"Ninety of the 105 nurses' unions and organizations in our survey -- representing 69 nations and every geographic region -- reported their countries were experiencing a nursing shortage. This is bound to have a negative impact on the quality of patient care," says Dr. Paul F. Clark, professor of labor studies and industrial relations.
While noting that the exact cause of the nursing shortage varies from country to country, Clark attributes the shortage in the United States to the for-profit, bottom-line managed care system, which cuts costs by pruning the labor force, including nurses, and compelling the remaining staff to work longer hours under more trying conditions. "Staff reductions and mandatory overtime wreak havoc with the personal lives of nurses and exacerbates stress," he adds.
Clark and fellow researcher, Darlene A. Clark, R.N. and instructor of nursing in Penn State's School of Nursing, recently completed a preliminary report on their two-year world survey of nurses' unions and associations. Their data consists of responses from 105 nurses' unions and associations in 76 countries. They presented their findings today (June 28) at the International Industrial Relations Association Regional Congress of the Americas.
The work-related problem cited most frequently in the survey was understaffing, especially in the United States. This situation was less serious, but still a major issue, for nurses in Europe and Asia, the researchers note.
They add that many nurses also object to the practice of floating, whereby understaffed hospitals move nurses from one unit to another with which they are less familiar (e.g. from obstetrics to ER).
Safety and health problems are seen as most serious in North America and Africa and least serious in Europe and Asia, Darlene Clark says. Nurses' unions and associations list stress as their leading safety and health problem, followed by back and musculoskeletal ailments; contact with contaminated needles that can sometimes result in a nurse contracting hepatitis or AIDS; and workplace "bullying" or violence.
Mandatory overtime and violence in the workplace are viewed as a bigger problem in North America than anyplace in the world. Workplace violence is committed against nurses by patients or relatives of patients.
"Also, 44 nurses' associations and unions in 33 countries -- primarily in Oceania, Africa, Central America and the Caribbean -- reported that the outflow of nurses to more affluent countries was a serious to extremely serious problem," Darlene Clark says. "This exacerbates the shortage that already exists in poorer countries and further weakens their health care systems."
"Overall, nurses' associations and unions rank better salaries and benefits and improved patient care as their members' two highest priorities. The second is all the more significant since registered nurses have traditionally seen themselves as the patient's advocate." Paul Clark notes. "Other priorities are professional development, greater voice in the workplace and improved safety and health concerns."