“I worked as a nurse in Georgia for 30 years. I participated in the reform of the primary healthcare system. I worked as a family nurse and a trainer-teacher. But the state does not support the salary motivation of nurses. The same situation is in clinics. Due to the descending salary, nurses have to work in several clinics in order to earn a minimum wage to survive… 1000 GEL at least. They work at night, almost unable to work… This is not news… There showed it on TV many times, there is no result. That is why nursing staff is emigrating. Soon a qualified Georgian nurse will be hard to find… I have also emigrated.”
This is how a nurse responded to a question from Aprili Media in one of the Facebook groups. The message was anonymous, but the point was clear.
Inadequate pay, overtime work, overloaded work schedules, inappropriate patient-to-nurse ratios — according to various studies and reports, over the years, the main problems that nurses have faced and continue to face in their daily work have accumulated and recurred. It is these unresolved problems that have forced many of them to change their fields of work, and many to leave the country.
According to the World Health Organization, 90% of nurses globally are women. This speaks to both the gender pay gap and other forms of gender discrimination in the workplace. In general, because care work is associated with “women’s work,” and the majority of those employed in education, health, and social work are women, these sectors are often associated with low-paid work.
Why nurses are leaving this profession and the country, what concerns and desires they have, and what statistics tell us — in this article we will tell you about the working conditions of nurses.
“Let’s emphasize that I’ve been talking about this for over two years, and nothing has changed to this day,” Ia Kheladze tells us before the interview begins. She has been working as a nurse for 15 years.
She believes that neither now nor in the past, under any government, has the medical field been valued and provided with adequate conditions. However, she says that she loves this job so much that she can’t leave it.
“When I first started working in this field, the salary wasn’t high, but the workload wasn’t either… Over the years, the salary was low, but the number of patients was increasing and increasing… When I started working as a nurse, my salary was 200 GEL, but current prices can’t compare to that.”
Ia now works a 24-hour schedule, every other day. She tells us that there was a period when she had three jobs. Her children often ask her not to work or to change her profession. She says that it is impossible to make a decent living in the medical field today.
“You can’t find a nurse who works only one job. Because of the salaries, everyone is employed in two, three jobs. When we contact each other, there is one problem everywhere — many patients and few nurses. And this is not just because there is a shortage of staff or because few are studying this profession […] Clinics are economizing and reducing staff.”
With the number of assistants and nurses reduced, patient safety will no longer be guaranteed, Ia tells us. A nurse may have to work at least 8 shifts, or eight nights, during a month, but if she works in two or three places, she can expect 16 shifts. Those who guard the health of others do not have the time or finances to take care of their own health.
“The biggest problem is that we, the medical staff, do not have medical insurance, and if we need basic tests, we will have to pay from our minimum salaries. In fact, we are unable to take care of our health.”
Although compensation is very important, salary is not what worries her the most — she wants to have the kind of work capacity that her patients need.
“What worries me the most is that patients are often dissatisfied because we are physically unable to provide them with the care they need […] I remember a case from pediatrics, I had 12 patients. I received a complaint because I was unable to give one of them an inhalation the other one needed it more. The patient did not understand this. It is true — they are in the clinic because they need service […] But I could not do it, I had too many patients.”
She says that this problem was even more noticeable during Covid. At that time, patients mainly had breathing difficulties and were dependent on oxygen.
“I was there where the patient needed me the most, but another patient also had a complaint that I should be there with them. Even today, there is often such a complaint: why are you not there where the patient needs you? You can’t be there because you physically can’t do it — you are one and have two arms and two legs, you just can’t do it.”
According to the National Statistics Service of Georgia, the number of nursing personnel in 2023 was 21,000. From 2016 to 2021, the number of nurses increased slightly, but after 2021 it has been decreasing. It is noteworthy that the decrease is related to the post-Covid period.
“The Covid period took its toll on nurses, we went through the most difficult period,” says senior nurse Natia Tsanava. The number of patients increased, medical staff was insufficient, roads were blocked, transportation was complicated, and responsibility increased — this is how she describes the Covid period.
“We often provided nurses with our own funds, we also put up money so that they could bring us a nurse […] For three months, it was not possible to bring a nurse to the clinic — as you know, nurses work on a very minimal salary, and for three months, some had to be brought from Kaspi, some from Gori […] our car was physically unable to go and could not be brought. The nurse, the head nurse, we all worked with the patients, as well as cleaning. We did everything — in addition to taking care of the patient, we had additional work.”
Covid has made the problems more visible, although stories about unfavorable working conditions in the healthcare sector, the shortage of nurses, and other challenges had been circulating before that. For example, to create a space for the study, analysis, and discussion of nurses’ work, the trade union Solidarity Network conducted a study “Nurses’ Working Conditions in Georgia” — the organization surveyed 200 nurses and orderlies in ten different institutions in 2018.
This document shows that while according to international standards, one nurse is assigned to an average of 4 patients (depending on the hospital and department), in Georgia, one nurse often has to care for 11 or more patients.
“The workload, responsibility, and psychological stress are quite high, especially for nurses. The shortage of staff and the large volume of work force nurses to prioritize what work to do, who to devote more time to, whose pain to think about, and so on,” the document reads.
Survey respondents cited salary, workload, physical strain, staff shortages, and unappreciated work as the main reasons for leaving their jobs.
The document also states that from the beginning of a patient’s treatment, after the doctor writes a prescription, the workload and responsibility completely shifts to the nurse, and it is the nurses who carry out the doctor’s prescription:
- They care for the patient both physically and mentally;
- They complete patient documentation;
- They keep records of medications;
- They organize the wards and manipulation tools;
- Patients undergo necessary examinations;
- They perform the manipulations prescribed by the doctor.
The working conditions and social guarantees of female nurses are also assessed in the report “ Key Challenges of the Social Protection System for Various Vulnerable Groups in Georgia” published by the Coalition for Equality in 2022.
Overtime work, inadequate pay, work during Covid, the absence of social policies for nurses – these issues are mainly discussed in this document.
“When talking about the difficult working conditions of nurses, it is also necessary to mention the problem of nurses not properly using the leave established by law. According to the focus group participants, if a colleague goes on leave, their work schedule almost doubles. The amount of their shift increases due to the distribution of work to be performed by the employee who went on leave, and additional work performed is not compensated. Due to established practice, it can be said that nurses cannot use their own leave, which is determined by the Labor Code. They have to use their leave at the expense of each other’s extra hours of work.”
Natia Tsanava says that some clinics have paid leave, but they don’t have a replacement for nurses to take advantage of this right.
“Sometimes it happens that you have to cover for someone first, then she has to cover for you, which results in a double workload. As for the bulletin, in some places it is paid, but exactly how much they pay you is always unclear. In some clinics they say that if you only have one staff, in that case both the bulletin and the vacation are paid, but in Georgia, as you know, no one has one staff, that is, everyone has additional shifts because of the money.”
Natia worked in several clinics from 2008 to 2024 as a nurse and senior nurse. After 16 years of work in Georgia, she moved to Germany. This decision turned out to be very difficult and stressful. She says that it is good abroad, but she was satisfied with working in her country, with her colleagues, and if the salary was adequate and decent, she would never have left.
“I simply had no other choice. I worked in several clinics, but the salary is the same everywhere, no matter where you go. And you have to work hard everywhere. In addition, you are responsible for everything and everyone […] It can last a year, two, three — in my case, it lasted 16 years, but then you just can’t continue all this anymore and you need money to continue living. You leave your health there, you are there forever.”
Natia recalls that since she was a senior nurse, her work was supposed to end at five o’clock, but she rarely left the clinic at that time — she left work at eight o’clock, ten at night, twelve, two… She even spent several days at the clinic.
“They ask why you’re here, even to the director. So you can’t do your job? How can I not do it, but I perform the duties of a head nurse during the day, and then when a patient is in trouble and a nurse needs help, I can’t help but come. So my time is spent on this, because I don’t have enough nurses.”
Some nurses emigrate for decent conditions, while others find work in other fields.
“Most nurses went into cosmetology. The job is not stressful, the salary is higher. In general, such nurses left the profession that they could not be sent abroad or to another sector. […] No one wants to go back to medicine, because it is impossible for a person to leave their children at home and come to the clinic for 600 GEL, work a shift, and the next day take perfect care of the child.”
Natia worked in Germany for a year and three months in her own profession. Since the diploma recognition procedure was not completed, she had not yet been assigned a salary as a nurse, although she was able to support herself in Germany with that salary and send it to her family. Now she is in Georgia and already has offers from clinics, although she says she will not start working because the conditions have not improved and have even worsened. She plans to return to work in Germany.
“It may sound harsh, but I sacrificed my time and health for this job […] I worked as a nurse in several clinics in Georgia and the maximum salary was 5 GEL per hour. In the end, I was earning 1200-1400 GEL per month, I have never had more than that […] As for Germany, a nurse has 3000-3500 euros, a senior nurse — about 5000-5500 […] A nurse in Georgia does not have 600-700 GEL as travel money, and when they go to Germany with their family, husband, children, they have to pay for the apartment tax, other taxes, they come and go to Georgia and support themselves […] How do they survive and what do we survive on? We do not have this salary for anything .”
She thinks that there may not be exactly the same salary in Georgia, but the pay and schedule should be such that people find it worthwhile to work and emigration is not the only solution. She also emphasizes that in addition to physical fatigue, the work of nurses is also emotional and stressful.
“Children [patients] are like that, it’s impossible to say you’re tired. You can’t, you don’t have the right to do that — you see, someone’s child is dying […] It’s very stressful for you too, it destroys a person, especially if you can’t do something and there’s no way to do it.”
Studies conducted on the work of nurses show that during a shortage of nurses, not only the health of patients but also the health of nurses is at risk – there are frequent cases of “burnout” and omission of various medical procedures, and the risk of developing occupational diseases increases.
The problematic nurse-patient ratio is also described in the Healthcare Barometer, published by the international foundation Curatio in 2022. According to the document, Georgia significantly lags behind the European average in the number of people employed in the healthcare sector:
The State Audit Office’s 2023 performance audit also revealed that there is a shortage of nurses in the Georgian healthcare system . In the same year, the first stage of the mandatory minimum hourly wage reform for medical personnel began, according to which the minimum wage for doctors was set at 7 GEL per hour (at least 1,260 GEL per month), and for nurses at 4.4 GEL per hour (at least 792 GEL per month).
The Ministry of Health has also announced the expansion of the hourly minimum wage reform for medical personnel, effective January 1, 2024. According to the ministry, the minimum wage threshold will be set for medical personnel employed in the following positions:
- Junior doctor – at least 960 GEL per month (5 GEL per hour);
- Nursing assistant – at least 672 GEL per month (3.5 GEL per hour);
- Midwife – at least 844 GEL per month (4.4 GEL per hour);
- Sanitation — at least 576 GEL per month (3 GEL per hour);
“How can I get a job in Germany, what are the conditions, can you record a video about being a nurse? Is there any chance for someone with a midwifery diploma to start working as a nurse? What program are you there with? Should I come to Germany? Is it worth coming?” — Salome Chokoshvili, a nurse who has been working in Germany for the past year, is asked.
In response to these questions, she created a platform on social networks and now publishes informational videos related to the medical field and living and working in Germany.
“It’s a bit difficult to keep track of so many incoming messages and respond to everyone, repeating the same thing every day, several times a day. This led me to the conclusion that I should record videos where I would simply share honestly the path that people can take.”
Salome worked as a nurse in Georgia for a year before moving to Germany. She says she was lucky both in the clinic where she was employed and in the colleagues she worked with here. However, she decided to move to Germany for professional development and advancement.
“I don’t have much practical experience. I try to deepen my theoretical knowledge every day, because medicine is constantly developing. Health is the most precious thing to me, and I want to help people maintain this most precious thing. This has been my motivation since childhood, why I chose the medical field.”
Modern medical technologies and interest in what is happening in other countries in this field, as well as better pay — these three factors made working in Germany interesting for Salome. She has been there for a year now and the difference is very clear.
“For example, in Georgia, a nurse is responsible for a lot. There are many manipulations and interventions that a doctor does in Germany […] In Germany, a nurse is defined as a person/professional who cares for a patient, and here so many manipulations and medical professional interventions are not included in your duties. The duties of a doctor and a nurse never intersect, they are sharply separated.”
While it is unusual for Georgian nurses to have fewer responsibilities, their German colleagues are amazed by the comprehensive knowledge and experience of Georgians, says Salome.
Nevertheless, you still have to start life in another country from scratch — the Georgian nursing diploma is not equivalent to the German one, so you may have to work as a nursing assistant first. It also takes a certain period of time for the diploma to be recognized. Added to this is the language barrier and various exams. Salome is new there, so she is currently a nursing assistant and is now waiting for the exam.
“When you are a beginner, a trainee, you consider yourself a nurse’s assistant, the salary after taxes ranges from 1,500 to 2,500 euros. When you are already a nurse, it starts from 2,500 euros to about 4,000 euros […] I note once again that the salary of Georgians and the salary of locals are different. In general, the salary of “arrivers”, so to speak, is different, because the locals have more experience and knowledge.”
In Germany, the scheme of promotion and development in the profession is also different. Therefore, the salary may depend on the direction. Salome now works in the cardiology department and is satisfied with both the direction and the work with colleagues. She thinks that she will connect the future with this field. In parallel with professional development, she also continues to record and share informational videos and advises people not to trust all employers in the market, because many lie.
The Ministry of Health itself identifies the shortage of nurses in Georgia as one of the main problems in the field. According to the 2024 Action Plan, by 2030 there will be twice as many nurses as doctors in medical institutions. It is also planned to include nurses in the continuing education system. However, for now, all this remains a distant plan, and the situation is as follows: nurses emigrate or change their field, and those who remain in the profession continue to work with a more hectic regime and inadequate pay. The fatigue and burnout of nurses due to unsuitable conditions directly affects the quality of service and the health of patients.