Alarming increase in industrial action by nurses is a symptom of global crisis in healthcare systems

Photo Credit: monitor.co.ug

The International Council of Nurses (ICN) says the alarming rise in the number of nurses taking strike action across the world is a direct response to governments’ failure to tackle the root causes of our fragile, severely weakened, and in some cases collapsing healthcare systems. Across the globe ICN has identified numerous examples of nurses engaged in industrial action over a range of basic issues including safety, security and protection, all of which jeopardise both healthcare staff and patients.

One of the fundamental root causes is the global shortage of nurses, which is putting unsustainable pressure on the nurses currently working in healthcare systems that have been disrupted by staff shortages, the COVID-19 pandemic and historical chronic underfunding. These pre-existing shortages have led to a worrying increase in industrial disputes and strikes – for example a report from Cornell University’s ILR Worker Institute shows that half of all strikes in the United States in 2021 were of workers in healthcare settings, and this Saturday 18 June nurses in Spain will hold a nationwide demonstration. Among other examples, ICN has pinpointed nurse actions in Europe, the Americas and Africa.

ICN President Pamela Cipriano said: “Industrial action by nurses is always a last resort, but it is not surprising it is happening, given the state of the health systems nurses are having to work in, which do not enable them to deliver the high-quality care they expect to. This is because of the pressures they are working under, the lack of value and recognition they receive, historic inequities related to gender, and poor pay and working conditions.

‘These past two years have taught the world just how important nursing care is to our health and our social and economic wellbeing, but the lessons learned are not been heeded by the people with the power to make a difference to the state of their health systems, the quality of patient care and the lives of nurses everywhere.”

Ahead of a meeting with the President of the United Nations General Assembly, Abdulla Shahid, at the Palais Nations in Geneva, ICN Chief Executive Officer Howard Catton said:

“ICN is calling out governments for not tackling the roots of the unrest in our healthcare systems which are fragile, severely weakened and in some cases bordering on collapse. Instead of papering over the cracks they must address the fundamental issues of inequality and gross underfunding which have led to lack of fair pay, shortages and increased risks to patient safety.”

In his statement to Mr Shahid, Mr Catton said:

“ICN believes that the current greatest threat to global health is workforce shortages. With a global shortage of six million nurses and 18 million healthcare workers before the pandemic, we are now seeing increased turnover and quit rates which are highly likely to increase these numbers. This matters because there is no healthcare without a healthcare workforce.

‘The pandemic powerfully demonstrated that our health and our economic welfare are inextricably linked. Spending on healthcare is not a cost, but a cast-iron investment that brings huge returns. If we do not make the investments to grow and strengthen our global health workforce, we will continue to struggle economically, and access to high-quality healthcare for all will remain nothing but a pipe dream.” Read full statement here

Nursing strike in Spain

This Saturday on 18th June, thousands of nurses in Madrid, Spain will be demonstrating to demand urgent improvements to the Spanish healthcare system and the working conditions of the professionals who work in it. They will also be denouncing the apathy and disinterest of the public and political authorities. The demonstration, convened by Unidad Enfermera, will draw attention to patients being at risk because of the lack of safety in healthcare due to insufficient numbers of nurses.

The Spanish nurses will also denounce the serious problem of aggression, both physical and verbal, which is suffered by nurses in Spain on a daily basis, and demand safe working environments that protect their physical, psychological and emotional integrity.

Mass resignations in Finland

Meanwhile, nurses in Finland are preparing for even more decisive action after a long-running dispute over pay and working conditions with employers, and new legislation from the Finnish government that would have made nurses’ industrial action illegal.

Trade unions Tehy and SuPer in Finland held a strike in April to call for decent salaries and working conditions. See here for details. A second two-week strike planned for April was cancelled because of the threat of the new law, the process of which through the Finnish parliament has been suspended.

Now, instead of planning further strikes, Finnish nursing unions are scheduling mass resignations, possibly later in the autumn, if an acceptable negotiation solution is not reached before then, to show the strength of their feelings and their determination not to allow the current situation to continue.

The two nursing unions say that if the new Patient Safety Act were enacted striking nurses could be ordered back to work on the grounds of ensuring patient safety.

Employers have said the unions’ did not provide safe staffing levels during previous disputes and that their plans for mass resignations are ‘completely irresponsible.’ The unions deny that and say that during the strike staffing levels were at some units even better than usual. They say that patient safety is in danger every day during the current lack of nurses, and this should be the main worry of the politicians and employers, not the legal strikes.

Anna Suutarla, Head of International Affairs at the Finnish Nurses Association (FNA), told ICN that some nurses have already resigned, with some of them even asking for their names to be removed from the Finnish nursing register. Some wards and services have been closed because of a lack of nurses. She said the FNA supports the industrial action aims by Tehy and SuPer and is lobbying for solutions to be found, based on findings in ICN’s Sustain and Retain report and the ICN-influenced World Health Organization’s Global Strategic Directions for Nursing and Midwifery (2021-2025).

President of FNA Nina Hahtela added: “Lack of nurses is at critical point, and we need urgent action. Industrial action is not an end in itself, but necessary if the situation is not otherwise remedied. This cannot continue, wages and working conditions must be rectified as a matter of urgency.”

Further news on industrial action

In Denmark nurses have warned for years that salaries and working conditions do not reflect nurses' competencies, tasks and responsibilities. Last year, the Danish Nurses Organization (DNO) balloted its members and nurses went on strike in a bid to put pressure on employers to raise wages. The strike lasted 70 days and was the longest in Danish history, but the government imposed a pay deal that was rejected by the nurses. Now almost 10% of nursing posts (5,000) are vacant, and Denmark is experiencing a severe labour shortage, with fewer younger people than in the past, and fewer applicants for nurse training. The DNO has published a paper with 12 recommendations for government and employers to tackle the issue. DNO President Grete Christensen told ICN: “There is an urgent need for it to be made more attractive to work as a nurse – and the nurses have said it over and over again - it is first and foremost better pay and working conditions that are needed.”

On 7 June, health workers in France held a one-day strike to protest about unmet demands on staff recruitment, better salaries and shortages. In North Rhine-Westphalia, Germany, nurses at university clinics are protesting against unacceptable working conditions. In the United States, nurses at several hospitals in Oregon, California and Minnesota have been striking to demand better wages and raise nurse staffing levels.

ICN recently sent a statement of solidarity to its two members in Mexico, the Colegio Nacional de Enfermeras, A.C. and the Federación Mexicana de Colegios de Enfermería, AC, concerning recent strikes in Chiapas State.

In New Zealand, nurses have voted to take an historic pay equity offer back to the Employment Relations Authority amid concerns that the current proposal does not include full back pay. The New Zealand Nurses Organization said that while nurses would not strike, the workforce would continue to feel disregarded until the issue was resolved.

Nurses in Uganda have recently suspended their strike action. The Ugandan Union of Nurses and Midwives President, Justus Kiplangat Cherop, explained that following receipt of a letter from the Minister of Public Service promising that increased wages for nurses and midwives would be included in the budget, they had decided to suspend industrial action. However, he added that “Sometimes government can promise and not deliver.” The UNMU will now analyse whether the budget set to come into force on 1 July will reflect their salary increase.

ICN’s 2011 position statement on industrial action states that “ICN expects nurses to have equitable remuneration and decent working conditions, including a safe environment. As employees, nurses have the right to organise, to bargain collectively, and to take industrial action. Strike action is considered the measure of last resort; to be taken only after all other possible means to conclude an agreement have been explored and utilised.”

Download the press release here