Organization of work in hospital departments. Scientific organization of labor in health care The difference between an employment contract and civil law

SCIENTIFIC ORGANIZATION OF LABOR IN HEALTH- improving the forms and methods of organizing the work of medical workers based on the achievements of science, technology and best practices, aimed at developing and putting into practice evidence-based recommendations for further increasing efficiency and improving the quality of work.

Scientific organization labor (NOT) in health care - scientific direction applied nature, integrated on the basis of many scientific disciplines: economics, statistics, ergonomics (see Labor), aesthetics (see Industrial aesthetics), hygiene, physiology and psychology of labor, legal and technical sciences.

Under the NOT in health care is usually understood as a continuous improvement in the organizational forms of the use of human labor within the framework of a single honey. collective, however, under socialism, the scientific approach is also characteristic of the organization of labor within the framework of the entire system of socialist health care. On the one hand, HOT in health care contributes to the intensification, growth of the efficiency and quality of the work of physicians, and on the other hand, it helps to improve the conditions and content of work, to better develop the spiritual interests of medical workers, to increase their degree of satisfaction with their work, and to turn labor into the first vital need.

The tasks to be solved during the introduction of NAT in healthcare can be divided into three groups: economic - aimed at increasing the productivity of health workers through the introduction of modern achievements in science and technology; the best organization their work, to search for reserves and increase the efficiency in the use of labor and material resources, to improve the structure and functions of health authorities and institutions in order to constantly improve the quality and culture of medical care, to improve public health; psychophysiological - aimed at creating the most favorable conditions functioning of labor collectives, improvement of working conditions and regime; social - consisting in providing conditions for the comprehensive and harmonious development of the personality of health workers, increasing the content and attractiveness of their work, the most complete and appropriate application of the knowledge and qualifications of each specialist.

Communist Party and Soviet government at all stages of development, the countries paid great attention to the issues of improving the organization of labor in all sectors of the national economy. The first works on the scientific organization of labor in the health sector date back to the 1920s. 20th century and are connected with the mass movement that has unfolded in the country on the initiative of V. I. Lenin to improve the organization of labor in scientific basis. Research on the rationalization of the work of health workers, conducted under the leadership of the People's Commissar of Health N. A. Semashko, was based on scientific analysis working hours of a number of categories of medical staff (doctors, nurses, paramedics, laboratory assistants), on the study of factors affecting the fatigue of workers.

In the 30-50s. questions of the organization of work in separate links to lay down. - prof, establishments (regulation by a registry of a polyclinic of a stream of patients, work of reception and diagnostic departments in hospitals, etc.) were studied. The workload of doctors at outpatient appointments was analyzed, the structure of the population's appeal for medical care was studied.

Conducting scientific research and practical work on HOT in health care became significantly more active after the publication in 1966 of the order of the Minister of Health of the USSR “On improving the work in the field of scientific organization of labor of workers in health care institutions”, in accordance with the Crimea, scientific and methodological scientific and methodological NOT centers, and in health care bodies and institutions, NOT councils and groups.

Much attention was paid to the questions of the NOT at the 24th and 25th Congresses of the CPSU. In the resolutions of the congresses, the special importance of the comprehensive introduction of NOT into practice is noted. The General Secretary of the Central Committee of the CPSU, Chairman of the Presidium of the Supreme Soviet of the USSR L. I. Brezhnev, speaking of increasing the efficiency of social production, emphasizes: “For all this, discipline, initiative, the widespread use of the achievements of science and technology, the introduction of a scientific organization of labor, and the improvement of the management of our economy and the entire national economy” (L. I. Brezhnev, “Lenin’s course”, vol. 5, p. 177).

The decisions of the party and the government were a powerful stimulus for the deployment of purposeful organizational measures for the comprehensive introduction of NOT. These primarily include the creation in a number of Union republics of specialized IOT services, the centralization of logistical support for IOT activities, and the introduction of planning and reporting on IOT.

NOT in health care is based on the general theoretical and methodological provisions of the science of labor organization. The directions of NOT are largely universal, they determine the general ways of improving the organization of labor, regardless of the industry. At the same time, the main directions of NOT in health care have a number of specific features arising from the characteristics of health care as social system, as well as from the originality of honey. labor and its place in the system of the national economy.

The methodological arsenal of NOT is aimed at studying labor processes and the conditions for their implementation in various parts of the health service and includes: methods for studying the use of working time, organizing labor processes and workplaces; methods for studying working capacity and psychophysiological and socio-psychological factors of labor activity.

Great importance in the scientific substantiation of the recommendations of the NOT, there are methods for studying the cost of working time, including timing, photography of the working day, photo timing, the method of momentary observations, etc. , his examination, keeping records in honey. documents, etc.; the method of photographing the working day determines the structure of the cost of working time for a working day or part of it, and identifies time losses; the method of momentary observations records the frequency of repetition of certain elements of work for a certain period of time, etc.

Ensuring maximum productivity and effective use working time largely depends on the improvement of the forms of division and cooperation of labor, as the leading direction of NOT in health care. Improving the organizational and functional structure of healthcare institutions based on redistribution labor functions, the creation of new divisions in the structure of honey. institutions is connected with constant improvement of methods of diagnostics and treatment, equipment to lay down. - prof., establishments of new honey. equipment. This direction is also solved on the basis of the development and use of systematically updated job descriptions. A circle is fixed in the job descriptions functional duties rights and responsibilities of each individual employee, taking into account his knowledge, experience and nature of work.

An important direction is the centralization of treatment, diagnostic and support services in healthcare institutions. Centralization covered clinical diagnostic lab. research, organization of intra- and out-of-hospital consultations, accounting of dispensary contingents, medical services. supply of sterile materials (dressings, syringes, surgical linen), medicines, honey. gases, as well as blood delivery, household services, etc.

So, for the centralized supply with sterile materials in structure to lay down. - professional, institutions the central sterilization departments providing higher quality and reliability of sterilization, and also economy of working time of nurses are created.

In large multidisciplinary business centers, the organization of consultations and consultations is centralized, which saves the medical staff from performing organizational functions and at the same time allows for a more precise planning of the advisory work of specialists.

The labor productivity of health workers is significantly increased as a result of the creation of intra-institutional operational communication systems, which in the field of health care are usually divided into three groups: administrative and managerial, medical-technological and dispatching communications. The first group includes systems: two-way administrative and managerial communication (head - secretary), radial administrative and managerial communication (head - subordinates), circular communication (for operational business meetings manager with staff). The second group includes search and call signaling systems, remote monitoring of patients, and communication with visitors. The third group includes dispatching systems for organizing intra- and out-of-hospital consultations and managing the work of support services.

The technical means of operational communication used in healthcare institutions are very diverse and include wired communication means (intra-organizational telephone and loud-speaking equipment, signaling equipment), wireless communication means (radio communication), as well as audiovisual communication means (television installations and video telephones).

Improving documentation, taking into account the significant time spent by health workers to work with it, is also one of the most relevant areas of NOT for health authorities and institutions. It consists mainly in the unification of documents - the creation standard forms and texts, as well as in the wide use of various technical devices. For example, on the basis of standard tests, a number of forms of insert sheets have been developed in individual card outpatient, inpatient card, designed to record the results of the initial examination of the patient by specialists in various fields, consultative examinations, stage epicrisis. The use of standard forms significantly reduces the time spent on filling out documents. In health care institutions, standard texts are used, in addition, in the form of standard referral forms for laboratory and instrumental studies, as well as unified prescriptions.

Widespread in the practice of health care institutions received a dictaphone-typewritten method of conducting honey. documentation, carried out centrally and decentralized. The creation of hospital voice recorder centers, the development of this method by medical residents allows them to significantly save work time and use it for a deeper study of the patient.

The effectiveness of the preparation of honey. Documentation is enhanced by modern copiers - electrographic and thermographic copiers, as well as microfilm technology. The use of microfilming is especially effective in hospital archives, as it allows many times to reduce the volume of stored documentation, while facilitating the search for the necessary data.

Much attention in healthcare institutions is paid to the creation of rational systems for storing and retrieving documents. This purpose is served by various designs of desktop and cabinet filing cabinets, mobile racks, and mechanized filing equipment.

Improvement of working conditions of workers of institutions of health care is in many respects connected with such direction of NOT as the rational organization of a workplace, edges includes actions for improvement of planning of workplaces, rationalization of their equipment, creation of a gigabyte. comfort, aestheticization of the working environment.

A prerequisite for ensuring the rational organization of workplaces is compliance with ergonomic requirements, both in relation to honey. furniture, and in the development of designs for honey products. technology. For a number of categories of mass honey. professions, standard schemes for equipping workplaces have been developed (the office of a local general practitioner, the post of a ward nurse, the workplace of a pharmacy assistant, etc.).

One of the important directions of NOT in health care are prof. orientation, prof. selection of young people for admission to medical educational establishments, material and moral stimulation of labor, the use of the educational power of tradition, the improvement of the style and methods of leadership, as well as the study psychological compatibility working in a team and the skillful movement of specialists to ensure normal relationships.

Moral and material incentives labor is important for improving the organization of honey. team. Decree of the Council of Ministers of the USSR "On the expansion of the rights of heads of health care institutions that are on the state budget" (1976) to heads of medical and professional institutions in the presence of savings on the fund wages granted the right to reward for achievement good results and high quality of medical care for the population of the best workers within 1.5% of the wage fund established by the institution. Moral stimulation is also of great importance in developing the creative initiative of the working people, in instilling in them a communist attitude to work.

A certain place in the improvement of socio-psychological relations in labor collectives is given to positive traditions, for example, the annual meeting of young professionals, honoring labor veterans, ceremonial farewell to retirement, etc.

Of great importance in the formation of the socio-psychological atmosphere in honey. collectives has the improvement of management methods, the mastery of health care organizers by the Leninist style of leadership.

A significant place is given to labor rationing, training and advanced training of honey. personnel, the development of work and rest regimes for medical staff, the prevention of occupational diseases and the use of labor as a therapeutic and prophylactic factor.

The main directions for improving the organization of labor are applicable in healthcare institutions of any level. However, recommendations for NAT in various sectors of health care have their own specifics. For example, in establishments a dignity. - epidemiological. services, where a large amount of information is summarized, the issues of streamlining the conduct of honey are of particular relevance. documentation. This service is widely used unified forms documents ( model forms), punch cards.

The principle of centralization in a dignity. - epid. The service is also implemented in the form of creating inter-district SES in cities with a district division. Enlargement of SES as a whole, and through the use of various forms of centralization, for example, the creation on the basis of large urban and district SES of interdistrict dignity. laboratories, increases work efficiency, allows you to fully use the lab. equipment and apparatus, ensures the introduction of a continuous system of research and modern means mechanization.

In pharmacies, among the NOT activities, the introduction of automated methods for determining the needs and organizing the provision of the population is of particular relevance. medicines and honey. products, as well as the rational organization of the work of pharmacies and workplaces in them (equipment with mechanization). For this purpose, such devices as dispensers, electromechanical mixers, devices for filtering solutions, devices for mixing, filling and packaging ointments, suppositories, powders, liquids, washing machines, devices for supplying distilled water to workplaces are widely used in pharmacy practice. etc.

These devices help to increase the productivity of pharmacy workers, improve the quality of medicine preparation.

Improving the activities of health authorities requires the integrated use of recommendations in a number of areas of NAT. At the same time, measures to improve documentation and workflow, the regulation of labor functions based on job descriptions, the organization of institutional operational communications, and the improvement of management methods are of particular importance.

In the conditions of the scientific and technological revolution, an important factor in improving the activities of health authorities and institutions is the use of mathematical methods (see) and computer technology (see. Electronic computer).

The introduction of automated information processing and management systems (see Automated Management System) allows you to free health workers from time-consuming counting work, increases the validity of those responsible management decisions, allows you to significantly expand and improve the quality of control over performance discipline, raises the culture of work to a new, higher level.

The organization of the implementation of HOT in health authorities and institutions is regulated by the relevant organizational and administrative documents M3 of the USSR. In the Union and Autonomous Republics, territories and regions, a service for the implementation of NAT is being created under the relevant supreme health management bodies of a particular territory.

The organizational system of centralized management of the implementation of NAT in the work of health authorities and institutions includes four groups of activities: 1) administrative and managerial activities (current and long-term planning, phased control over the progress of work, collection and compilation of reporting data, material and moral incentives); 2) research work (study and generalization of best practices, development and approbation of new forms of labor organization, development of NOT recommendations, forecasting and long-term plans, teaching the basics of NOT in the system of pre- and postgraduate training of doctors); 3) organizational and technical measures (material and technical support of NOT means, organizational and technical design and implementation, ensuring the operation of NOT systems, development work); 4) advisory and methodological work (publication and distribution methodical literature, holding seminars and conferences, promoting best practices, holding consultations).

Bibliography: Lenin V. I. The next tasks of the Soviet power, Poln. coll. cit., vol. 36, p. 165; Brezhnev JI. I. Leninsky course, Speeches and articles, vol. 5.5th ed., p. 177, M., 1976; Burenkov S. P., Golovteev V. V. and Korchagin V. Socialist health care: tasks, resources, development prospects, M., 1979; Kanep V.V., Lipovetskaya L.L. and Lukyanov V.S. Theory and practice of the scientific organization of labor in health care, M., 1977; Kanep V.V. and Lipovetskaya L.L. Scientific organization of labor in healthcare institutions, M., 1981; Kanep V. V., Tsaregorodtsev G. I. and Olshansky B. Ts. The work of medical workers in a developed socialist society (Assessment and stimulation), Riga, 1976; Materials of the XXV Congress of the CPSU, M., 1976; Matsko BM Fundamentals of the scientific organization of labor in hospitals and clinics, M., 1969; Petrovsky B. V. Tasks of the Soviet health care in the implementation of the decisions of the XXV Congress of the CPSU, Vestn. USSR Academy of Medical Sciences, No. 10, p. 6, 1976

Labor Code of the Russian Federation Article 350

For medical workers, a reduced working time of no more than 39 hours per week is established. Depending on the position and (or) specialty, the working hours of medical workers are determined by the Government Russian Federation.

For medical workers of healthcare organizations living and working in rural areas and in 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.

(see text in previous edition)

In order to implement the program of state guarantees of free provision to citizens medical care in an emergency or emergency form, medical workers of medical organizations, with their consent, may be placed on duty at home.

Home duty - stay of a medical worker medical organization at home while waiting for a call to work (for emergency or emergency medical care).

When taking into account the time actually worked by a medical worker of a medical organization, the time on duty at home is taken into account in the amount of one second hour of working time for each hour of duty at home. The total duration of the working hours of a medical worker of a medical organization, taking into account the time of duty at home, should not exceed the norm of working hours of a medical worker of a medical organization for the corresponding period.

Positions of heads, deputy heads of medical organizations subordinate to federal executive authorities, executive authorities of constituent entities of the Russian Federation or bodies local government, heads of branches of medical organizations subordinate to federal executive authorities are replaced by persons under the age of sixty-five years, regardless of the duration of employment contracts. Persons holding these positions and having reached the age of sixty-five years are transferred, with their written consent, to other positions corresponding to their qualifications.

The founder has the right to extend the term of office of an employee holding the position of the head of a medical organization subordinate to a federal executive body, an executive body of a constituent entity of the Russian Federation or a local government body, until he reaches the age of seventy years on presentation general meeting(conferences) of employees of the specified medical organization.

The head of a medical organization subordinate to a federal executive body, an executive body of a constituent entity of the Russian Federation or a local self-government body has the right to extend the term of office of an employee holding the position of deputy head of the said medical organization or the position of head of a branch of a medical organization subordinate to the federal executive body, until he reaches the age of seventy years in the manner prescribed by the charter of the medical organization.

Art. 350 of the Labor Code of the Russian Federation. Some features of the regulation of the work of medical workers

3. Requirements for the skin.

3.1. For personal safety, healthcare workers need to keep the skin and its appendages clean and intact. To do this, you need to regularly wash and care for your nails, change underwear and clothes, use cosmetic protective and disinfectants, avoid contact with potentially contaminated objects, protect (enclose) the skin and hair with working (sanitary, special) clothing and by individual means skin protection.
3.2. doctors, nurses, midwives are required to wash and disinfect their hands not only before examining each patient or before performing procedures, but also after, as well as after performing “dirty procedures” (including: cleaning rooms, changing clothes for patients, visiting the toilet, etc.) .
3.3. If hands are contaminated with blood, serum, secretions, it is necessary to thoroughly wipe them with a swab moistened with a skin antiseptic, then wash with running water and soap and re-treat with a skin antiseptic.
3.4. If the patient's biological fluid gets on the mucous membranes of the oropharynx, you should immediately rinse your mouth and throat with a 70% solution of ethyl alcohol or a 0.05% solution of potassium permanganate. If biological fluids get into the eyes, rinse them with a solution of potassium permanganate in water at a ratio of 1:10,000.
3.5. In case of injections and cuts, wash hands without removing gloves with running water and soap, remove gloves, squeeze blood out of the wound, wash hands with soap and treat the wound with 5% alcohol tincture of iodine.
3.6. If there are microtraumas, scratches, abrasions on the hands, seal the damaged areas with adhesive tape.

4. Basic requirements for working and living conditions medical personnel:

1. Human exposure to harmful and dangerous factors must be completely excluded.

1.1. Device and equipment industrial premises and workplaces of medical and service personnel must comply with sanitary rules and provide normative (safe) parameters of hospital environment factors (temperature, humidity, air velocity, chemical composition, biological pollution, noise, electromagnetic fields, ionizing radiation, etc.).
1.2. Arrangement of medical and technical equipment, its operation must be carried out in accordance with the rules of labor protection and the possibility of its processing (for example, it is not allowed to use anesthesia and other devices without equipment for the removal and absorption of inhalation anesthesia and their vapors in exhaled air, as well as with violations of the tightness of gas supply systems In procedural, aerosol-inhalation rooms, dressing and sterilization departments for performing manipulations associated with the use of highly active drugs, fume hoods with a sink and flush into the sewer must be equipped).

2. In medical organizations, conditions must be created to maintain a high efficiency of a doctor during working hours, especially during daily duty.

2.1. The correct arrangement of workplaces and the rational use of furniture and equipment are necessary when the body is in a forced position during work with increased strain on the organs of vision, local muscle loads.
2.2. There should be equipped rooms for intra-shift rest of personnel and physical culture breaks lasting 15 minutes every 3 hours of work. 2.3. For doctors whose work is associated with significant psycho-emotional and physical stress, rooms for psychological relief should be organized.
2.4. In every structural unit there must be the necessary composition of sanitary facilities for medical and service personnel: staff room, dressing room, shower rooms and toilets equipped for women special equipment. The room for staff should be at least 12 square meters. m, equipped with a refrigerator, an electric water heater, a food warmer and a sink. The dressing room should be equipped with double-leaf lockable ventilated cabinets according to the number of employees, providing separate storage of personal (home) and work (sanitary) clothing, shoes and hats. In the women's personal hygiene room, there should be a treatment cabin equipped with a hygienic shower with a flexible hose and a hot and cold water mixer, as well as hooks for linen and clothes.
2.5. To provide staff with hot meals, a canteen or buffet should be provided at the rate of 10-12 seats per 100 employees.

5. Fundamentals of medical and preventive care for employees of medical organizations:

1. In order to protect health, prevent the occurrence and spread of diseases, employees of medical organizations are required to undergo preventive medical examinations: primary (when hiring) and periodic (during work).

1.1. During the primary medical examination it is necessary to determine the suitability (suitability) of the employee for a particular job, to identify the presence of somatic and mental illnesses, primarily infectious and occupational. All new employees with unfavorable production factors are subject to a preliminary medical examination. The issue of suitability for work should be decided in each case individually, taking into account the characteristics of the functional state of the body, existing contraindications, age and vocational training, length of service and future working conditions. If necessary, they request information from medical organizations at the place of residence. The data of the preliminary medical examination is recorded in the insert form. medical card outpatient (form 025 / U-87) and make a conclusion on professional suitability.
1.2. Conducting periodic medical examinations should ensure dynamic monitoring of the health status of workers in conditions of occupational hazards or unfavorable working conditions, the timely establishment of initial signs of occupational diseases and the prevention of subsequent stages, the identification of common diseases that prevent the continuation of work in a medical organization and pose a risk of the emergence and spread of nosocomial infections . Periodic medical examinations are subject to medical and service personnel of specialized departments and offices, sterilization and disinfection departments, catering departments, canteens and canteens, pharmacies, laundries and other departments that work with harmful chemicals or are exposed to adverse production factors. Medical workers of obstetric hospitals and surgical departments are required to undergo medical examinations according to a special plan.
1.3. After a periodic medical examination, medical and recreational measures should be planned for each person: dynamic monitoring and necessary outpatient treatment, inpatient or sanatorium treatment, temporary transfer for health reasons to another job, with the exception of contraindicated factors of the hospital environment.
1.4. For all persons who have identified deviations in the state of health, where the main etiological role is played by professional factor hospital environment, dispensary supervision should be established with relevant specialists. 1.5. In cases of detection of signs of occupational diseases, medical workers should be sent to the center of occupational pathology for a special examination and establishment of a connection between the disease and professional activity.

2. In conditions of epidemic trouble, medical workers should be subjected to immunoprophylaxis. Both the administration of the medical organization and the workers themselves should be interested in the immunization of medical workers. Most often, there is a need to vaccinate medical workers against influenza, viral hepatitis B, diphtheria, measles and other infections.

During the organization and implementation of the treatment and diagnostic process, it is vital for a doctor to constantly remember about the radiation, chemical, biological and psychological safety of his own, colleagues and assistants, patients.

He must know and be fluent in all the basic approaches, methods and means of ensuring safety, including: preventing the body from contact with potentially pathogenic environmental factors, correcting the medical environment, increasing the body's resistance to exposure external factors, first aid and medical care. Prevention of the body's contact with potentially pathogenic environmental factors is possible with the use of removal, shielding and shortening the duration of exposure.

In addition to security measures,

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 chores department and is responsible to the head of the department and the chief physician 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 services, 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 load norms for one 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 implemented in most hospitals, and it 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 for the work on a day off of 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 hours is established for all categories of workers, both with normal and reduced due to harmful, dangerous and special conditions labor on a working day.

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 may 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, polyclinics, dispensaries and other institutions that have both outpatient and polyclinic stationary units, doctors who are on the staff of outpatient departments 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 extra days work (every eighth Saturday) is carried out on a common 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 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 distributing 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.

For medical workers, a reduced working time of no more than 39 hours per week is established. Depending on the position and (or) specialty, the working hours of medical workers are determined by the Government of the Russian Federation.

In accordance with the Decree of the Government of the Russian Federation of February 14, 2003 N 101 "On the duration of the working hours of medical workers depending on their position and (or) specialty", the following reduced working hours are established for medical workers depending on the position they hold and ( or) specialties:

36 hours a week - according to the list in accordance with Appendix No. 1; For example, health workers working in infectious diseases hospitals, departments, wards, as well as in offices; dermatological and venereal dispensaries, departments, medical workers working with HIV-infected people, etc.

33 hours a week - according to the list according to Appendix No. 2; (outpatient doctor who performs exclusively outpatient admission of patients in medical and preventive organizations, institutions (polyclinics, outpatient clinics, dispensaries, medical centers, stations, departments, offices)

30 hours per week - according to the list in accordance with Appendix No. 3; (doctors, as well as paramedical personnel working Vtuberculosis (anti-tuberculosis) healthcare organizations and their structural subdivisions;

24 hours a week - for medical workers who directly carry out gamma therapy and experimental gamma irradiation with gamma preparations in radio manipulation rooms and laboratories.

Certain categories of medical workers may be provided annual additional paid leave. The duration of additional leave is established by the Government of the Russian Federation.

According to Article 22 of the Federal Law "On Preventing the Spread of the Disease Caused by the Human Immunodeficiency Virus (HIV) in the Russian Federation", employees of enterprises, institutions and organizations of the state and municipal healthcare systems that diagnose and treat HIV-infected people, as well as persons who work who are associated with materials containing the human immunodeficiency virus, an allowance is paid to the official salary, a reduced working day and additional leave for work in especially dangerous working conditions are established. The procedure for granting these benefits is determined by the Government of the Russian Federation. In particular, in accordance with Decree of the Government of the Russian Federation of April 3, 1996 N 391 "On the procedure for granting benefits to employees at risk of infection with the human immunodeficiency virus in the performance of their duties" to employees of healthcare organizations that diagnose and treat HIV-infected people, as well as employees of organizations , whose work is related to materials containing the human immunodeficiency virus, the working hours are 36 hours per week and the annual paid leave is 36 working days (taking into account the annual additional leave for working in hazardous working conditions).

Decree of the Ministry of Labor of Russia of August 08, 1996 N 50 "On approval of the procedure for granting reduced working hours (36 hours a week) and annual paid leave of 36 working days (including annual additional leave for work in hazardous working conditions) to employees healthcare organizations that diagnose and treat HIV-infected people, as well as employees of organizations whose work is related to materials containing the human immunodeficiency virus "approved the procedure for granting reduced working hours and annual paid leave to employees of healthcare organizations, the categories of which are given in the appendix to this decree .

Thus, the resolution defines the categories of employees who are assigned a reduced working time (36 hours a week) and an annual paid leave of 36 working days (taking into account the annual additional leave for working in hazardous working conditions). It is also provided that a reduced working day (shift) based on a 36-hour working week is approved for the categories of workers specified in the resolution only on those days when they were actually employed in work in hazardous working conditions.