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).
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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