护士罢工行动的惊人增长是全球医疗保健系统危机的征兆 | ICN

Full text

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.”

全文翻译（仅供参考）

国际护士理事会 (ICN) 表示，全球范围内采取罢工行动的护士人数的惊人增长是对政府未能解决我们脆弱、严重削弱甚至在某些情况下崩溃的医疗保健系统的根本原因的直接反应. 在全球范围内，ICN 已经确定了许多护士就一系列基本问题（包括安全、安保和保护）参与工业行动的例子，所有这些都危及医护人员和患者。

根本原因之一是全球护士短缺，这给目前在医疗保健系统工作的护士带来了不可持续的压力，这些护士因人员短缺、COVID-19 大流行和历史上的长期资金不足而受到干扰。这些预先存在的短缺导致了令人担忧的劳资纠纷和罢工增加——例如康奈尔大学 ILR 工人研究所的一份报告显示，2021 年美国所有罢工中有一半是医疗机构的工人，而本周六 18西班牙6月护士将举行全国性示威。在其他例子中，ICN 已经确定了欧洲、美洲和非洲的护士行动。

ICN 主席帕梅拉·西普里亚诺（Pamela Cipriano）说：“护士的行业行动始终是不得已而为之的手段，但鉴于护士必须工作的卫生系统状况，他们无法提供高水平的医疗服务，这并不奇怪。他们期望的优质护理。这是因为他们承受的工作压力、缺乏价值和所获得的认可、与性别相关的历史性不平等以及糟糕的薪酬和工作条件。

“过去两年向世界展示了护理对我们的健康以及社会和经济福祉的重要性，但那些有能力改变他们的卫生系统状况的人并没有注意到所吸取的教训，病人护理的质量和各地护士的生活。”

在与联合国大会主席阿卜杜拉·沙希德在日内瓦万国宫会晤之前，ICN 首席执行官霍华德·卡顿说：

“ICN 呼吁各国政府不要解决我们医疗系统中动荡的根源，这些系统脆弱、严重削弱，在某些情况下濒临崩溃。他们必须解决不平等和资金严重不足的根本问题，而不是掩盖裂缝，这些问题导致缺乏公平的薪酬、短缺和患者安全风险增加。”

卡顿先生在给沙希德先生的声明中说：

“ICN 认为，当前对全球健康的最大威胁是劳动力短缺。在大流行之前，全球短缺 600 万护士和 1800 万医护人员，我们现在看到流动率和离职率增加，这很可能会增加这些数字。这很重要，因为没有医疗保健劳动力就没有医疗保健。

“大流行有力地表明，我们的健康和我们的经济福利是密不可分的。医疗保健支出不是成本，而是带来巨额回报的铸铁投资。如果我们不进行投资以发展和加强我们的全球卫生人力，我们将继续在经济上苦苦挣扎，而所有人获得高质量的医疗保健将只是一个白日梦。” 在此处阅读完整声明

西班牙护士罢工

6 月 18 日这个星期六，西班牙马德里的数千名护士将进行示威，要求紧急改善西班牙的医疗保健系统和在其中工作的专业人员的工作条件。他们还将谴责公众和政治当局的冷漠和冷漠。该演示由 Unidad Enfermera 召集，将引起人们对因护士人数不足导致医疗保健缺乏安全性而面临风险的患者的关注。

西班牙护士还将谴责西班牙护士每天遭受的严重的身体和言语攻击问题，并要求安全的工作环境保护他们的身体、心理和情感完整性。

芬兰大规模辞职

与此同时，在与雇主就薪酬和工作条件发生长期争议之后，芬兰的护士正准备采取更加果断的行动，芬兰政府的新立法将使护士的罢工行动成为非法行为。

芬兰的工会 Tehy 和 SuPer 在 4 月举行了罢工，要求提供体面的工资和工作条件。有关详细信息，请参见此处。由于新法律的威胁，计划于 4 月举行的第二次为期两周的罢工被取消，通过芬兰议会的罢工进程已暂停。

现在，芬兰护理工会没有计划进一步罢工，而是安排大规模辞职，可能在秋季晚些时候，如果在此之前无法达成可接受的谈判解决方案，以显示他们的感情力量和他们不让当前局势恶化的决心继续。

两个护理工会表示，如果颁布新的《患者安全法》，可以以确保患者安全为由命令罢工护士重返工作岗位。

雇主们表示，工会在之前的纠纷中没有提供安全的人员配备水平，他们的大规模辞职计划是“完全不负责任的”。工会否认这一点，并表示在罢工期间，某些单位的人员配备水平甚至比平时还要好。他们说，在目前缺乏护士的情况下，患者的安全每天都处于危险之中，这应该是政客和雇主的主要担忧，而不是合法的罢工。

芬兰护士协会 (FNA) 国际事务负责人 Anna Suutarla 告诉 ICN，一些护士已经辞职，其中一些甚至要求将他们的名字从芬兰护士登记册中删除。由于缺少护士，一些病房和服务已经关闭。她说，FNA 支持 Tehy 和 SuPer 的工业行动目标，并正在游说根据 ICN 的维持和保留报告中的发现以及受 ICN 影响的世界卫生组织护理和助产学全球战略方向（ 2021-2025 年）中的发现找到解决方案) .

FNA 总裁 Nina Hahtela 补充说：“护士短缺正处于关键时刻，我们需要采取紧急行动。工业行动本身并不是目的，但如果情况没有得到补救，则必须采取行动。这种情况不能继续下去，必须紧急整顿工资和工作条件。”

有关工业行动的更多消息

在丹麦 护士多年来一直警告说，工资和工作条件并不能反映护士的能力、任务和责任。去年，丹麦护士组织 (DNO) 对其成员进行了投票，护士进行了罢工，以向雇主施加压力以提高工资。这次罢工持续了 70 天，是丹麦历史上最长的一次，但政府实施了一项薪酬协议，但遭到护士的拒绝。现在几乎 10% 的护理职位（5,000 个）空缺，丹麦正经历着严重的劳动力短缺，年轻人比过去少，申请护士培训的人数也减少了。DNO 发表了一篇论文，其中包含 12 条建议，供政府和雇主解决这个问题。DNO 总裁 Grete Christensen 告诉 ICN：

6 月 7 日，法国的卫生工作者举行了为期一天的罢工，以抗议对员工招聘、提高工资和短缺的要求未得到满足。在德国北莱茵-威斯特法伦州，大学诊所的护士正在抗议不可接受的工作条件。在美国，俄勒冈州、加利福尼亚州和明尼苏达州的几家医院的护士一直在罢工，要求提高工资并提高护士配备水平。

ICN 最近就恰帕斯州最近发生的罢工事件向其在墨西哥的两个成员——Colegio Nacional de Enfermeras, AC 和 Federación Mexicana de Colegios de Enfermería, AC,发出了声援声明。

在新西兰，由于担心目前的提议不包括全额补发，护士们投票决定将历史性的薪酬平等提议带回就业关系局。新西兰护士组织表示，虽然护士不会罢工，但在问题得到解决之前，劳动力将继续被忽视。

乌干达的护士最近暂停了罢工行动。乌干达护士和助产士联盟主席 Justus Kiplangat Cherop 解释说，在收到公共服务部长的一封信，承诺将增加护士和助产士的工资纳入预算后，他们决定暂停工业行动。然而，他补充说，“有时政府可以承诺而不是兑现。” UNMU 现在将分析定于 7 月 1 日生效的预算是否会反映他们的工资增长。

ICN 2011 年关于工业行动的立场声明指出：“ICN 期望护士获得公平的报酬和体面的工作条件，包括安全的环境。作为雇员，护士有权组织、集体谈判和采取行业行动。罢工行动被认为是不得已而为之的措施；只有在探索和利用了所有其他可能的缔结协议的手段之后才能采取。”

THE  END