How Nursing is Overlooked in Ukraine’s Healthcare Crisis

Iryna (not her real name) is a 49-year-old nurse in a paediatric emergency and infectious diseases department in a hospital in central Ukraine. Despite her 28 years of experience, she earns just 14,000 hryvnia (€298) a month for a full-time nursing position. She described her situation:

I cry very often, probably because of stress and cortisol [...] It’s a kind of despair, you know, there’s this psychological term ‘frustration’ – it’s a negative emotion you feel when a goal isn’t achieved. After 28 years, everyone should have something to show for it. And I realise that [for me] these 28 years [have gone] down the drain. You seem to be a smart person and you do very useful work, but something just feels wrong. Ah, burnout. Yes. That’s the word I was looking for. Emotional and physical.

To explore the work and lives of Ukrainian nurses amid the war with Russia and structural reforms in Ukraine’s healthcare system, this author and two other sociologists, together with the nurses’ association Be Like Us Medical Movement, conducted 48 in-depth interviews with nurses in 2024. The study revealed how deregulation has affected nurses across specialisations, regions, and institutions, with impacts on their daily routines, workloads, and private lives. The evidence shows why restoring national workload standards is crucial to preventing the collapse of Ukraine’s healthcare infrastructure.

Healthcare reform

In 2016, Ukraine launched a healthcare reform that changed the funding rules for public healthcare institutions and their management model. High-profile measures, such as the consolidation of hospitals and the closure of healthcare facilities, attracted attention and even public protests in some cities. But another critical aspect of the reform – its impact on nurses – was largely overlooked.

As part of this reform, national workload standards for nurses were abolished. Although these standards had previously been inconsistently enforced, their removal created legal uncertainty about nurses’ responsibilities in state and municipal healthcare institutions – a development we refer to in our research as the deregulation of nursing care.

In 2020, a second stage of the reform introduced a new funding mechanism. Hospitals began receiving money based on so-called care packages that comprise the number and type of services delivered. These packages include specific requirements for doctors and medical equipment but offer little to no guidance on staffing for mid-level or junior personnel. This regulatory gap has allowed hospitals that face financial pressure to significantly reduce nursing staff, intensifying the workloads of those who remain.

Increasing workloads

In this way, hospitals gained the autonomy to decide how many nurses to hire and how much work they could do. Amid budget constraints, this often meant doing more with fewer staff, resulting in the spread of overtime. But a far more common and insidious problem, especially for nurses in inpatient facilities or emergency care, was more intensive work. This trend manifested itself not only in more patients per nurse but also in an expanded range of responsibilities. For instance, emergency nurses expressed frustration about having to wash ambulances because their employers were unable to hire junior medical staff.

Anecdotal evidence highlights the occupational safety risks of such multitasking. One of the nurses we interviewed said that their hospital had laid off many orderlies and technical personnel and contracted a cleaning company to clean the hospital rooms. However, the company’s workers did not engage in daily hygiene support tasks, such as changing bedpans. So, work previously done by orderlies had to be carried out by nurses, alongside other tasks that fall within their actual duties, such as injections, that require high hygiene standards.

In interviews with nurses in mental health facilities and addiction treatment centres, it was not uncommon to encounter cases where, at night, only one nurse, accompanied by an orderly, was on duty for the entire ward. Our interviewees also reported a lack of adequate physical safety at work, especially during night shifts.

Collective employment agreements should have protected nurses from performing tasks outside their job descriptions without additional pay. But in practice, these agreements could be ignored, and nurses could even be barred from reviewing them. It appears that nurses often have little say in shaping these documents and even less knowledge of what they contain.

An exhausting vicious cycle

Increasing workloads and significant emotional strain are key factors behind the widespread feelings of exhaustion and burnout reported by our interviewees. The psycho-emotional state described by many shows signs of compassion fatigue, a condition that can develop among professionals whose work involves caring for others, especially those who are in pain or have experienced trauma. This severe emotional exhaustion negatively affects nurses’ ability to care for patients and perform their professional duties, and is one of the reasons many eventually leave the profession.

Many interviewees saw their low pay as a symbol of the way nursing work has been devalued and made invisible. Nurses’ limited options to influence their workload or refuse additional tasks or patients gave many a sense of injustice and powerlessness.

Our study showed how a vicious cycle takes hold: low salaries, increasing workloads, physically and emotionally intense work, a lack of funding, and administrative decisions drive nurses and junior medical staff to leave the public sector or the profession entirely. Those who remain then face even greater workloads and worse working conditions, which provoke a further outflow of personnel. The World Health Organisation estimates that the number of nurses in Ukraine fell by 30 per cent between 2015 and 2022.

Restoring the foundations of care

The quality of medical care depends on having enough nurses who can perform the work they are trained to do. Therefore, it is critical to increase the number of mid-level medical staff, fill vacancies in healthcare facilities, and establish clear, nationwide standards to regulate nurses’ workloads. These steps could help nurses fully and effectively carry out their duties, contributing to better-quality healthcare and reducing the outflow of nurses from the sector. If these challenges are not addressed in time, the cancellations of surgical procedures reported in our study because of a lack of mid-level staff may become increasingly common in the coming decade.

Nataliia Lomonosova is a fellow at the Ukraine Research Network@ZOiS, funded by the Federal Ministry of Research, Technology, and Space. She recently co-authored the study ‘One for Three: How Ukrainian Nurses Work’