Challenges Facing Nurses' Associations and Unions: A Global Perspective
Clark, Paul F., Clark, Darlene A., International Labour Review
Health care systems around the world are facing very significant challenges as they restructure and "reinvent" themselves in an effort to make more efficient use of available resources (ICN, 2001). As health care is a labour-intensive industry, the stresses experienced by these systems inevitably affect their employees.
Nurses, as the most highly trained caregivers with regular patient contact, are at the heart of any health care system. Widespread anecdotal evidence suggests that the problems in health care have had a particularly negative effect on the workplace experience of nurses.1 News accounts regularly report on the challenges nurses face in the workplace. These range from low pay in Ireland, to safety and health problems in South Africa, to emigration in the Philippines, to mandatory overtime in the United States. These stories suggest that nursing is a profession in crisis and that this crisis extends around the world. However, there is little systematic, comparative evidence available as to the nature and extent of the problems nurses face and the strategies they employ to deal with those problems.
This article reports the key findings of the World Nurses' Associations and Unions Project, which was conceived to gather information systematically about the employment issues nurses face worldwide and the strategies their organizations employ to address those issues. The first and second sections of the article provide some background information on the worldwide crisis in health care and on the historical development of nurses' organizations. Following an outline of the sample of organizations that participated in the project, the third section analyses the data collected by the survey in order to identify not only the problems facing nurses but also the priorities and strategies of their organizations in dealing with those problems. A final section offers some concluding comments.
The crisis in health care
Health care systems around the world are in crisis. On all continents, in developed and developing countries alike, health care systems are unable to meet the medical needs of the people who depend upon them. This crisis is caused by a number of factors.
Many health care systems are experiencing shortages of trained medical personnel. Both developed and developing countries appear to be facing a serious shortage of nurses (and physicians). Developed countries, however, are in a better position to attract health care professionals from abroad, thereby exacerbating the shortage in less developed countries (RCPSC, 2001).
Epidemics are also contributing to the crises some health care systems are experiencing. In 2002, for example, AIDS was the leading cause of death in Africa and the fourth leading cause of death worldwide (WHO, 2002a). In recent years, there has been a significant increase in the incidence of tuberculosis in eastern and central Europe, as well as in developing countries around the world (WHO, 2002b); and malaria is on the rise worldwide, having caused some 60,000 deaths in recent years (WHO, 2002c). Such epidemics place significant stress on health care systems, particularly in less affluent countries.
Environmental problems (air pollution, water contamination, etc.), natural disasters, and the consequences of war (civilian casualties, refugees, etc.) continue to burden health care systems around the world. And changing demographics, particularly an increase in the elderly population, have also placed greater demands on health care systems (WHO, 2002d).
Finally, health care reforms introduced around the world, including privatization and the introduction of market-based approaches to health care, have brought new pressures to bear on health care systems and health care workers (Clark et al., 2001; WHO, 2002e).
While the crisis in health care is a multifaceted phenomenon, the root of the problem can ultimately be traced to economics. …