Introduction
Nursing is
one of the most important professions in the world because of how many
illnesses and injuries occur. We must shed light on the plight of nurses because
if they are struggling to do their jobs effectively the health of the patients is
put into jeopardy. It is important to keep in mind that the vast majority of
nurses are women because it has implications for how they are treated in the
workplace. Nurses have been suppressed both as women and as workers in
patriarchal societies. However, that has not stopped them from fighting for
better working conditions. I will be focusing on the organizing strategies of
nurses in Australia, Japan, and the United States. I have chosen these
countries because I acquired comprehensive sources that detail the hardships, struggles
for change, and subsequent victories. When nurses organize into a collective
force they are often met with resistance from people in positions of authority.
I argue that nurses have to organize to fight for improvements in the field of
nursing because they can only rely on themselves.
Militant
Action in Australia
One of
the options for many nurses is strike action if they feel that improvements
need to be made. Glenda Strachan (1997) indicates that strikes have been a
controversial course of action in past decades for nurses in Australia. Prior
to the prominence of strikes in the 1980s there were other strategies that
nurses used to fight for better conditions such as political lobbying, marches,
prohibition of overtime, refusal to wear nursing uniforms, and threats to
resign in large numbers (Strachan, 1997). She reveals that the main nursing
association in the country was The Royal Australian Nurses’ Association, which
maintained a no-strike policy. In 1970 the nurses in the Victoria chapter of
RANF instigated a ban on duties unrelated to nursing such as clerical services
as a way to protest against low salaries and non-nursing activities (Strachan,
1997). She adds that these nurses also organized a rally that grew to about
4,000 nurses. The author informs us that nurses were less divided over the
option to use strikes by the early 1980s because their working conditions
continued to depreciate as a result of nurse shortages. She adds that RANF held
a vote in 1984 and 65% of the members voted to abolish the rule that prevented
them from striking.
Australian
nurses in the state of Victoria went on strike for seven days in 1985 and fifty
days the following year (Strachan, 1997). The nurses decided to go on these
strikes because of their frustration with subpar salaries and poor working
conditions that were exacerbated by the number of nurses who were quitting, according
to the author. Strachan explains that the process began in 1985 when 5,000 of
the nurses in Victoria voted to strike. The initial weeklong strike did not
resolve their issues so the following year they voted to go on strike once
again (Strachan, 1997). The author adds that the votes were collected during
meetings where large numbers of nurses attended. Strachan explains how the nurses
picketed outside numerous hospitals as a reduced number of nurses remained
inside to provide limited support for the patients. Australian nurses have
always taken steps to ensure that a small number of nurses are permitted to
work in the hospital for the sake of the patients in poor condition (Strachan,
1997). She conveys that the strike gave many nurses a sense of unity but it
also alienated those who did not support it. The government threatened to place
criminal charges on the nurses during the fifty-day strike because they refused
to work (Strachan, 1997). The author indicates that the talks between the union
and government culminated with settlements that resulted in improved working
conditions.
Strachan (1997)
notes how it is a difficult decision to make when nurses realize that the
health of patients may be jeopardized if they are neglected. She contends that
the reluctance to go on strike has roots in the 19th century when
female nurses were striving to be known as professional workers. She explains
that in order to be regarded as a professional the nurses had to display a
devotion to their work and this would have been compromised if they neglected
their duties. Back then a protest would not have been considered justified if
it was related to salary, career opportunities, or working conditions for the
nurses (Strachan, 1997). The research of Kendra Coulter (2011) indicates that
unions have to be aware that the influence of gender norms can impact the
willingness of female workers to participate in unionization. This point could
explain why some of the nurses did not align themselves with the unions. From
their point-of-view they may have considered union involvement to be masculine
behaviour.
The
RANF is currently known as the Australian Nursing Federation (ANF) and they
have a page on their official web site that lists some of their campaigns. One
of the ongoing campaigns is the “Organizing For Safe Patient Care 2013” that
focuses on the home care nurses who care for the elderly and the disabled (ANF,
2012). The ANF reports that the government is making budget cuts and this demographic
of nurses will be the first to suffer from the reduced funding. The union has
organized a campaign to fight for the protection of these nurses’ wages so they
can earn the same as public health nurses (ANF, 2012). The “Stop Passing the
buck, Australia’s nursing grads need jobs” campaign is run by the ANF as well
and its purpose is to pressure to federal government to collaborate with
governments of the various territories to deal with the increasing shortages of
nurses (ANF, 2012). They are urging members of parliament to increase funding
for strategies that will help nursing graduates find work (ANF, 2012). The ANF
website has a feature that provides contact information for every politician in
the country so that it is easy for nurses to send messages to politicians that
preside over their territory. The ANF website is a good resource because it
keeps nurses aware of what the campaigns are and what they can do to support
them.
The ‘Nursing
Wave’ of Japan
Nurses in
Japan have had their share of hardships over the years. Seishi Katsuragi (1997)
contends that nursing shortages have been a problem in Japanese hospitals. Subpar
working conditions have led to many nurses leaving their profession, which has
made matters worse for the nurses left behind (Katsuragi, 1997). Kendra Coulter
(2012) asserts that unemployment is one of the main factors that can cause
someone to live in poverty. She adds that we should not blame individuals for
their marginal economic status because it is the laws set in place by
politicians that are responsible for thrusting people into poverty. Considering
these points it is important to recognize that the inadequate policies in Japan
were the reason for nurses quitting their jobs and losing income that was
keeping them out of poverty. The Japan Federation of Medical Workers Unions
(Nihon Iroren) carried out a survey of health care workers in 1988 that found
the majority of nurses were suffering from fatigue and anxiety (Katsuragi,
1997). Two-thirds of its members are nurses so the survey included the
responses from thousands of nurses (Katsuragi, 1997). The results garnered
attention from TV stations and newspapers, as noted by the author. Katsuragi notes
how the president of Nihon Iroren announced in 1989 that the union would use
all of its resources to fight for increases in nursing personnel and other improvements.
She conveys that this was the beginning of the ‘Nurse Wave’ movement. Some of
Nihon Iroren’s demands to government were an increase in nurses required to be
on site, additional funding for training, wage increases, and limited night
duties (Katsuragi, 1997).
During
the first year of the movement there were rallies and public demonstrations in
the streets with nurses wearing white uniforms to create awareness of their
hardships (Katsuragi, 1997). Briskin (1999) would refer to this public strategy
as mainstreaming, which she notes is the process of making a connection with as
many people as possible to generate interest in a cause. Katsuragi adds that nurses
also carried out petitions, surveyed patients, organized meetings, and wrote
articles for newspapers. During the second year the focus was on the appeal for
staff increases and less night shifts (Katsuragi, 1997). Progress was made
during this time because night duty limitations were set in place at more than
100 hospitals and administrators agreed to increase staff by 15,000 (Katsuragi,
1997). She adds that pay increases were achieved as well. Katsuragi (1997) states
that Nihon Iroren orchestrated a nursing strike that involved 100,000 workers. During
the third year of the ‘Nursing Wave’ the focus was on the need for a national
policy that would increase the minimum number of nurses required to be on site
(Katsuragi, 1997). Coulter (2012) suggests that the best results could be
produced when union activity is paired with some form of political action that
might influence the government to enact policies that could improve working
conditions. The nurses who belonged to Nihon Iroren went beyond typical union
activities when they chose to acquire signatures from Japanese citizens with
the intention of showing them to politicians (Katsuragi, 1997).
Katsuragi
states that in less than ten months the nurses collected 5.4 million signatures
from around the country. The nurses acquired signatures from patients,
community members, and even elected officials (Katsuragi, 1997). The author conveys
that during this period there were rallies, strikes, and sit-ins featuring
nurses in their white uniforms. The union delivered the petition signatures to
government and after three years of militant campaigning a new law was enacted
that guaranteed minimum staffing levels (Katsuragi, 1997). In 1989 the number
of nurses in Japan was 802,000 but by 1995 that number increased to 961,000 and
funding for training programs increased along with wages (Katsuragi, 1997). She
maintains that the ‘Nursing Wave’ campaign was the first example of direct
action within the movement of Japanese health workers. In a country with an
ageing population and a decreasing birth rate it is imperative that people do
not ignore the hardships endured by nurses (Katsuragi, 1997).
A more
recent example of Nihon Iroren’s agenda is the online update provided by its
president regarding the relief efforts they implemented
after the tsunami hit Japan in March of last year. Chieko Tanaka (2011) asserts
that Nihon Iroren organized the Disaster Response Committee shortly after the
earthquake happened. He adds that the committee issued updates on a daily basis
since its formation. They gathered information regarding the locations of Nihon
Iroren union members (Tanaka, 2011). The committee also initiated a fundraising
operation to provide resources for people affected by the tsunami (Tanaka,
2011). He conveys that they organized the transport of health care workers to
the areas where the people were in need of medical assistance. Nihon Iroren met
with the government to appeal for greater support to the victims of the tsunami
such as the distribution of public funds to repair damages to hospitals (Tanaka,
2011).
Unions and Strikes in the United States
Nurses
in the United States have been the victims of sex discrimination in the
workplace. Karen Lucas Breda (1997) asserts that nurses belong to a gendered
health system, which means they are subjected to patriarchal social relations. The
author conducted a study to examine the ways that professional nurses at the
Shawmut Hospital in rural New England improved their working conditions by forming
a union. She indicates that it formed in 1981 when the nurses were under the
control of an authoritative doctor who demanded they follow instructions
without resistance. The nurses were not permitted to be a part of the
decision-making process and they were largely responsible for following the
orders of the physicians (Breda, 1997). The nurses earned less than their
counterparts at nearby hospitals but they indicated that working conditions
were the main incentive for creating a union because they wanted respect and
autonomy (Breda, 1997). The efforts to form a union were met with animosity but
management’s attempts to stop it were futile because the vast majority of the
nurses voted to certify the union (Breda, 1997).
The
nurses and management resorted to a confrontational approach because there were
increasingly hostile work relations (Breda, 1997). Throughout the 1980s the
union nurses became more aggressive with their tactics and in 1985 they went on
strike (Breda, 1997). She mentions how the union dealt with many complaints from
nurses that sometimes related to a breach of contract. The author asserts that
until the end of the decade the union nurses were able to negotiate for higher
wages and better benefits. There were a handful of union nurses who handled the
negotiations on behalf of the group (Breda, 1997). The union leaders organized the
1985 strike and the 1989 “sick-in” to have solidarity with the other workers
who were on strike (Breda, 1997). The union leaders also organized pickets that
provided information to the public that expressed their concerns regarding
subpar working conditions, as noted by Breda.
The CEO of Shawmut convinced
the nurses that the hospital’s financial situation put their operations in
jeopardy (Breda, 1997). This led to many nurses gossiping that the hospital
might close down and it caused insecurity because they were afraid of losing
their jobs, according to Breda. The union underwent periods when solidarity was
fragile because of contract negotiations and strikes (Breda, 1997). Breda states
that the nurses who never joined the union were against the use of militant
strike action because they considered union involvement to be unprofessional. She
adds that several nurses left the union after the “sick-in” of 1989. The union
members became more compliant with authority after the militant actions that
hurt morale and the disappointing negotiations of 1991 (Breda, 1997). The
administration’s use of intimidation including the threat of layoffs was a
significant factor in the breakdown of the union (Breda, 1997). Coulter (2011) states
that workers are often afraid of being fired or reprimanded in some way by their
employers. She also insists that employers can handily dismantle a union if it
is smaller in numbers. The hospital only had sixty beds therefore the nursing
staff was small and vulnerable (Breda, 1997). The working conditions at Shawmut
declined as the nurses became overwhelmed by cuts that increased the workload, according
to Breda.
The union leaders
decided to radically alter their relations with management when it was time for
the 1993 contract bargaining (Breda, 1997). A nurse who was skilled with
conflict resolution strategies guided the union during negotiations and it was
a departure from their previous strategy of confrontation (Breda, 1997). The
author notes how this influenced the union nurses to be more clear and specific
about what they wanted. Coulter (2011) has noted that it is important for
leaders to emerge in the workplace. The nurse at Shawmut Hospital who was
talented at solving problems in a civilized manner was crucial for the union’s
return to prominence because she helped create a more comfortable atmosphere. The
nurses who felt alienated by the militant strategies were able to align
themselves with the union and therefore strengthen its effectiveness (Breda,
1997). Breda states that the leaders enlarged the negotiation group so that
most of the union nurses would be present for the meetings and this resulted in
more nurses voicing their concerns about the inadequate working conditions (Breda,
1997). Conflict between nurses and silent obedience vanished during this new
era of peaceful unionization at Shawmut (Breda, 1997). The union became even
more cohesive when they discovered that the managers had been dishonest about
the hospital’s financial situation in order to justify frugal spending (Breda,
1997).
Political
Action in the United States
Nurses have
also become involved with campaigns outside of work to support candidates who
will fight for better health policies. Bethany A. Hall-Long (2004) identifies
herself as a nurse who became an elected representative in the U.S. state of
Delaware. She immersed herself into the political arena to advance the
interests of nurses and to ensure that adequate resources are afforded to the
nursing practice (Hall-Long, 2004). Linda Briskin (1999) maintains that insider organizing can challenge the status quo
from within institutions and open the door for activists to change the existing
social arrangements. Hall-Long was able to become an insider who then made it
one of her objectives to set policies in motion that will benefit nurses all
across the state, as noted by the author. The nursing field is affected by
health policy because it determines what training programs receive funding as
well as how many nurses are required to work in hospitals (Hall-Long, 2004).
She asserts that nurses can increase their influence if they support candidates
during a campaign. Nurses helped her to win because they were of assistance throughout
her election campaign (Hall-Long, 2004). She mentions how the nurses
volunteered to help organize social gatherings, festivals, and call centres. They
also engaged in letter writing to the media, went door-to-door to promote her
candidacy, and also helped to organize fundraisers (Hall-Long, 2004).
Discussion
Mapping
is the study of various forms of women’s organizing and how they complement or
interfere with each other (Briskin, 1999). She notes how mapping allows us to
see that women’s organizing is never one-dimensional anywhere in the world. The
articles I studied focused on nurses who belonged to unions with the exception
of Bethany A. Hall-Long who chose to run for public office. The formation of a
union is essential for a small or large group of nurses if they plan to make
demands on employers or politicians. The union activities that I have studied prove
that unionization is beneficial for nurses because it gives them more
bargaining power and job security. All of the unionized nurses saw their
working conditions improve as a result of their organizing. The nurses in New
England, Victoria, and all across Japan ended up participating in one or more
strikes once they were unionized. A strike is evidently the most effective
strategy because of how disruptive it is for routine operations. It is clear
that if nurses want to go on strike as a way to protest then it is necessary
for them to belong to a union. It is more difficult for the employers to fire a
nurse who has formed an alliance with other nurses.
It was a
challenge for some of the nurses to maintain solidarity during unionization and
strikes. Some nurses were not interested in aggressive union tactics and
strikes. This created some tension between the nurses but at the same time
there was a sense of camaraderie among the nurses who banded together. These
forms of collection action caused many of them to feel secure and confident.
The profession of nursing has a long history of feminization because most
nurses have been female. This can explain why Shawmut managers wanted to
sustain gendered social relations that allow them to have dominance over the
nurses. The history of feminization can also explain why some nurses prefer not
to take an aggressive stance on labour issues because they have a traditional
perception of femininity.
One
of the challenges for nurses is intimidation from employers and government.
During the Victoria strike of 1986 the government threatened to press charges
against the nurses. The nurses at Shawmut were wrongfully led to believe that
layoffs could happen and that the hospital might close down. Their unionization
was met with animosity and tensions remained high for many years. Prior to
unionization the Shawmut nurses were expected to follow the commands of
physicians at all times without any space for their own opinions. The
patriarchal social relations at the hospital made it difficult for the nurses to
feel comfortable, independent, and respected.
For the
Australian and Japanese unions there was an emphasis on the shortage of nurses,
which resulted in a heavy workload. Many of the nurses in Japan admitted to being
tired all the time and acknowledged that they had very little time to spend
with loved ones because of work duties. The shortage of nurses takes a mental
and physical toll on the nurses who must overexert themselves for the entire
shift. The employers demonstrated an ignorance and/or lack of concern for the
nurses’ commitments outside of work. Many nurses have children to take care of so
when they leave work to handle responsibilities at home it needs to be regarded
as a double shift. These working mothers are responsible for unpaid labour at home
as they socially reproduce human beings. The most significant theme is the
nursing shortage because of how much pressure it puts on nurses. However, the
employers and politicians do not actively make changes to regulations on their
own to accommodate nurses who do unpaid work in the private sphere. Nurses have
had to demand changes to staffing levels before anything improved. The protocol
at the hospitals with staff shortages could be regarded as gender neutral
because they do not take into account the chores that workers do at home. The
nurses also indicated that pay increases were desired. These examinations of
nursing in three countries suggest that nurses are an underpaid demographic.
Low wages and salaries can be considered factors that lead to high levels of
stress for the nurses because many of them do not feel appreciated. This brings
us to the next point, which is that nurses seem to value respect more than
monetary benefits. The nurses want to feel comfortable in their work
environment. The nurses at Shawmut placed the most emphasis on independence and
respect when they were making demands.
The
‘Nursing Wave’ movement proved to be successful because it eventually led to pay
increases, funding for training, and the enactment of new laws that improved
working conditions. The movement was a heterogeneous blend of strategies such
as unionization, strikes, public demonstrations, and petitions. It was a
nation-wide phenomenon therefore it makes sense to assume that none of the
tactics used were detrimental to the cause. The petitions proved to be
invaluable because they were a way for millions of people to show their
support. Media coverage and subsequent support from the general public were
themes from the organizing in Japan and Australia. The negotiations of 1993
proved to be the greatest achievement for the unionized nurses of New England
because it ushered in a new era of higher wages, independence, and union
solidarity. The election of Bethany A. Hall-Long was a success for the nurses
who helped with her campaign. Those nurses were strictly involved in political activities
but their efforts paid off because a professional nurse with their interests in
mind became a state representative. As an insider she can have an influence on
policymaking and elevate the status of nurses in Delaware. Even though she has
a liberal feminist agenda that is focused on improving conditions under state
capitalism her election is still promising. The ‘Nursing Wave’ is a powerful
example of progress for women as nurses and mothers. Special attention should
be paid to that movement in order to understand what tactics are the most
effective for nurses. In all of the cases examined in this paper the nurses had
to rely on themselves and each other in order to achieve their goals. Employers
and politicians did not approach groups of nurses to deliberately inspire
revolutionary activity. It was the nurses who had to take the initiative.
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