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PubMed1992

Effect of two French nurses' strikes on mortality in a geriatric hospital.

PURPOSE: To study the influence of the 1988 French nurses' strikes on mortality in a geriatric hospital. MATERIALS AND METHODS: Two nurses' strikes affected the Charles Foix Hospital near Paris from June 29 to July 31 and from September 17 to October 22, 1988. Mortality was studied in nine geriatric wards of this hospital, including two rehabilitation units comprising 187 beds, and seven long-term care units comprising 1,132 beds. Monthly mortality rates were calculated from the hospital's administrative registers and expressed as deaths per 1,000 patient-days. These rates were calculated in each of the aforementioned nine units for the 36 months preceding the first strike (control period) and for the 12 months following it (study period). RESULTS: Over the control period, monthly mortality was significantly higher in rehabilitation units than in long-term care units (2.46 +/- 1.21 versus 0.83 +/- 0.47, p less than 0.001), but mortality rates among rehabilitation units, as well as among long-term care units, were comparable. Also, during the control period, large seasonal fluctuations in monthly mortality rates were observed in both rehabilitation units and long-term care units (peak in winter and nadir in summer). These rates tended to decrease from year to year in rehabilitation units but not in long-term care units. A statistical model based on time-series analysis of the control period data was used to calculate the expected monthly mortality rates for the study period in rehabilitation units and in long-term care units, respectively. Three of the 12 actual monthly mortality rates exceeded the upper limit of the 95% confidence interval of the 12 expected monthly mortality rates, in the units where the more severe care disruption occurred. A detailed analysis of discharge summaries of these units failed to identify a possible link between some of these deaths and a possible absence of care. CONCLUSIONS: The nurses' strikes did not induce a clear-cut increase in mortality in this population of elderly patients. However, we cannot exclude the possibility that these strikes had some negative effects on health. Our results fail to provide answers to the difficult ethical problems created by such stoppages.

Aged↗
PubMed1995

Impact of a nurses' strike on the cesarean birth rate.

OBJECTIVE: Our purpose is to describe the impact of a 31-day nurses' strike on the cesarean birth rate in the province of Manitoba, Canada. STUDY DESIGN: Computerized hospital records, obtained for all births over a 24-month period, were used to identify complications of labor indicating cesarean section, method of delivery, and adverse maternal and newborn outcomes. The strike interval was compared with a 16-month prestrike period. RESULTS: The cesarean section rate in the strike interval, 12.5 per 100 deliveries, was significantly lower than the prestrike rate of 14.6 per 100 deliveries (p < 0.05). Reductions occurred primarily among breech deliveries and among women with a previous cesarean section. No differences were observed in the rates of individual adverse maternal or newborn outcomes. However, the pooled incidence of adverse newborn outcomes was significantly higher during the strike than during the prestrike period (10.2 vs 8.1/100 deliveries, odds ratio 1.27, 95% confidence interval 1.07 to 1.52). CONCLUSION: In response to constraints imposed by a reduced nursing complement, physicians increased the frequency of vaginal birth in breech presentation and among women with previous cesarean section.

Breech Presentation↗
PubMed1989

Instructional assignments and the recent collective bargaining agreement: effect on nursing education.

Nursing teachers employed in the community college nursing programmes in Ontario were discontent with their workloads. Along with other teachers in the community college setting, they went on strike in the fall of 1984. Attention was focused on the workload formulae. In 1986, a new contract was ratified for all the teachers in the community colleges in Ontario. What issues emerged? Discussion will focus on contract changes with respect to instructional assignments, the effects upon the nursing instructors and students, and finally the implications for the programme.

Collective Bargaining↗
PubMed1986

The political economy of doctors' strikes in Nigeria: a Marxist interpretation.

Professions have been traditionally conceptualized as special occupational categories with distinguishing traits called to provide needed service. The social and economic context of these attributes is assumed unproblematic or taken for granted. This study of doctor's strikes in Nigeria critiques this conception and offers a political economy alternative. It analyses professions and their traits within a given context, and in relation to other groups. It is suggested that doctors in Nigeria are a powerful and privileged group, a view they seem to successfully use to pursue their interests.

Hospitals, Public↗
PubMed1988

Nurses' autonomy and job satisfaction.

Nurses' autonomy is structurally limited by physicians' close supervision and control. A prolonged physicians' strike in Israel in 1983 created a special situation where for 3 months nurses had to provide primary health care services without physicians. This study, undertaken at the end of the strike, focuses on nurses' comparative perceptions of autonomy and job satisfaction with relation to role performance during the strike and in usual work conditions. Data were collected by means of a self-administered questionnaire. Sixty one percent (n = 1144) of the primary health care nurses in Israel responded. The strike situation increased the normal work load of the nurses, but it also gave many nurses the opportunity to initiate and carry out special programs in their clinics and communities. The majority of nurses report that in general they are satisfied with their work and perceive it as autonomous. The increase in routine as well as self-initiated activities was found to be positively but weakly correlated with an increase in job satisfaction and in the perception of role autonomy during the strike. These findings suggest that even after, or perhaps because of, being exposed to a significant change in contextual autonomy (working without physicians for a prolonged period of time) most Israeli primary care nurses do not appear to desire increased autonomy in the work place.

Adult↗
PubMed1989

Autonomy, job satisfaction and professional self-image among nurses in the context of a physicians' strike.

This paper tests the hypothesis that structural changes in nurses' work settings, which allow nurses to autonomously exercise their knowledge and skills will lead not only to an enhanced feeling of professional autonomy, but also to an improvement in their professional self-image and to an increase in job satisfaction. An opportunity to test this hypothesis arose when physicians in Israel went on a strike which lasted 116 days. Primary care (PC) clinics were completely abandoned by physicians, leaving nurses to operate them on their own, while in hospitals, nurses continued to work as usual under physicians' supervision. The study compares the effect of the strike on head nurses in the two sectors. Data were collected by means of self administered questionnaires. The findings indicate that during the strike, PC head nurses expanded their activities and responsibilities and consequently felt more professional autonomy and job satisfaction, as well as an improvement in professional self-image. Hospital head nurses experienced significantly less changes in their work situation and, as expected, less change in all work related attitudes. It is suggested that, when given the opportunity to define for themselves roles where they can use their experience, knowledge and skills, senior nurses stand up to the challenge and consequently are more satisfied and their professional self-image improves.

Humans↗
PubMed1984

Emergency department utilization during a doctors' strike.

Emergency department (ED) patient volume at Jerusalem's Shaare Zedek Hospital was 33% higher during the 1983 doctors' strike as compared with the same period in 1982. Excess visits were recorded for both sexes (P less than 0.0001), but there were many more excess visits by females than males. The largest increase in visits by adults (60-70%) was in persons aged 40-64 years (P less than 0.02), and there was also a large and unexplained increase in ED visits by girls under age 6 (P less than 0.0003). In contrast to excess ED visits, which were higher during the strike for both sexes, excess hospital admissions via the ED were recorded only among females (P = 0.007). The number of ED visits during the strike was increased on all three hospital work shifts (P less than 0.0001), with the greatest number of excess visits occurring between 7 AM and 3 PM.

Adolescent↗
PubMed1984

Patterns of emergency department use during the Israel doctors' strike.

We studied changes in emergency department utilization at a major Jerusalem regional hospital during the 4-month-long Israel doctors' strike. The number of ED visits was increased by 35% over control levels. There were larger increases in female visitors than male and larger increases in visits by children and in women of childbearing age. Use of laboratory tests, ECGs, and x-rays were increased minimally, and hospital admissions via the ED were unchanged. We conclude that the vast majority of excess strike-related ED visits were for trivial illnesses and that very large numbers of persons with medical symptoms elected not to seek any medical attention at all during the strike.

Adolescent↗