Nurses, industrial action and ethics: considerations from the 2010 South African public-sector strike

The impact of strike action by Ghana registered nurses and midwives on the access to and utilization of healthcare services

BACKGROUND

As the largest professional group, nurses and midwives play instrumental roles in healthcare delivery, supporting the smooth administration and operation of the health system. Consequently, the withdrawal of nursing and midwifery services via strike action has direct and indirect detrimental effects on access to healthcare.

OBJECTIVE

The current study examined the impact of strike action by nurses and midwives with respect to access to and use of health services.

METHOD

Data were collected retrospectively from a total of 181 health facilities from all the 16 administrative regions of Ghana, with the support of field officers. Because the strike lasted for 3 days, the data collection span three consecutive days before the strike, three days of the strike and three consecutive days after the strike. Data analysis was focused comparing the utilization of healthcare services before, during and after strike. Data were analysed and presented on the various healthcare services. This was done separately for the health facility type and the 16 administrative regions.

FINDINGS

The results showed that; (1) the average number of patients or clients who accessed healthcare services reduced drastically during the strike period, compared with before the strike. Majority of the regions recorded more than 70% decrease in service use during the strike period; (2) the average number of patients or clients who accessed healthcare services after the strike increased by more than 100% across majority of the regions.

CONCLUSION

The study showed that strike action by nurses and midwives negatively affected access to and utilization of healthcare services.

Between a rock and a hard place: Ethics, nurses' safety, and the right to protest during the COVID-19 pandemic

AIM

In this paper, we critically discuss the ethics of nurses' choice to strike during the COVID-19 pandemic, considering legal and ethical arguments, overlaying the Ubuntu philosophy, an African ethic.

BACKGROUND

The recent unprecedented coronavirus disease pandemic and the increased reports on the absence of personal protective equipment in South Africa places many health workers' lives at risk. Nurses spend most of their time with patients, which exposes them to fatal risks as they work in unsafe environments.

RESEARCH METHODS

Exploratory literature review was conducted using Pubmed, CINAHL, Google Scholar and Science Direct) and law cases repository.

FINDINGS

Nurses thus may be justified in striking to protect their safety. State healthcare entities are obliged to ensure safety and protect the health of professionals during the pandemic. According to their Code of Practice and Pledge of Service, they are ethically obliged to put patients first, and as a result, they are legally barred from engaging in strike action.

CONCLUSION

We conclude that there may be constitutional human rights arguments to support strike action. We also find that ethical principles alone do not provide clear direction to guide nurses in making justified and ethical decisions regarding service provision in an environment threatening to compromise their safety.

Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County

BACKGROUND

While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers' strikes.

METHODS

We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n = 5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n = 26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses' strike.

FINDINGS

In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes.

CONCLUSION

Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.

Paediatric and obstetric outcomes at a faith-based hospital during the 100-day public sector physician strike in Kenya

Published reviews of national physician strikes have shown a reduction in patient mortality. From 5 December 2016 until 14 March 2017, Kenyan physicians in the public sector went on strike leaving only private (not-for-profit and for-profit) hospitals able to offer physician care. We report on our experience at AIC-Kijabe Hospital, a not-for-profit, faith-based Kenyan hospital, before, during and after the 100-day strike was completed by examining patient admissions and deaths in the time periods before, during and after the strike. The volume of patients increased and exceeded the hospital's ability to respond to needs. There were substantial increases in sick newborn admissions during this time frame and an additional ward was opened to respond to this need. Increased need occurred across all services but staffing and space limited ability to respond to increased demand. There were increases in deaths during the strike period across the paediatric medical, newborn, paediatric surgical and obstetric units with an OR (95% CI) of death of 3.9 (95% CI 2.3 to 6.4), 4.1 (95% CI 2.4 to 7.1), 7.9 (95% CI 3.2 to 20) and 3.2 (95% CI 0.39 to 27), respectively. Increased mortality across paediatric and obstetrical services at AIC-Kijabe Hospital correlated with the crippling of healthcare delivery in the public sector during the national physicians' strike in Kenya.

Improving work conditions through strike: Examination of nurses' attitudes through perceptions of two physician strikes in Israel

BACKGROUND

Strikes are means to influence policies related to working conditions, yet raise ethical dilemmas for healthcare workers. Nurse strikes have become more prominent around the world.

OBJECTIVE

To assess the change in Israeli nurses' attitudes towards strikes in light of two physician strikes that have preceded a nursing strike.

METHODS

An anonymous survey was administered once in 2000 (N = 106) and again in 2011 (n = 175) following 110 days of a physician strike, to assess nurses' attitudes towards the strike and resulting ethical issues.

RESULTS

A statistically significant change (p < 0.05) between administrations revealed that in 2011 more nurses identified striking as a legitimate mechanism, would strike under the same circumstances, and felt that collaboration with physicians persisted despite the strike. Additionally, an increasing number of nurses said that the suffering of patients due to the strike is somewhat or entirely justified, although they were faced with a difficult dilemma of loyalty to physician colleagues vs.

PATIENTS

Nurses reported finding ways to mitigate the suffering of patients resulting from the strike.

CONCLUSIONS

While patient-centered care remains nurses' first and foremost priority, findings indicate an increasing support of collective bargaining and strike to promote working conditions related to professional and public health agendas.

'Practice what you preach': Nurses' perspectives on the Code of Ethics and Service Pledge in five South African hospitals

BACKGROUND

A recent focus of the global discourse on the health workforce has been on its quality, including the existence of codes of ethics. In South Africa, the importance of ethics and value systems in nursing was emphasised in the 2011 National Nursing Summit.

OBJECTIVE

The study explored hospital nurses' perceptions of the International Code of Ethics for Nurses; their perceptions of the South African Nurses' Pledge of Service; and their views on contemporary ethical practice.

METHODS

Following university ethics approval, the study was done at a convenience sample of five hospitals in two South African provinces. In each hospital, all day duty nurses in paediatric, maternity, adult medical, and adult surgical units were requested to complete a self-administered questionnaire. The questionnaire focused on their perceptions of the Code of Ethics and the Pledge, using a seven-point Likert scale. STATA(®) 13 and NVIVO 10 were used to analyse survey data and open-ended responses, respectively.

RESULTS

The mean age of survey participants (n=69) was 39 years (SD=9.2), and the majority were female (96%). The majority agreed with a statement that they will promote the human rights of individuals (98%) and that they have a duty to meet the health and social needs of the public (96%). More nuanced responses were obtained for some questions, with 60% agreeing with a statement that too much emphasis is placed on patients' rights as opposed to nurses' rights and 32% agreeing with a statement that they would take part in strike action to improve nurses' salaries and working conditions. The dilemmas of nurses to uphold the Code of Ethics and the Pledge in face of workplace constraints or poor working conditions were revealed in nurses' responses to open-ended questions.

CONCLUSION

Continuing education in ethics and addressing health system deficiencies will enhance nurses' professional development and their ethical decision-making and practice.