of further improvement of healthcare is the rational use of all resources. Determining the scope of activities of a particular group of medical personnel, establishing a direct link between indicators and wages, calculating the cost of providing medical care to the population as a whole and its individual types is especially important during the introduction of economic management methods in health care and the transition to insurance medicine.

A significant tool for solving these problems is labor rationing. To date, the needs of the population for certain types of medical care remain insufficiently studied, scientifically based proposals have not been developed on a number of healthcare institutions, their structural divisions and positions of medical personnel, as well as recommendations on rational forms of labor organization.

The method of labor rationing is a set of techniques for studying and analyzing labor processes, determining the cost of working time, identifying and accounting for norm-forming factors, designing a rational organization of labor and developing standards.

The regulation of the work of medical workers is the most difficult issue, reflecting the specifics of the industry and requiring a careful approach and scientific justification in its solution. In health care, as in other sectors of the national economy, there are two types of labor rationing methods: analytical and summary (Fig. 1).

Figure 1- Methods of labor rationing

The analytical method provides for the division of the labor process into separate components. Depending on the methods of developing labor standards, this method is divided into analytical research and analytical and calculation.

The analytical research method is a method in which the labor rate is set on the basis of a study of the cost of working time using photochronometric observations directly at the workplace. It involves a detailed study of the production process and labor costs for the constituent elements. Based on these data, the most rational technological modes of equipment operation and the organization of the workplace and labor are designed.

The analytical-calculative method provides for the calculation of time costs according to pre-established time standards, equipment operating modes, as well as formulas for the dependence of time on factors affecting the duration of the operation. This method establishes the normalized number of auxiliary workers, managers, specialists and technical performers.

The total method of labor rationing establishes the cost of working time as a whole per unit of output of a particular work process without analyzing the latter. The way the work is done is determined by the worker. Varieties of the total method are experimental, statistical and comparative methods.

Experienced method. The expert gets acquainted with the workplace, means and working conditions and intuitively, based on his subjective impressions and previous experience, determines the labor rate. The established labor rate is not an average value, but only a particular value of the possible costs of working time. Its validity, compliance with the conditions of the workplace entirely depend on the experience of the expert. This method is not able to provide the same intensity of norms. In addition, it only reflects past experience. Practice shows that labor standards established by an experienced intuitive method are, as a rule, of poor quality. This is evidenced by the significant overfulfillment of such norms by the majority of workers.

statistical method. Labor standards are set mainly on the basis of statistical reporting data on the volume of work. This method can be used only if you are sure that the doctor, on the one hand, does not have underloaded working hours, and on the other hand, the technology of the diagnostic and treatment process is followed, and the patient is provided with proper medical care in full.

The comparative method of establishing labor standards is used when the technology of personnel work is similar to that for which there are already standard indicators. For example, the activities of medical registrars, statisticians, etc. are homogeneous in all types of institutions.

The total method, which does not fully take into account the content and organization of the labor process, the rational use of working time, cannot be recommended for widespread use in the development of labor standards. At the same time, its simplicity and efficiency in some cases makes it preferable to this method.

Thus, at present, for the centralized development of labor standards, it is advisable to apply mainly the analytical research method. In healthcare institutions, to determine the number of personnel required for a particular amount of work, to establish a number of standard indicators, the calculation and analytical method should be widely used. In cases where there are no developed standards for personnel workloads, for example, when introducing new types of instrumental studies, when organizing a new service, you can apply summary rationing methods to establish temporary standards so that in the next 2–3 years, based on existing work experience, their scientific basis.

Methods for studying the cost of working time

There are 4 methods for studying the cost of working time (Fig. 2).

Figure 2 - Methods for studying the cost of working time

Let's consider each of them.

Timing, methodology.

Timekeeping is a method of studying the cost of working time by measuring the repeating elements of an operation.

Its main purpose is to identify the most optimal methods of work and determine the time standards corresponding to them. Timing allows you to evaluate the organization of the workplace, differentially study the structure of an individual operation and the conditions for its implementation. The timing process includes three steps.

At the first (preparatory) stage, the operation is divided into separate elements using fixing points. A fixing point is a distinct external sign, perceived by the eye or by ear, signaling the beginning and end of one or another element of the operation. At the same stage, the worker is instructed and the workplace is studied. This is documented on the front side of the time-observation card, where data on the operation is entered, the number of products produced at a certain time, the types and condition of the means of labor, the nature of the process, the qualifications and length of service of the performer, the wage system used are indicated.

At the second stage, observation and time recording is carried out. Time measurements are made in a collective and cumulative way using a two-hand stopwatch. The observer must mark the time by fixing points and enter the stopwatch readings into the observation sheet of the time card, follow the order of the operation.

At the third stage, the data is processed and the duration of the operation element is determined. The obtained values ​​of the duration of the operation element are recorded in the timing variation series, where the top line of the option is the measurements in ascending (descending) order of the duration of the measurements (t), and the bottom line of frequencies (p) shows how often this option occurs in the timing series. The total sum of frequencies must be equal to the number of measurements. Inaccurate (defective) measurements are preliminarily excluded and then the quality of the time series is assessed.

Photo of working time, types and methods of carrying out

A photograph of working time is the observation, measurement and sequential recording of all, without exception, the time spent during a work shift or other period.

If the observation period coincides with the length of the working day, it will be a photograph of the working day.

Photo of working time is used to identify the loss of working time and the reasons that cause them, as well as to establish the relationship between individual types of time spent. The data obtained are used as initial data for normalization.

The subject of the photo can be workers, machines or the production process as a whole. If the object of observation is one worker, then the photo of working time is individual, and if a group of workers is group. When the costs of working time are fixed by the worker himself, there is a self-photograph of working time in order to study the loss of working time and their causes.

Photography of working time is carried out in three stages.

At the first stage, a preliminary study of the work is carried out, the choice of the object of observation. The object is selected depending on the purpose of observation. If it is necessary to obtain stable indicators of exemplary work, then the best worker is selected, and if it is necessary to study the reasons for non-fulfillment of the norms, then lagging behind workers.

The second stage includes direct observation and study of all time expenditures with an accuracy of one minute. The results are recorded in special observation sheets. At the same time, the types of work and breaks, as they are registered, are entered in the column "Name of the time spent", and the moment of their completion - in the column "Current time".

At the third stage, based on the data of the observation sheet, a table of the same costs and the actual balance of working hours are compiled. In conclusion, an analysis of the results of the observations carried out is carried out, irrational costs and direct losses of working time are established, which are excluded when drawing up the projected balance, and the coefficient of a possible increase in labor productivity by eliminating losses and irrational costs of working time is determined.

Photochronometry

Photochronometry is a type of observation in which timekeeping is carried out simultaneously with a photograph of working time during its individual periods. It is advisable to use it when studying the time spent on individual elements of work that are not repeated cyclically during the working day.

In the practice of labor work, individual and group photochronometry is used. Thus, group photo timing is recommended to be carried out when establishing the composition of the brigade and distributing functions between its members, individual elements of which do not have a cyclic repetition.

Observations and measurements are carried out by the accepted methods of processing the results of observations, the analysis of the data obtained and the design of rational labor processes during photo timing are carried out separately according to the data of timing observations and photographs in the prescribed manner.

Method of instant observations

The method of momentary observations allows you to register and take into account during the observation period the same-name costs of the working time of a group of performers or the time of work and breaks in the work of a different number of equipment and, on this basis, determine the specific weights and absolute values ​​​​of time costs. The method is characterized by low labor intensity and simplicity of conducting observations and processing the results, the efficiency of the study, a wide coverage of various objects by observation, as well as the involvement of personnel in research while simultaneously performing their main work, etc. The disadvantages of the method include: obtaining only average values ​​of the cost of working time and time of use of the equipment; lack of data on the sequence of execution of the processes under study, as well as possible changes, etc.

When conducting research, it is recommended to use pointer clock instruments (clocks, one- and two-pointer stopwatches), special equipment that allows you to automatically record both time and content, structure and method of performing normalized processes (oscillography, photo-video and film equipment).

Filming ensures the objectivity and high accuracy of recording all elements of the labor process in time and space, as well as the conditions that determine it, the completeness of the characteristics of the process under study (trajectories and speeds of movements, distances of movement of objects of labor, the sequence and degree of combination of techniques, actions and movements, etc. .)

Rationing of labor of middle and junior medical personnel

Rationing of work of middle and junior medical personnel of outpatient clinics

The positions of middle and junior medical personnel in outpatient clinics are established according to the number of positions of outpatient doctors of a particular specialty (to calculate the number of positions of nurses and nurses in the respective rooms). The positions of outpatient doctors include all positions of doctors of outpatient clinics, except for the positions of doctors of clinical laboratory diagnostics, bacteriologists, radiologists, radiologists, physiotherapists, reflexologists, manual therapy, endoscopists, anesthesiologists, resuscitators, statisticians, doctors of points (departments) of medical care at home , in physiotherapy exercises, sports medicine, functional or ultrasound diagnostics, health centers, city and district pediatricians, as well as medical leaders of all ranks.

The need to allocate medical posts for outpatient appointments is due to the fact that, depending on their number, according to staff standards, the number of posts of doctors and paramedical personnel of auxiliary and some other medical and diagnostic units is determined:

The total number of posts of outpatient doctors: nurses in the treatment room, medical registrars (to calculate the number of positions of nurses in the treatment room, medical registrars);

· the total number of positions of doctors (to calculate the number of medical statisticians);

Changing the work of a unit or institution (to calculate the number of nurses in the procedural, vaccination rooms, registry);

The number of the population and its individual contingents (to calculate the number of nurses in vaccination rooms, nurses for collecting breast milk, etc.);

Mixed procedure for establishing positions: to calculate the number of paramedics or filter nurses in a children's city polyclinic (job change and number of children).

Most of the current staffing standards for outpatient clinics were approved more than 25 years ago: the staffing standards for urban and children's urban polyclinics located in cities with a population of over 25 thousand people were determined by order of the USSR Ministry of Health dated October 11, 1982 No. 999, in cities and towns of urban type with a population of up to 25 thousand people. Order of the Ministry of Health of the USSR dated September 26, 1978 No. 900. In 2001, an order was approved according to the staffing standards of children's polyclinics that are part of city and children's city hospitals, medical units with hospitals (order of the Ministry of Health of Russia dated October 16, 2001 No. 371), however, the lack of substantiation of the main provisions of this order makes it unacceptable for healthcare practice.

According to the nature and volume of activities of the nursing staff established for outpatient doctors in various specialties, these positions can be divided into the following groups:

nurses carry out outpatient reception of patients together with the doctor;

Along with outpatient appointments, together with the doctor, the nurses of district general practitioners, pediatricians, general practitioners (family medicine) also carry out doctor's appointments to provide appropriate medical, diagnostic and preventive care at home to the population of the site.

Nurses of surgeons, traumatologists and orthopedists carry out dressings, applying and removing plaster, etc.

The first group includes most of the positions of nurses of outpatient doctors. The normative ratio of middle and medical personnel in this group is, as a rule, 1: 1, i.e., one position of a nurse is planned for one position of a doctor. At the same time, in such specialties of doctors as neurology, endocrinology and dentistry, this ratio is violated and, in accordance with the current staffing standards, 0.5 positions of a nurse are established for one position of a doctor in these specialties. It is difficult to find a logical explanation for such standards, and in the absence of relevant recommendations at the sectoral level, it is advisable for the heads of healthcare institutions to establish the number of posts of paramedical personnel in these specialties, corresponding to the medical one, on the basis of the rights granted to them to form the number of personnel of healthcare facilities. By order of the Ministry of Health and Social Development of Russia dated April 14, 2006 No. 289, this provision for the children's dental clinic was corrected, and the positions of nurses in medical offices are established at the rate of 1 position for each position of a pediatric dentist, dental surgeon and orthodontist. Such a standard is fully consistent with modern technologies of the diagnostic and treatment process in dentistry using modern composite materials, “four-handed” work, and ethical and legal standards for receiving a patient in a separate office.

In recent years, in connection with the introduction of compulsory health insurance in the territories where payment is made for certain medical services, classifiers of medical services have been developed and approved, which establish the appropriate time limits for a doctor and a nurse. The expediency of such a separate establishment of time standards for those specialties where the standards define an equal number of doctors and paramedical personnel raises serious doubts. So, for example, in one of the classifiers in otolaryngology, where, according to staff standards, one position of a nurse is established for one position of a doctor, the time spent on anterior tamponade of the nose (including after bleeding) is determined in the amount of 2.0 UET for a doctor and 1.5 UET for a nurse, i.e. 20 and 15 minutes, respectively. It is unlikely that a nurse, having completed the procedure before a doctor, will provide assistance to another patient without an appropriate medical examination and appointments. The situation becomes more complicated when the indicated costs of the doctor's working time are less than those of the nurse. For example, to replace the cystostomy drainage, the urologist was given 3.0 THU, i.e. 30 minutes, and the nurse - 4.0 THU, i.e. 40 min. After completing this operation, the doctor will accept the next patient without a nurse, which may lead to a violation of the technology of the treatment and diagnostic process, which involves the joint work of a doctor and a nurse, or wait for the nurse to complete this labor operation within 10 minutes.

Thus, the establishment of different time standards for individual labor operations for a doctor and a nurse conflicts with industry labor standards that determine the ratio between the number of positions of nurses and outpatient doctors in a particular specialty.

Moreover, as noted in the Recommendations, the determination of the time spent on individual labor operations, as well as on simple and complex medical services, can only be considered as an intermediate stage for the formation of standard costs for a more aggregated indicator recorded in the reporting and accounting documentation of health facilities, i.e. for a visit.

The normative number of positions of junior medical personnel is also differentiated according to the specialties of outpatient doctors. So, in urban polyclinics located in cities with a population of over 25 thousand people, the positions of nurses are established at the rate of 1 position for each position of a surgeon, traumatologist, orthopedist, infectious disease specialist; for every 2 positions of physiotherapy doctors, allergists-immunologists; for every 3 positions of other doctors conducting outpatient appointments.

Rationing of labor of middle and junior medical personnel of hospitals

The rationing of the labor of middle and junior medical personnel of hospital institutions has certain features, which are listed below:

the need to provide round-the-clock service to patients in the hospital;

· the indicator serving as the basis for calculating the number of posts is the number of beds;

Establishment of workload (service) standards for the day of the patient's stay in the hospital or shift.

The norms for the number of middle and junior medical personnel of hospital institutions are expressed in the number of beds per position, or per one round-the-clock post. Depending on this and the norms of time are set either on the day of the position, or on the day.

I stage. The normative costs of working time of medical personnel of hospitals are determined per 1 patient per day or per day. The stay of the patient in the hospital for the calculation of standard indicators for labor is differentiated as follows:

the day of receipt;

day of treatment

day of release.

Time costs are usually set on the basis of timing.

The calculation of the weighted average indicator of the cost of the working time of a nurse or a nurse working daily, on the day of the patient's stay in the hospital (Tday) is carried out according to the formula:

Tday \u003d (tp + tl x 0.825 (m - 2) + tv) / (m x 0.825), (1)

where tp is the time spent by a nurse or doctor on a patient on the day of admission;

tl is the time spent on the patient during the treatment period per one day;

tv - time spent on the patient on the day of his discharge;

m is the average duration of inpatient treatment (in days).

A coefficient of 0.825 has been introduced into the formula, showing the reduction in the number of days the nurse or nurse works during the entire period of stay due to holidays and weekends. When calculating the coefficient, 12 holidays and 52 days off are taken into account when working on a six-day working week: (365-52-12) / 365 ≈ 0.825.

Under the indicated regimen, i.e., nurses work daily, providing individual care for seriously ill patients, dressing rooms, procedural nurses, barmaids, nurses.

Calculation example

The cost of the nurse's time for organizing individual care for seriously ill patients per 1 day of the patient's stay is 100 minutes on the day of admission, 80 minutes daily during the treatment period and 70 minutes on the day of discharge. The weighted average for an average length of stay of a patient of 13 days, calculated according to formula 1, is 83.5 minutes.

(100 + 80 × 0.825 × (13 2) + 70) / (13 × 0.825) ≈ 8.4.

There are approximately 10% of seriously ill patients in the department, therefore, this indicator per one hospitalized is 8.4 minutes (83.5: 10).

Most of the middle and junior medical staff of hospitals work around the clock. In this case, a 2 or 3 power queuing system is introduced.

The use of a 2-degree system provides for the care of patients by a doctor and a nurse. At the same time, the ward nurse fully and directly serves the patient, and the nurse performs only sanitary and hygienic functions in the wards and utility rooms. The forced performance by ward nurses of the functions of junior medical personnel, for example, cleaning rooms in the absence of the proper number of nurses, certainly worsens the quality of medical care and is contrary to sanitary and hygienic requirements.

With a 3-degree system, a doctor, a nurse and a nurse are involved in patient care.

The calculation of the weighted average cost of the working time of a nurse or a nurse per day of a patient's stay in a hospital (Tsut) is calculated using a formula similar to formula 1, but without taking into account the coefficient 0.825:

Tsut \u003d (tp + tl x (m - 2) + tv) / m, (2)

All designations correspond to formula 1, not per day, but per day of the patient's stay in the hospital.

The weighted average time costs are calculated separately for patients admitted in a planned manner and for emergency indications, and for surgical departments, in addition, for operated and non-operated patients. Then, taking into account the proportion of emergency hospitalization and operational activity, an indicator of the average time spent by a nurse or nurse per patient is determined. This method of calculation allows modeling the effective indicator of the average time spent per patient according to the profile of the department, depending on changes in the basic working conditions: an increase or decrease in the volume of emergency hospitalization, the number of surgical interventions, changes in the average duration of a patient's stay in a hospital, etc.

Calculation example.

The cost of the working time of a nurse per one patient per day for the periods of stay in the hospital, admitted according to emergency indications and in a planned manner.

Calculations of the time spent per patient per day, carried out according to formula 2, show that for those admitted in a planned manner with an average length of stay equal to 12 days, they will be 40.8 minutes:

(73.8 + 34.6 (12 2) + 70.2) x 12 ≈ 40.8.

The cost of working time for patients admitted on an emergency basis, with an average length of stay in the hospital equal to 8 days, will be 107.4 minutes: (396.6 + 60.8(8 2) + 97.8) / 8 ≈ 107, 4.

The average time spent for a 10% emergency hospitalization is 47.5 minutes: (107.4 × 10 + 40.8 × 90) / 100 ≈ 47.5.

The average time spent for a 30% emergency hospitalization is 61.8 minutes: (107.4 × 30 + 40.8 × 70) / 100 ≈ 61.8.

Thus, an increase in the share of hospitalization for emergency indications from 10 to 30% leads to an increase in the cost of the nurse's working time per patient per day from 47.5 to 61.8 minutes, i.e. by 30%.

II stage. Estimated load (service) rates for medical personnel of hospital institutions are expressed in the number of patients served per day or per day according to the formula:

Nb = (B x k) / T, (3)

where Nb - the norms of the load on the medical staff of the hospital;

B - daily working hours of medical personnel (according to a six-day working week) or daily working hours;

k is the coefficient of using the working time of the nursing staff for the main and auxiliary activities;

T is the average time spent per patient per day (from formula 2).

The main activity of medical personnel is, as a rule, work carried out directly with the patient, i.e., the time of direct contact of personnel with the patient, namely the performance of various procedures and manipulations. However, some categories of medical personnel do not have any contact with patients at all, for example, a cleaning nurse with a two-stage service system, so their main activity is to perform a direct production task.

All preparatory work carried out to perform the main activity and carried out both in the presence and in the absence of the patient is ancillary activities: preparation and cleaning of the workplace, preparation for manipulation, procedure, transfer to another department, etc.

During the working day, the staff needs short-term rest, meals, and sanitary and hygienic measures. These costs relate to personal time required.

Intersectoral methodological materials recommend devoting about 10% of working time to personal necessary time. The experience of labor rationing in health care shows that the coefficient of working time for the main and auxiliary activities for most positions of medical personnel (except for the auxiliary medical and diagnostic service) is 0.923, i.e., out of a 6.5 hour working day, about 30 minutes are allocated to other types of work : (6.5 - 0.5) / 6.5 = 0.923.

For further calculations, you can take a coefficient of 0.9.

Calculation example.

The estimated norms of the workload of a nurse for organizing individual care for seriously ill patients with the cost of working time per one hospitalized is 8.4 minutes. The norms of the workload (service), calculated according to formula 3, are 42 hospitalized:

(6.5 × 60 × 0.9) / 8.4 ≈ 42.

Calculation example.

Estimated workload rates for a nurse at the cost of working time per 1 patient per day, equal to 47.5 minutes, determined by formula 3, are 27 hospitalized: (24 × 60 × 0.9) / 47.5 ≈ 27,

and at a cost of 61.8 minutes, 21 patients: (24 × 60 × 0.9) / 61.8 ≈ 21.

III stage. The standard for the position of medical personnel of a hospital, expressed in the number of beds per position, is calculated by the formula:

Nk = (Nb x 365) / R, (4)

where Nk is the number of beds per position;

Nb - load in the number of patients per day (from formula 3);

R is the planned number of bed days per year.

The value of the indicator R in formula 4 is:

· for city, regional hospitals - 330-340 days;

for hospitals located in rural areas - 320 days;

· for infectious diseases hospitals – 310 days;

· for maternity hospitals – 300 days.

Calculation example.

The standard for the position of a nurse for organizing individual care for seriously ill patients of a department of a city hospital, calculated according to formula 4, with the time spent per patient per day equal to 8.4 minutes and the number of patients served equal to 42, is 45 beds ((42 x 365 ) / 340) for one position.

Calculation example.

To ensure the activities of the ward nurse of the department in the conditions of a city hospital with the cost of working time per 1 patient per day equal to 47.5 minutes, and the estimated workload of 27 patients, a round-the-clock post for 29 beds is required ((27 x 365) / 340), and at costs equal to 61.8 minutes and load norms for 21 patients, a round-the-clock post for 23 beds ((21 x 365) / 340).

The calculation of the number of posts to ensure the operation of a round-the-clock post is carried out according to the formula:

Dpost = (24 × 60 × 365) / B, (5)

where Dpost - the number of posts to ensure the work of a round-the-clock post;

B - the annual budget of the working time of the position.

The annual working time budget (B in formula 5) is calculated according to the formula presented in the Methodological recommendations “Development of labor rationing technology in healthcare”:

B \u003d m × d - n - z,

where B is the annual working time budget;

m - the number of hours of work per day for a five-day working week;

d is the number of working days in a year according to a five-day working week;

n - the number of hours of reduction in the duration of the working day or shift on holidays (during the year);

z - the number of working hours per vacation period, which is determined by multiplying the weekly working hours by the number of weeks of vacation.

In accordance with Art. 350 of the Labor Code of the Russian Federation for medical workers, a reduced working week is established - no more than 39 hours. Decree of the Government of the Russian Federation of February 14, 2003 No. 101, in connection with the special working conditions for a number of categories of medical personnel, established a reduced working week of 24, 30, 33 and 36 hours.

In accordance with the clarification of the Ministry of Labor of Russia of December 29, 1992 No. 5, approved by Decree No. 65 of December 29, 1992, the daily norm of working time is calculated according to the calculated schedule of a five-day working week with two days off on Saturday and Sunday. The length of the working day is determined by dividing the weekly length of working time by 5 days.

In accordance with Art. 95 of the Labor Code of the Russian Federation, the duration of the working day or shift immediately preceding a non-working holiday is reduced by 1 hour.

If a weekend and a non-working holiday coincide, the day off is transferred to the next working day after the holiday. For the purpose of rational use by employees of days off and non-working days, the Government of the Russian Federation has the right to transfer days off to other days. As a rule, as a result of such transfers, there are 7 or 8 pre-holiday days during the year. Currently, the number of non-working holidays in the Russian Federation is determined by the Law of the Russian Federation of December 29, 2004 No. 201 “On Amendments to Article 112 of the Labor Code of the Russian Federation”:

When calculating the number of workers, holidays, non-working and pre-holiday days in a year, it is advisable to use the Production Calendar.

In 2009 - 250 working days on a five-day working week, 7 pre-holiday days.

In connection with the adoption of the Labor Code of the Russian Federation, a transition was made to the calculation of labor leave in calendar days (Article 115 of the Labor Code of the Russian Federation), however, the duration of the leave remained the same. In calculating the annual budget, it is advisable to define vacation time as the product of weekly working time by the number of weeks.

Calculation example.

The annual budget of working time for the position of a nurse in a city hospital with a 39-hour working week, 28 days of vacation (in terms of calendar days), calculated for 2009, is 1787 hours: (39 / 5) × 250 - 7 - 4 × 39 = 1787 h or 107220 min (60.0 × 1787).

Calculation example.

The number of nursing positions to ensure the operation of a round-the-clock post with an annual working time budget of 1787 hours, calculated according to formula 5, is 4,916 positions ((24 x 366) / 1787)

The calculation of the number of posts in a particular department is carried out according to the formula:

Dotd = (Dp × K) / P, (6)

where Dotd is the number of positions in the department;

Dp - the number of posts per 1 post;

K - the number of beds in the department;

P - the number of beds per 1 post (according to the standard).

Calculation example.

In a department with 30 beds, with a standard indicator of 20 beds per 1 post, and the number of nurse positions (ward), to ensure the operation of one round-the-clock post, equal to 4,916 positions (with a 39-hour working week and 28 days of vacation), 7,374 positions of a ward nurse: (4.916 × 30) / 20 = 7.374.

The calculation was carried out according to formula 6.

Peculiarities of labor rationing of middle and junior medical personnel in day hospitals

In recent years, hospital-replacing types of care have received significant development. The staff standards of medical personnel of day hospitals establish the position of a senior nurse (regardless of the total number of beds). The positions of nurses are introduced at the rate of 1 position for 15 beds, the positions of ward nurses or junior nurses for patient care are established according to the positions of nurses (order of the Ministry of Health of Russia dated 09.12.1999 No. 438).

The volume of work of middle and junior medical personnel is associated with the need to organize care and fulfill medical appointments during the daytime, and in different institutions the hours of operation of the day hospital are determined depending on specific local conditions and range from 5 to 9 hours daily. In some cases, a two-shift operation of a day hospital is practiced. When calculating, it is necessary to take into account the number of days of work of a day hospital in a year: on a five-day or six-day working week, without weekends and holidays, etc.

The calculation of the number of middle and junior medical personnel in day hospitals can be performed based on the data of photochronometric observations. However, given the complexity of photochronometric observations to determine the time standards in healthcare facilities, it can be recommended to use the existing regulatory framework for labor for these groups of personnel in hospitals, but taking into account the working hours of a day hospital.

Planning the number of ward nurses, nursing assistants, ward nurses, ward nurses-cleaners of hospitals is carried out by establishing round-the-clock posts for a certain number of beds. When organizing the work of this staff, the load (service) norms in the daytime, as a rule, increase, and at night they decrease. For example, when planning one post for 20 beds during the day, you can set a load of 15 beds, and at night - 40–50 beds.

However, the differences in the composition of patients in a day hospital compared to a regular hospital department, the mobility of patients and the ability to self-service allow us to take the total number of beds per post as the basis for planning the number of middle and junior medical personnel in a day hospital.

The calculation of the number of positions of ward nurses, ward nurses in a day hospital is carried out according to the formula:

Dday = Dpost x (T / W) x (K / N), (7)

where Ddnevn - the number of positions of ward nurses and nurses in a day hospital;

Dpost - the number of positions of nurses or nurses to ensure the work of a round-the-clock post;

T is the number of hours of operation of the day hospital during the year;

W is the number of hours of operation of a round-the-clock post per year;

K - the number of beds in the day hospital;

N is the standard number of beds in a hospital with round-the-clock stay at 1 post.

Calculation example.

The therapeutic day hospital for 25 beds operates from 10 am to 6 pm, i.e. 8 hours daily for 303 days (according to a six-day working week).

Therefore, T = 2424 hours (8 × 303). A round-the-clock post of a ward nurse in the therapeutic department of the city hospital is set up for 20 beds, and for cleaning nurses - for 30 beds (with a two-stage service system). 4,916 positions are needed to ensure the work of a round-the-clock post (with a 39-hour work week and 28 days of vacation). Calculations according to formula 7 show that in this day hospital in 2009 1,696 posts of nurses and 1,131 posts of nurses are needed.

In accordance with the procedure for rounding off posts, 1.75 positions of a ward nurse and 1.25 positions of a ward nurse-cleaner can be introduced into the staff list.

Conclusion

The formation of a socially oriented market economy and its development is impossible without developed labor relations. The material basis of any society is the labor activity of people. Labor is a condition of human existence independent of any social forms and constitutes his eternal natural necessity. All areas of work need to be regulated. In this regard, the regulation of labor in health care is becoming even more relevant.

Currently, there is no single base for labor regulation for medical institutions, which affects the quality of medical services provided. All developed materials in the field of labor regulation, which are used in the organization of work in health care institutions, were either developed in the late 1980s or were published several years ago without serious revision, taking into account the current situation in the modern health care system of the Russian Federation. The modern organization of labor rationing in healthcare requires improvement in terms of determining and using in further calculations the coefficients for the use of working time for the main and other activities, as well as for operational and auxiliary time.

As can be seen from the work done, scientifically based labor standards, correctly reflecting specific conditions, provide an increase in labor productivity. If the labor standards are too low, they can give rise to pessimism, which negatively affects the results of productivity; if the standards are too high, they are not feasible. In both cases, the growth of labor productivity will be hampered. Thus, all changes in the organization of labor and production, equipment and technology of work are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise. Labor rationing is the basis of labor planning.

In health care organizations, work on labor rationing should be carried out in a timely manner in order to further reduce the time spent on providing medical services to the population, taking into account the use of new working methods, best practices, as well as improving workplaces and equipment used. The result of using the proposed methodological recommendations will be the developed rational load standards for medical personnel of medical institutions.

Bibliography

one . Valchuk E.A. Socio-economic norms and standards. Their use in healthcare management // Medicine. - 1998. - No. 2.

2. Kadyrov F.N. Incentive wage systems in health care. Moscow: Grant, 2000.

3 . Organization and regulation of labor / Ed. V.V. Adamchuk. - M.: CJSC "Finstatinform", 1999.

4 . Shipova V.M. Organization of labor rationing in health care / Ed. acad. RAMS O.P. Shchepin. Moscow: Grant, 2002.

5 . Adamchuk V.V., Romanov O.V., Sorokina M.E. Economics and sociology of labor: Textbook for universities. - M.: UNITI, 1999.

6. Course of Economics: Textbook / Ed. B.A. Reisberg. - INFRA-M, 1997.

7 .Methodological recommendations “Development of labor rationing technology in health care”, approved by the Ministry of Health and Social Development of Russia on December 20, 2007 No. 250-PD / 704. The authors-developers are employees of the National Research Institute of Public Health of the Russian Academy of Medical Sciences: O.P. Shchepin, A.L. Lindenbraten, V.M. Shipova, V.V. Kovaleva, N.K. Grishina, V.I. Filippova, S.M. Golovina, O.A. Kozachenko, N.B. Solovyov.

8. Shipova V.M. Planning the number of medical personnel in hospitals. M.: Grant. 1999.

9. Margulis A. L., Shilova V. M., Gavrilov V. A. The number of posts of health care facilities // Methodological and regulatory materials for calculating the number of posts and compiling the staffing tables of medical institutions. – M.: Agar, 1997.

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RESOLUTION of the Ministry of Labor of the Russian Federation dated February 15, 2002 13 ON THE APPROVAL OF THE STANDARDS FOR THE NUMBER OF EMPLOYEES IN BOARDING HOUSES FOR THE ELDERLY AND ... Relevant in 2018

Organization of work of medical personnel

Workplaces in the institutions of the system of boarding schools are medical offices designed for the work of doctors of the represented specialties, treatment and manipulation rooms, posts on duty and ward nurses.

The labor activity of the medical and paramedical staff of the boarding school, basically, takes place in the conditions of a free regime of reception and movement during the working day. Part of the working time is spent by the medical staff of boarding schools at their desks.

The desktop of the doctor and nursing staff should be in the most illuminated part of the office. It is necessary to have a space around the table that ensures the free movement of the doctor and nurse to any item in the office. The surface of the table should not be covered with glass, the shiny surface of which is harmful to vision.

The workplace of medical personnel is recommended to be equipped with a single- or double-pedestal table, which provides convenient placement of medical equipment and documents on the surface of the table, and storage of operational documentation in drawers. Folders, documents and equipment should be arranged so that each item of labor has a specific place. On the drawers of the table, it is recommended to strengthen the cards indicating their contents. A cabinet is provided for storing documents and reference material, and a safe is provided for storing strict reporting forms.

The couch for examining the patient should be positioned so that the right half of his body is on the side of the doctor. It is advisable to place the couch by the window, next to it there are scales and a height meter. The location of each item should be thought out in such a way as to minimize the cost of movement. The door of the office must be visible so that the doctor can see the incoming person.

In the boarding house, light and sound signaling devices should be widely used (for calling nurses to the wards, for inviting patients for procedures).

The post of the ward nurse should be equipped with special furniture, which includes a desktop, a sectional cabinet for medicines and devices for distributing them, for storing care items for those served.

The workplace of the procedural sister can be equipped with additional tables for dressings and sterile material.

Workplaces should be located in bright, dry rooms. The rational organization of the light regime in the premises of boarding houses should be to provide a sufficiently high level of illumination for the elderly and disabled people served and at the same time create conditions for the optimal work of medical personnel throughout the working day.

The main service areas should be illuminated primarily by natural light. Significantly facilitates the labor activity of artificial lighting - sufficient in intensity, without blinding brightness. In nursing homes, incandescent lamps and fluorescent fluorescent lamps can be used.

To ensure clean air and a uniform temperature, constant air exchange is of great importance. Increased requirements are imposed on the dustiness of the air with chemical and medicinal substances.

The color design of the working premises should ensure the stable performance of the medical staff throughout the working day.

The ratio of colors should be based on the fact that pink, orange and yellow colors create a feeling of warmth, while at the same time providing a tonic effect. Blue, blue, purple colors create a feeling of coolness. In rooms with low ceilings, the walls should be painted only in light colors. If the windows of the working room are facing north, then the walls should be painted in warm colors. In rooms with windows to the south, the walls can be painted in cold colors.

In order to streamline the regime of work and rest of the medical staff at the boarding school, it is recommended to perform gymnastic exercises, to reduce fatigue, it is recommended to use a complex of autogenic training aimed at increasing the general tone. Functional music (the music of "working out", "rest") has a positive effect on the general condition of the body throughout the working day.

"Medical Law", 2004, N 4

FEATURES OF LABOR REGULATION OF MEDICAL WORKERS

The work of a doctor at all times has been honorable and respected, and its importance is invaluable even now, since a medical worker is directly responsible for the life and health of the patient. Therefore, special requirements are imposed on him, which, in turn, are compensated by benefits and compensations. All these requirements and compensations are usually reflected in the employment contract with the employee.

In addition to the general provisions of the Labor Code of the Russian Federation, medical workers are subject to the provisions of the Fundamentals of Legislation on the Protection of Citizens' Health dated 07.22.1993 N 5487-1, dedicated to engaging in medical activities, as well as a number of other subordinate regulatory legal documents. The main document regulating the work of a physician is an employment contract concluded with an employer.

CONCLUSION OF AN EMPLOYMENT CONTRACT

The definition of an employment contract is given in Article 56 of the Labor Code of the Russian Federation, it states that this is an agreement between an employer and an employee, according to which the employer undertakes to provide the employee with work according to the conditional labor function, to ensure working conditions provided for by the Labor Code of the Russian Federation, laws and other regulatory legal acts, collective agreement, agreements, local regulations containing labor law norms, pay the employee wages in a timely manner and in full, and the employee undertakes to personally perform the labor function determined by this agreement, to comply with the internal labor regulations in force in the organization. The parties to an employment contract are the employer and the employee.

The employment contract is concluded in writing, drawn up in two copies, each of which is signed by the parties. One copy of the employment contract is transferred to the employee, the other is kept by the employer. The need for a written form of the contract is due to the fact that the relations regulated by it are designed for a long period, contain essential conditions for both the employee and the employer, a change in these conditions must be agreed and mutual.

The possibility of the emergence of labor relations with the actual admission to work with the knowledge or on behalf of the employer or his representative is not excluded, regardless of whether the employment contract was properly executed (Articles 15, 67 of the Labor Code of the Russian Federation). In the future, however, it is still necessary to formalize the employment relationship in writing.

Employment is formalized by an order (instruction) of the employer, issued on the basis of a concluded employment contract (Article 68 of the Labor Code of the Russian Federation). This, in fact, is an internal document of the organization necessary for conducting personnel records management. However, the order is announced to the employee against receipt within three days from the date of signing the employment contract. Also, the employee has the right to demand the issuance of a duly certified copy of the order (instruction).

ESSENTIAL TERMS OF THE EMPLOYMENT CONTRACT

The essential conditions of the contract are the conditions on the subject of the contract, the conditions named in the law or other legal acts as essential or necessary for contracts of this type, as well as all those conditions regarding which, at the request of one of the parties, an agreement should be reached. This concept is borrowed from civil law (Article 432 of the Civil Code of the Russian Federation).

When considering the essential terms of an employment contract, one should dwell on the differences between employment contracts and civil law contracts that are close in content to labor contracts (contracts, paid services, commissions, agency services, etc.).

The search for differences between employment contracts and civil law is relevant, because. often the employer tries to replace the latter with an employment contract, especially when hiring for temporary work. The employee considers such a contract as a labor contract. The consequences of concluding a civil law contract are somewhat different than when concluding an employment contract. For example, according to paragraph 3 of Art. 238 of the Tax Code of the Russian Federation, when calculating the amount of the unified social tax, the tax base (in terms of the amount of tax payable to the Social Insurance Fund of the Russian Federation) does not include any remuneration paid to individuals under civil law agreements, including copyright and license agreements.

Participants in civil law relations are equal and independent. In labor relations, the employee is subject to internal regulations, but at the same time has the right to paid sick leave, vacation, various compensations and benefits.

Article 57 of the Labor Code of the Russian Federation provides a list of essential conditions of an employment contract. The contract must indicate: the last name, first name, patronymic of the employee and the name of the employer (last name, first name, patronymic of the employer - an individual) who have entered into an employment contract.

The Code provides for the need to specify conditions such as:

Place of work (indicating the structural unit);

Start date of work;

The name of the position, specialty, profession, indicating qualifications in accordance with the organization's staffing table or a specific labor function. Decree of the Government of the Russian Federation of October 29, 2002 N 781 approved the List of positions and institutions, work in which is counted in the length of service, giving the right to early appointment of an old-age labor pension to persons who carried out medical and other activities to protect public health in state and municipal health care institutions, in accordance with subparagraph 11 of paragraph 1 of Article 28 of the Federal Law "On labor pensions in the Russian Federation". Therefore, if an appointment is made to a position indicated in the List, then the name of this position must correspond to this List;

The rights and obligations of the employee;

Rights and obligations of the employer;

Characteristics of working conditions, compensation and benefits to employees for working in difficult, harmful and (or) dangerous conditions;

The mode of work and rest (if it is different for this employee from the general rules established in the organization);

Terms of remuneration (including the size of the tariff rate or official salary of the employee, additional payments, allowances and incentive payments). In budgetary healthcare organizations, one should be guided by the Order of the Ministry of Health of the Russian Federation of October 15, 1999 N 377 "On approval of the regulation on the remuneration of healthcare workers",

Types and conditions of social insurance directly related to labor activity. According to the changes made to Art. 63 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens Federal Law of August 22, 2004 N 122-FZ, measures of social support for medical and pharmaceutical workers of healthcare organizations that are on budget support at various levels (federal, subject of the Federation, municipal), are established by the relevant authorities (Government Russian Federation, state authorities of the subject or local authorities).

Also, according to the amendments made by the said law, medical and pharmaceutical workers are deprived of the right to receive priority housing, install a telephone, provide their children with places in preschool and sanatorium-resort institutions, and purchase on preferential terms vehicles used to perform professional duties during the traveling nature of work. .

Doctors, pharmacists, employees with secondary medical and pharmaceutical education of the state and municipal health care systems, working and living in rural areas and urban-type settlements, as well as members of their families living with them, are not entitled to claim free apartments. These changes come into effect on January 1, 2005.

The employment contract may provide for conditions on probation, on non-disclosure of secrets protected by law (state, official, commercial and other), on the obligation of the employee to work after training for at least the period established by the contract, if the training was carried out at the expense of the employer, as well as other conditions not worsening the position of an employee in comparison with the Labor Code of the Russian Federation, laws and other regulatory legal acts, a collective agreement, agreements.

The terms of the employment contract can be changed only by agreement of the parties and in writing.

As a general rule, an employment contract is open-ended.

If a fixed-term employment contract is concluded, it shall indicate the period of its validity and the circumstance (reason) that served as the basis for concluding a fixed-term employment contract in accordance with the Labor Code and other federal laws. The Decree of the Plenum of the Supreme Court of the Russian Federation dated March 17, 2004 N 2 (paragraph 13) states that the conclusion of a fixed-term employment contract is a right, not an obligation of the employer.

The Supreme Court also pointed out that when establishing during the trial the fact of the repeated conclusion of fixed-term employment contracts for a short period to perform the same labor function, the court has the right, taking into account the circumstances of each case, to recognize the employment contract as concluded for an indefinite period.

THE DIFFERENCE OF AN EMPLOYMENT CONTRACT FROM CIVIL LEGAL

CONTRACTS CLOSE IN THE CONTENT OF LABOR

Unlike an employment contract, a prerequisite for most paid civil law contracts is the start and end dates of the contract.

The most common type of civil law contracts used to regulate labor relations is a work contract. Article 702 of the Civil Code of the Russian Federation defines a work contract as an agreement under which one party (contractor) undertakes to perform certain work on the instructions of the other party (customer) and hand over its result to the customer, and the customer undertakes to accept the result of work and pay for it.

The subject of the contract is a certain result of the work of the contractor, and not the performance of a specific labor function, as is the case in the employment contract. According to Art. 703 of the Civil Code of the Russian Federation, a contract is concluded for the manufacture, processing or processing of a thing or for the performance of other work with the transfer of its result to the customer. As a general rule, Art. 704 of the Civil Code of the Russian Federation, the contractor performs the work at his own expense, that is, from his own materials, on his own and with his own resources. The employee always performs the function stipulated by the employment contract personally, that is, on his own, but the provision of materials and means necessary for the performance of work is the responsibility of the employer. The contractor, if his obligation to perform the work provided for in the contract personally does not follow from the law or the work contract, has the right to involve other persons in the performance of his obligations (clause 1 of article 706 of the Civil Code of the Russian Federation). The employment contract implies that the employee performs his labor duties only personally.

Unlike an employee, as a general rule, Art. 705 of the Civil Code of the Russian Federation, the risk of accidental loss or accidental damage to the result of the work performed before it is accepted by the customer is borne by the contractor. This risk of the contractor is that in the event of these random events, the contractor loses, in whole or in part, the right to payment for the work performed. This cannot happen to an employee, since all similar property risks are borne by the employer, and the employee retains his right to receive payment for the performance of the function provided for by the employment contract, even if the expected result was not achieved due to circumstances beyond the control of the employee.

The price of work in the contract is not one of its essential conditions (Article 709 of the Civil Code of the Russian Federation), the amount and terms of remuneration are necessarily indicated in the employment contract (Article 57 of the Labor Code of the Russian Federation).

A contract for the provision of services for a fee is more similar to an employment contract than a work contract, since the subject of a contract for the provision of services for a fee is the performance by the performer of certain actions or the performance by him of other specific activities (Article 779 of the Civil Code of the Russian Federation), which, as a rule, is not accompanied by the creation of any or a certain thing. In addition, according to Art. 780 of the Civil Code of the Russian Federation, the contractor, as a general rule, is obliged to provide services personally. Therefore, the main criterion for distinguishing between an employment contract and a contract for the provision of services for compensation is the presence or absence of the contractor's obligation to comply with the internal labor regulations of the customer when providing the service. At the same time, it should be noted that the general provisions on the work contract apply to the contract for the provision of services for compensation, if this does not contradict the norms of the Civil Code of the Russian Federation on the provision of services for compensation and the features of the subject of this agreement (Article 783 of the Civil Code of the Russian Federation).

It should be noted that by virtue of Part 3 of Art. 11 of the Labor Code of the Russian Federation, if a civil law agreement is concluded between the parties, however, during the trial it will be established that this agreement actually regulates labor relations between the employee and the employer, the provisions of the Labor Code of the Russian Federation should apply to such relations.

ADMISSION TO MEDICAL ACTIVITIES.

CERTIFICATE OF SPECIALIST

To work in a medical organization, a secondary or higher medical education is required; for an employee with a higher education, a certificate of a specialist in a medical specialty is also required.

In the case of hiring an intern student, the task becomes more complicated, because To date, a clear regulatory framework regulating the procedure for internships for young professionals, including obtaining a certificate, has not been developed.

The main documents on this issue are: art. 54 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens dated 07/22/1993 N 5487-1, Orders of the Ministry of Health of the USSR dated 01/20/1982 N 44 "On measures to further improve the training of medical personnel in internships" and dated 08/16/1972 N 669 "On approval of instructions on the procedure for paying wages to doctors undergoing a one-year specialization (internship), and additional payment to the heads of departments of city (central district), regional, regional and republican hospitals that provide direct training for doctors and follow instructions on the procedure for enrolling graduates of medical institutes in internship and work " .

In connection with the cancellation of the Order of the Ministry of Health of the Russian Federation of December 19, 1994 "On approval of the Regulations on the procedure for admission to professional (medical and pharmaceutical) activities" (with clarifications of the Ministry of Health of the Russian Federation of August 7, 1995 N 15-00), the question of the procedure for obtaining -Intern Specialist Certificate. Let us recall that earlier, in accordance with the above documents, a specialist certificate was issued after the completion of an internship without an additional exam.

WORK TIME. OUT OF NORMAL OPERATION

WORKING HOURS

The permissible duration of the daily work of medical workers is not indicated in the Labor Code, but part 3 of Article 92 of the Labor Code of the Russian Federation provides for the possibility of establishing reduced working hours for medical workers by adopting the relevant Federal Law (such a law has not yet been adopted), and Article 350 of the Labor Code of the Russian Federation for medical workers a reduced working time is established - no more than 39 hours per week. Decree of the Government of the Russian Federation of February 14, 2003 N 101, adopted in accordance with the specified article of the code, establishes even shorter working hours for certain categories of medical workers - from 36 to 24 hours a week. The new edition of the Labor Code of the Russian Federation, which will come into force on January 1, 2005, will provide for the possibility for the Government of the Russian Federation to establish additional annual paid leave for certain categories of medical workers.

Separately, it is necessary to dwell on the issue of work outside the normal working hours. Labor legislation provides for two options: overtime work (carried out at the initiative of the employer) and part-time work, if the initiative comes from the employee (Article 97 of the Labor Code of the Russian Federation).

Overtime work - work performed by an employee at the initiative of the employer outside the established working hours, daily work (shift), as well as work in excess of the normal number of working hours for the accounting period.

The employer has the right to involve the employee in overtime work in legally established cases (part 2 of article 99 of the Labor Code of the Russian Federation), while the written consent of the employee is required. If the employee is involved in such work due to other circumstances, the employer must obtain, in addition to the written consent of the employee, the approval of the elected trade union body of this organization (part 3 of article 99 of the Labor Code of the Russian Federation). That is, the performance of overtime work is carried out within the framework of the existing labor contract, a new labor contract is not concluded.

Overtime work is limited to four hours on two consecutive days and 120 hours per year.

Payment for overtime work is made for the first two hours of work at least one and a half times, for subsequent hours - at least twice the size. Specific amounts of payment for overtime work may be determined by a collective agreement or an employment contract.

Unlike the Labor Code of the Russian Federation, now, at the request of the employee, overtime work instead of increased pay can be compensated by providing additional rest time, but not less than the time worked overtime (Article 152 of the Labor Code of the Russian Federation).

Part-time work is devoted to chapter 44 of the Labor Code of Russia. Part-time employment is the performance by an employee of other regular paid work on the terms of an employment contract in his free time from his main job. Part-time work can be performed by an employee both at the place of his main job and in other organizations.

Part-time work, as a general rule, cannot exceed four hours a day and 16 hours a week.

Separately, the Labor Code of the Russian Federation indicates the features of part-time work for certain categories of workers, including doctors.

Decree of the Ministry of Labor of the Russian Federation of 30.06.2003 N 41 "On the peculiarities of part-time work of pedagogical, medical, pharmaceutical workers and cultural workers" establishes: for medical, pharmaceutical workers, internal part-time jobs are allowed in cases where reduced working hours are established.

The duration of part-time work for the specified categories of employees during the month is established by agreement between the employee and the employer, and for each employment contract it cannot exceed:

For medical and pharmaceutical workers - half of the monthly norm of working time, calculated from the established duration of the working week;

For medical and pharmaceutical workers whose half of the monthly norm of working time for their main job is less than 16 hours per week - 16 hours of work per week.

For doctors and paramedical personnel of cities, regions and other municipalities where there is a shortage of them - the monthly norm of working time, calculated from the established duration of the working week. At the same time, the duration of part-time work for specific positions in institutions and other organizations of federal subordination is established in the manner determined by the federal executive authorities, and in institutions and other organizations that are under the jurisdiction of the constituent entities of the Russian Federation or local governments - in the manner determined by the bodies state authorities of the constituent entities of the Russian Federation or local governments;

For junior medical and pharmaceutical personnel - the monthly norm of working hours, calculated from the established duration of the working week.

At the same time, the duration of part-time work for specific positions in institutions and other organizations of federal subordination is established in the manner determined by the federal executive authorities, and in institutions and other organizations that are under the jurisdiction of the constituent entities of the Russian Federation or local governments - in the manner determined by the bodies state authorities of the constituent entities of the Russian Federation or local governments.

This Decree also provides a list of types of work that are not part-time jobs and do not require the conclusion (execution) of an employment contract, since the performance of these works is allowed during main working hours with the consent of the employer.

COMPENSATION AND BENEFITS TO EMPLOYEES FOR WORK

IN SEVERE, HARMFUL AND/OR DANGEROUS CONDITIONS.

MANDATORY INSURANCE FOR MEDICAL WORKERS

The Labor Code of the Russian Federation (Articles 92, 117) establishes reduced working hours for workers employed in jobs with harmful and (or) dangerous working conditions, as well as additional paid leave. Lists of such industries, jobs and positions, giving the right to a shorter working day and additional leave, must be approved by the Government of the Russian Federation. Prior to their adoption, in accordance with Article 423 of the Labor Code of the Russian Federation, it is possible to apply regulatory legal acts issued before the adoption of the Labor Code of the Russian Federation, in part that does not contradict it.

Decree of the USSR State Committee for Labor and the Presidium of the All-Union Central Council of Trade Unions of October 25, 1974 N 298 / P-22 approved the List of industries, workshops, professions and positions with harmful working conditions, work in which gives the right to additional leave and a shorter working day. There is also an Instruction for its use (approved by the Decree of the USSR State Committee for Labor, the All-Union Central Council of Trade Unions of November 21, 1975 N 273 / P-20). This List has section XL "Health Care", which lists the various medical and preventive institutions and their departments, work in which entitles you to additional leave and reduced working hours. Thus, employers are obliged to provide employees holding relevant positions with the required benefits. According to Art. 126 of the Labor Code of the Russian Federation, the replacement of vacation with monetary compensation to such employees is not allowed.

It should be noted that, in accordance with Art. 120 of the Labor Code of the Russian Federation, additional holidays, like the main ones, are calculated in calendar days, and in the aforementioned List they are set in working days. A way out of this situation can be found if, for example, the duration of additional leave in calendar days is indicated in the collective agreement or an order or instruction is issued for the organization, in which the number of calendar days of additional leave corresponding to working days is set.

The length of service, which gives the right to additional annual paid leave for work with harmful and (or) dangerous working conditions, includes only the time actually worked in such conditions (Article 121 of the Labor Code of the Russian Federation). Therefore, the organization needs to organize a separate accounting of working time, giving the right to such holidays.

Employers also need to take measures to protect the health of workers. Order of the Ministry of Health and Social Development of the Russian Federation of August 16, 2004 N 83 approved the lists of harmful and (or) dangerous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, as well as the procedure for conducting these examinations (examinations).

Harmful and (or) dangerous production factors are listed in the List of chemical, biological, physical factors, as well as factors of the labor process. If an employee is exposed to any of the above factors, such as ultraviolet radiation, he must undergo medical examinations in accordance with this document.

The Federal Law of August 22, 2004 N 122-FZ, which concerns the monetization of benefits, amending a large number of laws, including the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, among other things, specifies the conditions for compulsory insurance of medical, pharmaceutical and other workers state and municipal health care systems, whose work is associated with a threat to their life and health.

Thus, the new edition of Article 64 of the Fundamentals refers to the list of positions, the occupation of which is associated with a threat to the life and health of employees, the amount and procedure for compulsory insurance, which must be approved by the Government of the Russian Federation.

The amount and procedure for compulsory insurance for medical, pharmaceutical and other employees of health care organizations that are under the jurisdiction of the subjects of the Russian Federation or under the authority of municipal health care organizations whose work is associated with a threat to their life and health are established by the state authorities of the subjects of the Russian Federation or local governments, respectively. .

Compulsory insurance also provides for the payment of a one-time cash benefit to the families of state and municipal health workers who died in the performance of their work duties or professional duty during the provision of medical care or scientific research.

CHANGING THE EMPLOYMENT CONTRACT

In the process of work, organizational or technological working conditions may change at the initiative of the employer. Such changes relating to the essential terms of the contract must be agreed with the employee and executed in writing, either in the form of an additional agreement to the employment contract, or by renewing the contract with the employee.

The employer shall notify the employer in writing of the introduction of such changes no later than two months prior to their introduction.

If the employee does not agree to continue working in the new conditions, the employer is obliged in writing to offer him another job available in the organization that corresponds to his qualifications and state of health, and in the absence of such work - a vacant lower position or a lower paid job that the employee can perform according to his qualifications and state of health.

In the absence of the specified work, as well as in the event that the employee refuses the proposed work, the employment contract is terminated in accordance with paragraph 7 of Art. 77 of the Labor Code of the Russian Federation.

If the employee refuses to continue working on the terms of the relevant working hours, then the employment contract is terminated in accordance with paragraph 2 of Art. 81 of the Labor Code of the Russian Federation with the provision of appropriate guarantees and compensations to the employee.

The cancellation of the part-time work regime is carried out by the employer, taking into account the opinion of the representative body of the employees of the organization.

Changes in the essential terms of the employment contract that worsen the position of the employee in comparison with the terms of the collective contract or agreement cannot be introduced.

The Code describes a number of cases when amendments to the employment contract are not required, we are talking about an initiative coming from the employer (Articles 72, 74-76):

1. Transfer to another permanent job in the same organization at the initiative of the employer, that is, a change in the labor function or a change in the essential terms of the employment contract, as well as transfer to a permanent job in another organization or in another locality together with the organization is allowed only with the written consent of the employee ( article 72 of the Labor Code of the Russian Federation).

Transfer to another permanent job in the same organization, as well as transfer to a permanent job in another locality, together with the organization, is formalized by an order (instruction) of the employer. An appropriate entry about the transfer is made in the work book.

When transferring to work in another locality, employees are paid appropriate compensation: the cost of travel for the employee and his family members, the cost of baggage, expenses for settling in a new place, etc. (Article 169 of the Labor Code).

Under "other" is understood the area outside the administrative-territorial boundaries of the corresponding settlement. A transfer to work from one locality to another, even within the same administrative region, is considered as a transfer to another locality, regardless of whether there is a bus or other regular service between these points.

An employee who, in accordance with a medical report, needs to be provided with another job, the employer is obliged, with his consent, to transfer to another available job that is not contraindicated for him for health reasons. If the employee refuses to transfer or if there is no relevant work in the organization, the employment contract is terminated in accordance with paragraph 8 of Art. 77 of the Labor Code of the Russian Federation.

The Code establishes that it is not a transfer to another permanent job and does not require the consent of the employee to move him in the same organization to another workplace, to another structural unit of this organization in the same locality, to entrust work on another mechanism or unit, if this does not entail changes in the labor function and changes in the essential terms of the employment contract. Although information about the structural unit is one of the essential conditions of the employment contract.

2. It is also not required to amend the employment contract in case of temporary transfer to another job, in case of production necessity (Article 74 of the Labor Code of the Russian Federation). The employer has the right to transfer the employee for a period of up to one month to work not stipulated by the employment contract in the same organization with remuneration for the work performed, but not lower than the average earnings for the previous job. Such a transfer is allowed to prevent a catastrophe, industrial accident or eliminate the consequences of a catastrophe, accident or natural disaster; to prevent accidents, downtime (temporary suspension of work due to economic, technological, technical or organizational reasons), destruction or damage to property, as well as to replace an absent employee. At the same time, the employee cannot be transferred to work that is contraindicated for him for health reasons.

The duration of a transfer to another job to replace an absent employee cannot exceed one month during a calendar year (from January 1 to December 31).

With written consent, an employee may be transferred to a job requiring a lower qualification.

3. The Labor Code of the Russian Federation (Article 76) imposes on the employer the obligation to remove from work (not allow to work) an employee: who appeared at work in a state of alcoholic, narcotic or toxic intoxication; who has not undergone training and testing of knowledge and skills in the field of labor protection in the prescribed manner; who has not passed the mandatory preliminary or periodic medical examination in accordance with the established procedure; as well as in case of revealing, in accordance with the medical report, contraindications for the employee to perform work stipulated by the employment contract; at the request of bodies and officials authorized by federal laws and other regulatory legal acts, and in other cases provided for by federal laws and other regulatory legal acts.

The employer suspends from work (does not allow to work) the employee for the entire period of time until the circumstances that are the basis for suspension from work or exclusion from work are eliminated.

During the period of suspension from work (non-admission to work), wages are not accrued to the employee, with the exception of cases provided for by federal laws. In cases of suspension from work of an employee who has not undergone training and testing of knowledge and skills in the field of labor protection or a mandatory preliminary or periodic medical examination through no fault of his own, he is paid for the entire period of suspension from work as for downtime.

In the event of a change in the owner of the property of the organization, the new owner, no later than three months from the date of the emergence of his right of ownership, has the right to terminate the employment contract with the head of the organization, his deputies and the chief accountant. With other employees of the organization, the new owner is not entitled to terminate employment contracts only on the basis of a change in ownership of the organization's property. At the same time, after the state registration of the transfer of ownership, a reasonable reduction in the number or staff of employees is allowed, which is not directly related to the change in the owner of the organization.

The employee may refuse to continue work in connection with the change of ownership of the property of the organization. In this case, the employment contract is terminated in accordance with paragraph 6 of Art. 77 of the Labor Code of the Russian Federation.

When changing the jurisdiction (subordination) of the organization, as well as when it is reorganized (merger, accession, division, separation, transformation), labor relations continue with the consent of the employee.

TERMINATION OF AN EMPLOYMENT CONTRACT

The grounds for termination of an employment contract are listed in Art. 77 of the Labor Code of the Russian Federation, it is precisely the paragraphs of this article that must be referred to when making an entry about the dismissal in the employee's work book in accordance with the Rules for maintaining and storing work books, preparing work book forms and providing employers with them, approved by Decree of the Government of the Russian Federation of 04.16.2003 N 225, with the exception of cases of termination of the employment contract at the initiative of the employer and due to circumstances beyond the control of the parties.

Upon termination of the employment contract at the initiative of the employer, an entry is made in the work book about the dismissal (termination of the employment contract) with reference to the relevant paragraph of Article 81 of the Labor Code of the Russian Federation.

Upon termination of an employment contract due to circumstances beyond the control of the parties, an entry is made in the work book on the grounds for termination of the employment contract with reference to the relevant paragraph of Article 83 of the Labor Code of the Russian Federation.

In all cases, the day of dismissal of the employee is the last day of his work.

Legal Counsel for a law firm

"Unico-94"

N.I.STRELKINA

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