Rare footage: why nurses and junior nurses disappear from hospitals
In the Lipetsk region, it was only through the court that six Dobrinskaya CRH employees, who were listed as cleaners, but actually performed the functions of orderlies and junior nurses, were reinstated. They were reduced when they tried to prove that their duties were the functions of junior medical staff with appropriate salaries and bonuses. This situation is not uncommon, moreover, over the past 10 years, the number of junior medical staff has almost tripled. About why hospitals are reducing nurses, whether it is legal and how to deal with it, is in the Izvestia article.
Why were the cleaners fired?
In mid-March, the Dobrinsky District Court reinstated six illegally reduced employees in the Dobrinskaya CRH in the Lipetsk region, the Action health workers' union reported. They should be paid a salary for three months of forced absenteeism, as well as 50 thousand rubles each in compensation for moral damage. All six employees are cleaners who, being non—medical staff of the hospital, actually performed the functions of orderlies and junior nurses.
Anastasia Manzia, a lawyer at the MPRZ Action, told Izvestia that the nurses had been transferred to the position of cleaners more than seven years ago, but they did not know that their rights had been violated until a consultation with the trade union in April 2024. After that, it was decided to go to court so that the name of the position corresponded to their work function. In court, they demanded that the rates of junior medical staff be restored to the hospital's staffing table.
— The employer claims that all deadlines have expired, although we say that this is a continuing violation. We involved the territorial department of Roszdravnadzor in the case, petitioned that the agency should conduct an inspection and restore the positions of junior medical personnel. But Roszdravnadzor avoided participating in the case, and the court did not consider our petition," she said.
The territorial department of Roszdravnadzor told Izvestia that this problem falls under the "individual labor dispute between employees and the employer of the Dobrinskaya CRH State Medical Institution and is not under the control of the department."
In response to the lawsuit, the employer launched a reorganization at the hospital at the end of September, reducing all cleaning positions and introducing nursing assistant positions instead. These are also non-medical staff, although the duties are similar to those of orderlies and junior nurses. The employees refused to transfer to the created positions of assistants, as they considered the reorganization fictitious and discriminatory towards them. In December 2024, women were reduced.
Then the union sued, challenging the dismissal as well. As a result, the Dobrinsky District Court satisfied the requirements regarding the recognition of the dismissal orders as illegal.
But on the first claim for their reinstatement as nurses and for recognition of the fact that they performed the functions of junior medical staff, the district court issued a complete refusal. The Action trade union notes that they were fully prepared for this: when it comes to lawsuits against district hospitals, the courts of first instance rarely satisfy the claims against the defendant. It is usually possible to achieve victory at a higher level. Moreover, the district prosecutor's office supported most of the arguments and demands of the employees.
This has happened before, although there are not many examples yet, says Anastasia Manzia. In 2021, in Yekaterinburg, the Verkh-Isetsky District Court declared illegal the transfer of an employee to the position of a preparator and demanded that she be reinstated as a nurse at the radionuclide diagnostics department. In the same year, there was a similar case at the Angersudzhenskaya City Hospital in the Kemerovo region, where it was possible to recognize the illegal reduction of positions of a junior nurse, as well as to restore one of the employees in this position. In Perm, in 2020, the court declared illegal the transfer from the position of nurses to the position of cleaners of industrial premises and reinstated the employee at work in her original position. In each of these cases, the hospitals were also forced to pay compensation for moral damage. Decisions on all these cases are available to Izvestia.
— I see that the judicial practice is developing in favor of employees, — Anastasia Manzia said. — Yes, we do not have case law, but there is such a thing as uniformity of judicial decision, and courts should strive for it.
Why are nurses being cut back?
The reduction of nurses is a common situation. Anastasia Manzia says that after one of the mentioned court sessions, the losing defendant, leaving the courtroom, stated with confusion: "It's the whole region that's going to sue now!"
— There are fewer and fewer junior medical staff, — says the lawyer. — And when we won a court case at the Yekaterinburg Regional Children's Clinical Hospital, there was a situation where the reinstated employee became the only nurse in the entire hospital!
Alexey Kurinny, deputy chairman of the State Duma Committee on Health Protection, noted that there is indeed a problem with reducing the posts of orderlies.
"Nurses are officially equivalent to nurses in terms of salary — 100% of the regional average," he explained to Izvestia. — This, in my opinion, is not entirely true. But instead of correcting the mistake, medical officials began to reduce the number of nurses. In fact, many of them actually performed the functions of cleaners, but it comes to the point that nurses are reduced even in surgical departments.
According to him, all this has led to an increased shortage of this category of workers and shifting their functions to already overloaded nurses.
"Trade union organizations should systematically resist unjustified cuts in nurses," says Alexey Kurinny. — Moreover, in some cases, cleaners are forced to perform the functions of nurses, despite the fact that there are no such duties in the job descriptions of cleaners.
The All-Russian Trade Union of Healthcare Workers told Izvestia that this story has been going on since 2012, when a presidential decree was issued that established additional criteria for salaries of nurses and orderlies. Then, to solve the problem, it was decided to increase the salary of the average medical staff at the expense of regional budgets — and many subjects of the Russian Federation agreed to this. However, it also happened that the chief doctors began to look for ways to reduce the salaries of junior nurses and nurses. Many hospitals completely abandoned nurses in 2012-2014, although they should have been according to licensing requirements. The union said it had worked out "thousands of such situations," but they still occur sporadically. It is important that the cleaners are not subject to the presidential decree — they do not receive preferential medical experience in terms of salaries.
Moreover, due to the problems that have arisen, compulsory education has been returned for orderlies and junior nurses — courses that can be completed in a few months. Now those who have no education cannot be orderlies or junior nurses. By the way, some of the cleaners at Dobrinskaya CRH had the necessary education, while others received it in the summer of 2024 in order to apply for transfer to the positions of nurses.
How many junior medical staff are there in Russia
However, the Action trade union is confident that the issue of junior medical personnel is still very acute, as indicated by statistics.
According to Rosstat, at the beginning of 2022, there were 284.9 thousand junior medical personnel in Russia. At the beginning of 2025, there are already 257.9 thousand employees in these positions. By the way, there have been even a few more doctors during this time. The documents of the Central Research Institute of Healthcare Organization and Informatization contain data on 845 thousand people. junior medical staff in 2010.
— We see further actions to reduce these positions, so we are trying to create a positive judicial practice in such situations, — said Andrey Konoval.
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