Professional standard for junior medical personnel. Responsibilities of a nurse and paramedical personnel

In healthcare, the main role is, of course, given to doctors. Without their skillful qualifying work, many patients would have remained sick, and some would even have lost their lives altogether. But no less important than doctors are those employees who are commonly called paramedical personnel. Who are they and what is their role in saving lives and helping people?

What does middle staff mean?

Paramedical personnel are doctors who were educated not in higher educational institutions, but in secondary ones. They, as a rule, perform pre-medical care for patients, and also, under the direct supervision of their doctor, carry out various types of activities related to patients: sanitary, medical, rehabilitation, and so on. Nursing staff is called paramedical because their work directly depends on the orders of the doctor who stands above them and is their direct and immediate supervisor.

Who belongs to the nursing staff?

Below we will list all the specialties that are commonly called paramedical personnel, but let us clarify right away: this is only in Russia. In other states, this category includes some other professions.

So, in our country, paramedical personnel in healthcare are considered: paramedic and types of positions, medical instructor, nurse or nurse, obstetrician, dentist and/or dental technician, instructors: disinfectant, physical therapy, pharmacist, x-ray technician and optometrist. We will talk about each of these professions in a little more detail below, but first about which educational institutions train such specialists.

I’ll become a nurse, let them teach me!

Either to become nurses or to become pharmacists - it doesn’t matter. Another thing is important - where to go to get taught in order to get the desired specialty?

As we mentioned above, such specialties are not taught in higher educational institutions. You need to go to a specialized secondary school, that is, to a medical school. It is there that all the above-mentioned specialists are trained. An important point: in some cities there are separate schools for pharmacists, most often they are called pharmaceutical colleges. And in some, on the contrary, in ordinary medical schools they offer training in this specialty as well.

As a rule, most schools (including medical ones) have a similar practice: a person who has graduated from such an educational institution and wants to continue his studies at a higher level is accepted into the institute immediately for the third or at least the second year. It all depends on the specific program of a particular institution.

Studying at a medical school can be divided into four stages. This is, firstly, a theoretical course, where the basics of science are put into the heads of future specialists; educational practice aimed at practicing acquired skills and usually taking place on mannequins within the walls of the native school; production and technological practice is already outside its walls, in its own profile; and finally, an internship, also known as pre-graduate practice, during which the graduate can immediately take a vacant position in the hospital or healthcare institution where he is doing his internship.

What does it take to get into medical school? Regardless of the chosen profile (by the way, nursing and midwifery are recognized as the most popular areas), you need documents about graduation from school - a Unified State Examination certificate, a document confirming your identity and citizenship, a certificate of passing a medical examination and six three-by-four photo cards are required. Some schools accept students only based on the Unified State Examination results, while some have their own entrance tests. This issue needs to be clarified locally.

Paramedic

Let's start our conversation about specialties related to paramedical personnel with paramedics, and the first on their list is sanitary. He is also sometimes called an assistant health officer. Who is this, what are the specifics of his work? We’ll say more, but first let’s briefly explain who, in principle, is called a paramedic. This is a physician with secondary education who has the right to diagnose a particular disease, independently carry out the necessary treatment and send the patient to the required specialist. The assistance provided by a paramedic is called pre-medical care, and the specifics of his work are essentially no different from the activities of a therapist or emergency doctor.

So, sanitary paramedic. A paramedic of this type performs preventive work related to preventing the occurrence of possible diseases in the population of any age. Its tasks include ensuring such working conditions at enterprises and various institutions in which people will face minimal exposure to negative factors that could affect their health. So, for example, it is this kind of paramedic who is responsible for monitoring sanitary and hygienic conditions, ensuring that water bodies are not polluted, preventing the occurrence of infections, and so on. The activities of paramedical personnel of this type are not only practical, but also partly scientific research: for example, these specialists study the impact of various factors on human health and well-being, conduct various hygienic studies, and the like. As a rule, sanitary assistants are indeed assistants to sanitary doctors, but they can work not only as assistants: they also work as assistants to epidemiologists, for example, at city epidemiological stations. The salary of such a specialist is different in each city, but the national average is about twenty to twenty-five thousand rubles.

Another person who belongs to the paramedical staff is a military paramedic. There is no wisdom here: this is an ordinary paramedic, who is in military service and has a military rank. They are attached to all military units and are also available in every military medical institution.

It is interesting that for the first time paramedics began to be trained precisely under the armed forces. And even more interesting is the fact that these intricacies were initially taught to barbers - the most, of course, the most prepared. Massive training of military paramedics took place during the Great Patriotic War, when their task was to provide assistance on the battlefield. Now military paramedics are trained in specialized military medical institutions.

Laboratory assistant

This is the third type of paramedic, also related to paramedical personnel. To obtain such a specialty, you need to enroll in medical diagnostics or laboratory diagnostics. Accordingly, as you can guess from the name of the profile, diagnostic activities are also included in the list of functions and responsibilities of a medical laboratory assistant. He works in a laboratory - in a research institute, hospital, clinic - and is engaged in all kinds of research there: biological material of blood, stomach, cerebrospinal fluid and the like, in other words, he conducts tests. He does not work alone - under the direct supervision of higher-level physicians, and provided that he has enough experience, he may well be considered a “generalist” specialist. How correctly the doctor diagnoses the patient and prescribes treatment largely depends on how high-quality and competent the work of the medical assistant-laboratorian is.

Medical instructor

The next person who belongs to the nursing staff is the sanitary instructor.

Like a military paramedic, this is a specialization of a military medical nature, but, so to speak, of a lower rank. They also study in special institutions, are also members of military units, and also undergo certain military training. The task of medical instructors is to provide medical care to their unit, including personal hygiene products, as well as to provide assistance to sick military personnel and monitor compliance with hygiene standards and requirements. The medical instructor, in addition, instructs, as follows from the very name of the position, military personnel on methods of providing medical care to both themselves and other people. A medical orderly is subordinate to a paramedic, and a military instructor is subordinate to the head of the unit to which he is attached.

Nurse

One of the most popular and sought-after specialties. Moreover, of course, there are many times more nurses than nurses, but lately they have often appeared. There are special courses for nurses that are also gaining popularity. As a result of completing these courses, you can obtain many specializations - from junior nursing staff to caring for patients to a massage therapist or cosmetologist. It all depends specifically on the courses themselves and, of course, on different regions and cities. But in general, nursing (or nurse) courses are a good example of obtaining additional specialization, and therefore additional income.

But let's return to the nurse and her functions. Of course, they vary slightly depending on which institution and in which office (there is a difference - a physiotherapy room or a surgery room) the specialist works, but in general they are the same, and you can get a general idea.

To obtain the specialty of a nurse, you must first study in the field of “Nursing.” Receiving such an education will enable the physician to provide primary care for patients, including assessing their condition; carry out the appointments and orders of doctors and their immediate superiors; perform the necessary procedures, and also assist during operations; provide emergency first aid and send to a specialist and much more. Nurses work in different profiles - everyone needs them: pediatricians, ophthalmologists, and cardiologists... The average salary of nursing staff in this field in the country is about thirty thousand rubles.

Obstetrician

This specialty should not be confused with an obstetrician-gynecologist, which belongs to senior medical personnel. An obstetrician, or in other words, a paramedic-obstetrician, is a mid-level specialist who provides the necessary assistance during childbirth to women in labor, as well as pregnant women. Obstetricians are trained in the direction of “Medical and Obstetric Affairs”, and after receiving the appropriate education they can perform the following functions: assisting with childbirth, assisting with gynecological operations, providing first aid in a gynecological profile, taking smears for analysis, patronizing women in labor and newborns, and the like.

At first, back in ancient times, women who were engaged in such work were called midwives or midwives in Rus'. Later, the word “obstetrician” came from the French language, and the profession itself, previously quite rare, became more in demand and came to the fore.

Dentist (dental technician)

Surprisingly, who else belongs to the paramedical staff is the dentist. It would seem that he is like a doctor! Why then is he considered a mid-level specialist?

Dentists have been known in Russia since the time of Peter the Great; it was he who brought instruments for dental treatment to our country. At that time, dentists were called dentists (this word was again borrowed from the French language), but later the name was replaced by the word “dentist” and practically replaced the first one from general use. Meanwhile, there is a fundamental difference between these terms and, consequently, between the professions themselves. A dentist is a specialist who has received a higher education. A dentist is someone who has a specialized secondary education; he deals with dental prosthetics and provides practical assistance in their treatment. He is able to cure simple cases with unadvanced caries; anything more difficult requires a visit to the dentist. Dentists are specialists such as dental technicians and dental assistants.

Instructor-disinfector

This specialist carries out all kinds of disinfection measures, and he also decides with what, in what way and to what extent these measures will be carried out. It is his responsibilities that include monitoring the preparation and use of disinfection solutions, keeping the necessary equipment clean and in order. The same specialist also regulates compliance by disinfectors (they are subordinate to him) with labor protection and safety rules. In addition, the job description of a medical disinfector stipulates the need to prepare all relevant documents. The average salary of a disinfector varies between twenty and thirty thousand rubles.

Physical therapy instructor

Exercise therapy is an abbreviated name for physical therapy. There is no need to explain what this is. But the responsibilities of nursing staff in this profile are the following: conducting individual and group exercise therapy classes and preparing for them; recommendations to patients on necessary physical exercises and independent exercises; monitoring the condition of all kinds of exercise equipment, swimming pools and other equipment and premises necessary for exercise therapy. This physician must have knowledge of the physiological (including pathological) characteristics of the human body, methods of physical therapy, the specifics of therapeutic massage, and also understand the indications and contraindications for physical therapy. A person who has received secondary medical and/or physical education education can become an exercise therapy instructor.

Pharmacist

A pharmacist, in other words, a pharmacist, is the same person who stands behind the counter in a pharmacy and not only dispenses the necessary medications, but can also give recommendations if necessary. Pharmacists are trained, as mentioned above, depending on the region, both in regular medical schools and in specialized pharmaceutical colleges.

Despite the apparent simplicity, this is a very difficult job: how much medicine you need to know, keep all sorts of analogues in your head, remember what this remedy is for and what it is for something else... The pharmacist must know, in addition to what contraindications the drug has, what else can be advised to the referring patient. This is really serious and responsible work.

X-ray technician

A person applying for this position can complete a course in any field - “Obstetrics”, “General Medicine”, “Nursing”, but a certificate of an x-ray laboratory assistant in radiology must be a plus.

This specialist conducts X-ray examinations, maintains the necessary equipment and the X-ray room itself, monitors the patient’s condition during the procedure and, if necessary, provides first aid. Anyone wishing to work in this field should know a lot of important information, including the rules of work in radiology departments.

Optometrist

This specialist has common roots with an ophthalmologist; he also specializes in the eyes, but in a slightly different area. The name "optometrist" is related to the word "optics". This person is a vision correction professional. In many countries, an optometrist is only a separate profession, but in our country you can find an ordinary ophthalmologist working in a clinic who prescribes glasses himself, that is, he is also an optometrist. Nevertheless, individual specialists in this field, of course, also exist. They work in optical shops, for example.

An optometrist can not only prescribe glasses and give advice, he also measures intraocular pressure, checks the condition of the cornea or lens, and also diagnoses the quality of vision using a computer. It is the optometrist who can see the alarming symptoms of the disease and advise you to contact an ophthalmologist, who is directly involved in treatment - this is a significant difference between these two close, but different professions. The average salary of an optometrist fluctuates around 45 thousand rubles.

Training

Advanced training of nursing staff is possible in a fairly large number of different areas. This includes nursing, obstetrics and gynecology, surgery, and so on. You can get promoted in special training centers or on the basis of medical colleges and institutes.

From all of the above, it is clear to the naked eye how important and responsible the role of nursing staff is in preserving the health and life of the population. The memory of the so-called little man involuntarily comes to mind. The nursing staff is also a “little person”, but without them there would be no “big” people!

"Medical statistics and organizational methods work in

healthcare institutions", 2013, N 12

Organizers of nursing staff activities face some typical problems. They are related to the correct names of the positions of cleaners, nurses and nursing assistants, the definition of their job responsibilities and work standards, as well as the organization of their training. This article is devoted to the analysis of these problems.

Job titles for junior medical personnel

Medical workers, according to Art. 350 of the Labor Code of the Russian Federation, have the right to a shortened working week: it, taking into account the reduction of 30 minutes on Saturday, should not exceed 38.5 hours. Does this right apply to nurses and cleaners of healthcare institutions?

Since this right concerns medical workers, it is necessary to find out whether nurses and cleaners are medical workers? The answer to the question should be sought in the nomenclature of the positions of medical workers. Thus, in accordance with the nomenclature of positions for medical workers and pharmaceutical workers<*>Junior medical personnel include:

• junior nurse for patient care;
• orderly;
• nurse driver;
• sister-hostess.

<*>Approved by order of the Ministry of Health of Russia dated December 20, 2012 N 1183n.

As you can see, the nomenclature includes the position of a nurse, i.e. she is a medical professional, and there is no position of a cleaner, who, therefore, is not a medical professional. The conclusion is clear: nurses have the right to a shortened working week, but cleaners do not.

The situation is less certain when it comes to a barmaid or bath attendant, since these positions are not included in the list of medical workers. However, in the event of a conflict with the inspection authorities, you can refer to the orders on staffing standards that have not yet been canceled, where these positions are named. However, success is not guaranteed.

The issue arises even more acutely when it comes to the assignment of preferential pensions to nursing assistants and barmaids in infectious diseases and anti-tuberculosis institutions. Let us give an example of such a court case.

Dispute over early retirement

When determining the employee’s right to early retirement, the Pension Fund of the Russian Federation refused to include in the length of service giving the right to early retirement the 10 years that she worked as a nurse-barmaid in a tuberculosis department. As a result, she did not have enough preferential service and was denied early retirement. The woman filed a lawsuit. In support of her claim, she noted that while working as a barmaid, she cared for the patients of this department, organized the distribution of food, fed the sick, and cleaned the dining room and pantry. The plaintiff combined her position with the work of a ward nurse in the tuberculosis department. The work was carried out in contact with patients.

The representative of the Pension Fund did not admit the claim in court, citing the validity of the refusal to grant a pension due to insufficient special experience. The nomenclature of positions for medical workers, as well as the list of positions for health workers who are entitled to early retirement, do not contain the position of “nurse-barmaid”. The employee also did not provide the Pension Fund with a job description that would indicate her responsibility to care for the sick.

The representative of the hospital where the plaintiff worked considered the stated demands to be justified and subject to satisfaction, since her work was carried out in contact with patients.

The court took into account Instructions of the Ministry of Health of Russia dated April 26, 1993 No. 1-31-U “On the procedure for applying Section XXIV of List No. 2 of production, work, professions, positions and indicators that give the right to preferential pension provision,” which states that when resolving issues related to the assignment of preferential pensions to nursing and junior medical personnel directly serving patients, according to List No. 2, Section XXIV, one should be guided by the following: “Direct patient care” is work that is carried out in the conditions of contact between a medical worker and a patient. Carrying out a number of diagnostic and treatment procedures, measures for patient care, and the creation of an appropriate medical and protective regime require direct contact between staff and patients." Also, these Instructions of the Ministry of Health provide approximate lists of types of activities of junior staff related to the direct care of patients, which in particular includes washing dishes, distributing food, feeding the sick and approximate lists of junior staff positions related to direct care of patients. However, the position of a nurse-barmaid is not on this list. But, as stated in the Directions, the given list is approximate and the final decision on determining the list of jobs and positions whose employees are entitled to preferential pensions, remains with the administration, which confirms the nature of the work and brings it to the attention of the employees.The court examined the nature of the plaintiff’s work as a nurse-barmaid, interviewed witnesses and found out that she was engaged in direct work with patients. She was in direct contact with the patients, fed them, cleared the dishes, and also had to wash, cut, and change bedding for patients in the tuberculosis department.

Taking into account the above, the court decided that the absence of the plaintiff’s job description indicating direct care of patients in the tuberculosis department does not affect the factual and legal essence of her medical activities and her right to early retirement. The personal invoices submitted to the court, which indicate a 25% bonus to wages for harmful work at the main place of work, as well as a certificate of the number of shifts and hours worked, confirm the plaintiff’s work on a full-time basis and shifts in the tuberculosis department. The court upheld the claim and ordered the Pension Fund to include in the plaintiff’s special experience the period of work as a nurse-barmaid in a tuberculosis department.

Thus, when determining an employee’s right to a preferential pension, the Pension Fund, first of all, checks whether the position held by the employee is in the nomenclature of positions for medical workers and in List No. 2, which lists the positions of employees entitled to benefits. The current nomenclature of positions does not provide for the position of a nurse-barmaid. She is also not on List No. 2. Further, the Fund’s employees usually do not understand and refuse a preferential pension on formal grounds. On this basis, a pension was also denied to the barmaid from the tuberculosis department.

Therefore, in order to ensure the right of barmaid nurses in anti-tuberculosis and infectious diseases hospitals to early retirement, it is necessary to rename the position of barmaid nurse to the position of nurse, of which the employee should be notified in writing at least 2 months in advance. Otherwise, due to the incorrect title of the position, the nurse-barmaid will have to prove her right to be included in the work experience that gives the right to a preferential (according to List No. 2) pension through the court.

Qualification characteristics for positions of junior medical personnel

Having learned that the young nurse in the surgical department was good at using a computer, the head of the department ordered her to type discharge summaries into the computer during her free time from cleaning. Is this legal?

Disputes often arise in work collectives about whether it is possible to oblige an employee to perform this or that work. The qualification characteristics of the employee’s position can help you figure this out. The labor functions he performs must correspond to his qualifications. Let's consider the qualification characteristics for junior medical staff positions.

Qualification characteristics of positions of junior medical and pharmaceutical personnel<*>

<*>Approved by order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 N 541n “On approval of the Unified Qualification Directory of Positions of Managers, Specialists and Employees.”

Junior nursing nurse

Job responsibilities. Assists in patient care under the direction of a nurse. Performs simple medical procedures (placement of cups, mustard plasters, compresses). Ensures that patients and premises are kept clean. Ensures proper use and storage of patient care items. Changes bed and underwear. Participates in the transportation of seriously ill patients. Monitors compliance by patients and visitors with the internal regulations of the medical organization. Carries out the collection and disposal of medical waste. Carries out measures to comply with the rules of asepsis and antisepsis, conditions for sterilization of instruments and materials, and the prevention of post-injection complications, hepatitis, and HIV infection.

Must know: techniques for performing simple medical procedures; rules of sanitation and hygiene, patient care; rules for the collection, storage and disposal of waste from medical institutions; internal labor regulations; labor protection and fire safety rules.

Qualification requirements. Primary vocational education in the specialty "Nursing" without requirements for work experience or secondary (complete) general education, additional training in the field of professional activity without requirements for work experience.

Sister-hostess

Job responsibilities. Supervises the work of nurses and cleaners in keeping the premises of a medical organization (unit) clean and in order, provides the serviced unit with household equipment, special clothing, hygiene items, office supplies, detergents, bed and underwear for patients. Changes gowns and towels for employees of medical organizations. Draws up requests for repairs of premises, equipment, inventory and monitors its implementation. Provides food units (buffet, canteen) with equipment, utensils and ensures their correct labeling and use. Maintains accounting and reporting documentation.

Must know: expiration dates of linen and equipment used in a medical organization (unit); methods of sanitizing equipment; conditions of operation and storage of equipment; forms of accounting and reporting documentation and rules for filling them out; rules for observing the sanitary and hygienic regime in a medical organization (unit); internal labor regulations; labor protection and fire safety rules.

Qualification requirements. Secondary (complete) general education and additional training in the field of professional activity without presenting requirements for work experience.

Nurse

Job responsibilities. Cleans premises in a medical organization. Assists the senior nurse in obtaining medications, instruments, equipment and delivering them to the department. Receives from the housewife and ensures proper storage and use of linen, household equipment, dishes and detergents. Cleans bedside tables for bedridden patients after each meal. As directed by the ward nurse, accompanies patients to diagnostic and treatment rooms. Acts as a courier and washes pharmaceutical glassware. Informs the sister-housewife about malfunctions in the heating system, water supply, sewerage and electrical appliances. Prepares rooms and baths. Systematically (after each patient) carries out sanitary and hygienic treatment of the bathtub and washcloths. Assists patients in taking a hygienic bath, undressing and dressing. In the absence of a junior nurse, he receives underwear and bed linen from the housewife and changes it. Receives ready-made food at the catering unit, checks it by weight and count. Signs the handout sheet. Heats food. Distributes hot food to patients according to the menu and prescribed diet. Washing dishes, cleaning the pantry and dining room, observing sanitary requirements. Systematically cleans refrigerators intended for storing food for patients. Provides sanitary and hygienic maintenance of the pantry and dining room. Promptly informs department management about the need to repair pantry equipment and inventory.

Must know: rules of sanitation and occupational hygiene; purpose of detergents and rules for handling them; internal labor regulations; labor protection and fire safety rules.

Qualification requirements. Secondary (complete) general education without any work experience requirements.

As you can see, there are no requirements in the qualifications of a nurse to be able to work with medical documentation and have computer skills. This means that no one has the right to charge her with the responsibility of printing discharge summaries.

Job Descriptions

Nurses at the reception department were required to perform courier functions. Nurses from the intensive care unit were involved in transporting the corpses to the morgue. Is this legal?

The labor responsibilities of each employee are determined by his job descriptions. It is necessary to firmly understand that there are no uniform job descriptions for all nurses or junior nursing assistants in our country, and there cannot be. They are compiled in each health care facility and for each workplace individually. It all depends on the specific working conditions. So, in one office, the duties of a nurse may include performing courier functions, for example, delivering samples for research in a laboratory, but in another - not. The job descriptions must also indicate whose instructions the employee must follow, and who is obliged to provide him with the information necessary for the job. Let us give an example of a current job description for a nursing nurse in the intensive care unit of one of the large departmental hospitals.

Job description of a junior nurse for care

1. General provisions

1.1. A person with at least an incomplete secondary education and who has completed courses for junior nurses in patient care is appointed to the position of junior nurse for patient care. Specific on-the-job training must also be provided upon entry into the position.

1.2. A junior nurse for patient care is appointed to a position and dismissed from a position on the basis of an order from the chief physician on the recommendation of the head of the department and the head nurse.

1.3. The junior nursing nurse in her work reports to the senior nurse of the department, the ward nurse.

1.4. In her work, the junior nurse for patient care is guided by the regulations on the department of anesthesiology and resuscitation and the department of resuscitation and intensive care, the internal labor regulations of the department, and this job description.

1. The junior nurse for patient care is obliged to:

2.1. Assist the ward nurse in caring for patients (feeding, washing and cleaning patients);

2.2. Ensure that patients are kept clean and tidy, for which purpose timely re-making the patients' beds, carrying out sanitary and hygienic measures for the care of patients (removing bedpans, trays and then treating them with disinfectants);

2.3. Systematically carry out wet cleaning, ventilation, and wards. To clean the wards, she must have the necessary equipment and devices;

2.4. Monitor compliance with the sanitary-epidemiological regime and safety regulations;

2.5. Participate in shifting and transporting patients;

2.6. Participate in rearranging corpses for delivery to the morgue;

2.7. Provide assistance in the delivery of linen, equipment and other property, deliver food and feed the sick;

2.8. Follow fire safety rules. In the event of a fire in the department, take part in the evacuation of patients, property and equipment.

1. A junior nurse caring for patients has the right:

3.1. Demand from the administration of the department the required quantity of good-quality equipment for cleaning wards, caring for patients, and means of small-scale mechanization;

3.2. Make proposals to the department administration to improve the organization of working conditions;

3.3. Participate in basic plumbing classes for junior staff;

3.4. Inform the sister-owner of the department about all malfunctions of the heating, lighting and other systems.

1. The junior nursing assistant is responsible for:

4.1. Accurate and timely fulfillment of duties provided for in this job description and the internal labor regulations of the department.

Let us pay attention to paragraph 2.6. on the transportation of corpses - its inclusion in the job description is explained by the peculiarities of the work of the intensive care unit. Let us also draw attention to the mandatory participation of nurses in training as part of the plumbing minimum for junior medical staff. The instructions do not indicate how to perform courier duties. This is neither good nor bad - it simply reflects the situation in the specific department for which this instruction was compiled. At the same time, I would like to draw attention to one drawback of the given instructions: it does not define the responsibility of the care nurse to inform the ward nurse or doctor about changes she has noticed in the patient’s condition, for example, about the appearance of an inadequate reaction to her treatment.

Professional standards for positions of junior medical personnel

Drawing up job descriptions for different groups of personnel is often difficult. Therefore, many managers prefer to use a variety of collections of ready-made instructions, despite the fact that they do not always correspond to the established practice of work in their health care facilities. Where to look for help?

We invite the reader to turn for help to the draft professional standards for the positions of mid-level and junior medical staff. Currently, large-scale work is underway in the country to draw up professional standards for all sectors of the national economy, including for healthcare workers. In particular, draft professional standards for positions of junior and nursing staff were developed by the Russian Association of Nurses. By now, the period for their discussion by the nursing community has ended. Their approval is awaited.

Professional standards will contain requirements for the content and working conditions, qualifications and competencies of medical personnel. They will list the main job functions for each position, job actions for each function and a list of knowledge, skills and abilities necessary to perform these actions.

Let us give an example of how the draft formulates the main labor functions of a nurse and other junior medical staff. It is these lists of job functions that, first of all, can come to the rescue when it is not possible to find suitable wording when developing job descriptions.

Labor functions of a nurse

• Carrying out hygiene procedures for patients;
• cleaning the wards;
• sanitary maintenance of wards;
• cleaning offices and surgical departments;
• performing auxiliary sanitary work in offices and surgical departments;
• disposal of medical waste.

Unlike a nurse, the draft standard for a cleaner only includes:

• cleaning common areas in health care facilities;
• cleaning sanitary facilities and toilet rooms in health care facilities;
• collection, temporary storage and transportation of waste to health care facilities.

A care nurse has a wider range of job functions compared to a nurse:

• general medical care for patients with poor self-care;
• maintaining a protective treatment regime in health care facilities;
• maintaining infectious safety of the hospital environment;
• determination of insufficiency (deficit) of self-care in patients;
• transportation, support and movement of patients;
• general hygienic care for patients with insufficient self-care;
• feeding patients with limited personal care capabilities;
• performing simple medical nursing procedures;
• provision of benefits and care for physiological functions;
• provision of first aid;
• general medical care for the dying;
• health education and patient/family training in general caregiving skills.

Thus, the professional standard first defines labor functions by position. Next, for each labor function, a detailed breakdown of the labor actions that must be performed to implement it is given. For example, when carrying out hygienic procedures for patients, a nurse, according to the draft standard, must perform the following actions:

• obtaining medical information about the volume of sanitary treatment of the patient;
• coordination of the volume and type of work with the nurse;
• receiving linen, detergents and cleaning products, and household equipment from the sister-housewife;
• preparing the bathroom for hygiene procedures;
• providing the patient with soap, towels, a set of clean underwear, pajamas, and slippers;
• carrying out special sanitary treatment of the patient in the emergency department in accordance with the doctor’s prescription;
• accompanying (transporting) the patient to the ward after a hygienic bath (shower);
• informing the patient about the possibility of staying in hospitals in home clothes and using personal hygiene items;
• sending the patient’s personal clothes and shoes for storage or transferring for storage to his relatives (acquaintances);
• sending personal clothing of patients with infectious diseases for chamber disinfection in the prescribed manner;
• carrying out routine hygienic treatment of patients;
• providing assistance with physiological functions to patients with insufficient self-care;
• cleaning, maintaining sanitary condition and order in the bathroom;
• collection of dirty hospital linen;
• transfer of dirty linen to the central linen room;
• compliance with labor protection and fire safety;
• providing first aid in emergency situations, injuries, accidental poisonings, and accidents.

And finally, the draft standard reveals what knowledge, skills and abilities workers must have in order to perform the necessary work actions. So, in order to carry out the listed actions to perform hygiene procedures, a nurse must be able to:

• ensure communication is based on respect for others;
• comply with internal regulations, medical and protective regime of health care facilities;
• prepare and ensure storage of a hospital set of clean underwear, pajamas, and slippers for patients;
• use special clothing and personal protective equipment;
• carry out hand disinfection according to the instructions/algorithm;
• carry out sanitary treatment of the patient as prescribed by the doctor in accordance with technology standards;
• provide assistance in showering, bathing or wet wiping, cutting nails and other hygiene procedures for patients with insufficient self-care;
• use a special gurney to carry out hygiene procedures for the patient;
• carry out all types of bathroom cleaning in accordance with regulatory documents;
• escort the patient from the bathroom to the ward;
• collect, sort and remove dirty linen in the prescribed manner;
• provide first aid in case of injuries, poisoning, accidents;
• observe labor protection and fire safety measures, use fire extinguishing equipment;
• adjust one’s own activities based on the decisions of the manager and the work team.

In addition, in order to perform the necessary professional actions on patient hygiene, according to the draft standard, a nurse must know:

• professional standard requirements and job responsibilities;
• rules of conflict-free behavior when communicating with patients and employees, environment
• fundamentals of legislation on protecting the health of citizens;
• legal support for the activities of junior medical staff of health care facilities;
• medical and protective regime of health care facilities;
• requirements for the rules of personal hygiene of patients and medical staff of a medical institution in accordance with regulatory documents;
• the procedure for storing the patient’s personal clothing and shoes in health care facilities;
• the procedure for sending personal clothing of patients with infectious diseases for chamber disinfection;
• sanitary rules and standards for the maintenance of premises, equipment, and inventory in health care facilities;
• standard measures to ensure infection safety of patients and staff;
• methods, techniques and means of ergonomic movement of patients and heavy objects;
• the physiological needs of the patient and their violations, the degree of insufficiency of self-care;
• technology standards (algorithms) for patient sanitization and hygienic care;
• technology standards (algorithms) for providing benefits for physiological functions to patients with insufficient self-care;
• rules and regulations of labor protection, fire safety, equipment operation;
• first aid algorithms for emergencies, injuries, accidental poisonings, and accidents.

According to a similar plan, the draft standard describes the remaining labor functions of a nurse and other medical workers from among junior and mid-level personnel.

It is obvious that professional standards, after their adoption, will help more accurately determine the professional responsibilities of workers, as well as conduct their professional training and evaluate professional qualifications. In the meantime, draft standards can only be used as teaching materials.

Requirements for professional training of junior medical personnel

What professional training should a nursing assistant have?

The level of professional training of employees is determined by their qualification characteristics. Thus, according to the qualification characteristics, a nurse should not have any special professional training at all - only general secondary education. The hostess sister must have additional professional training, but the details are not specified. For a nursing assistant, it is said that she may have an initial education in "Nursing" or additional vocational training in addition to secondary general education. Requirements for such training have not yet been established.

Thus, until the Ministry of Health has established additional requirements for the training of junior medical staff in order to meet the qualification characteristics, housekeepers and junior care nurses must, at a minimum, undergo this training at the health care facility where they work. In turn, health care facilities must provide them with such training. It can be carried out at the workplace and by your own staff - an epidemiologist, an occupational safety engineer, nurses and doctors. The training program can be drawn up based on qualification characteristics, draft professional standards discussed above, as well as taking into account the characteristics of a particular health care facility and specific jobs.

Deputy Chief Physician for Work

with secondary and junior medical

by the staff of the medical unit of OJSC "Kromburg"

Nursing staff

persons who have received special education and appropriate qualifications in secondary medical educational institutions and are admitted to medical practice in accordance with the established procedure. In accordance with the level and profile of education, the medical assistant provides pre-hospital medical care, looks after patients, and carries out preventive, diagnostic, treatment and rehabilitation, sanitary, anti-epidemic and organizational work under the guidance of a doctor.

The composition of medical assistants includes paramedics, midwives, nurses, sanitary paramedics, medical laboratory assistants, X-ray laboratory assistants, dentists, dental technicians, etc. Professional requirements for the knowledge and skills of medical assistants for each specialty are determined by qualification characteristics: job rights and responsibilities of S. m.p. are regulated by relevant regulations and instructions. The list of positions of the S.M.P. contains approximately 120 titles.

The FAP paramedic provides the population with pre-hospital medical care, receives and visits patients at home; if necessary, refers patients for consultation with a doctor or hospitalizes sick and injured people in the local hospital; at the direction of the doctor, carries out certain types of therapeutic measures (injections, physiotherapeutic procedures, etc.), as well as anti-relapse treatment for persons under dispensary observation; keeps records of morbidity and ensures medical examinations of the population (see Medical examination), under the guidance of a doctor, carries out a set of sanitary and health measures aimed at reducing morbidity, increasing the hygienic culture of the population and improving the territory.

The paramedic of the mobile ambulance and emergency team provides emergency medical care to the population in case of life-threatening conditions, accidents, acute severe diseases and exacerbations of chronic diseases at the scene of an incident and during the transportation of sick and injured people. Works under the direct supervision of the team physician.

Midwife provides pre-hospital preventive and therapeutic obstetric and gynecological care to women in outpatient and inpatient medical institutions, as well as at home. In the maternity hospital (Maternity hospital) (departments), antenatal clinic (Women's consultation) and gynecological departments of hospitals, she works under the guidance of a doctor, in examination rooms, at the first aid station - independently within the limits of her competence. In emergency cases, the midwife provides pre-hospital medical care.

The midwife in the examination room carries out a preventive examination of women for the purpose of early detection of gynecological diseases and malignant neoplasms, and refers women with identified pathology or suspected cases to a doctor.

A midwife in a maternity hospital (department) provides care and observation to pregnant women, women in labor and postpartum women, provides assistance during childbirth, carries out primary treatment of newborns, assists the doctor during medical procedures and surgical interventions, and carries out doctor’s orders.

A midwife at a antenatal clinic, under the guidance of a doctor, keeps records and monitors pregnant women, conducts physical and preventive preparation for childbirth, and carries out medical and diagnostic prescriptions for pregnant and gynecological patients in consultation and at home. It also promotes a healthy lifestyle aimed at protecting motherhood and childhood, incl. to prevent unplanned pregnancy.

At the feldsher-obstetric station, the midwife conducts outpatient visits, identifies pregnant and gynecological patients and provides them with therapeutic and preventive care, if necessary, refers them to an obstetrician-gynecologist for consultation, carries out pregnant and sick patients at home, carries out prescriptions and carries out preventive work on family planning issues .

Paramedic-laboratory assistant works in the laboratory of treatment-and-prophylactic, sanitary-preventive and research medical institutions, conducts clinical, biochemical, bacteriological, histological, hygienic and other studies in accordance with the laboratory’s profile. In emergency cases, provides pre-hospital medical care.

Dentist. In our country, the title “dentist” is awarded to persons who have graduated from medical school or the dental department of medical schools. Dentists conduct independent appointments in outpatient dental and denture establishments and have the right to conduct therapeutic and surgical treatment of teeth, jaws, tongue, gums and oral mucosa; jaws with fractures; in accordance with the rules, issue certificates of incapacity for work, write out.

Dental Technician works in the denture laboratory of a dental institution (department) and independently performs technical work on dental prosthetics, incl. production of artificial crowns, simple designs of post teeth, various designs of bridges, removable plate and clasp dentures, orthodontic and maxillofacial structures.

X-ray technician works in the X-ray room (department) under the guidance of a radiologist and the head of the X-ray room (department). His responsibilities include operating X-ray diagnostic and fluorographic equipment, participating in X-ray examinations, preparing X-ray contrast agents, solutions of photochemical materials, and processing X-ray film. If necessary, the x-ray technician provides emergency medical care.

Military paramedic- a mid-level medical officer on active military service in military units, medical units and institutions of the Armed Forces. They are called up for military service from among those who have graduated from civilian secondary medical schools. The military ranks “warrant officer” and “senior warrant officer” are assigned to military paramedics in the ground forces.

In a regiment medical center (Regimental Medical Station), a separate medical battalion (Separate Medical Battalion), and a military hospital (Military Hospital), he is a direct assistant to a military doctor in carrying out a set of measures to preserve and strengthen the health of military personnel. In military units (on ships) that do not have full-time doctor positions, the paramedic carries out

MEDICAL STAFF, honey workers serving the medical san. institutions. Higher medical education - doctors, dentists; M. average - med. nurses, paramedics, paramedics, midwives, dental technicians, X-ray technicians, dissection and laboratory technicians, massage therapists, masseuses, disinfectants, smallpox inoculators and vaccinators, pharmacists; Junior M. n. - nurses, orderlies, nannies, nurses of mother and child homes (numbers - see. Honey-caiimpyd). To administrative and economic. M.'s group includes household managers, caretakers, storekeepers, knotters, stokers, yard workers, and kitchen staff. institutions, etc. Regulation of medical. activities. The basic rights and obligations of medical workers are regulated by the relevant legislation. In contrast to pre-revolutionary times, when medical workers were separate class and professional groups, the activities of which were interpreted as a private legal function in accordance with all bourgeois - the landowner system of that time, the MP in the USSR, called upon to be an active participant in socialist construction, is one of the detachments of the proletarian army of labor, performing responsible public tasks to protect the health of the working population, i.e. strengthening the labor resources of the proletarian state. The pre-revolutionary nomenclature of medical ranks (doctor, district doctor, midwife, sister of mercy) has now been established in the USSR new medical ranks (doctor, midwife, nurse, etc.). On professional work and the rights of medical staff" (Collection of laws and orders of the Workers' and Peasants' Government, Art. 892, 1924, No. 88) defines the rights and responsibilities of medical personnel of different categories, and the right of medical. and pharma. work is assigned only to persons who have an appropriately certified medical certificate. rank. In pre-revolutionary legislation, although there was Article 220 of the Medical Regulations, which granted the right to practice as a doctor only to persons who have a diploma of completion of the appropriate medical school. educational institution, nevertheless, the prohibition arising from this article from practicing for persons who did not have the appropriate medical title, was actually annulled by Article 226 of the Medical Charter, which stated that “persons who, out of love for humanity, help free of charge with their advice and means of treatment known to them, are not subject to punishment for illegal healing.” Further clarifications from the Senate and the Special Meeting of the State. The council actually legitimized the provision of medical treatment. assistance by persons who do not have any special knowledge certified by relevant certificates or medical diplomas. educational institutions. Honey. The activities of medical centers in the USSR are regulated by special regulations. instructions issued by the People's Commissars of Health of the Union republics. Honey. and pharma. upon entering the service, employees are required to present to the administration of the institution documents on the special education they have received. Hiring these workers without presenting educational documents is punishable by criminal law. By Decree of the Council of People's Commissars of the USSR dated 10/IV 1936, from 1/VII 1936, mandatory personal registration by local health departments of doctors, pharmacists, paramedics, and medical staff was introduced. nurses with secondary medical education and midwives working in institutions and enterprises of all departments and organizations of the USSR and union republics. Registration of medical personnel is carried out upon their arrival for permanent residence, upon departure to another place and upon change of place of work within the district or city. Medical personnel of the Red Army and the border and internal guards of the NKVD of the USSR are not subject to registration (Official collection of the NKZDrav of the RSFSR, X "9, 1936). Honey. workers wishing to engage in private practice are required to register with the relevant health department (post, All-Russian Central Executive Committee and Council of People's Commissars of the RSFSR dated January 10, 1930, Issue of Health, official department, No. 6, 1930). Documents confirming the availability of medical titles are certificates of completion of the corresponding medical. educational institution or certified copies of certificates, service records or labor lists indicating the medical title, place and time of its receipt and certified copies of service records or labor records. For persons who received the title of doctor before 1916, confirmation of the title is also the mention of this medical. employee in the Russian medical list published by the Office of the Chief Medical Inspector until 1916. The presence of the title of preparator is established by special reviews of laboratories and institutes, in which the relevant persons acquired their technical skills. If these documents are missing or are questionable, a certain period of time is given for their submission; if they are not submitted within the specified period, medical workers belonging to the category of persons who have received higher or secondary medical education. education, are subjected to verification tests according to the established program within the established time limits: doctors and dentists - with medical. universities, secondary medical education - at the relevant departments of medical technical schools and pharmacists - at pharmaceutical technical schools or chemical and pharmaceutical faculties of medical universities. If a health worker registered with the health department has discovered clearly insufficient knowledge in his practical activities, then the health department has the right to subject him to practical training for up to 1 year for doctors and up to 6 months for other medical items, and further medical professional work is only allowed to him in the presence of a satisfactory review from the institution where the internship was completed. Passage of practical experience in the relevant medical san. institutions, clinics, medical Universities, well-established large hospitals, dental outpatient clinics and pharmacies are also subject to health workers who did not work in their medical field. profession for over 5 years and wishing to obtain a registration certificate for the right to work in medicine. The length of practical experience is determined by the health department for each given case, depending on the duration of the previous medical experience. work and duration of the break: for doctors - from 1 to 6 months, and for other health workers - from 1 to 3 months, and this period can be reduced if the health worker, before the expiration of the established period, finds sufficient preparation for practical activities. This period can, if necessary, be extended by the health department, but not more than 9 months for a doctor and 4!/2 months for other categories of health workers. If a health worker has a break from work and has lost a document certifying his right to medical care. title, then to obtain the right to honey. After completing practical work, he must undergo a verification test (Instruction of the People's Commissariat of Health and the People's Commissariat of Health dated 3/VIII 1928, Vrpr. zdra-voohr., 1928, No. 16). Doctors and dentists are tested at medical universities, paramedics, pharmacists, midwives and nurses - at the corresponding secondary medical educational institutions. These educational institutions issue an appropriate certificate of verification testing. Nurses with practical experience for at least 3 years out of the last 6 years and who have demonstrated sufficient knowledge during their work, if they lose the title document, they are not subject to a verification test, and based on data on previous work, they receive from the health department a certificate for the right to further medical work (Issues of health -voohr., official department, 1929, No. 47). In all these cases, medical workers undergo practical experience at a certain medical-sanitary institution, the latter is obliged to issue the medical worker, at the end of the period appointed by the health department, in the case of his established preparedness for practical activities, an appropriate certificate signed by the head of the institution. Based on this certificate, the health department allows further medical treatment. Job. Military (company, squadron) paramedics who have not practiced their profession continuously for 3 years or more are deprived of the right to medical care. work, even if they had a document certifying the rank of military paramedic. The same military paramedics, who have been engaged in their profession for at least 4 years during the last 6 years and who are in the service or registered at the labor exchange, in case of loss of their rank documents are not subject to a verification test, but on the basis of their existing certificates about previous service has the right to obtain permission from the local health department for further work (instruction of the NKZDr. , NCP and Central Committee of Medsantrud, No. 225/mv dated 3/VIII 1928). In general, persons holding the rank of military paramedic (company, squadron, battery) may be granted the right to medical service. work in medical san. institutions under the supervision of a doctor only in exceptional cases with the permission of the health department and provided that the military paramedic has worked continuously for the last 3 years in a civilian hospital. institutions (resolution of the All-Russian Central Executive Committee and Council of People's Commissars dated 1/HI 1924, Collection of Legislation, 1924, No. 8). Medical assistants of the Red Army, who graduated from the school of military medical assistants at Military Medical. academies, can be accepted into all civilian medical ranks upon discharge from military service. institutions for the positions of secondary medical assistants (paramedics) (Circular NKZDr., No. 157/mv dated 23/IV 1930, On the health front, official department, 1930, M" 16). The specified practical experience is paid, and the amount of payment is equal to half the salary for the corresponding position in this mod.-san. institution for the following categories of health workers: persons who worked for hire not in their main profession, and persons who previously worked for hire, but stopped working for good reasons (instruction of the People's Commissariat of the RSFSR dated 10/IX 1929, No. 101, Issues of healthcare, 1929, No. 27). Health workers, within the limits of their specialty and competence and the rights granted to them, can issue appropriate certificates about the state of health, health, injuries and treatment, and these certificates must contain an indication of the time and place of issue and the purpose for which they were issued. These certificates are sealed with a signature indicating the rank and the seal of the health worker who issued the certificate, and in the absence of a seal, the signature is certified by the relevant institution. Doctors can issue certificates not only about health status and treatment, but also birth and death certificates. Paramedics are given the right to issue, with their signature, certificates about the persons used by them, about the preventive vaccinations and vaccinations performed, and about death in cases that do not require forensic medicine. autopsies. Dentists have the right to issue certificates about the treatment performed and about the health status of the dentists they use. Midwives have the right to issue birth certificates for children they have adopted only in the absence of a doctor (resolution of the All-Russian Central Executive Committee and Council of People's Commissars of the RSFSR dated 1/KhP 1924, Collection of Legislation, Art. 892, 1924, No. 88). These certificates are issued according to the requirements of health authorities, administrative, judicial and investigative authorities and the requirements of interested individuals (certificates for presentation to the state). institutions about birth, death, illness, smallpox vaccination, etc.). The procedure and conditions for the issuance of certificates by medical workers are determined by special instructions (NKZDr. and NKYU RSFSR, 1925; Bulletin of the NKZDr., 1925, № 21). Payment of stamp duty certificates is made on the basis of the Stamp Duty Statute. Certificates of public health protection and birth and death for submission to the registry office are not subject to stamp duty. Prescriptions written by healthcare workers must contain the designation of their medical device. ranks. To avoid abuse through advertising, health workers are allowed to indicate only their rank and specialty, last name, first name and patronymic, time and place of appointment in advertisements on signs. Responsibilities M.p. For every health worker involved in practical medical treatment. activities, the obligation to provide medical care is assigned. assistance if necessary. These responsibilities are determined by the special instructions of the NKZdr., NKVD, NKT and All-Union Central Council of Trade Unions dated 2/Sh 1926 (Bulletin of the NKZdr., 1S26. No. 5). In particular, doctors working in rural areas. institutions are required to travel to provide assistance at home within their area in cases requiring immediate assistance, when the patient cannot be taken to the hospital without danger to life or obvious harm to health. institution (see Doctor). Depending on the case, the doctor may send a person of secondary medical care to provide assistance at home. Refusal to provide medical assistance is punishable by law (see below). Health workers are required to notify the nearest health department within 24 hours of each case of highly infectious diseases received for their use [plague, cholera, typhoid fever, dysentery, typhus, relapsing fever, smallpox, scarlet fever, diphtheria, leprosy, anthrax, glanders, influenza ( during an epidemic) and epidemic encephalitis] and about each case of death from these diseases, and mandatory notification can be distributed by local health departments, if necessary, to other infectious diseases (Resolution of the People's Commissariat of Health of the RSFSR dated 7/VIII 1918; Izvestia of the People's Commissariat of Health of the RSFSR, No. 7 -8, 1918; also in Izv. All-Russian Central Executive Committee, 18/VIII 1918, No. 177). Health workers are also required to notify about prof. poisonings and diseases no later than a week after the patient contacts them (resolution of the People's Commissariat of Health and the People's Commissariat of Health of the RSFSR dated 1/3 1924, No. 95/346; Bulletin of the People's Commissariat of Health. 1924, No. 10; circular of the People's Commissariat of Health of the RSFSR dated 23/VI *2U B15 MEDICAL STAFF by her 1924, No. 129, Bulletin of the NKZDr.:, 1924, No. 12). The health worker is obliged to send an immediate notification or report by telegraph or telephone if several cases of poisoning have occurred (more than three) or emergency measures are required. Detailed instructions on the procedure for mandatory urgent notification of prof. poisoning and prof. diseases is given in the circular of the NKZDrav of the RSFSR dated 21/V 1928, Mk 143/31. Sending notifications is mandatory for a health worker in all cases of poisoning, murder, grievous bodily harm or suicide that have occurred in his practice. There are special instructions on the procedure and forms of these notifications (circular of the NKZDr. RSFSR dated 8/VII 1925, Bulletin of the NKZDr., 1925, No. 14). A special instruction (circular of the People's Commissariat of Health of the RSFSR dated 8/II 1925, No. 134) establishes in detail the responsibilities of medical workers to maintain complete and accurate records of all cases of bodily injury. The activities of different categories of medical centers are regulated by special provisions and instructions, such as the instructions on the rights and responsibilities of the district medical workers (instructions of the NKZDr., NKYU, NKT and All-Russian Central Council of Trade Unions from the IDI 1926; Bulletin of the NKZdrava, 1926, No. 5). Rights and responsibilities of medical personnel performing san. functions are regulated by a number of government regulations. Rights and responsibilities of dignity. doctors as bodies of inquiry, rights and responsibilities of the state. rank inspectors and instructions on the procedure for exercising the rights and responsibilities of the dignity. inspectors and dignity. doctors - see Sanitary doctor, Sanitary organization. A number of instructions define the responsibilities and rights of other categories of health workers, for example. instructions of the NKZdr. and NCP for doctors on children’s health (Bulletin of the NKZDr., 1923, No. 21); position of NKZdr. about the work of a health care doctor in preschool institutions (Vopr. Health, 1929, No. 28); position of NKZdr. on the rights and responsibilities of a doctor to protect the health of adolescents dated 3/XP 1932, No. 104, the same in relation to doctors working on water transport dated 25/XI 1932, No. 394 (appendix to the journal On the Front Health, official Department, 10/HP 1932, K> 33-34); position of NKZdr. about the instructor for the protection of motherhood and infancy (Bulletin of the NKZDr., 1925, No. 21), etc. The rights and responsibilities of forensic medicine are defined in especially detail. experts. According to the provisions of the NKZDr. and NKJu about forensic medical. experts from 16/KhP 1921 (Bulletin of the NKZDr., 1922, No. 1) forensic medical. experts are officials obliged to carry out forensic medical examinations. examination in accordance with existing rules (examination of living persons and examination of corpses in the presence of judicial and investigative authorities or police and 2 witnesses) with the drawing up of an act according to the form. Special rules exist for forensic medicine. examination of corpses (circular of the NKZDr. and NKJU of the RSFSR dated 7/1 1929, No. 6-70/mv), to draw up a conclusion on the severity of injuries (circular NKZDr. and NKYU dated 27/11927), on the examination of dead bodies in in the case of sudden death (circular of the NKZdrava dated 19/XN 1918) and on the form of preliminary inquiry in these cases (provisions of the NKZDr., NKVD and NKYU dated 29/VII 1919). According to the RSFSR, the duties of the medical examiner experts are established by special regulations (Vopr. zdookohr., 1929, No. 33). For forensic medical experts serving the rural population are provided with the same benefits in relation to periodic salary increases, scientific trips and vacations as for sanitary doctor(see) (resolution of the Council of People's Commissars of the RSFSR dated 15/VI1928, Collection of Legislation, Art. 492, 1928, No. 68). There are a number of provisions regulating certain aspects of medical pharmacy activities, such as the provision on various categories of pharmacy personnel (Vopr. zduroohr., 1929, No. 42); regulations on ambulance and emergency care and on operations allowed to be carried out outside medical institutions (circular of the People's Commissariat of Health of the RSFSR dated 20/X 1925, No. 207, Bulletin of the People's Commissariat of Health, 1925, No. 20); list of precautions and treatment. serums and vaccines approved for use by paramedics (circular of the People's Commissariat of Health of the RSFSR dated 16/V 1925, No. 1051); list of protozoa. operations allowed for paramedics (instruction of the People's Commissariat of Health of the RSFSR dated January 12, 1926); on the rights of midwives to honey. work (circular NKZdr. dated 2/11924, No. 2); on the rights of midwives (circular of the NKZDr. and NKP dated 2/1 1929, No. 4); about the morals of dentists on prof. work (circular NKZdr. and NKP dated 9/1 1924, No. 5); on the rights of dental technicians (Circular of the People's Commissariat for Health, No. 2/1, 1927, K" 6); on the rights of masseuses (Circular of the People's Commissariat of Health of 12/VIII 1926, No. 127). Among and yM.p. works under the guidance of doctors, carrying out their instructions as assistants, and the right to independent treatment. usually doesn't have a job. In the absence of doctors or their shortage, paramedics can manage medical centers and outpatient clinics, provided they have at least 3 years of work experience in the state. or an inpatient or outpatient public health facility. In this case, paramedics are understood to be medical workers who have completed a course at a normal paramedic school or a paramedic-obstetric technical school or have passed the appropriate test at a paramedic or former medical departments and have the appropriate certificates (for details on the rights and responsibilities of paramedics, see Paramedic). About the rights, responsibilities and character of honey. work of other categories of health workers - see. related articles. Rights and responsibilities of M. p. in the medical department. institutions are regulated by internal regulations and special provisions on the duties of each category of health workers, drawn up in accordance with the Labor Code. There are approximate internal regulations (circular of the People's Commissariat of Health of the RSFSR and the Central Committee of Medical Labor dated 10/VIII 1924, No. 186); regulations on district dignity. doctor (Health Issues, official department, 1929, No. 46 dated 15/XI-I 1929), about the head physician, head. department, resident doctor, doctor on duty, about the caretaker, the senior sister of the hospital department, the senior operating nurse, about the chief accountant of the hospital (Hospital Affairs, collection of orders of the People's Commissariat of Health of the RSFSR, Biomedgiz, 1935); instructions of the NKZDr. RSFSR from 16/V1933,23/VI1933, publ. Healthy at the front, official. Department, No. 15, dated 15/VII 1933, about an intern, an average medical assistant for patient care, about a ward nurse, about the rights and responsibilities of administrative and economic personnel - published by the NKZDr. RSFSR and the Central Committee of Medical Labor in the form of separate circulars (dated 22/VI 1927 and 23/IX 1927). The procedure for the hiring and dismissal of health workers is regulated by special instructions of the NKZD. Union republics and trade unions in accordance with generally established provisions on the procedure and conditions for hiring, distribution and dismissal of labor and specialists. Load standards for medical equipment are established by special orders of the NKZDr. Union republics in agreement with the Central Committee of the Mod-Santrud. Load standards for mechanical equipment in the RSFSR [Circuit. 15/XII 1929 (see Issues of health, official department, NKZDr. RSFSR 1929, No. 46)]. No. 44/mv from Lech. institutions Number of patients per 1 doctor General hospital: *"therapeutic department - nervous" ... infectious » ■ surgical department..... gynecological, eye and ear..... Maternity homes and maternity wards *! Children's bone sapa-thorium......... Ven. b-tsa........ Pulmonary sanatorium for adults "..... Children's pulmonary sanatorium.... ..... Venereological dispensary Day sanatorium for children.......... Day sanatorium for adults....... Night sanatorium. . . Tube dispensary..... Sanatorium for mildly ill patients and not in need of bed rest...... 35-40 35-40 30-40 30-40 50 60 Nervous sanatoriums Polyclinic.... For 1 person average. M. daytime on average 15-20 15-20 40-45 13-15 26-30 13-15 25-30 13-15 25-30 10 20 15 40 15 40 10-15 2.5 20-25 1 sister for 5-6 visits per day 30 30 1 examination nurse. up to 6 visits per day 1 per sanatorium For 1 person, junior M. daytime Note on average 10-15_ 20-25 10-15 8 10 20 20 40 20-25_ "40 10-15 In addition, one sister-housekeeper for 40-50 beds 4.5 2.5 4 b-n. hour is the same as therapeutically *" Help. departments (physiotherapy), as well as the operating room and dressing room are serviced by special personnel; when the number of wards increases beyond 2-3 wards with 40-50 beds (standard departments), the staff also increases; in each hospital department with 4-50 beds there is 1 nurse-housekeeper. * 2 Special personnel are required to service operating rooms and children's wards in maternity wards. * 3 For pulmonary hospitals and sanatoriums for seriously ill patients, the same load norms as in terats. departments. By the resolution of the board of the KKZdr. RSFSR dated 25/XI 1933 (see On the French health, official department, 1933, No. 15 of 15/VII 1933) in the form of a project indicated for therapy. departments 1 doctor for 45 beds, i sister for 10 beds and 1 junior staff member for 5 beds, and the department is conventionally taken as 40 beds; for surgeon departments for a doctor - 30-35 beds, for other personnel the same standards as for therapists. departments; for the eye department - 1 doctor for 30 beds, 1 nurse for 10 and 1 young person, staff for 7 beds; In addition, each department is provided with 1 senior nurse per department, 2 bath attendants and 2 cleaners. For the children's department, the following is also given in the form of a project. standards: 1 doctor for 25-35 beds, nursing staff - 1 person for 5 beds; for the maternity ward, the norm is also given in the form of a draft: for a doctor - 1 doctor for 30 beds, 1 nurse for 4 beds and 1 junior staff person for 2.5 beds. In addition, they rely on the children's department: Art. sister, instructor, 2 cleaners; In the maternity ward, a doctor, sister and nanny are on duty 24 hours a day. The average standards indicated in the table for the infectious diseases department are differentiated by the indicated resolution of the board of the N. KZDr. track. way: for the quarantine department: 1 doctor for 30 beds, 1 nurse for 3 beds and 1 person ml. staff for 2.5 beds; for the dismantling department - 1 doctor for 35 beds, for the rest of the medical care the same standards as in the quarantine; for the general department - 1 doctor for 45 beds, 1 sister for 5 beds and 1 junior medical officer for 4.5 beds. For x-ray. branches are installed as follows. service standards: 1 team consisting of 1 doctor, 1 nurse and 1 nanny for 18 units based on the production of 25 procedure units, and the unit of measurement is taken to measure the lungs: lungs - 1 unit, stomach - 2, intestines - 3; The calculation of 18 patients was compiled as follows. sample: 13 pulmonary - 18 units, 3 gastric - 5 units, 2 intestinal - 6 units, a total of 25 procedure units. A team consisting of a doctor and a laboratory assistant-photographer takes 5 pictures per hour, 20 during the working day; combined x-ray load. workers (filming, x-raying) is established by calculating units of procedures and the number of items removed. Special units have been installed for X-ray therapy. norms. For infants, adult standards are adopted with a 25% reduction in their education. work - individual teachers 1 per 15 If there is a hospital, additionally 1 doctor For 25 beds “19 6 20 illumination and 50% during filming. For a psychiatrist. b-nitsa and branches are installed next. norms: Departments of the hospital Doctors Nursing staff Shii "e R-I sonal Notes Reception and diagnostic. Neuro-psychiatric sanatorium...... Department for mild forms....... Department for severe forms.. ..... Department for chronic severe forms..... Department for chronically able-bodied... Infirmary...... 1: 5 1: B 1: 10 1: 10 1: 10 2.5 1.6 Instructor in cult, therapy for socially valuable patients - 1 instructor per department with 50 beds Instructor in labor, therapy - 1 for 25 working patients Instructor in physical education for socially valuable patients Bath attendant - 1 per department Bartender -1 per department Castellan -1 per department Cleaning lady -1 per department Norms for dentists 13 conservative dentistry office 16 patients per appointment (with an assistant) In the operative dentistry office 20 patients per appointment (with 1 assistant, 1 a nurse for a shift and 1 sister for 2 chairs). In the office of conservative dentistry there are 12 units per appointment. In the office of operative dentistry there are 15 units per appointment without an assistant. - Masseuse load rate: 16-18 units per worker day, counting massage of one limb, back or abdomen as one unit. -N o r m a for laboratory assistants. The duration of the wedge, urine analysis is 20 minutes. Considering a wedge, urine test as a unit of load, for the remaining tests the following number of units is accepted: wedge, blood test - 3, sputum - 1, blood for malaria - 1, blood for relapsing fever - 1, urine and mucus for gonococci - 1.5 , stool for worm eggs-1.5, films for diphtheria-1.5, general stool-2, Widal reaction-2, stool for cholera-3, stool for typhoid fever, paratyphoid fever, dysentery-4, gastric juice- 2. The time for performing tests in laboratories of average capacity and with average equipment increases by 15-20% (urine analysis - up to 24 minutes) and in small laboratories - by 25-30% (up to 27 minutes). Duration of RW (with parallel setting of 2 sedimentary reactions) in groups, simultaneously at least 20 analyzes - 20 minutes. (in large laboratories) or 2,600 analyzes per year. In relation to laboratories, it is more convenient to establish workload norms not daily, but annual, taking them for laboratories of various capacities in the following form: Research Large Medium Small Serological. 4 600 General clinical. ! z ooo Bacteriological, ski.......1 1,500 Sanitary. . . . " 400 ! 4,000 2,600 1300 360 3,500 2,000 1,000 300 Consultation for children: 1 doctor for 5-6 children per hour; for nursing staff: a) visiting nurse-1 for 5-6 home visits per day. In consultations for women: 1 doctor for 5-6 women per hour; nursing staff: a) visiting midwife for 5-6 visits per day. In the baby's house: doctors - 1 doctor for up to 40 babies; average staff - 1 sister for 10 babies during day duty and 15 during night duty. In orphanages: 1 doctor for 40-60 children; average staff: 1 sister per 10 children during day duty and 20 children during night duty. Additional staff of instructors is needed. In nurseries: 1 doctor for up to 60 children (without home visits); nursing staff - 1 sister for 12 children (additionally 1 sister for instructing). In child care homes: 1 doctor for 40-60 beds; average staff - 1 sister on 12 beds during the day and 30 beds during night duty. In children's rooms at maternity hospitals: 1 doctor for 40-50 beds; average staff - 1 sister for 12 children during the day and 20 children during night duty. In children's preventive outpatient clinics: 1 doctor per 20 children for 4 hours of outpatient appointments (1: 5), the remaining 2 hours are devoted to processing the material. Honey. nurses, as in an outpatient clinic, on a general basis. -In inpatient child health care institutions. Doctors: a) for institutions for physically weak children (forest school-sanatorium, etc.) - 1 doctor for 50 children; b) for psychoneurological institutions - 1 doctor for 25-30 children. Standards for outpatient appointments for doctors (1 hour) - see ". Outpatient clinic. - Standards for home care doctor: for 1 doctor - 8-9 visits per 6 hours. working day. The working hours of the medical center were established by a special resolution of the People's Commissariat of Labor of the USSR (dated January 10, 1931, No. 8), on the basis of which, from January 1, 1931, a new regulation on working hours in the hospital was put into effect. and vet. institutions.- Medical, veterinary and dental doctors, with the exception of doctors with a shortened (up to 5 and up to 4 hours) working day or irregular working day, as well as scientific workers of research institutions, work 6 hours a day. Doctors have a shortened working day : 1) sanatoriums, BC and departments of BC for hospitals with open forms of tbc and for bedridden tubes. 6 hours; 2) sanatoriums, departments of BC and barracks for infectious hospitals nykh - 6 hours; 3) psychiatric, institutions and hospitals, subject to direct service of the nykh - 6 hours; 4) correctional homes, places of detention, police reception rooms and sobering-up stations - 6 hours; 5) outpatient clinics, clinics , dispensaries and children's consultations, subject to work exclusively on outpatient visits - 5 1/2 hours; 6) medical examination bureaus and medical control commissions - 4 hours; 7) anatomical institutes and offices, subject to work exclusively in autopsy rooms -4 hours; 8) X-ray, institutes and offices, subject to staying in the field of X-rays, rays for the entire time - 4 hours; 9) radio institutes, offices and laboratories in cases where the work involves staying for the entire time working hours in the sphere of influence of radium - 4 hours - Irregular working day." have: medical personnel 1) heads of groups of institutions and institutions (including hospitals), their deputies and assistants, managers, chief doctors, directors, etc.; 2) site managers; 3) san. doctors and dignity inspectors; 4) epidemic doctors and 5) forensic medicine. experts.- Dentists. have a working day: prosthetists - 5V 2 hours; working on electric drills - 5 1/2 hours; working on foot drills - 5 hours - 3 second and second technicians - 8 hours. working day. Average M. and. [medical assistants, paramedics, paramedics, midwives, medical brothers and sisters, smallpox vaccinators, laboratory assistants, preparators and massage therapists] works 6 x / 2 hours; 8 o'clock the working day is established for the average medical worker working in sanatoriums and rest homes, chronic hospitals, homes for the disabled and charity homes, dairy kitchens, first aid stations, except for those serving enterprises (at first aid stations serving enterprises, the working day is is 6V2 h). The average M has a 7-hour working day. n. manger (regardless of where the manger is located). A 6-hour working day has an average M. of: 1) sanatoriums, BC and departments of BC for hospitals with open forms of TBC and for recumbent tubes. b-nykh; 2) BC, departments of BC and barracks for infectious hospitals; 3) mental health institutions and hospitals, subject to direct service to patients; 4) correctional homes, places of detention, police reception rooms and sobering-up stations. The following nursing staff have a 4-hour working day: 1) anat. institutes and offices, subject to working exclusively in autopsy rooms; 2) X-rays, institutes and offices, subject to being in the sphere of influence of X-rays and rays during the entire working time; 3) radio institutes and offices in cases where the work involves being in the sphere of influence of radium for the entire working time. Medical assistants, subject to independent work exclusively on outpatient visits, work 5 1/2 hours. Junior M.P. works 8 h. For junior mental health personnel, institutions directly serving patients, autopsy rooms with constant work in them, bath attendants (mud and sulfur baths), institutions for patients with open forms of tbc and infectious diseases departments, a 6-hour period is established. working day. For junior M. Matsesta hydrogen sulfide baths (bath-nanny) - 5 hours. working day; X-ray, institutes and offices, subject to stay in. during the entire working time in the sphere of influence of x-rays, rays, radio institutes and offices in cases where the work involves staying during the entire working time in the sphere of influence of radium, - 4 hours. working day. - Disinfectors, disinstructors, disinfectants, deratizers - 7 hours. - "Housekeeping personnel, with the exception of the above-mentioned administrative persons, work 8 hours. The following have a reduced working day: laundresses of mud baths - 7 hours; instructors of physical education and crafts - 67 2 hours ., tow trucks and telephone operators of ambulance stations - 67 2 hours; housekeepers, cleaners, dishwashers and sister-hostesses of sanatoriums, hospitals and departments for sick people with open forms of tbc and other bedridden tubes. hours; packers and workers of pharmaceutical warehouses, engaged exclusively in bottling medicine, formaldehyde and ammonia - 6 hours; workers of anatomical institutes and offices, provided they work exclusively in autopsy rooms - 6 hours. Household managers, their assistants , caretakers and workers whose working hours are divided into parts of indefinite duration (for example, drivers, coachmen, etc.) have irregular working hours. Office staff of medical institutions work 8 hours, cashiers in institutions - 6 x / 2 hours, other cashiers (including pharmacies) - 8 hours. Teaching staff of medical and educational institutions - educators - 4 hours. For minors, the working day cannot exceed 6 hours. Recording of working time of workers is carried out on a daily basis by the administration of institutions in accordance with the relevant instructions on the forms of recording and control of working time, and this recording is based on the monthly norm of 184 hours for those using 8 hours. working day, 144 hours - at 6 hours. working day, 120 hours - at 5 hours. working day and 96 hours - at 4 hours. working day. For medical workers whose work consists of home visits, a monthly work norm is established (number of visits, number of births performed, etc.), taking into account the length of a normal working day for this group of medical workers. workers, time spent waiting for a call, moving and actually visiting the patient. Night work time (from 10 pm to 6 am) is taken into account so that if it is possible to sleep, i hour is counted as 1/2, and if it is impossible to sleep, 1 hour is counted for workers with a 6-hour working day as 6/6 hours, for workers from 8 a.m. working day for 8/, hours. The distribution of working time and duty is established by internal regulations. Continuous work is allowed for no more than 12 hours with a mandatory subsequent rest of at least 12 hours. The duration of the next periodic continuous duty is allowed no more than 24 hours, and the employee during this duty is given a free daily allowance. Overtime work is allowed for workers in the cases, limits and procedures established by the Labor Code, and when recording working time on a monthly basis, overtime is considered to be work in excess of the monthly standard working time and is paid at one and a half times the rate for the first 48 hours, and beyond 48 hours in double size. The use of overtime work is allowed only with the permission of the labor inspector and with the consent of the medical labor union in each individual case. Regulations on the production of overtime work in medical-san. and vet.-san. institutions (decree of the All-Russian Central Executive Committee and Council of People's Commissars of the RSFSR dated 11/VII 1924, Code of Legislation, Art. 594\1924, No. 60, and Bulletin of the NKZDr., 1924, K" 13) temporary use of overtime work in medical-san is allowed. and vet.-san. institutions in emergency cases, provided that the total amount of overtime work of a health worker cannot be more than 50 hours per month and 120 hours per year. This maximum norm can be increased to 75 hours per month and 600 hours per year only for medical staff of sanatorium-resort institutions during the season, for workers of nurseries and dairy kitchens operating non-round the clock, for medical staff on duty in hospitals. -san., vet.-san. institutions and institutions for the protection of motherhood, infancy and childhood, for workers during the production of work who do not have a break (laboratory assistants, preparators, attendants, etc.); vic-tah, laboratories, anti-epidemic and epizootic stations. Application overtime work is allowed in each individual case only with the permission of the labor inspector and with the prior consent of the trade union.Benefits and advantages, clause. All benefits provided to engineering and technical workers apply to doctors [permanent Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party of Bolsheviks dated 14/Sh 1935, published in the Izvestia of the Central Executive Committee of the USSR dated 5/3 1935] Health workers in the civil service, specially sent or working constantly to combat infectious diseases (cholera, typhus, scarlet fever, leprosy, Siberian ulcers, glanders and malaria) in areas especially affected by epidemics, in the event of loss of ability to work in connection with this work, as well as the families of health workers who died as a result of infection with these diseases, receive state. pension provision (according to the resolution of the Council of People's Commissars of the USSR dated 31/III 1926, Izvestia of the Central Executive Committee of the USSR and the All-Russian Central Executive Committee dated 20/IV 1926, No. 90) in the established amounts. According to the instructions of the NKSO, NKT, NKF and the All-Russian Central Council of Trade Unions (Bulletin of the NKZDr., 1926, No. 15), this resolution applies only to persons whose disability or death occurred after the publication of the resolution. The resolution of the Council of People's Commissars applies the rules of the People's Commissariat of Labor of the USSR dated 3/1 1924, established to provide for disabled workers whose permanent disability resulted from a work injury, and to family members of workers and employees who died from injuries (S.U., 1924, no. 21, Art. 211). Persons working on the plague are provided in accordance with the resolution of the Council of People's Commissars of the RSFSR dated 21/P 1924 on benefits for medical personnel sent to fight the plague. The families of persons sent to fight against the plague are equal in terms of benefits to the families of those called up for military mobilization service, and in the event of death or disability due to infection with the plague, medical workers and their families are granted pensions on an equal basis with persons who have exceptional services to the Republic (Collection of Legislations , Art. 198, 1923, No. 15). Honey. and vet. workers: doctors, veterinarians doctors, dentists, paramedics, veterinarians. paramedic, paramedic-midwife and honey. sisters who graduated from honey technical schools (normal courses) and normal schools of Red Cross sisters acquire the right to a pension for long service if they have served in medical service. positions in rural areas and workers' settlements for at least 25 years, including less than 5 years under Soviet rule, and pre-revolutionary medical experience is also included in the length of service. Job. Breaks caused by service in the city do not count towards 25 years of service, but they do not interrupt the course of service. Pension provision for medical and vet. workers in rural areas and workers' settlements are made on the basis of post. Central Executive Committee and Council of People's Commissars of the USSR dated 25/IX 1929, Sat. knot 1929, N° 63, art. 582. When calculating length of service, 1 year of service in remote areas, starting from 1st October 1927, for medical workers sent from non-remote areas is equivalent to 1 year 8 months. and 1 year 3 m, depending on the zone of the respective remote area (resolution of the Central Executive Committee and the Council of People's Commissars of the USSR on benefits for workers in remote areas, Collection of Legislation, Art. 276, 1927, N° 25). This benefit is also extended to medical workers working in remote areas among the nomadic population. The length of service must be documented by relevant certificates. The length of service includes service in the Red Army, time spent in elected Soviet and professional positions. positions, the time of serving a sentence for political activity in the pre-revolutionary years and the time during which the health worker was suspended from work for revolutionary activity before the October Revolution; The time during which the health worker was unemployed or temporarily disabled is also taken into account. Pensions for long service are paid to pensioners themselves for life, regardless of their working capacity and property status; These pensions are assigned in accordance with Art. 18 Regulations on pensions and benefits but social insurance, approved. Central Executive Committee and Council of People's Commissars of the USSR 13/111930, Sat. knot 1930, No. I, art. 132. In the event of the death of a person deserving a pension, the right to a pension is enjoyed by those dependent on him and those who do not have sufficient means of subsistence: for young children, brothers and sisters, the pension is paid until they reach the age of 16, and for those studying in educational institutions - until the age of 18 , disabled children, brothers and sisters (I, II and III disability groups) - until restoration of working capacity, disabled parents and spouses or those who have reached 60 years of age for men and 55 years for women, a pension is given for life; the spouse receives x/2 of the full pension, each of the other family members receives ■ 1 ]i full pension, however, provided that the total amount for the entire family does not exceed the full pension salary: For parents and spouse, although able-bodied, but involved in caring for children, brothers and sisters of the deceased who have not reached 8 years of age, the pension is paid until the child reaches 8 years. The specified medical workers receive a long-service pension in the amount of half the average monthly salary for 12 months of employment in medical positions before the pension is assigned. The pension cannot be more than the maximum amount of the disability pension from general causes assigned to workers (Permanent Central Election Commission and the Council of People's Commissars of the USSR dated January 17, 1932, Coll. 1932, No. 5, Article 31), Retired doctors who remain in their jobs receive a pension in the amount of half their earnings. The assignment of a long-service pension is made by insurance companies cash desks* The decision of the insurance fund on the assignment of a pension is approved by the presidium of the relevant executive committee.The specified rules on pension provision (entered into force on 1/1929) do not apply to persons who have stopped medical care. work in rural areas and workers' settlements before 1/X 1929 (for details, see the instructions of the People's Commissariat of the USSR dated 3/XI 1929, No. 349, on the procedure for applying the resolution of the Central Executive Committee and the Council of People's Commissars of the USSR dated 25/IX 1929 “on pension provision for medical and veterinary workers in rural areas and workers' settlements for length of service"; Health Issues, official department, 1930, No. 1, and 1929, No. 44). See post for more details. The Central Executive Committee and the Council of People's Commissars of the USSR dated 23/IV 1931 on changing the legislation on pensions for educators, medical and veterinary workers (S. 3. 1931, "25 No. 26) and post. NKT of the USSR dated January 23, 1932 (Izvestia IIKT USSR, 1932, No. 5-6). M.p., sent for temporary work to combat cholera, typhus, relapsing fever, scarlet fever, leprosy, anthrax, glanders, malaria (to areas especially affected by malaria), retains his salary at the place of duty and is satisfied with a daily allowance in the amount of x /ia salary; when on a business trip to fight other diseases - in the amount of "/is salary. Qualified medical personnel (doctors, dentists, paramedics, midwives, pharmacists and nurses) working in rural areas are provided by law with a number of benefits and advantages when serving in in the village for at least 3 years under Soviet rule, including the preferential right to occupy positions in cities (see. Doctor). Resolution of the Council of People's Commissars of the RSFSR dated 2/XII 1925 regarding the improvement of the material and living situation of medical workers in rural areas, see. Collection of laws, Art. 625, 1925, N° 90, and instructions of the NKZDr. and the NCP of the RSFSR on benefits for children of district medical officers. personnel dated 24/Sh 1926, Bulletin of the NKZDr., 1926, No. 6. These benefits also apply to qualified medical workers working in a local hospital or local outpatient center located on the territory of an urban village (formerly a district city, factory or fishing village, etc.), unless to the specified treatment. institutions are assigned to provide inpatient, outpatient and traveling care to an area with a peasant population. The dignity also enjoys these benefits. doctors serving the rural population. Qualified honey and vet. workers living in rural areas and workers' settlements should be provided with free apartments with heating and lighting; They are then given regular leave of 1 month. Every 3 years, doctors in rural areas are provided with a scientific trip or a trip to advanced training courses with the provision of a scholarship, dormitory, with the preservation of salary, apartment and utilities for the duration of the trip (post. USSR Central Executive Committee on the training of doctors from 3/IX 1934, etc. 4, § in, published in Izvestia of the Central Executive Committee of the USSR dated 4/IX 1934, No. 208). Health workers and their families who went to work in a rural area or work settlement are retained living space at the place of their previous residence for 6 months from the date of departure; if the family leaves in this place, the living space is retained by it for the entire time the health worker works in a rural area or workers' village (decree of the All-Russian Central Executive Committee and Council of People's Commissars of the RSFSR dated 10/VI 1930, On the healthcare front, official department, 1930, No. 29 ; also in Izvestia of the Central Executive Committee of the USSR, 1930, No. 230). A number of special benefits and benefits are provided to the rank. doctors in all union republics. Thus, sanitary doctors are provided with scientific missions for a period of at least 3 months at least every 5 years of service as a sanitary doctor. San. doctors who constantly serve the rural population and workers' settlements are provided with free apartments with heating and lighting. San. Doctors are given an annual monthly leave (resolution of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR on improving the situation of medical doctors, Health Issues, official department, 1930, No. 6, and 1929, No. 40). - For medical centers serving the mentally ill (doctors , paramedics, matrons, nurses, orderlies and nurses), salary increases have been established (see. below). Resolution of the Council of People's Commissars of the RSFSR dated 8/V 1929. (Vopr. zdr., 1929, no. 27) proposed by the NKZdr. and the State Planning Committee to provide for the provision of housing for workers of psychiatric institutions located outside cities, and to strengthen the provision of nurseries and kindergartens for the children of these workers. Certain categories of medical workers have the right to an additional two-week leave due to the harmfulness of the work: doctors, paramedics, nurses. nurses, orderlies and nurses working during epidemics of typhoid, cholera, plague, glanders, dysentery, smallpox, all medical staff and orderlies, nannies, wardens and psychiatric supervisors. establishments, vet. doctors, paramedics, servants working to combat epidemics, disinfectors and exterminators on a permanent basis, doctors, secondary and junior M. p. tub. departments where heavy stationary medicines are used, workers in pharmaceutical warehouses and packers engaged exclusively in bottling medicine, formaldehyde and ammonia; treating, caring and support staff in leper colonies; workers directly employed full time in x-ray. offices and who have worked continuously for 57 months receive an annual six-week vacation, divided into 2 parts, each lasting 3 weeks. Part-time job. Due to the lack of personnel, medical san. employees are allowed to combine the services of doctors and paramedics in the same institution; remuneration for part-time work is made for the actual number of hours of work in the ordinary amount, based on the basic rate of the part-time employee, regardless of where the said part-time work takes place - at the place of the main job or in another institution; payment for the extension of the working hours of doctors and average medical personnel caused by temporary reasons (replacement on a budget, due to the provision of leave, business trips, etc.) is made as for overtime in the general manner. It is prohibited to pay for part-time work as overtime. For junior staff, part-time work is not allowed, and payment for overtime is made as for overtime work (Const. NKT of the USSR dated 19/1 1932, No. 7; published in Izv. NKT of the USSR dated 25/Sh 1932 for No. 8-9 ). Medical salary employees was established by a resolution of the Council of People's Commissars of the USSR and the Central Committee of the BCP (b) dated 4 /III 1935 “on increasing medical salaries. employees etc. on increasing appropriations for health care in 1935." (News of the Central Executive Committee of the USSR dated 5 /III 1935) in the form of official salaries, the size of which is determined not only by the position held, but also by the nature of the institution, the volume of its work, the length of service of the given medical service. the employee and the degree of his qualifications (having an academic degree is equivalent to more than 10 years of experience). When setting rates depending on length of service, 3 gradations of experience are established - up to 5 years, from 5 to 10 years and over 10 years. For head doctors of hospitals, rates are set depending on the size of the institution headed, determined by the number of beds, from 400 to 750 rubles. per month, and for doctors who are in charge of rural hospitals, depending on their experience, from 360 to 510 rubles, and for rural outpatient clinics - 300-450 rubles; doctors who manage outpatient clinics receive 350-600 rubles, depending on the size of the facility, determined by the number of visits per year; doctors, heads of department "27 lines of hospitals or clinics, heads of laboratories in a city or workers' village - 375-550. rub. depending on length of service; doctors of medical institutions - 300-400 rubles. in cities and workers' towns and 275-360 in rural areas. Doctors are regional state sanitary inspectors, sanitary and shpolno-san. doctors, bacteriologists - from 300 rubles. up to 400 rub. depending on the hundred; regional and city state sanitary inspectors and authorized state officials. rank inspections - 350-550 rubles; dentists who graduated from dental schools - 225-350 rubles; Dentists with completed higher specialized education are equivalent to honey. doctors. Pharmacists with higher medical degrees. education they receive, depending on experience, 300-400 rubles. (pharmacy managers) and 225-300 rubles. (recipe and controller). Paramedics, heads of independent medical services. point, they receive 200-300 rubles. per month depending on length of service; other paramedics 180-225 rubles in cities and workers' settlements and 160-200 rubles in rural areas. Honey. sisters with completed secondary medical education. education - 150-200 rubles. per month in cities and workers’ settlements and 135-175 rubles in rural areas; persons of average medical personnel without completed secondary medical education. education 100-140 rub. in cities and workers' towns and 90-120 rubles. in rural areas; senior operating nurses, senior clinic nurses with completed secondary education from 200 to 300 rubles; senior nurses in the department, dentists, dental technicians with completed secondary education - from 180 to 250 rubles. in cities and workers' towns and 160-200 rubles in rural areas. San. paramedic (assistant, doctors), heads of dispensaries, detachment, dignity. admission officer, disinfectant instructor, laboratory assistant with completed secondary education - 180-225 rubles. depending on experience. Honey. sisters without completed secondary medical education. education with more than 15 years of continuous work experience are equal in wage rates to medical education. nurses with completed secondary medical education and 10 years of experience. Pharmacists with secondary pharmaceutical education, depending on their experience, position and place of work (city, village), receive from 135 to 275 rubles. per month. For junior honey for personnel, the following gradations of experience are established for calculating salaries: up to 3 years, from 3 to 10 years, or up to 3 years, subject to completion of special courses, and over 10 years, or over 3 years, subject to completion of special courses. Orderlies and nurses of BCs, maternity hospitals and sanatoriums - 80 - BUT rub. per month in cities and workers' towns and 60-85 rubles. in rural areas; junior staff of outpatient and polyclinic institutions - 70-90 rubles. in cities and workers' towns and 55-75 rubles in rural areas; nurses of mud baths - 50-120 rubles. per month. Honey rates railway workers and water transport are equal to the rates of the corresponding medical groups. workers in cities. All previously existing periodic salary increases for the duration of work by the above-mentioned resolution of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party of Bolsheviks dated 4/III 1335 were cancelled, with the exception of periodic salary increases established by the resolution of the Central Executive Committee and the Council of People's Commissars of the USSR dated 12/VIII 1930 ( P. 3. USSR, 1930, No. 41, Art. 427) for persons working in remote areas of the 1st zone, as well as for workers of anti-plague institutions. For certain categories of health workers, increases are established depending on the harmfulness and danger of the work; So, for doctors, secondary and junior med. for staff of psychiatric and infectious disease centers and departments and X-ray rooms, as well as for health workers employed in serum-vaccine production, increases to the corresponding wage rates have been established in the amount of 15%, and for those working in troubled departments of psychiatric hospitals and in leper colonies -in the amount of 30%. In addition, these employees have a reduced length of service, which gives them the right to a salary increase; for the staff of psychiatric infectious hospitals and departments and x-ray rooms, instead of 5 years, 3 years and instead of 10 years, 7 years; for the staff of restless departments of psychiatric hospitals and leper colonies, instead of 5 years, 2 years and instead of 10 years, 4 years. Rates for honey have also been increased. personnel working in remote areas. Thus, wage rates for D.-V. were increased by 20%. crane, regions of the Trans-Baikal part of the V. Siberian Territory and aimags of the Buryat-Mopgol Autonomous Soviet Socialist Republic, listed in the resolution of the Council of People's Commissars and the Central Committee of the All-Union Communist Party of Bolsheviks dated 5/II 1934 (S. 3. 1934, № 9, art. 54), Yakut Autonomous Soviet Socialist Republic, Kara-Kalpak Autonomous Soviet Socialist Republic, Kirghiz Autonomous Soviet Socialist Republic, Korsakpaisky, Dosorsky, Balkhashsky districts and Karaganda of the Kazakh Autonomous Soviet Socialist Republic, Turkmen Soviet Socialist Republic and Khorezm, district of the Uzbek Soviet Socialist Republic. Salary rates were increased by 10% for the Uzbek SSR (except for Tashkent), the Tajik SSR and the Kalmyk Autonomous Region. For doctors and other health workers working in the far north of the USSR, salary rates increase by 50%. Doctors and teeth. doctors practicing at home have the right to an additional room or additional PERSONNEL628 area in the South 8 in excess of the existing general norm in the absence of a separate room (resolution of the All-Russian Central Executive Committee and the Council of People's Commissars of 28/P 1930; Izvestia of the Central Executive Committee of the USSR and the All-Russian Central Executive Committee, 1930, No. 116-117). With regard to rent, medical doctors, veterinary doctors, and dental technicians belong to the category of so-called persons. liberal professions, paying for the premises they occupy at the rates of employees, even if they have a side income; if these persons own lech. establishment, then they are equal to entrepreneurs in relation to rent (see NKVD instructions dated 21/VIII 1924, No. 359, NKVD Bulletin dated 27/IX 1924). Doctors, dentists, dental technicians, midwives and masseuses engaged in private practice are exempt from trade tax (Resolution of the NKF of the USSR dated 23/VII 1925, No. 108, Bulletin of the NKZDr., 1925, No. 17). Additional space is paid by practicing doctors and dentists at an increased rate, in accordance with the legislation on rent. Similar to the mentioned resolutions regulating the rights and obligations of labor workers in the RSFSR, in other union republics instructions were also issued through the corresponding People's Commissar of Health, instructions that do not differ significantly from those mentioned, since they are based on the general labor legislation of the USSR. - Working clothes. Regarding protective clothing and protective devices for medical workers. and pharmacy workers, special standards have been established for the issuance of relevant types of specials. clothes and wear time. So eg. for outpatient and hospital doctors, a robe made of light fabric is issued for 1 year, for doctors working in operating rooms - for 6 m, and in the san. epid. detachments - for 3 months, etc.; for paramedics and honey. nurses in hospitals and outpatients - light fabric gowns for 8 m., in operating rooms - for 6 m., in infectious diseases departments - for 4 m., etc. Other - see Standards of overalls for medical workers approved by the NKTSSSR dated 23/VII 1931. and pharmacy workers (News of the NKT dated 30/VII 1931, No. 21). Responsibility of health workers. For violation of the duties assigned to M. n. in the order of their medical performance. work, liability is established by law. Health workers are held accountable in cases of practicing such medical practice. practice, to which they have no right (U.K., Art. 157, as amended in 1926), in the event of failure to provide assistance to a person without a good reason; the guilt is aggravated if the refusal in honey. assistance could have dangerous consequences for the b-th (U.K., Art. 157), in cases of expert evasion from appearing when called by the body of inquiry, investigative or judicial body (Art. 92), giving knowingly false testimony (Art. 95 ) and in the case of expulsion of the fetus in the absence of certain medical indications, in an unsanitary environment; in cases of receiving payment for medical care. assistance, which the health worker had to provide free of charge as part of his official (and not professional) duties, even during off-duty hours. Refusal to medical assistance in cases where its provision was not part of the official duties of a health worker does not constitute a malfeasance and can be prosecuted under Art. 165 U.K. According to the explanations of the NKJ, “receiving remuneration in any form from private individuals OS" "thirty for providing medical services assistance in contacting them in Soviet and public loch. institution is completely unacceptable” and is punishable as receiving a bribe by an official. If medical workers in Soviet and public service received remuneration for providing medical care. assistance during off-duty hours, then they cannot be held accountable under Art. 114 U.K. as having committed criminally punishable acts, unless the said receipt of remuneration was accompanied by extortion, a threat, or did not occur during epidemics or a significant spread of one or another b-nor, the fight against the swarm was at this time a shock. Insulting by words or actions of an MP during the performance of his official duties, both administrative and professional, is punishable under Articles 88 and 10 of Art. U.K., i.e. insult by words or actions of medical workers is equated to public insult of individual government officials in the performance of their duties, and the case under Art. 88 can be initiated not only by the injured health worker, but also by the health department, prof. organization, prosecutor's office, etc. and is not subject to termination. Those guilty of insulting medical workers are punishable by imprisonment for a term of at least 6 months (circular of the People's Commissariat of Justice and the Supreme Court of the RSFSR dated 19/VIII 1926, No. 113, Bulletin of the People's Commissariat of Health, 1926, No. 15). d.gorfin. Prof. harmfulness of health workers. I. The main factors that determine the hazards of work in various detailed medical professions. 1) The danger of infection with infectious (epidemic) substances exists among all groups of health workers who come into contact with patients and their secretions, but is especially great among personnel working in institutions for infectious patients and those directly in contact with patients, as well as for treating, sanitary, dissection and laboratory personnel during epidemics. The danger of infection by epizootics (glanders, anthrax, etc.) occurs among veterinary personnel. diseases, the risk of contracting TBC is especially high among tubal workers (see below). Infection with syphilis during work threatens obstetric personnel more than other groups of health workers. Infection with a purulent infection, often fatal, threatens surgeons, prosectors and veterinary workers as a result damage during operations, autopsies or injuries from animals.Skin purulent diseases (boils, pyoderma) are characteristic of vet. staff; cutaneous tbc of fingers to pathologists (cadaveric tubercles); infection with leprosy-honey leper colony staff. 2) A large expenditure of neuropsychic energy is typical for the most responsible groups of health workers - medical and veterinary doctors, and to a lesser extent for nursing staff. Among the latter, the most difficult work is for the staff of psychiatric institutions. 3) Unfavorable sa n.g. A number of medical facilities have conditions. professions: a) unfavorable meteorological factor - for all traveling honey. and vet. staff, vet. workers of slaughterhouses, railways, and dignity. workers, especially those working under conditions of exposure to industrial hazards (sanitary inspectors, industrial hygiene doctors, etc.), workers of mud baths (a combination of high temperature, high humidity and poor ventilation), hydropathic clinics, light therapy rooms, frequent operating rooms ; b) pharmacy workers are exposed to dust, and Ch. arr. pharmaceutical warehouses with mass hanging of material, and tooth. technology; c) poisonous and irritating. stinging substances act by inhalation and swallowing, on the one hand, and absorption from the skin of the hands, on the other; the first danger is especially pronounced among disinfectants (working with hydrogen cyanide, cyclone IN, formaldehyde, sulfur dioxide). Significant levels of formaldehyde in the air are observed in dissection rooms, especially in preparation rooms. Although the concentration of certain substances in the air of disinfected rooms is certainly lethal, the short time the disinfector spends in the corresponding room and certain precautions he applies protect the disinfector from intoxication. Disinfectors and pat.-apat. workers work with substances that irritate the skin of the hands, mucous membranes of the respiratory tract, eyes (formalin, carbolic acid). It is an undoubted fact that disinfectants are intoxicated with mercury when working with sublimate (mercury is found in urine). Mercury intoxication also occurs among personnel who rub mercury into the skin of syphilitic patients if this is done without rubber gloves. Does mercury intoxication occur in teeth? doctors (as a result of the use of amalgams), has not yet been finally decided. There are indications of irritation of the skin of the hands with novocaine solutions used for local anesthesia. There is no convincing data on intoxication of pharmacy workers with inhaled substances. There is reason to think about the toxic effect of narcotic substances on persons undergoing systematic anesthesia. 4) The harmful effects of X-rays and radium cause characteristic prof. in radiologists and radiologists. diseases (for more details see X-ray therapy). 5) Physical labor is expressed in the work of junior and auxiliary medical workers. Severity of physical. labor among nursing staff in psychiatric institutions reaches a very high level. The same should be assumed for personnel caring for severe chronic diseases. Heavy physical labor is the work of masseuses and anat ministers. theaters 6) Eye strain occurs in people who work for a long time with a microscope. Working in light therapy rooms has a harmful effect on the organ of vision. 7) The danger of occupational injuries is especially high among workers serving psychiatric (see below) and prison institutions, and veterinarians. workers. II. Morbidity, mortality and disability of medical, veterinary and pharmaceutical workers have features that characterize the impact on the health of professional workers. harmfulness. Nowadays, enough data has accumulated on the morbidity of health workers, both on the basis of outpatient visits and insurance materials, and especially mass and special examinations. According to social statistics. insurance for 1925, the number of cases of b-nor per 100 insured health workers per year for all b-nami: "men - 39.68, women - 72.38 (without childbirth), and both sexes - 61," and in first place in height there are infectious diseases, then the digestive organs, influenza, tbc- lungs; The average duration of one illness associated with disability is 18.1 days, i.e., higher for health workers than for many other labor groups, as can be seen from the following table: Average duration of one illness according to io. Branches of work Both sexes Mining industry Garment industry... Printing production - 18.7 11.6 11.7 12.1 13.4 13.5 13.6 18.0 12.2 11.5 12.1 11.8 12.7 11.6 18.1 u, 6 11.7 12.1 12.3 13.5 13.0 Some Western European data are interesting. Doctors find a higher mortality rate from circulatory disorders, nervous and infectious diseases (Koelsch). According to Kölsch, sisters of mercy show a high mortality rate from TBC at the age of 20-40 years, which he explains partly by the fact that many people with hereditary burdens join the community, as well as girls from rural areas who are not accustomed to the hard work of sisters of mercy in enclosed spaces. Hard work and long working hours cause a high incidence of M. p. abroad. Streiter gives in his book (1924) many examples of various violations of the established 10-hour clock. working day, reaching 72-74 hours a week, with night shifts coinciding with days of daytime work. Added to this is the lack of exercise in the fresh air. Epstein calls Germany's caregivers "the stepsons of healthcare." According to Epstein, the sisters Kr. cross of the disabled, disability occurred b. h. due to disorders of the circulatory system, in rare cases due to TBC. Sisters often have heart disease and circulatory disorders in the lower extremities due to standing for a long time. Particular attention is paid to the spread of tbc among M. p. According to a survey conducted by the Health Administration in Germany in 1906-1911. (Hamel), stated by M. n. the connection between the incidence of tuberculosis and the profession in half of all cases of tuberculosis. diseases in M. p. in general hospitals, in certain cases in university clinics and in e/7 all cases in special tubes. institutions. Regarding doctors, Hamel states that out of 250 doctors who worked in internal departments, only 2 fell ill with TBC, while out of 243 doctors who worked in special departments. departments, died 14. III. Occupational safety of health workers. S a n.-g and g. and with a n.-t ekh. measures. Projects of construction and equipment for medical treatment. .institutions do not provide sufficient labor protection for health workers. Such projects were developed (in relation to construction and partly equipment) by the Center, the scientific advisory bureau under the Central Committee of the Union of Medical Labor in relation to b-cs for highly infectious and for tubas. b-nykh, medical san. laboratories, pathological anat. institutions, operating rooms, light therapy rooms, mud baths, and partly psychiatric institutions, but have not yet been introduced into law. Regarding x-ray institutions, there is a resolution of the People's Commissariat of People's Commissariat dated 9/IX 1922. , providing for their special arrangement and equipment with protective devices. Special types of special clothing are installed for certain groups of health workers: radiologists - for protection from the harmful effects of rays, operating theater workers, dissecting rooms working on plague, etc. - Rationalization of labor occupies an insignificant place in the labor protection system of health workers. Here we can only note the proposal of special pharmacy furniture, developed by the rationalization bureau of the Moscow Pharmacy Administration, carried out in a number of pharmacies and replacing work in a standing position with a sitting one; proposals to work while sitting, made for dentists, etc. There are also works devoted to psychotechnics in medicine. labor (psychiatric staff, laboratory assistants), but this work has not yet received practical significance. Lit.: Legal status of honey. personnel.-Laws, regulations and instructions relating to medical. personnel in the RSFSR, published in the official department of the magazine “On the Front of Health Care”, M., from 1930 (until 19X9 under the title “Problems of Health Care”); they are also collected in the following books: Collection of current legislation on health care, comp. S. Chernyak and G. Karanovic, ed. K. Konovalova, V. Berezina and S. Ma-Karenkova, vol. 1-4, M.-L., 1929-31; Freyberg N., Collection of laws and orders of the government of the Russian Republic on medical care from 7/XI 1917 to 1/IX 1919, M., 1922; aka, Collection of laws and orders of the government of the RSFSR according to doctor, san. deal with 1/IX 1919.no 1/1 1925, M., 1925; in Ukraine - Collection of current legislation on medical-san. and pharmacy in the Ukrainian SSR, comp. S. Rapoport and S. Sokolsky, Kharkov, 1926. In addition, see Bychkov I. and Rachkovsk and S., Rights, duties and responsibilities of pharmacy/workers, M.-L., 1927; Karlovich G. and Chernyak S., Professional rights and responsibilities of a medical worker, M., 1927; o Nizhe, Dictionary of a physician-administrator, M., 1927; Nikolaev I. and Rapoport S., Rights and responsibilities of a doctor in the Ukrainian SSR, Kharkov, 1930; On increasing medical salaries. workers and on increasing allocations for healthcare in 1935, Resolution of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party of Bolsheviks of March 4, 1935; E p sh t e p T., Legal status and judicial liability of doctors, Kazan, 1927; Joachim A.u. H., Die preussische Grebiih-renordnung fur approbierte Arzte und Zaimarzte, V., 1922; R a p m u n d-D ietricli, Arztliche Rechts- und Gesetz-kunde, Lpz., 1913. Work and life of honey. personnel-B o n d a r e v N., On prevention in psychiatric work, Health Care, 1929, No. 46; Vasilevsky L., Occupational hygiene of health workers, M., 1925; Vekeler I., Labor and health of workers in mud baths at KVM, Izv. State micro-biological Institute in Rostov N/Donu, Rostov n/DonU, 1930, No. 11; G e l m a n I., Data from a physical examination of the pathologist. workers, Vestn. modern Med., 1929, No. 11-12; Gen k in E., Study of prof. harmfulness of honey labor, ibid., No. 24; G r s be n sh ikov, Mortality tables of Russian doctors for 1890-96, Vestn. society hygiene, 1898, J* 7; Danilevsky V., Doctor, his calling and education, Kharkov, 1921; Dzhenchel-sky I. and Slinko A., Prof. infection rate of syphilis among medical workers. workers, Doctor, case, 1929, J$ 9-10; Koran V., Morbidity and mortality of medical personnel, Doctor, case, 1920, No. 12-17; Kuznetsov V., About prof. syphilis of medical personnel, Doctor, newspaper, 1929, JV" 17-18; Materials for the five-year health plan of the RSFSR, ed. NKZdr. RSFSR, M., 1930; Materials for the study of medical labor. and veterinary workers, ed. Center." Scientific Consulting Bureau of the Central Committee Medsantrud, M., 1928-29; Medical workers, Social hygiene and wedge, essays, edited by V. Kogan, issue 1-2, Kharkov, 1926; Miller S. Lopukhin D., Study of the fatigue of pharmacy workers using the “Bourbon” method, Proceedings and materials of the Ukrainian State Institute of Work Medicine, issue 4, Kharkov, 1926; Okunevskiy Ya., Prof. working conditions of disinfectants, Voach.gaz., 1929, No. 17-18; Ruzer B. and Altshuler L., Experience in studying the operational work of a surgeon. Nov. Surgeon., 1926, No. 3; Rusakov A. and Davydov I., On the issue of studying the working conditions of doctors, Vestn. modern Med., 1929, No. 17; Work and life of medical workers in Moscow and Moscow province, ed. Moscow Gubotdela Medsantrud, collection 1-5, M., 1923-27; Frenkel 3., On special occupational hazards of the work of personnel in psychiatric hospitals, Health Care, 1929, No. 10; X e s i n V., Medical labor and its hazards, M., 1925; he, Experience in researching the surgical work of a surgeon, New. hir., 1926, No. 3; Khesin V. and Alt Shuler L., On the issue of workload standards for hospital nurses, Moek. honey. zhurn., 1928, No. 1; Chernukha A. and Shney-d e r S, Working conditions and neuro-mental health med. workers of places of detention, Sov. Doctor, 1930, No. 11-12; Schneider S, Psychosanitary working conditions of honey. workers of places of detention, Moscow. honey. T., 1929, no. 3-4; Sh u f i r F., Experience in studying prof. infectivity of medical workers, M., 1928; Ekel S, Housing conditions of medical workers, Kharkov, 1926; Yuskovets M., Some results of work on the study of the work and life of veterinary personnel in the Moscow province, Vesti, modern. Veterinary Medicine, 1927, No. 4; he e, Professional aspects of veterinary work, Ibid., 1928, No. 7; N a h n M.,"Die Arbeits- und Gesundheitsverhaltmsse der deut-schen KrankenpHegeriimen, V., 1914; 8 t g e i t with g. G., Die wirtschaltliche und sociale Lage der berufliclien Kran-kenpflege im Dcutschland, Jena, 1924. See. also literature for articles Healthcare And Medicine.

The Ministry of Health recommended not to reduce the salaries of orderlies transferred to the position of cleaner. Letter of the Ministry of Health of Russia dated 02/07/2018 N 16-3/10/2-705 “On the transfer of junior medical personnel to office cleaners.”

Certification of junior medical personnel

According to Order No. 541n dated July 23, 2010 “Qualification characteristics of positions of workers in the field of healthcare”, as well as Order of the Ministry of Labor and Social Protection of the Russian Federation dated January 12, 2016 No. 2n “On approval of the professional standard “Junior medical personnel” in all In healthcare institutions, the qualifications (certification) of junior medical personnel are assessed for compliance of the job functions performed with the requirements of the professional standard.

Mandatory professional standard “Junior medical personnel”

The need to conduct qualification certification of junior medical staff is dictated by Article 195.3 of the Labor Code of the Russian Federation. This article indicates that professional standards are mandatory for execution only in that part where the qualification requirements necessary for the performance of labor functions are determined. Otherwise, the professional standard is advisory in nature. IN professional standard (download document in pdf format) qualification requirements have been determined, and junior medical staff must meet them: junior nurse (brother) for patient care, orderly

What to do if an employee has not passed the certification?

Termination of an employment contract: If during the assessment of the qualifications of a junior med. personnel, it turns out that the job functions they perform do not meet the qualification requirements of the professional standard, then the employment contract with this employee may be terminated on the basisparagraph 3, part one, article 81 of the Labor Code . It is important to keep in mind that termination of the contract occurs on the basis of:

Inconsistency of the employee with the position held,

Inconsistency of the employee with the work performed due to insufficient qualifications.

Transfer to the position of office cleaner : If the employee only cleans the premises, then he can be transferred to the position of cleaner. To do this, the employer makes changes to the staffing table. The same is done if the organization is reducing the number and staff of employees: junior staff,according to part three of article 81 of the Labor Code , the position of cleaner is offered.

What requirements must junior medical personnel meet - professional standards

According to the Order of the Ministry of Labor and Social Development dated January 12, 2016 No. 2n “On approval of the professional standard “Junior medical personnel”, these specialists can have one of 2 qualification categories: 2nd and 4th.

Orderly(2nd qualification category) must ensure the sanitary maintenance of wards, specialized offices, the movement of material objects and medical waste, and care for the body of a deceased person. He must have a secondary general education and undergo vocational training for the position of "Orphan". He must be able to provide first aid, disinfect care items, equipment, supplies and medical products. Carry out pre-sterilization cleaning of medical devices.

Must know infection safety requirements, comply with sanitary, hygienic and anti-epidemic regimes when transporting material objects.

Junior nurse for patient care (4th qualification category) ). These specialists must have secondary general education and vocational training for the position of "Junior nurse for patient care"orSecondary vocational education in the specialties "Nursing", "General Medicine", "Midwifery" - educational programs for training qualified workers (employees) for the position of "Junior Nurse for Patient Care".

Labor responsibilities of premises cleaners and their salaries

If an orderly has been transferred to the position of a cleaner, then it is prohibited to assign him the labor functions of an orderly. The cleaner should only be engaged in cleaning office premises, in accordance with the description of job functions,in Resolution of the Ministry of Labor of Russia of November 10, 1992 N 31 .

Training of junior medical personnel