LIETUVOS RESPUBLIKOS SOCIALINĖS APSAUGOS IR DARBO MINISTERIJA MINISTRY OF SOCIAL SECURITY AND LABOUR OF THE REPUBLIC OF LITHUANIA

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1 LIETUVOS RESPUBLIKOS SOCIALINĖS APSAUGOS IR DARBO MINISTERIJA MINISTRY OF SOCIAL SECURITY AND LABOUR OF THE REPUBLIC OF LITHUANIA International Labour Standards Department International Labour Office 4, route des Morillons CH-1211 GENEVE 22 No. ( )-SD-7320 REF.ILO: ACD 8-0 (2013) Article 22 of the Constitution of the ILO Report for the period ending June 2013 made by the Government of the Republic of Lithuania on the NURSING PERSONNEL CONVENTION, 1977 (No. 149) (ratification registered on 12 June 2007) I. The list of laws and other legal acts that implement provisions of the Convention in the Republic of Lithuania: 1. Labour Code of the Republic of Lithuania (OG, 2002, No ); 2. Law on Nursing Practice and Obstetrics (OG, 2001, No ; 2009, No ) and legal acts that implement it: 3. Specialised List of Nursing Fields, approved by 17 December 2009 Order No V of the Minister of Healthcare of the Republic of Lithuania (OG, 2009, No ); 4. Descriptions of Informal Education Programme Requirements for Specialised Nursing Fields, approved by 21 January 2010 Order No V-51 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No ); 5. Rules on Equation of Professional Qualifications that were Gained Before the Law on Nursing Practice and Obstetrics Practice Came into Force to the General Practice Nurse Professional Qualification, approved by 17 December 2009 Order No V-1038 of the Minister of Healthcare of the Republic of Lithuania (OG, 2009, No ). 6. Licensing Rules for Nursing Practice, approved by 30 December 2009 Order No V of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No 1-48).

2 7. Licensing Rules for Obstetrics Practice, approved by 30 December 2009 Order No V-1089 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No 1-49). 8. List of Diseases that Prevent Persons from Provision of Nursing or Obstetrics Services, approved by 12 August 2010 Order No V-720 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No ). 9. Law on Recognition of Regulated Professional Qualifications (OG, 2008, No ). 10. Law on Social Insurance of Occupational Accidents and Occupational Diseases (OG, 1999, No ; OG, 2003, No ) December 2009 Resolution of the Government of the Republic of Lithuania No 1749 On the Approval of the List of Study Courses and Fields, Pursuant to Which the Studies in Higher Education Institutions are Carried on and the List of Qualification Degrees (OG, 2009, No ) May 1999 Resolution of the Government of the Republic of Lithuania No 544 On the Approval of the List of Jobs and Fields of Activities Where Only Those Employees are Allowed to Work, Who Get a Prior Health Check and Later Periodical Checks for Infectious Diseases and the Procedure on Health Check of These Employees (OG, 1999, No ; 2002, No ). This Resolution defines the groups of workers (including nursing personnel) that are allowed to work only after they get checked and periodically get checked afterwards for infectious diseases May 2000 Order of the Minister of Healthcare of the Republic of Lithuania No 301 On Preventive Health Examinations in Health Care Institutions (OG, 2000, No ), that establishes that the health of nursing personnel must be examined once a year. 14. According to the Law on Safety and Health of Employees of the Republic of Lithuania (OG, 2003, No ), it is employer s duty to provide employees with safe and not hazardous working conditions in respect of all the work-related aspects. 15. Hygiene Standard of Lithuania No HN Healthcare Institutions. Requirements for Infection Control, approved by 19 October 2012 Order of the Minister of Healthcare of the Republic of Lithuania No V-946, that lays down the requirements for the control of infections March 2002 Order of the Minister of Healthcare of the Republic of Lithuania No 132 On the Improvement of Professional Qualification of Healthcare Institution Specialists and Pharmaceutics and the Funding Procedure Thereof (OG, 2002, No ) January 2007 Order of the Minister of Healthcare of the Republic of Lithuania No V-14 On the Approval of Description of Requirements for the Provision of Palliative Help Services for Adults and Children (OG, 2007, No 7-290) May 2008 Order of the Minister of Healthcare of the Republic of Lithuania No V-470 On the Approval of the List of Base Prices of Palliative Help Services for Adults and Children (OG 2008, No ) December 2005 Order of the Minister of Healthcare of the Republic of Lithuania No V-943 On the Approval of Description of the Procedure on Organisation of Initial Out-patient Healthcare Services and Payment Thereof, as well as of the List of Base Prices for the Initial Out-patient Healthcare Services (OG, 2005, No ) December 2007 Order of the Minister of Healthcare of the Republic of Lithuania No V-1026 On the Approval of Requirements for the Provision of Nursing

3 Services in Out-patient Healthcare Institutions and at Home (OG, 2007, No ) April 2003 Order of the Minister of Healthcare of the Republic of Lithuania No ISAK-480/V-210 On the Minimum Requirements for Preparation of Doctors, Doctors Deontologists, General Practice Nurses, Obstetrics and Pharmacists (OG, 2003, ). 22. Standard for Preparation of General Practice Nurses, approved by 10 July 2002 Order of the Minister of Healthcare of the Republic of Lithuania No 1302 On the Approval of the Standard for Preparation of General Practice Nurses (OG, 2004, No ). 23. Description on the Procedure for Establishing the Workload for Nursing Personnel, approved by 9 May 2012 Order of the Minister of Healthcare of the Republic of Lithuania No V-400 (OG, 2012, No ). 24. Description on the Procedure for Establishing the Workload for Obstetrics, approved by 9 May 2012 Order of the Minister of Healthcare of the Republic of Lithuania No V-399 (OG, 2012, No ). Medical standards establish the fields of activity, rights, duties, competence and responsibility of nurses of different nursing fields: June 2004 Order of the Minister of Healthcare of the Republic of Lithuania No V-437 On the Approval of Lithuanian Medical Standard MN 28: 2011 General Practice Nurse. Rights, Duties, Competence and Responsibility (OG, 2011, No ); August 2006 Order of the Minister of Healthcare of the Republic of Lithuania No 629 On the Approval of Lithuanian Medical Standard MN 22: 2006 Mental Health Nurse. Rights, Duties, Competence and Responsibility (OG, 2006, No ); December 2001 Order of the Minister of Healthcare of the Republic of Lithuania No V-437 On the Approval of Lithuanian Medical Standard MN 91: 2001 Children s Nurse. Rights, Duties, Competence and Responsibility (OG, 2001, No ); April 2006 Order of the Minister of Healthcare of the Republic of Lithuania No V-245 On the Approval of Lithuanian Medical Standard MN 40: 2006 Obstetrician. Rights, Duties, Competence and Responsibility (OG, 2006, No ); December 2001 Order of the Minister of Healthcare of the Republic of Lithuania No 628 On the Approval of Lithuanian Medical Standard MN 93: 2001 Operating Room Nurse. Rights, Duties, Competence and Responsibility (OG, 2001, No ); June 2011 Order of the Minister of Healthcare of the Republic of Lithuania No V-650 On the Approval of Lithuanian Medical Standard MN 57: 2011 Community Nurse. Rights, Duties, Competence and Responsibility (OG, 2011, No ) June 2011 Order of the Minister of Healthcare of the Republic of Lithuania No V-644 On the Approval of Lithuanian Medical Standard MN 60: 2011 Nurse- Anaesthetist and Intensive Therapy Nurse. Rights, Duties, Competence and Responsibility (OG, 2011, No ). 32. The Law on State Social Insurance (OG, 1991, No ; 2004, No ). 33. The Law on State Social Insurance Pensions (OG, 1994, No , 2005, No ). 34. The Law on Sickness and Maternity Social Insurance (OG, 2000, No ). 35. The Law on Unemployment Social Insurance (OG, 2004, No 4-26).

4 36. The Law on Social Insurance of Occupational Accidents and Occupational Diseases (OG, 1999, No ; 2003, No ). 37. The Law on Health Social Insurance (OG, 1996, No ; 2002, No ). II. Article 1 One of the basic principles of legal regulation of employment relationships is laid down in Paragraph 4 of Article 2 of the Labour Code of the Republic of Lithuania (hereinafter the Labour Code) equality of subjects of labour law irrespective of their gender, sexual orientation, race, nationality, language, origin, citizenship and social status, religion, intention to have a child (children), marital and family status, age, beliefs or views, membership in political parties and public organisations, factors that are not related to the employee's professional qualities. Article 11 of the Labour Code establishes the duty of the employer to ensure safety and health of workers in all work-related aspects. The duties of workers when protecting their own and other workers health and safety, do not release the employer from the mentioned duty. Measures of safety and health at work are financed from the employer s resources. In seeking to implement the employer s duty, a person representing the employer organises the implementation of preventive measures (technical, medical, legal, organisational, and others) intended for the prevention of accidents at work and occupational diseases, by laying down the procedure for implementing and controlling such measures in an undertaking, appointing the persons authorised by the employer and setting for them concrete assignments on the implementation of the preventive measures. According to Article 25 of the Labour Code, when implementing the duty of the employer to ensure safe and healthy working conditions for workers in all aspects related to work, an employer s representative takes all measures to ensure the conformity of the buildings of the undertaking where workstations are located, the workstations themselves, work equipment, and the working environment with the requirements established in regulatory acts on safety and health at work; organises or instructs the person authorised by the employer to organise the evaluation of occupational risk, and, on the basis thereof, evaluates (establishes) the actual status of occupational safety and health in the undertaking, its subdivisions and individual work stations. Upon having established that the status of safety and health at work does not meet the requirements laid down in regulatory acts on safety and health at work, the employer s representative must organise the preparation and implementation of necessary measures. According to the status of occupational safety and health in the undertaking, the employer s representative decides on the choice of collective protective equipment, organises the installation of the said equipment, and, in the event such equipment does not adequately protect workers from risks, provides the workers with personal protective equipment, organises the verification thereof, provides workers with safe work equipment, introduces safe work and technology processes, installs safety signs and equips ancillary facilities in the workplaces where there is a possibility of risks; ensures that the workers, upon their recruitment and in the course of employment in the undertaking, receive comprehensive information concerning the organisation of safety and health at work in the undertaking, the existing or possible occupational hazards, the existing measures for elimination and (or) reduction of risk, the appointed workers responsible for providing the first aid, organisation of rescue works, evacuation of workers in cases of possible natural disasters or fires, measures for firefighting and evacuation as well as information on the findings of the inspections of the

5 undertaking carried put by the State Labour Inspectorate; approves instructions on safety and health at work, job descriptions, fulfils obligations undertaken under collective agreements concerning improvement in safety and health at work; organises or instructs the person authorised by the employer to organise instruction of workers by ensuring that the workers are instructed on recruitment, transfer to another job, change in the organisation of work, introduction of new or modernised work equipment, introduction of new technologies, upon amendment or adoption of new regulations on safety and health at work. Establishes the procedure for training of workers and examination of their knowledge in the field of safety and health at work; provides conditions for proper functioning of the occupational safety and health service, the occupational safety and health committee of the undertaking; ensures the compliance of working time and rest periods of employees with the requirements of legal acts, organises filling of records on the actual employee working time; organises or instructs the person authorised by the employer to organise compulsory health examination of workers. Creates conditions for workers to have their health examined during the working hours; transfers workers (with their consent) to another job upon the conclusions of the Disability and Capacity for Work Establishment Office under the Ministry of the Social Security and Labour or the healthcare institution which has examined the worker s health; ensures that specialists in health and safety at work, an occupational safety and health service, a person authorised by the employer and exercising the functions of the occupational safety and health service, natural or legal persons exercising the functions of the occupational safety and health or a part thereof are provided with information on the recruitment of workers, which is necessary for them to be able to properly carry out preventive measures of occupational safety and health intended for all the workers; in accordance with the Regulations on the Investigation and Record of Accidents at Work and the Regulations on the Investigation and Record of Occupational Diseases approved by the Government, reports or instructs the person authorised by the employer to report accidents at work and occupational diseases to relevant State institutions, provide conditions for the investigation of accidents at work and occupational diseases; controls how workers fulfil the requirements of regulatory acts on safety and health at work, suspend from work in an undertaking those workers who do not follow the requirements for health and safety at work; in accordance with the procedure established the Regulations on the Investigation and Record of Accidents at Work and the Regulations on the Investigation and Record of Occupational Diseases organises or instructs the person authorised by the employer to organise the registration of accidents at work and occupational diseases; draws up or instructs the person authorised by the employer to draw up the lists of occupational accidents or occupational diseases when an employee has lost capacity for work for more than 3 working days, registers the incidents; performs other duties and implements necessary measures by creating safe and healthy working conditions for workers. Article 34 of the Labour Code establishes the following rights of employees: 1) to demand that the employer should ensure safety and health at work, install collective protective equipment, supply with personal protective equipment when collective protective equipment does not protect from the impact of risk factors; 2) to receive information from the workers' representative for the safety and health, head of the subdivision or another person authorised by the employer, or employer s representative about hazardous and (or) dangerous factors in working environment; 3) to have access to the conclusions of the initial and periodical compulsory health examinations and upon disagreement with the examination results, to repeat health examination; to demand to be transferred to another work if, according to the conclusions of the Disability and Capacity for Work Establishment Office under the Ministry of the

6 Social Security and Labour or a healthcare institution concerning his health condition, he/she cannot carry out the work or hold the office specified in the employment contract; 4) to negotiate the improvements of safety and health of workers with the head of a subdivision or employer s representative directly or via an authorised workers' representative for safety and health, workers representative; 5) to refuse to work in the event of danger to safety and health of workers. If the employer violates the requirements for safety and health of workers laid down by laws, the worker has the right to terminate a non-term or fixed-term employment contract in the manner prescribed by the Labour Code; 6) to require, in accordance with the procedure established by law, to be compensated for the damage to health caused by unsafe working conditions; 7) to address the workers' representative for safety and health, head of the subdivision, undertaking s occupational safety and health service, occupational safety and health committee, workers representatives, worker s representative, State Labour Inspectorate or other state institutions and agencies on the issues of the state of safety and health at a workstation or in an enterprise. There are no special rules for the nursing personnel voluntarily providing care and nursing services; however, requirements of legal acts also apply to the nursing personnel voluntarily providing care and nursing services under Item 2 of the Regulations on Prevention of Injures Made by Sharp Instruments at Healthcare Institutions, the requirements of these regulations apply to any activity carried out by the employees of healthcare institutions as well as all persons who are managed and supervised by employers or their representatives, where the risk of injuries made by sharp instruments arises or may arise. Employers or their representatives must seek to ensure that persons, who provide healthcare services directly or participate in providing the healthcare services according to contractual relationships established with the employer, follow the requirements of these regulations. One of the defined fields is for volunteers who help patients that are in need of palliative help services. Heads of the healthcare institutions are allowed to hire volunteers according to the procedure laid down by the head of this institution (11 January 2007 Order of the Minister of Healthcare of the Republic of Lithuania No V-14 On the Approval of Description of Requirements for the Provision of Palliative Help Services for Adults and Children ). Discussions and coordination procedures concerning various provisions were being carried out with the employee and employer organisations during the preparation of the mentioned document. The draft of the Regulations on Prevention of Injures Made by Sharp Instruments at Healthcare Institutions was prepared by a working group attended by the specialists from the Ministry of Social Security and Labour, the Ministry of Healthcare and State Labour Inspectorate, as well as representatives of the Union of Managing Doctors of Lithuania, Labour Union of Healthcare Employees of Lithuania, the National Association of Healthcare Institution Managers of Lithuania, Lithuanian Dental Chamber, Organisation of Nursing Specialists of Lithuania. Society was consulted regarding this draft by publishing the Draft Order in the information system of drafted legal acts of the Parliament of the Republic of Lithuania. The draft was coordinated with the Lithuanian Confederation of Business Employers, Lithuanian Confederation of Labour Unions, the Lithuanian Labour Union Solidarumas, Lithuanian Labour Federation, Lithuanian Confederation of Industrialists. Article 2

7 The national policy is applied to nursing services and nursing personnel by these legal acts: the Law on Nursing Practice and Obstetrics that establishes gaining the professional qualification of common practice nurses and obstetrics, practice conditions, rights, duties and responsibility, and the legal acts that implement this law: 1. Specialised List of Nursing Fields, approved by 17 December 2009 Order No V of the Minister of Healthcare of the Republic of Lithuania (OG, 2009, No ); 2. Descriptions of Informal Education Programme Requirements for Specialised Nursing Fields, approved by 21 January 2010 Order No V-51 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No ); 3. Rules on Equation of Professional Qualifications that were Gained Before the Law on Nursing Practice and Obstetrics Practice Came into Force to the General Practice Nurse Professional Qualification, approved by 17 December 2009 Order No V-1038 of the Minister of Healthcare of the Republic of Lithuania (OG, 2009, No ). 4. Licensing Rules for Nursing Practice, approved by 30 December 2009 Order No V-1088 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No 1-48). 5. Licensing Rules for Obstetrics Practice, approved by 30 December 2009 Order No V-1089 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No 1-49). 6. List of Diseases that Prevent Persons from Providing Nursing or Obstetrics Services, approved by 12 August 2010 Order No V-720 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No ). Other legal acts: 1. Obstetrics who have been integrated into the initial healthcare are provided with such conditions that their services are paid for by the resources from the National Health Insurance Fund resources (17 January 2008 Order of the Minister of Healthcare of the Republic of Lithuania No V-48 On the Amendment of the 5 December 2005 Order of the Minister of Healthcare of the Republic of Lithuania No V-943 On the Approval of the Description of the Procedure for Organising the Initial Out-patient Healthcare Services and Payment Thereof, as well as the List of the Base Prices for the Initial Out-patient Healthcare Services ); 2. Home nursing services are being expanded. 14 December 2007 Order of the Minister of Healthcare of the Republic of Lithuania No V-1026 On the Approval of Requirements for the Provision of Nursing Services in Out-patient Healthcare Institutions and at Home is designed to expand the provision of nursing services at patients homes by improving the quality of patients lives, preserving their independence in their domestic environment, encouraging their self-care; 3. The palliative help is being expanded. By 11 January 2007 Order of the Minister of Healthcare of the Republic of Lithuania No V-14 On the Approval of Description of Requirements for the Provision of Palliative Help Services for Adults and Children the arrangement and provision of palliative help was legitimised in Lithuania. This Order regulates the provision of palliative help services in out-patient and in-patient healthcare institutions, by organising the provision of these services in in-patient, day in-patient and out-patient conditions; 4. Bed facilities of nursing and maintenance treatment are being expanded. Decision on the expansion of these services and the number of nursing beds in healthcare

8 institutions is adopted by their founders, i.e. municipal institutions upon taking into account the needs of residents. 5. Description on Establishment of Workload for Nursing Personnel, approved by 9 May 2012 Order of the Minister of Healthcare of the Republic of Lithuania No V-400 (OG, 2012, No ). 6. Description on establishment of Workload for Obstetrics, approved by 9 May 2012 Order of the Minister of Healthcare of the Republic of Lithuania No V-399 (OG, 2012, No ). Measures that are essential in order to ensure the nursing personnel: With respect to education and training: 1) Mandatory improvement of professional qualification of nurses has been established (18 March 2002 Order of the Minister of Healthcare of the Republic of Lithuania No 132 On the Improvement of Professional Qualification of the Specialists of Healthcare Institutions and Pharmaceutics and the Funding Order Thereof (OG, 2002, No ); 2) The minimum requirements for preparation of general practice nurses has been established and approved by 11 April 2003 Order of the Minister of Healthcare of the Republic of Lithuania No ISAK-480/V-210 On the Minimum Requirements for Preparation of Doctors, Doctors Deontologists, General Practice Nurses, Obstetrics and Pharmacists (OG, 2003, ). With respect to the occupation and working conditions, remuneration: 1) Occupation of nursing personnel, working conditions and remuneration is established by local legal acts (job description, work regulations of the institution) that are approved by the head of the healthcare institution where the nurse is working and must be coordinated with labour unions. Consultations with the employee and employer organisations are carried out by asking for the opinion of professional organisations (Lithuanian Organisation of Nursing Specialists, Lithuanian Union of Managers of Nurses and other associations) on relevant matters and providing them with the drafts of legal acts for harmonisation and by taking into account the received proposals. Standing working group has been established for dealing with proposals provided by Lithuanian Organisation of Nursing Specialists in respect of nursing problems (draft of the Law on Nursing Practice, licensing problems of nursing personnel, improvement problems, unsafe working environment, workload and representation of labour group, etc.); this group was established by 6 February 2009 Order of the Minister of Healthcare No V-88. On 3 August 2007 The Ministry of Healthcare has concluded a Cooperation agreement No S-248 with the Lithuanian Organisation of Nursing Specialists, under which the ministry undertakes constant and constructive cooperation. Consultations with other nurse unions and associations are still carried out, their representatives are invited to the working groups when legal acts are drafted, and their proposals are taken into consideration. Trade union and union representatives are also included into working groups, commissions that are dealing with issues, under the approved orders of the minister of healthcare. Article 27 of the Law on Safety and Health of Employees of the Republic of Lithuania regulates the instructing and training of employees. According to the law, the employer may not demand that the employee should start working for the enterprise if he/she has not been instructed on the safe work performance. The employees are instructed

9 when employer s representative or a person authorised by the employer decides that it is required in order to protect the employees from traumas or occupational diseases. When professional knowledge or the knowledge gained during the instruction is not sufficient for the safe work of an employee so that his/her health would not be affected, the employer s representative or a person authorised by the employer arranges the training of the employee at his/her workplace, enterprise or training institutions that carry out training, according to the General Regulations on Training and Qualification Testing of Employees in Occupational Safety and Health Matters prescribed by the Law. The employer s representative establishes procedure on training and instruction of employees in the enterprise. An employee who has been temporarily sent to work for an enterprise from another enterprise, may not start working until he/she is instructed on safe work in the particular workstation despite the fact that he/or she has been instructed and trained to work safely under the established procedure in the enterprise he/she constantly works for. Employees who have been sent to work for another enterprise must also be provided with the information on the appointed employees of the enterprise who are responsible for the provision of the first aid, organising the rescue and evacuation of employees in the event of possible accidents, natural disasters or fires as well as on the measures of evacuation and for putting out fires; they must also get acquaintained with the employee evacuation plans. Employees who carry out work or provide services in other enterprises as well as employees, who carry out control functions stipulated by the laws or other regulatory acts, are instructed by their employers. Procedure on drafting occupational safety and health instructions and instructing of employees, working for enterprises carrying out any type of economic activities, is established by the State Labour Inspectorate. Only those employees who have gained special knowledge and passed the exam testing that knowledge under the General Regulations on Training and Qualification Testing of Employees in Occupational Safety and Health Matters, are allowed to use the potentially dangerous equipment, the list of categories whereof is approved by the Government, as well as to carry out the compulsory continuous maintenance during the exploitation of this equipment. Employer establishes the procedure for training and knowledge testing of employees who use the potentially dangerous equipment, which is not the subject of compulsory inspections of the authorised institutions for the inspection of the technical condition of dangerous equipment. Employer establishes the procedure for training and examination of knowledge on employee safety and health as well as on safe performance of this work of employees performing dangerous work, the list whereof is approved by the Government, except for cases when the laws or other regulatory acts establish a different procedure of training, knowledge examination and safe performance of work of these employees. According to the peculiarities of types of economic activities carried out by enterprises and professional risk, employers may prepare and approve, upon coordination with the State Labour Inspectorate, regulations on training and qualification testing of employees of these enterprises on the base of the General Regulations on Training and Qualification Testing of Employees in Occupational Safety and Health Matters. For different types of economic activities the laws may establish a different procedure on training and testing the knowledge of safety and health of employees than the one established by the General Regulations on Training and Qualification Testing of Employees in Occupational Safety and Health Matters. In this case the employees shall be trained and their knowledge on employee safety and health shall be examined under the procedure laid down by those laws.

10 The Regulations on Prevention of Injures Made by Sharp Instruments at Healthcare Institutions establish the following: The employer or employer s representative organises the proper training of employees, according to the procedures and strategy on the prevention of injuries made by sharp instruments, including the training on: 1. the proper use of equipment with the mechanisms protecting from injuries and (or) pricks; 2. introductory training for all new or temporary employees; 3. the risk related to the impact of blood or other body liquids; 4. preventive measures, including standard means of precaution, safe working systems, the importance of proper use of sharp instruments as well as disposal procedures and immunization thereof; 5. the importance of providing information about the accidents of incidents related to sharp instruments, reacting and health monitoring procedures; 6. the measures that must be taken in case of injury. Employers or their representatives must release from work those employees who have to attend the training. This training is carried out on a regular basis under the procedure established by the employer, according to the results of monitoring the effectiveness of applied preventive measures. Article 3 The key requirements for the education and training of nursing personnel are laid down in these legal acts: 1. The Law on Nursing Practice and Obstetrics (OG, 2001, No ; 2009, No ), that establishes gaining the professional qualification of general practice nurse and obstetrics, practice conditions, rights, duties and responsibility. 2. The Law on Recognition of Regulated Professional Qualifications (OG, 2008, No ), that establishes the principles and procedures for the recognition of professional qualifications of nationals of Member States of the European Union, nationals of countries of the European Economic Area and nationals of the Swiss Confederation obtained in the European Union, European Economic Area and Swiss Confederation, and administrative cooperation, safeguards that persons who obtained professional qualifications in another Member State shall have the same rights as nationals of the Republic of Lithuania to pursue, on either a self-employed or employed basis, a regulated profession in the Republic of Lithuania. This Law does not hinder the recognition of professional qualifications of third country nationals obtained outside the European Union, European Economic Area and Swiss Confederation by the Republic of Lithuania in accordance with the procedure laid down by other legal acts. When recognising professional qualifications, the minimum training conditions for the respective professions must be complied with in all cases December 2009 Resolution of the Government of the Republic of Lithuania No 1749 On the Approval of the List of Areas and Fields of Studies, Pursuant to Which the Studies are Carried on in Higher Education Institutions and the List of Qualification Degrees (OG, 2009, No ) March 2002 Order of the Minister of Healthcare of the Republic of Lithuania No 132 On the Improvement of Professional Qualification of the Specialists of Healthcare Institutions and Pharmaceutics and the Funding Order Thereof (OG, 2002, No ).

11 5. Standard for Preparation of Nurses of General Practice, approved by 10 July 2002 Order of the Minister of Healthcare of the Republic of Lithuania No 1302 On the Approval of the Standard for Preparation of General Practice Nurses (OG, 2004, No ) April 2003 Order of the Minister of Healthcare of the Republic of Lithuania No ISAK-480/V-210 On the Minimum Requirements for Preparation of Doctors, Doctors Deontologists, General Practice Nurses, Obstetrics and Pharmacists (OG, 2003, ). Coordination of education and training in nursing field is ensured by mutual cooperation of the Ministry of Healthcare, the Ministry of Education and Science, institutions that prepare the nursing personnel (colleges and universities) and labour unions. Article 4 Requirements for the nursing practice are established in these legal acts: The Law on Nursing Practice and Obstetrics (OG, 2001, No ; 2009, No ) and the legal acts that implement it: 1. The Specialised List of Nursing Fields, approved by 17 December 2009 Order No V-1037 of the Minister of Healthcare of the Republic of Lithuania (OG, 2009, No ); 2. Descriptions of Requirements for Informal Education programmes of the Specialised Nursing Fields, approved by 21 January 2010 Order No V-51 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No ); 3. The Rules on Equation of Professional Qualifications Gained Before the Law on Nursing Practice and Obstetrics Practice Came into Force and the General Practice Nurse Professional Qualification approved by 17 December 2009 Order No V-1038 of the Minister of Healthcare of the Republic of Lithuania (OG, 2009, No ); 4. The Licensing Rules for Nursing Practice, approved by 30 December 2009 Order No V-1088 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No 1-48); 5. The Licensing Rules for Obstetrics Practice, approved by 30 December 2009 Order No V-1089 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No 1-49); 6. The List of Diseases that Prevent Persons from the Provision of Nursing or Obstetrics Services, approved by 12 August 2010 Order No V-720 of the Minister of Healthcare of the Republic of Lithuania (OG, 2010, No ). Medical standards that establish areas of activities of nurses of different nursing fields, their rights, duties, competence and responsibility: June 2004 Order of the Minister of Healthcare of the Republic of Lithuania No V-437 On the Approval of Lithuanian Medical Standard MN 28: 2011 General Practice Nurse. Rights, Duties, Competence and Responsibility (OG, 2011, No ); 2. 4 August 2006 Order of the Minister of Healthcare of the Republic of Lithuania No 629 On the Approval of Lithuanian Medical Standard MN 22: 2006 Mental Health Nurse. Rights, Duties, Competence and Responsibility (OG, 2006, No ); 3. 4 December 2001 Order of the Minister of Healthcare of the Republic of Lithuania No V-437 On the Approval of Lithuanian Medical Standard MN 91: 2001

12 Children s Nurse. Rights, Duties, Competence and Responsibility (OG, 2001, No ); 4. 3 April 2006 Order of the Minister of Healthcare of the Republic of Lithuania No V-245 On the Approval of Lithuanian Medical Standard MN 40: 2006 Obstetrician. Rights, Duties, Competence and Responsibility (OG, 2006, No ); 5. 4 December 2001 Order of the Minister of Healthcare of the Republic of Lithuania No 628 On the Approval of Lithuanian Medical Standard MN 93: 2001 Operating Room Nurse. Rights, Duties, Competence and Responsibility (OG, 2001, No ); June 2011 Order of the Minister of Healthcare of the Republic of Lithuania No V-650 On the Approval of Lithuanian Medical Standard MN 57: 2011 Community Nurse. Rights, Duties, Competence and Responsibility (OG, 2011, No ); June 2011 Order of the Minister of Healthcare of the Republic of Lithuania No V-644 On the Approval of Lithuanian Medical Standard MN 60: 2011 Nurse- Anaesthetist and Intensive Therapy Nurse. Rights, Duties, Competence and Responsibility (OG, 2011, No ). Article 5 According to Article 41 of the Labour Code, representatives of employees and employers and their organisations are considered to be the parties of social partnership social partners. In case of a tripartite social partnership the Government and municipal institutions participate in the partnership on an equal basis with representatives of employees and employers and their organisations. Social partnership may be developed on the following levels: national; sector (production, services, professional); territorial (municipality, county) and enterprises, establishments or organisations and their structural divisions. Social partnership may be implemented through participation in the activities of bipartite or tripartite councils (commissions, committees) through the exercise by employees representatives of information and consultation rights and other rights of participation in the employer's decision-making processes, by conducting collective bargaining and concluding collective agreements. The system of social partnership is comprised of the Tripartite Council of the Republic of Lithuania and other tripartite and bipartite councils (commissions, committees) formed in accordance with the procedure established by laws or collective agreements. One of the key and, it is true to say, the most effective form of the nationally carried out social partnership is the formation of Tripartite Council of the Republic of Lithuania and the activity of social partners that comprise it and the State, when solving issues directly related to the legal status of employees, employers and legal subjects that represent them; by initiating the drafting of legal acts that regulate labour relations. Social dialog carried out by this institution plays an important role in coordinating the interests of participants of legal labour relations. The Tripartite Council of the Republic of Lithuania has been granted enough rights to regulate labour relations on the national basis. By agreement between social partners, the Tripartite Council is formed from the equal number of members enjoying equal rights: representatives of central (national) trade unions, employers' organisations and the Government. The functions, rights, procedure of formation, organisation of work of the Tripartite Council are established in the Regulations of the Tripartite Council. Representatives of trade unions, employers' organisations and the Government must provide the Tripartite Council with the necessary information on the issues under consideration. The Tripartite Council may conclude trilateral agreements on

13 employment relationships and associated social and economic conditions, also on the regulation of mutual relationships between the parties to the agreement. The Tripartite Council's agreements are published in "Valstybės žinios" by the orders of the Prime Minister and come into force in the manner prescribed for the Government resolutions. Other trilateral or bilateral councils (commissions, committees) may be established in accordance with the procedure prescribed by laws or collective agreements for addressing and solving issues of work, employment, employee safety and health and social policy implementation on the ground of trilateral and bilateral co-operation based on equal rights. The procedure for the formation of such trilateral or bilateral councils (commissions, committees) and their functions is established in the regulations of relevant councils (commissions, committees). The regulations shall be approved by the subjects specified by laws or the subjects of collective agreements in cases established by laws. 13 June 2005 the Government of the Republic of Lithuania, labour union and employer organisations signed the Agreement on Trilateral Cooperation of the Government of the Republic of Lithuania, the Labour Unions and Employer Organisations in order to continue and improve the trilateral cooperation in various labour fields of general interest and social security, that was initiated under 5 May 1995 agreement and further developed by 11 February 1999 agreement. The interests of the State, employers and employees, related to safety and health are coordinated in the Commission of Employee Safety and Health of the Republic of Lithuania, that is established by the principle of trilateral cooperation of social partners (the parties) and working according to the Regulations of the Commission of Employee Safety and Health of the Republic of Lithuania, approved by 9 January 2002 Resolution of the Government of the Republic of Lithuania No 13 (OG, 2002, No 4-97). The Commission analyses draft legal acts, provides comments and proposals to the Ministry of Social Security and Labour, the Ministry of Healthcare, other state institutions and agencies, when needed, provides the respective state institutions with proposals on the expedience of drafting new legal acts on employee safety and health, the change or amendment of valid legal acts, discusses the report on work safety conditions and implementation of labour laws published by the State Labour Inspectorate, analyses the state of employee safety and health, proposes measures and ways for improving the employee safety and health conditions to the Ministry of Social Security and Labour, the Ministry of Healthcare, other state institutions and agencies, employer organizations, labour unions and enterprises, discusses plans of the programs and measures for improving the safety and health of employees as well as results of implementation thereof. The issues on prevention of infringement of employee safety and health requirements are dealt with by the territorial and municipal commissions of employee safety and health, established according to the principal of trilateral cooperation of social partners. According to Article 47 of the Labour Code, the employees representatives have the right to information and consultation. Information means the transfer of information (data) to the employees representatives for the purpose of introducing them to the substance of the matter. Consultation means the exchange of views and the establishment and development of dialogue between the employees representatives and the employer. The employer must regularly, at least once a year, inform the employees' representatives and hold consultations with them about the current and future activities of the enterprise (structural division), its economic situation and the status of employment relationships. Prior to taking a decision on collective redundancies, the employer must inform the employees representatives and hold consultations with them. Information must cover the reasons for the planned redundancies, the total number of employees and the number of employees to be made redundant by category, the period over which employment contracts are to be terminated, the criteria for the selection of employees to be made redundant, the

14 conditions for the termination of employment contracts and other relevant information. Consultations must be held with a view to avoiding collective redundancies or reducing the number thereof, or mitigating the consequences of such redundancies. Prior to taking a decision on the reorganisation of the enterprise, transfer of business or a part thereof and other decisions that are likely to have substantial effects on the organisation of work in the enterprise and the legal status of the employees, the employer must inform the employees representatives and hold consultations with them about the reasons for such a decision, the legal, economic and social implications for the employees, as well as about any measures envisaged to avoid or mitigate the expected consequences. Other cases, conditions and procedure of information and consultation is established by laws, collective agreements and agreements between the employer and the employees representatives. In the case of information provision, the employer must provide the employees and their representatives with information in writing in a timely manner free of charge and is responsible for the correctness of such information. Upon submitting a written obligation not to reveal any commercial (industrial) or professional secret, the employees or their representatives have the right of access to information, which constitutes a commercial (industrial) or professional secret but is necessary for the performance of their duties. The employees and their representatives, irrespective of where they are and regardless of the termination of employment relationships or powers of representation, are prohibited from using for any other purpose or disclosing to the third persons any information, which has been communicated to them as a commercial (industrial) or professional secret. Access to State, official secrets and liability for the disclosure or unlawful use thereof is regulated by special laws. Consultations concerning the information (data) communicated by the employer and the opinion expressed by the employees' representatives must be held in a timely manner, enabling employees' representatives to meet the competent decision-making representatives of the employer and obtain reasoned responses. Consultations must be held with a view to reaching a decision satisfactory to both the parties. The results of consultations shall be recorded in the minutes. The employer may refuse in writing to provide any information, which constitutes a commercial (industrial) or professional secret, or to have discussions with the employees' representatives when the nature of that information or discussion might, according to objective criteria, seriously harm the functioning of the undertaking concerned or would be prejudicial to it. The employees' representative, disagreeing with the decision of the employer, may, within one month, apply to the court. After the court s ruling that the refusal to provide information or have discussions is unjustified, the employer in question is obligated to provide such information or carry out the discussion within a reasonable period of time. The peculiarities of information and consultation procedures in Community-scale undertakings, Community-scale groups of undertakings, European companies and European cooperative societies are established by special laws. According to Article 6 of the Law on Safety and Health at Work, the interests of the State, the employers and employees related to occupational safety and health, shall be coordinated by the Commission of Employee Safety and Health of the Republic of Lithuania, established upon the principle of trilateral cooperation of social partners (the parties). Procedure on establishment and functions of this Commission is stipulated by the Regulations of the Commission of Employee Safety and Health approved by the Government. According to the principle of trilateral cooperation of social partners, Territorial district commissions of employee safety and health may be established, municipal commissions of employee safety and health may be also established in order to deal with issues on the prevention of infringements of occupational safety and health requirements. The Minister of social security and labour lays down the procedure for establishment and composition of the territorial district and municipal commissions of

15 employee safety and health. According to the principle of bilateral cooperation between the employer organisations and the labour unions of respective branch, commissions of safety and health of employees of different fields of economic activities may be established. Founders of these commissions lay down the procedures for establishment and composition thereof. Under Article 13 of Law on Safety and Health at Work, the employer s representative, or authorised persons must inform and consult employees on all the issues related to the state of their safety and health, plans for improvement thereof, arrangement of measures, their implementation and control. The employer s representative or heads of the subdivisions provide conditions for employees and their representatives for safety and health to take part in discussions concerning occupational safety and health matters. To this end, occupational safety and health committees are established in an enterprise or representatives for safety and health of employees are elected. Occupational safety and health committee is established in an enterprise where there are more than 50 employees. In case less that 50 employees work for the enterprise, occupational safety and health committee may be established by the initiative of the employer or the employee representatives, or upon the proposal of more than a half of employee staff of the enterprise. In some enterprises that carry out particular economic activities, where the professional risk is higher, the occupational safety and health committee may be established even when there are less than 50 employees in the enterprise. The types of economic activities that qualify for the establishment of committees in enterprises having more than 50 employees and the types of economic activities in respect of which the establishment of committees in enterprises having more than 50 employees is recommended, are defined in the General Regulations of Occupational Safety and Health Committees. The Commission of Employee Safety and Health approves these regulations. The Committee is formed by the bilateral principle from the equal number of employer s representatives appointed by employer s representative (management officers of the enterprise) and the elected employee representatives for safety and health. Activity of the Committee is carried out and it is managed by the chairman of the committee employer s representative or an employee representative appointed by him/her. The chairman organises the work of the committee. The employee representative for occupational safety and help is elected the secretary of the committee. Employer provides members of the committee with equipment and information required for carrying out their duties. Under the periods defined by the collective agreement, members of the committee are periodically trained at educational institutions that provide education services related to occupational safety and health, according to the General Regulations on Training and Qualification Testing of Employees of Occupational Safety and Health Matters; in seminars or the enterprise using employer s financial resources. Issues on education of committee members are dealt with by concluding collective agreements. The time that the committee member spends carrying out duties delegated to him related to occupational safety and health or studying, is remunerated with his average wage. According to the General Regulations on Occupational Safety and Health of Enterprise Employees, enterprises draft the Regulations of the Committee of Employee Safety and Health. Employer s representative approves these regulations upon their coordination with employee representatives. Following regulations of the committee of employee safety and health, the labour union of the enterprise and in case there is no labour union other employee representatives elected at the staff meeting, organises the election of the employee representative for safety and health and the election of members of the committee of employee safety and health. Employee representatives establish the number of enterprise subdivisions and employees that are represented by the employee representative for safety and health. In case there is more than one employee representative for safety and health, one of them is elected the senior employee