Collective dismissal of nurses： the professional dilemma of college nurses

Reporter Xia Jieyi Intern reporter Wei Zhaoyang

In June 2023, Li Li, a nurse from Inner Mongolia Stomatological Hospital (hereinafter referred to as "Stomatological Hospital"), received a notice from the hospital asking her to sign a resignation application. Lily feels expect the unexpected. She has worked in this hospital for three years, and hopes that she can continue to work. What makes Li Li feel suddenly is, "Party A in this resignation agreement is a property management company, which I have never heard of. At that time, the hospital leaders said that after signing this resignation agreement, they would give us a re-examination and solve the problem of turning positive. I didn’t think much and signed it immediately. "

Li Li told this magazine that she saw the recruitment announcement issued by the Stomatological Hospital in the second half of 2020. After registration, she passed the written test and interview and became a nurse in this public top three stomatological hospital. The examiner in the interview was the dean of the Stomatological Hospital at that time. She never knew there was another property company. Looking back now, the only thing that feels a little strange is that she didn’t remember signing any contracts when she joined the company. But in this Li Li’s past employment experience, it seems that it is not a big flaw. Before Li Li worked in a private dental clinic, there was no labor contract signed there. Moreover, she found out that some older nurses in stomatological hospitals did not have labor contracts.

What’s more, after joining the company, she was satisfied with the working environment of the hospital and felt that the working atmosphere was simple. "Every day, I came to work, and the cooperation with doctors was also very tacit, and there was no interpersonal problem." Compared with other public general hospitals, the working hours here are reasonable and the work intensity is not high, from eight to five. After working for three years, Li Li’s monthly income can basically reach six or seven thousand yuan, which is a good treatment in third-tier cities.

"I am very proud and cherish being a nurse in a top three hospital." Li Li said that three other nurses interviewed by Inner Mongolia Stomatological Hospital also expressed similar feelings. The only thing that makes the nurses feel the fly in the ointment is that the hospital has never paid them five insurances and one gold. "The old nurse in the hospital said that this is the rule here, so we will wait until it turns positive."

Li Li’s so-called "regularization" refers to signing a formal labor contract directly with the hospital. In the recruitment announcement issued in 2020, the oral hospital’s rhetoric about the treatment of nurses was vague: "Stomatologist posts enjoy the salary of Hohhot institutions and five insurances and one gold, while other posts are treated according to academic qualifications and other conditions." It has been Li Li’s expectation for three years to become a formal contract worker and enjoy the same salary as the staff. However, in June 2023, after she and more than 40 nurses signed the resignation application according to the requirements of the hospital, they failed to wait for the news of "turning positive", but waited for the notice of the hospital that "the contract will not be renewed when it expires".

The hospital told the nurses whose contracts expired that they were actually employees of Lido Property in Inner Mongolia, a third-party labor dispatch company hired by the hospital, and because the cooperation relationship between the hospital and the company was terminated, the nurses automatically "resigned". Subsequently, the hospital signed a temporary labor contract with the nurses. According to the contract, nurses can continue to work in the hospital until December 31, 2023, and they must leave when a new batch of recruited nurses enter the job.

Most of these nurses joined in 2020, but there are also some old employees who have worked for 5 years and 8 years, including many lactating mothers and pregnant women. They not only spent the growth period of rapid performance growth with the hospital, but also experienced the test of epidemic situation for 3 years. "I remember sending us to the community site for support in February 2022. On that day, it was MINUS 10 degrees Celsius, and the snow was very thick. We stood in the outdoor tent, repeatedly applying disinfectant and collecting nucleic acid, and our hands were frozen purple and unconscious. A colleague also fell into the problem of shaking hands, which has not been good so far. When the infection tide broke out in Hohhot, we were sent to the shelter for three months. In order to track the positive patients regularly, we often got up in the early morning to collect nucleic acids, and we could only sleep for three or four hours every day. Because of mental stress and lack of rest, a pregnant colleague also gave birth, and we were all heartbroken. During the epidemic prevention and control period, the hospital promised that we would solve the problem of turning positive when we came back. Why is it all different now? " Li Li felt cheated and thought that the reason why the hospital let them leave was unreasonable. She decided to ask the hospital for an explanation with other nurses.

Are nurses employees of a third-party labor dispatch company? On this point, both sides hold their own words. The hospital’s president, Da Mou, said that the nurses signed a labor contract with Lido Property Company in Inner Mongolia when they joined the company, and the hospital kept the contract evidence. Damou admitted that since the nurses joined the company, the property company has never paid five insurances and one gold. "We will urge them (the property company) to solve the problem as soon as possible, and the compensation will be compensated."

Several interviewed nurses told us that the so-called contract signed with the property management company was a contract with blank and unknown content after the hospital asked them to sign the resignation application in June 2023. After the resignation dispute, they obtained a copy of the contract from the hospital and found that Party A wrote "Lido Property Company in Inner Mongolia" and Party B’s post said "Care Worker". Nurses think that this is the hospital’s "stealing the column", and "our nurse’s practice certificates are all registered in the stomatological hospital. How can we change from nurses to nursing workers?"

Why did you end the employment of these nurses? Dean Damou explained that these oral nurses who were forced to leave their jobs were indeed "outstanding" in their usual work performance, and it was not easy to cultivate them. However, last year, the Hohhot Municipal Health and Wellness Committee (hereinafter referred to as the "Health and Wellness Committee") issued a regulation for all affiliated hospitals, requiring nurses who participated in the open recruitment examination to have a bachelor’s degree or above. "At that time, the nurses took part in the examination, which was not a formal examination organized by the hospital and controlled by the Health and Health Commission, but was organized by the property management company … We are also a tertiary hospital now, and people entering tertiary hospitals are required to take the examination. Most of these nurses are junior college and secondary school students. After the promulgation of the new regulations last year, it is a bit difficult for them to turn positive. "

According to the hospital, the relationship between these nurses and the hospital is labor dispatch rather than labor. According to the Interim Provisions on Labor Dispatch issued by Ministry of Human Resources and Social Security, China, employers can only use dispatched workers in temporary, auxiliary or alternative jobs; The duration shall not exceed 6 months, and the number of dispatched workers used by the employing unit shall not exceed 10% of its total employment. A lawyer who has served as a legal adviser to several hospitals and handled similar labor disputes told this magazine that nurses belong to the core position of the main business of hospitals and cannot be regarded as temporary, auxiliary or alternative positions. In addition, most of the nurses employed by Inner Mongolia Stomatological Hospital have worked for more than three years, accounting for nearly 17% of the total staff.

Inner Mongolia Stomatological Hospital, formerly known as "Hohhot Stomatological Hospital", was founded in 1985. It is located near the South Second Ring Road in Yuquan District, Hohhot, in the east of the First Hospital of Hohhot. It is a four-storey blue-and-white building, which is not very eye-catching, with only more than 230 employees in the hospital. Li Li remembers that when she was a student, this stomatological hospital was not well-known among nurses, and all the students from junior colleges went to large public general hospitals with better pay.

Six or seven years ago, Hohhot Stomatological Hospital embarked on the fast lane of rapid development. In 2017, it was approved as the "core unit of the National Center for Clinical Medicine of Stomatology", and passed the top three evaluation in December 2018, becoming the only public top three stomatological hospital in Inner Mongolia Autonomous Region, and was awarded the excellent performance appraisal unit of municipal institutions in the next year. According to the official website information of the hospital, the business volume of the hospital increased by 631.4% in 2020 compared with that in 2012. In the performance appraisal of the national tertiary public hospitals in that year, Hohhot Stomatological Hospital ranked 28th in the national tertiary public stomatological hospital.

Perhaps due to the rapid growth of business volume, Hohhot Stomatological Hospital started a wave of large-scale recruitment. According to its WeChat official account information, the hospital issued five recruitment announcements from 2018 to 2020, recruiting dozens of medical staff. At that time, nursing education only required junior college. Most of the nurses who were forced to "leave" this time entered the hospital in two large-scale recruitment in 2020.

Li Li was born in the countryside around Hohhot. Her father was a truck driver, her mother was a housewife, and her parents’ education level was less than junior high school. Li Li followed her parents to work in the city since she was a child, lived a poor life and rented a house. Her primary school and junior high school were both studying in Hohhot, but because she failed to settle down in the city, the senior high school had to go back to the county near her hometown to study, and in 2016, she was admitted to a junior college nursing major in Inner Mongolia.

Li Li chose nursing major at that time because of "good employment". According to the statistics of the National Health and Family Planning Commission (now the National Health and Hygiene Commission), by the end of 2015, the total number of registered nurses in China was 3.241 million, and the national doctor-nurse ratio was only 1∶1.07, which just reached parity, and there was still a great gap in the demand for nurses. At that time, the qualifications of nurses were mainly secondary school students and junior college students, and nurses with bachelor degree or above only accounted for 14.6%. Nursing major is an excellent choice for rural children with low education like Li Li. "I don’t have to worry about finding a job, I can go to a big hospital, and my income is stable."

But when Li Li graduated in 2019, the situation in the job market has changed. "I have signed up for several public top three hospitals, and the competition is particularly fierce. Hundreds of people compete for several positions. The most exaggerated one even recruits 20 people with more than 3,000 people." Li Li took part in three or four written tests in public hospitals, but failed to make the shortlist, so she had to work in a private dental clinic first.

Rollin Wang, another nurse who joined in the same period, recalled that in 2020, there were more than 70 nurses recruited in two batches, and their life trajectories were very similar-most of them came from rural areas in Inner Mongolia or migrant workers’ families in Hohhot, and graduated from technical secondary schools or junior colleges. In addition to the fresh graduates, there are some former graduates who have been employed in private dental clinics and township health clinics, and signed up after seeing the recruitment information of stomatological hospitals. It was through this channel that Rollin Wang successfully passed the written examination and interview, and became a nurse in this public 3A stomatological hospital.

"I felt very lucky at the time." Rollin Wang said that among the college students in the same period, only about 10% were able to go to public 3A hospitals. Compared with large general hospitals, stomatological hospitals are not high in work intensity, and there are almost no night shifts; Compared with private clinics, nurses will not be assigned sales tasks, there is no performance pressure, and their positions are more stable.

Working in a stomatological hospital, Rollin Wang often stops for a whole day, but because she likes it, she seldom feels tired. Her job is mainly to clean and prepare instruments, and provide timely assistance to doctors according to patients’ different conditions. Years of four-handed operation (the work of stomatology needs doctors and nurses to work together) have formed a solid tacit understanding with doctors in departments. "Basically, I can predict the next operation of doctors, and I can know what they need with one look."

As the only public top three stomatological hospital in Inner Mongolia Autonomous Region, there are a lot of tourists here. Many nurses recalled that during the three-year epidemic, the traffic of stomatological hospitals was still growing, and many patients came from other counties and cities in the province. "After 8: 00 in the morning, it is difficult to get the number. The waiting room is full from morning till night, and the doctors in the outpatient department have to work overtime for an hour or two every day to finish reading it." In the second half of 2022, due to the outbreak of the epidemic in Inner Mongolia Autonomous Region, the hospital stopped for about three months, but even so, Rollin Wang remembered that in 2022, the leader mentioned in his year-end speech that the hospital still made a profit of nearly 5 million, which was "rare among peers". Nurses recalled that during their work, their monthly performance income rose by nearly 1000 yuan every year.

Because they "cherish" this job, the nurses have been waiting patiently for the job. However, at the end of July and the beginning of August, 2023, Hohhot Stomatological Hospital passed the third-class review, and was upgraded from a municipal hospital to a provincial hospital, renamed "Inner Mongolia Stomatological Hospital". It was also around this time that the hospital leaders told the nurses that "the contract will not be renewed when it expires".

In October, 2023, Stomatological Hospital issued a new announcement on the selection of human resources service companies to undertake personnel recruitment and examination services. More than a month later, the hospital issued a recruitment announcement again, recruiting personnel with filing system, including 58 nurses, but requiring full-time undergraduate education or above. This made Li Li more worried about her future. She found it difficult to find another job as a nurse in a public hospital. "Most of our nurses are now in their 30s. I am old and the time has passed. I really don’t know where else to go. "

In the job market of nursing specialty, the water temperature has been changing. One of the most obvious changes is in the academic requirements.

After combing the recruitment announcements of contract staff in nine hospitals affiliated to the Health and Health Commission of Hohhot, we found that from 2014 to 2018, only one hospital required nurses to have a bachelor’s degree or above, but from 2019 to 2023, most hospitals upgraded the requirements of nurses’ academic qualifications to a bachelor’s degree, and the number of specialist registration positions was obviously limited. After 2023, all three hospitals that publish nurse recruitment information require a bachelor’s degree or above.

At the same time, the academic structure of nurses is also changing. According to the data of National Health Commission, in 2022, 30.4% of nurses in China had bachelor degree or above, while in 2015, only 14.6% had bachelor degree or above. The expansion of academic qualifications has brought about an overall rise in the hospital’s recruitment requirements for nurses. Many graduating nursing college students told this magazine that in the past two years, public top three hospitals in first-tier cities and provincial capitals have almost stopped recruiting college students. A college student in Guangzhou said: "In the past, three or four offer were randomly selected, but now the junior three can’t get in, and even the mental hospital in my hometown (Shantou) has to be an undergraduate."

A student from Fujian College told us that only 10% of the outstanding students in the class can find jobs in public top-three hospitals, and some students are diverted to ordinary public hospitals in small cities in the fourth and fifth lines, but half of them still failed to get an offer, and they were unsuccessful in exams in which thousands of people competed. Some students choose to continue to upgrade their academic qualifications, but cruelly, many hospitals will indicate in their recruitment announcements that they "do not accept undergraduate courses".

Some well-known hospitals have higher academic requirements for nursing staff than undergraduate courses. In November, 2023, the academic requirements for recruiting nursing staff in some positions in the Second Hospital of West China were Master’s degree, which caused public outcry. According to the data of official website of West China Second Hospital, as of December 2022, there were 1,600 nurses in the nursing department of the hospital, with a total of 1,295 undergraduate degrees, accounting for 81%; There are 107 graduate students, accounting for 7%, including 7 doctors.

In this dispute over nurses’ resignation, Da Mou, president of Inner Mongolia Stomatological Hospital, said that the Hohhot Health and Health Commission is taking the lead in solving the employment problem of these nurses, providing some posts in community hospitals, township health clinics and private stomatological clinics, and recommending nurses to compete for employment. However, many nurses said that they still want to continue to work in the stomatological hospital, which has both practical considerations and emotional needs. Rollin Wang expressed a sense of disappointment and anger at being abandoned: "We have survived the epidemic with the hospital and the top three review, but now we are forced to leave."

What puzzles these nurses who are caught in the resignation dispute is, is it true that their years of work experience in stomatology is not as valuable as their academic qualifications? Nurses are not "sophisticated" but more practical jobs. Should academic qualifications be used as a one-size-fits-all entry threshold?

Shao Dongsheng used to work in Beijing Stomatological Hospital, and now he is the director of Beijing Xinhe Dental Clinic, Prosthetic Department and Implant Department, with nearly 20 years’ experience. In his view, if a new nurse is not majoring in oral nursing or stomatology, but graduated from a general clinical major, it will take at least one to two years of training to become a qualified oral nurse: "A good oral nurse, you should know everything the doctor knows, the difference is that you can’t do it. Just say that pulling out a tooth, different dental conditions, what anesthetic to prepare, how much to use, what needles and instruments to use, you must be clear, you can’t wait for the doctor to say, otherwise it will prolong the tooth extraction time and aggravate the patient’s fear. "

Yuan Tian, a nurse who has worked in Inner Mongolia Stomatological Hospital for several years, is also one of the nurses who were forced to leave this time. After the contract expired, the hospital asked an experienced old nurse like her to stay for two more months and bring out the "new nurse". On one occasion, during tooth extraction, the patient swallowed and inhaled by mistake and went into anaphylactic shock. The new nurse was at a loss and almost missed the golden first aid time. "It’s just a work detail. It’s not easy to take a model for the patient, but it takes a long time to practice to take out a complete tooth model without making the patient sick and hurting his mouth."

In the interview with our reporter, many doctors in stomatology believe that the service level of nurses in this specialty is higher, and the service level is largely derived from the familiarity of the business, not the absolute level of education-the stomatology specialty requires doctors and nurses to operate with four hands, and the old nurses are familiar with the doctor’s treatment process and operating habits, but the new nurses are unfamiliar with the business, which will prolong the treatment time and reduce the sense of experience. "A very good nurse in our department is a college degree. After working here for five or six years, one person can top 10 people. When the doctor is busy, she will collect patients’ information and condition in advance, coordinate patients to go to different departments for examination, and give the most efficient plan according to the flow of people in the hospital. After the doctor finishes the treatment, she will also take the initiative to explain the precautions to the patient, and continue to observe and pay a return visit. But among young nurses nowadays, it is becoming more and more scarce to do this. " The chief physician of a public 3A stomatological hospital said.

China Hospital Talent Management and Discipline Management Committee is a think tank dedicated to the multi-dimensional connotation construction of hospitals. Its chairman Han Gendong and the nursing discipline health evaluation class Yang Mingying told this magazine that there are actually other solutions for experienced and outstanding medical staff with low academic qualifications, instead of repaying them across the board. Although in order to realize the positioning of "providing care for difficult and critically ill patients", the requirements of tertiary hospitals for nurses’ academic qualifications are generally higher, but for nurses with low academic qualifications who have been employed, they encourage hospitals to adopt the following strategies: "First, cooperate with relevant educational institutions to provide on-the-job education opportunities for medical staff with low academic qualifications, such as adult education, evening classes, self-study exams, etc.; Second, organize regular internal training, including professional knowledge, operational skills, communication skills and other content, to enhance their professional ability and comprehensive quality; Third, formulate appropriate professional title promotion policies to encourage low-educated medical staff to improve their own level. "

Damou, president of Inner Mongolia Stomatological Hospital, said that if nurses want to come back to work, the only way is to upgrade their academic qualifications and then participate in the open recruitment of hospitals. However, a "college-upgraded" nurse told this magazine that she had consulted the hospital personnel department about whether her education was qualified or not, but she was still rejected. "Personnel said that the first education must be a full-time undergraduate."

(At the request of the interviewee, Li Li, Rollin Wang and Yuan Tian are pseudonyms.)