in Graziano Lebiu
19 DIC – Dear Director,
the current legislative provisions which provide for, and allow, that Medical Health Managers can opt for an exclusive employment relationship by choosing to carry out freelance activities within a health care company, declined in a nursing key, are developing a rather mass distraction debate which gives a context that is actually useful and achievable.
In fact, intramoenia is not the only or main perspective of many nurses who contribute to sustaining the fate of the health system in a significant way.
They aspire to a different freedom of action and in professional action which does not resolve itself, precisely, in the intra-building activity alone but which can materialize, in the exercise of the free profession also for public employees belonging to the organic endowments as nursing professional collaborators.
Exactly, and without any distinction, as arranged for the medical health management.
The provision of the exclusivity of the employment relationship tends to avoid a conflict of interest between a civil servant and the public administration, and if the right of the medical director to exercise the intra-mural “freelance” activity is established, also for the purpose of legitimate ambitions economic and professional growth, this right must in any case be recognized, and financed, also for the public health employee who is a nurse.
The goal is to reduce the inequality between professions and professionals, i.e. creating conditions that are not totally or partially incompatible with the exercise of the extra-institutional nursing “free profession”, therefore possible beyond the 36 weekly contractual hours, therefore outside the establishment hospital or territorial service, therefore among citizens.
Among citizens, the free extra-institutional nursing profession would also respect the constitutionally protected principles of guaranteeing them uniformity and universality in the answers to health questions.
In my opinion, the current debate is misleading when it does not clarify or would like to imply that the intra-mural freelance activity within the public administration and therefore in a subordinate position is also to be understood as a form equivalent to the free profession extramoenia. It’s not like that.
Free-lance intra-mural activity can be carried out by healthcare professionals on an exclusive employment basis and in compliance with the organizational methods established by the company.
Freelance extra-walls is the one that can be exercised by healthcare professionals with a non-exclusive employment relationship, has no volume limits, has no conditions, allows you to have a VAT number, is a free profession in the most complete sense of the term.
It also emerges significantly from the different tax regime between the two activities, which from an administrative-accounting point of view cannot be assimilated.
In distinguishing the contexts mentioned above, it should also be taken into consideration, and not secondarily, that among the purposes of carrying out the freelance intra-moenia medica activity, there are to streamline the waiting lists and to obtain additional economic resources for the public service.
A free-lance nursing activity within the walls would certainly represent a possibility of diversifying the institutional offer, but it would not streamline waiting lists and would not bring significant economic resources to the meager coffers of the NHS and the SSR.
Both to overcome the resistant “hospital-centric” paradigm as a place of care and assistance which in the collective imagination revolves around the medical director alone, and to definitively bridge the gap of personal growth, professional recognition, career ambitions, progression economic and social identification, the rebalancing between rights must be accepted, with the total cessation of the exclusivity bond also for nurses, precisely by virtue of the existence of exclusive elements characterizing the services rendered to citizens in carrying out the exercise of an intellectual health profession exactly superimposable to the other health profession of excellence.
If the public employee and freelance medical executive does not violate the duty of loyalty to the public administration, it is not clear why a profession of equal rank in the medical area such as nursing should be incidentally “authorised” to exercise beyond the contractual mandate rather than carried out autonomously for a formal and legislative recognition and not through the kind and discretionary concession of officials, very diligent in denying and in pursuing, contesting and often sanctioning even irrelevant contexts of unauthorized extra-institutional activities.
In conclusion, therefore, it is not only with the easing of the exclusivity constraint referring only to the provision of the intramoenia freelance activity that we will level the nursing profession compared to the medical area.
This reduction of the cultural and regulatory gap, this run-up to equal professional opportunities and economic treatment, this achievement of equal dignity between professions and professionals, will be possible by guaranteeing the freelance profession outside the contractual 36 hours per week referred to in the health sector: I public nurse employee of a public health company administration, I am available to practice exclusively in the company at increasing and guaranteed pay and organizational conditions.
Failing that or alternatively, beyond the contractual minimum of the service to be rendered weekly, I must automatically be authorized to freelance if, where, how, when I, an intellectual healthcare provider, indicate according to my skills and my knowledge.
In doing so, the profession referred to in the profiles of nurses and pediatric nurses is made attractive again, and more attractive among others, because it will be possible not to remain trapped indefinitely in the contradictions of the CCNL and the CIA, for which the the substance is that one is worth one and no effective differentiation of values and merit among professionals is possible due to the recurring, indistinct and structural fallout of almost all economic incentive forecasts, both because career progression is in fact, at the moment , a utopia.
The exclusivity allowance with annual values, gross and inclusive of the thirteenth month salary for those who opt for intramural activity as an act of “loyalty” in the context of employment relationships which imply total availability for institutional activity, would also fill a pay gap.
But even those who give up wanting to get involved because extra institutionally one is not worth one but measures himself against the others, bets on himself and on the rights of the citizens to whom he addresses himself in a different guise fills an economic gap.
Graziano Lebiu
Male nurse
Opi President of Carbonia Iglesias
December 19, 2022
© breaking latest news
Other articles in Letters to the editor
