On 19th March, MSAH announced that requirements for emergency/first aid staff can be relaxed in order to ease their recruitment for work. Helsinki-Uusimaa Hospital district operating at the epidemic centre has started training existing surgical and ward staff in treating COVID-19 patients, including intensive care. Similar efforts have also been taken by other hospital districts, for instance Pirkanmaa hospital district and Tampere University Hospital. There have also been discussions on recruiting medical students to do contact tracing as the test capacity increases.
On March 25th the Government issued a decree (1) to implement the obligation of healthcare professionals to carry out work set out in the Emergency Powers Act (2011)(2). The aim is to ensure the sufficiency of labour force in the healthcare sector so that labour shortage caused by the coronavirus epidemic does not endanger human lives. The Decree will be in force from 26 March 2020 to 14 May 2020 throughout Finland. In line with the decree, people working in both public and private healthcare who have received training in the field and who are between 18 and 68 years of age may be required to work. An order to work is issued based on the needs of the healthcare system and on individual discretion. A person who is covered by the obligation to work in the healthcare sector and has been issued with a work order must carry out necessary work in the healthcare sector. The obligation to work can be introduced to safeguard resources for the performance of any necessary tasks in the healthcare sector during the state of emergency. In addition, provisions on the employment relationship of a person obliged to work, the terms and conditions of employment, employer’s obligation to disclose information and work obligation register will apply. On April 2nd the Constitutional Law Committee of the Parliament considered that the work obligation had been introduced too early, but declared it valid.(3)
The Union of Health and Social Care Professionals in Finland and the Finnish Medical Association (FMA) emphasise the importance of the health care workforce’s wellbeing. FMA offers distant external counselling to support the physicians in their work during the epidemic (4). The Union of Health and Social Care Professionals calls attention to employers’ responsibility to take care of the employees' wellbeing (5). According to the corona survey conducted by Sairaanhoitajaliitto (Nurses’ Union) there are deficiencies in the occupational safety, and nurses are worried about insufficient guidance for new work tasks such as ICU work and they are burdened by rapidly changing information and unclear governance (7). The Union is running a radio and social media campaign through which the public can show their appreciation of nurses' efforts during the corona epidemic (8). The City of Helsinki has made special parking arrangements to ensure easy commuting and sufficient parking areas close to hospital for health care personnel (6). Private actors and companies have supported health care personnel e.g. with free wellness coaching and discounts for home cleaning.
TerveyskyläPro is a service portal for health and social care professionals. Among other information it provides, it now gathers essential information related to COVID-19, such as instructions by the MSAH, the University Hospitals, and also general instructions on how to take care of professionals own mental wellbeing during the epidemic. (13)
On 6 May 2020 the Government issued further decrees on extending the use of powers under the Emergency Powers Act in order to safeguard the functioning of the healthcare social welfare service system. The aim is to extend the powers provided under the Emergency Powers Act to direct the operations of the healthcare and social welfare units and to adjust the operations of healthcare and social welfare units. This could mean for instance temporary derogations in the application of certain provisions of the Annual Holidays Act, the Working Hours Act and the Employment Contracts Act in critical functions of society. (9)
The Pirkanmaa and Northern Ostrobothnia Hospital Districts have announced co-operation negotiations to ensure the organization of workforce according to the current needs of health care, given the long duration of the epidemic. (10,11) The Varsinais-Suomi Hospital District announced then the implementation of actions and possible co-operation negotiations to mitigate the financial difficulties caused by the epidemic due to response and decreased use of other services. (12) Until 18th of May only a few clusters of COVID-19 cases among health care workers have been reported in Helsinki-Uusimaa region.
Additional financial support for health workforce is currently agreed locally in Finland. Some individual health and social care providers distribute COVID-19 bonuses to their employees, e.g., Fimlab laboratory company pays 10% extra pay for employees working in COVID-19 testing and one-time bonus for employees whose work the epidemic has affected (14). In addition, a private health care provider Terveystalo announced distributing a 500 euro one-time bonus for all their contract employees to thank for the extra effort performed this year that resulted in good profit for the company. (15) Helsinki University Hospital introduced a temporary additional work allowance and continue using the call-out pay more flexibly to ensure sufficient health workforce during the holiday season. (16)
Surveys conducted by the Finnish Institute of Occupational Health show that the epidemic had a major impact on social and health care workers. One survey reveals that one in three of the social and health care workers have feared for their health due to COVID-19 in their work. The epidemic has also increased their workload, especially nursing directors’ and head nurses’. In addition, work recovery has weakened among social and health care workers, in particular among workers under the age of 30 years. Only 14 % of the survey responders had moved to remote work either fully or partially, and the results showed that their well-being at work in general was better compared to the ones not working remotely.(17) Another survey revealed that while in general the level of stress during the pandemic has decreased among the municipal employees, stress in health care workers has increased. Well-being at work seems to be better among employees who have transitioned to remote work. Moreover, nurses who as a result of the pandemic have moved to other work tasks seemed to have experienced the most strain. (18)
Shortages of workforce led the Oulu University hospital to shut down five of their approximately 50 operation rooms from Feb 15, 2021 to the end of April, 2021. All emergency and urgent operations as well as significant part of the planned operations continue. The measure is temporary and meant to relieve the fatigue and stress of the workforce while other solutions are sought. During the spring 2020, the elective and non-urgent operations were suspended, and health care personnel were further trained in order to create ICU surge capacity. These measures resulted in increase in the surgery waiting times and created strains on the health workforce. In the autumn 2020, a maximum of 1100 patients had been waiting longer than 6 months for their operation, while in February 2021 there are approximately 200 patients waiting longer than 6 months for their operation. The current temporary measure is not expected to increase the surgery waiting times. (19, 21) Temporary shortages of workforce are also present in Jyväskylä, where COVID-19 infections started increasing sharply in the end of January 2021 and resulted in disruptions of non-urgent care provided by nurses in the health centres. Nurses where redeployed to COVID-19 related tasks such as testing, contact-tracing and vaccinations.(20)
On 4th March 2021 the Local Government Employers (KT) and the main employee organisations have set local agreements during the pandemic. These agreements can concern working arrangements, such as flexibility for breaks and working time. These agreements also affect labour relations between healthcare workers and municipalities at the local level, as in practice they may concern, amongst others, moving personnel from one task to another, flexibility in working time, and cancelling annual leave if deemed necessary. (22)