Nursing Ethics

This paper explores the law relating to strikes and other industrial action in the UK and the problems faced by nurse practitioners. It also reviews the advice given to nurses by the professional associations.

If any employee takes part in industrial action, he or she could personally face four arenas of accountability for this action: disciplinary proceedings before the employer; criminal proceedings; civil proceedings for negligence; and professional conduct proceedings.

During 1995, there was a major shift in the United Kingdom in the debate of whether it is right for nurses to strike. The Royal College of Nursing, the former advocate of a non-industrial action policy, moved towards the UNISON position that industrial action is ethical in some circumstances, as well as the necessary thing to do. The authors, both nurses and UNISON officials, look at the reasons for this change and why UNISON’s historical position sees industrial action as an effective weapon in defending services, as well as wages and jobs. It can be right to strike.

The purpose of this article is to deliberate the moral and legal dilemma entailed in the weapon of the labour strike as a pressure tactic on the Israeli Finance Ministry regarding job slots, budgets and, in effect, violating the collective agreement signed by the nurses and impairing patients’ treatment, as opposed to refraining from striking and suffering the heavy burden of work, the lack of trained personnel, low wages, and the inability to give patients proper, high quality treatment.

Deciding to take industrial action or go on strike has been an issue of great concern for nurses. While it is typical for most groups of workers to undertake industrial action in the pursuit of better wages and working conditions or improved quality of services, historically, nurses have found this a difficult course to pursue. Frequently, nurses have been caught between acceptance of themselves as ordinary workers and a professional model, which has carried with it the implication that a profession does not engage in industrial action (although, in reality, professions, including medical practitioners, have undertaken industrial action). Nurses in Australia have gone on strike, although widespread industrial action was not undertaken until the 1980s, when lengthy industrial campaigns, including strikes, were used in an effort to achieve enhanced status for the profession, improved career paths and increased salaries. While debate remains about the efficacy of this course of action, large numbers of nurses have been involved in these campaigns. Significant changes in salaries and status were achieved in the 1980s.

Over the last decade, successive New Zealand governments have instituted social, political and economic changes that have fundamentally challenged nurses’ sense of themselves and their position in society. Major upheavals in the health service have occurred as a result of reforms promoting competition and contestability. This paper deals with the impact of one aspect of the reforms, that of the deregulation of the labour market through the Employment Contracts Act 1991. More specifically, the way in which discussions and decisions regarding the withdrawal of nursing labour are shaped by the language available to those involved are considered. The intersection of ethics and union discourses may exacerbate feelings of ambiguity and confusion in nurses facing strike action. The result can be unnecessary and unproductive division and conflict: among nurses, between employers and employees, between unions, between nurses and the public, and between nursing organizations and the Government. An examination of some of the discourses of strike action may serve as a tool to elucidate the way nurses see themselves and their clients in the context of social change and social action.

Japanese nurses, like their counterparts in many other countries, are suffering from staff shortages and severe working conditions. The Japan Federation of Medical Workers’ Unions (Nihon Iroren) launched a campaign in 1989 for nurses called the ‘Nurse Wave’. Their demands were many: to increase the numbers of nursing staff, the regulation of night shifts, the implementation of a five-day working week everywhere, a fair appraisal of nurses’ work, better vocational training, etc.

Nurses in white uniforms assembled at meetings, marched and took part in nationwide strikes. They collected over 5.4 million petition signatures, which they submitted to Parliament. After three years of campaigning, they won the enactment of a law for securing sufficient numbers of nursing personnel.

This struggle, which highlighted the most pressing demands of nurses and was supported by the general public, was a new experience for Japanese nurses. It was a militant movement which demanded that the Government should change its health policy. Against the sluggish image of the Japanese labour movement, strikes and demonstrations organized by nurses dressed in white have made a strong impression on the Japanese people.

As health care is a public service on which the life and death of people depend, a strike at a health institution naturally has constraints and must follow specific procedures. In this article, the measures taken by Nihon Iroren to minimize the consequences of strikes on patients and the local community, the impact of the nurses’ movement on the society, as well as the lessons drawn from the campaign, are presented.

In the United States, there has been a continuous debate between those who favour collective bargaining for nurses and those who believe it is not professional. Likewise, the controversy over whether nurses should strike has been longstanding and continues today. Those who oppose the idea of nurses striking often state that they are abandoning their patients, and that it is not ethical, even though federal legislation requires a 10- day strike notice so that management can make patient care arrangements. The American Nurses Association (ANA) has supported the right of nurses to strike, as a last resort and after careful consideration of every factor. This support has divided the membership of ANA and the nursing profession, even though the strikes have been used sparingly and effectively by nurses in this country; and so the debate continues.

Those who want to know anything about strike action by Italian nurses will find very little written about it. This contribution intends to show that, whatever they are prepared to admit, Italian nurses are not used to strike action because they mostly think of their profession as a form of mission. Even if we could agree with the idea of nursing as a profession subscribing to an ideal of service, we have to distinguish between a real profession and philanthropic work; vocational motivation is not enough to make a good professional. Historically, nurses perceived strikes as contradictory to human need and action; patients must never be left alone. However, Italian nurses are now interested in a dramatic transformation of many aspects of their professional life, becoming conscious of the duty to protect themselves from every kind of exploitation, even if the typical idealism and dedication of nurses makes them vulnerable.

In this article I would like to express my personal ideas and points of view about strike action, which I think many colleagues will share. I am a qualified paediatric nurse, currently working in the central operating theatre of a university hospital in Germany. At the same time, I am also finishing my studies in health care sciences. Apart from two short protest strikes, I have not taken part in any strike, because there have not been any during my whole professional career at the hospitals where I have worked. I am personally deeply convinced that strikes are important and are a good and useful tool, in particular to protest against ‘rationalizations’, which so far have led only to lower salaries and fewer jobs for nurses, and have brought no improvement in the conditions for staff or patients.