Demansionamento e blocco ferie, intervento del Nursing Up

Dear General Director
Dear Risk Manager
ASL Roma 5 Company
Lazio Region


Subject: everything is possible at the ASL in question! First it was possible to replace 1 nurse with a healthcare assistant (OSS), now after depriving the wards of a nursing unit, it has been decided to eliminate the support units as well.


On July 9, 2020, a hospital, whose staff has become eclectic, like that of Palestrina, returned to being a general hospital after being a Covid Hospital, ...but by reducing the nursing units, replaced with OSS.

The Palestrina hospital, for example, but not only Palestrina, is transformed into a Covid Hospital according to regional and/or company needs and directives, returning to being a general hospital, which is asked to quickly recover the healthcare activities that were suspended due to Covid.

The staff has shown itself to be highly versatile, with extraordinary abilities, moving smoothly from Covid center to general hospital and vice versa. ...at the same time, Management seems to want to put these proven abilities to the test, depriving the facility of staff who have been trained and tested in these experiences.

By the way, is the pandemic over?
Nursing Up, at the time, wrote, as it does today, contesting these choices as reckless and imprudent.

Nurses cannot be replaced by other professional figures.
On September 1st of this year, after reducing the number of nurses from 3 to 2, to replace them with OSS; the ASL in question decided to "redirect" the OSS staff as well, towards sectors dealing with emergencies.

This information was received by this union and by the staff themselves with great perplexity; the OSS role was created to meet the hygienic, domestic, and hotel needs of patients, ...therefore it seems incongruous to assign OSS staff to emergency departments, such as the emergency room, intensive care, and operating rooms.

One can imagine a situation of deskilling even for OSS staff, since in certain contexts, the OSS cannot work under the nurse's delegation in a relatively autonomous way, ...they could not handle a critical patient without the presence of a nursing unit; likely, OSS staff could be involved in activities normally assigned to porters.

An OSS, "alone" was not an adequate solution, but now two nurses, in L-shaped wards, how can it be expected that they organize themselves to do both the nurse's and the OSS's roles?

This is well beyond deskilling!

Since September 1st, the ASL, which has impoverished the wards of nurses, has decided to also move support staff, such as OSS, elsewhere.

The facilities are no strangers to blocking holidays, now a sad custom, a tradition of the ASL, as if the heavily tried staff did not need holidays. ...but they prefer to manage the ASL with staff reduced to a minimum, and since the blanket is very short, a staff crisis is not unlikely, for any little thing.

Nursing Up says "NO" to deskilled Nurses and OSS, in the interest of the nurses themselves and the patients.

We have been trained, first with the regional path, and then with the university one, to work in multiple units.

The presence of two nursing units, in addition to support staff, is fundamental to reduce the number of hospital infections. ...but Management and the Lazio Region seem not to care at all! It is emphasized that nursing staff are not responsible for carrying out hygienic-domestic-hotel tasks!

It should also be remembered that the nurse, in jurisprudence, has a position of guarantee towards the users.

The nurse cannot and must not omit the monitoring of vital functions, since they would be liable for manslaughter. The nursing staff would not be justified, before a judge, if instead of monitoring a patient, they were engaged in hygienic care or changing sheets for the arrival of a new admission.

Colleagues are also concerned about the possible need to accompany a patient to radiology, the morgue, or elsewhere, a task that does not concern the nurse, who should not leave a ward, for any reason.

The Company in question persists in not considering, despite our numerous letters, that when working with few nursing units, the probability of making mistakes increases and there is also a risk of not receiving timely help in case of injury or emergency.

Suva, the Swiss Institute for Insurance and Accident Prevention, evaluates negatively and as a high risk, the absence of visual contact with another person in charge at a workplace. ...and for example, in Palestrina, the wards are L-shaped, making it even more complicated to see one side or the other of the ward.

The employer "should" ask themselves, regarding staff working alone: "can the nurse ask for help, at any time, in case of emergency?"

Also from the same source, SUVA, it is stated that the excessive effort of the person required to work alone, "the lack of contact with colleagues can considerably increase the risk of injury".

This solitude can, in turn, cause psychological stress, with possible feelings of isolation, fear. Faced with exceptional events, people working alone may feel under pressure, physically, intellectually, or psychologically (lack of assistance, mental confusion).

In these stressful situations, the probability increases, for the nurse forced to work alone, of making wrong decisions, making mistakes, or starting to behave dangerously." Unacceptable!

The lack of help, in case of injury or critical situation: "in all jobs that involve dangers to health and safety, it is tacitly assumed that immediate help can be received in case of injury or a critical situation", for those working alone "this timely help is not guaranteed".

And in the absence of timely help, "the consequences of an injury or a critical situation can worsen considerably".

Colleagues, alas, are convinced that there is a plan for downgrading, aimed at closing many facilities of ASL Roma 5, such as those in Palestrina and/or Colleferro, as if they were superfluous.

Therefore, we ask for the reorganization of staff shifts, with no fewer than "three nursing units per shift and an adequate number of OSS", the structure of the wards does not allow for other choices, provided that sensible choices are intended, Kind regards

Rome, 30.09.2022        Regional Manager Lazio Nursing Up
                                                                 Laura Rita Santoro