ENSAYOS

Nursing from the perspective of Decent Work

Enfermería desde la perspectiva del Trabajo Decente

Quintana Zavala, María Olga^*; Valenzuela Suazo, Sandra^** and Paravic Klijn, Tatiana^***

^*PhD in Nursing. Professor of the Department of Nursing. University of Sonora. E-mail: mariaoquintana@udec.cl
^**PhD in Nursing, Professor, Department of Nursing. Faculty of Medicine. University of Concepción, Chile

ABSTRACT

Introduction: The International Labor Organization encourages improvement in the quality of life for workers, highlighting poor working conditions and promoting Decent Work for all.
Objective: To reflect on the implications of the work of nursing in relation to the concept of Decent Work.
Development: Decent Work responds to the increasing vulnerability of workers, mainly young people, women and the poor. Nursing as a profession is made up mostly of women, faces multiple occupational hazards, including psychosocial risk factors, biological, physical, chemical and ergonomic, which means that this health care profession has higher health risks, is not the best paid job, nor is well recognized socially around the world.
Conclusion: Decent Work involves competitive salaries, social security, fair globalization, education, gender equality, low risk, with labor rights and fairness. Nursing professionals, health institutions and governments should reconsider attending to the multiple risks that are faced in any hospital to make nursing work comply with all the features of Decent Work, promoting the reduction of occupational hazards and providing better salaries and working conditions in general to all nurses and improving the quality of their working life.

Keywords: Nursing; Occupational Risks; Decent Work.

RESUMEN

Introducción: La Organización Internacional del Trabajo es un organismo que realiza propuestas y recomendaciones enfocadas a mejorar la calidad de vida de las y los trabajadores, evidenciando las condiciones deficientes de trabajo y enfatiza sobre la importancia de que todo ser humano tenga acceso a un Trabajo Decente, el cual es un concepto con profundos marcos éticos que busca la justicia social.
Objetivo: Reflexionar sobre las implicancias del trabajo de Enfermería en relación al Concepto de Trabajo Decente.
Desarrollo: El término Trabajo Decente surge como respuesta a la situación de creciente desprotección de los trabajadores(as), principalmente de los jóvenes, las mujeres y los más pobres. La Enfermería como profesión conformada en su mayoría por mujeres, se enfrenta a múltiples riesgos laborales, que la convierten en la profesión sanitaria con mayores riesgos a la salud, pero no en la mejor remunerada, ni en la más reconocida socialmente alrededor del mundo.
Consideraciones finales: El Trabajo Decente implica salarios competitivos, seguridad social, globalización equitativa, formación, equidad de género, libre de riesgos, con derechos laborales e igualdad. Los profesionales de Enfermería, las Instituciones de Salud y los Gobiernos, deben reconsiderar las condiciones de trabajo y los múltiples riesgos adicionados a la labor de las Enfermeras, para hacer que la Enfermería cumpla con todas las características de un trabajo decente, fomentando la prevención de riesgos laborales e incentivando con mejores salarios y condiciones de trabajo en general, para mejorar la calidad de vida laboral de las Enfermeras y Enfermeros.

Palabras clave: Enfermería; Riesgos Laborales; Trabajo Decente.

Introduction

The International Labor Organization (ILO) was created as part of the Treaty of Versailles in 1919 in order that governments, employers and workers join efforts in favor of social justice and better conditions of life and work for all human beings¹.

ILO, throughout history, has carried out proposals and recommendations focused on the improvement of the life of workers, evidencing injustices because they need to work, and has highlighted the importance that all human beings have access to Decent Work (DW), which implies employment in sufficient amount and with the proper quality; appropriate, dignified, and fair. Work should include the respect for human rights, proper and equal income, satisfactory work conditions and social protection, in the context of Union freedom and social dialogue²

However, the world reality in relation to the shortage of employment reflects great insecurity in which, unfortunately, the least protected are women, children, older people, indigenous people, and/or people with some kind of disability, who due to their condition a certain degree of vulnerability is adjudicated, but that amounted to the situation of living in underdeveloped countries, of being migrants, not having education and/or being of color, making it for them more difficult to access resources and specifically to have the opportunity of a family income that is backed up by DW. Moreover, work changes due to globalization make more precarious the condition of the work of vulnerable groups; therefore it is vital to emphasize the importance of higher education, respect for the rights and dignity of workers, which are part of the features of DW³.

Nursing, as a professional group inserted in the work market is not exempt to the changes of current work conditions, and when making an analysis of some of the current nursing work characteristics it can be said that it is not aligned with the concept of DW provided by the ILO, since some of the work forms and hiring of male and female nurses affect both physical and mental health, which transcend to the attention they provide, this is a situation that is necessary to consider since the Professional of Nursing are a numerous trade group that support health services around the world.

Therefore, the objective of this article is to reflect on the implications of Nursing Work in relation to the concept of DW provided by the ILO, through the development of historic background, the explication of the concept, the analysis of transformation in the current work relationships and challenges that DW represents for the Nursing Profession.

Historical background of the ILO

The International Labor Organization (ILO) was born as part of the Treaty of Versailles, at the end of the First World War. "Its formation was prepared between January and April, 1919, by a Work Committee established by the Peace Conference, which met for the first time in Paris and after that in Versailles. The Committee, run by Samuel Gompers, President of the American Federation of Labor, was comprised of representatives from nine countries: Belgium, Cuba, Czechoslovakia, France, Italy, Japan, Poland, The United Kingdom, and the Unites States of America. The result was a three-fold organization of its kind, with representatives from the government, employers, and workers in its executive bodies."⁴.

The main reason that motivated the emergence of the ILO was adopting really humane work with respect to: Regulation of working hours, contracting of labor, prevention of unemployment, and the supply of a dignified salary; protection for the worker against illnesses or accidents as a consequence of their work, and for children, youth, and women, old age retirement pension and disability pension; protection of the interests of the workers who work abroad; acknowledgement of the equality of salary and equality of conditions and union freedom as well as the organization of professional and technical teaching⁴.

Currently the Chilean Juan Somavia, is the ninth General Director of ILO, who took possession of his 5-year mandate in March 4, 1999, becoming the first representative from South America in directing the ILO. In March 2003, he was re-elected for a second 5-year mandate and on November 18 he was re-elected for a third 5-year mandate, and was the person who proposed the Program of Decent Work, which he has boosted during his tenure⁵.

Concepto of Decent Work

The concept of DW was born as an answer to the increasing vulnerability of male and female workers and to the insecure situations in which contemporary societies operate, especially in developing countries (Developing countries are those where there has been a delay regarding human development, which is measured with three indicators: long life, education, and dignified live level), before the world issues around the dehumanization of work, and the neo-liberal trend that prefers production and generation of riches, and as a consequence, the exploitation of human beings. Thus, ILO declared that DW is: "productive work in which the human rights are respected, with protection and security, and with the possibility to participate in the decisions that affect workers"⁶.

Moreover, DW incorporates the following attributes: employment of quality and in sufficient amount, proper income, work safety, continuous professional education and regarding the job offer; union strengthening and collective bargaining, participation of workers in decisions of economical and social policies, social dialogue, and tripartism, social protection in employment and society, in conditions of freedom, equity, and dignity for all members of the society ⁶.

Some authors argue that the DW concept is a term still in construction, due to the constant transformations of working relationships, the focus on competitiveness from companies, both in state-of-the art sectors as well as traditional ones, which emphasize the apparition of a new form of productive organizations such as company clusters, service outsourcing, work at home, and several forms to bring together the external management of projects or auxiliary services commonly known as outsourcing, (English Word frequently used in Spanish which is translated as "externalize", that is, subcontracting of professional services to meet specific need and decrease contracting costs) which has produced differentiated production models that cause problems to the configuration of work and social security ⁷.

DW causes debates in the way it is operated since it pretends to be a reality around the world, and the debates are more vigorous when they are about countries with higher poverty indexes, which constitute strong criticism before the current economical model⁸.

Transformation in work relationships

The transformations in the working relationships generated by globalization comprise aspects such as changes of jobs, flexibility in the work market, changes in work regulations, restructuring of social security systems, weakening of trade unions and collective bargaining; others such as weakening of the state role as allocator of resources and as income redistribution agent and the strengthening of company autonomy not only to make economical decisions but also to unilaterally define work and salary conditions as well as profit margins that businesses want to reach⁶.

To mitigate some of the negative work transformation, the main objective of ILO is to "promote strategies so men and women can get a decent and productive job in conditions of humane freedom, equality, security and dignity by putting into practice four strategic objectives, which are: 1) Job creation; 2) Guarantee workers' rights; 3) Extend social protection; 4) Strengthen tripartism, promote social dialogue, and gender equality⁹.

Nowadays there is a deficit of DW in the world, that is why it is urgent that government assume the challenge to create 600 million productive jobs in the next decade, and even though there will be 900 million workers living with their families with incomes lower than the poverty threshold of 2 American dollars per day, especially in developing countries. The panorama of the creation of jobs affects especially young people, since there are 74.8 million young people between 15 and 24 years of age who are unemployed. Among the 900 million poor workers, 456 million live in extreme poverty with income lower than the threshold of 1.25 American dollars. At world level, it is estimated that the number of vulnerable jobs is 1.52 million. The proportion of women in situation of work vulnerability is 50.5% and it exceeds that of men³.

In Latin America, the perspective is positive since the interruption caused by the 2009 world crisis, the vulnerable job rate keeps going down and according to that trend in the long term adult women will keep benefiting from job opportunities³; however, in order for this employment to be considered DW it is vital to meet the proper job conditions, work rights, and support to professional education since, as it is stated by Amartya Sen: "there will be no decent work without social justice and citizenship. And nothing of this will exist without professional education"¹⁰.

Decent Work challenges for the nursing profession

By analyzing some of the characteristics of Nursing work under the Decent Work concept, we can say that there are points to consider in the work that nurses perform around the world that are not according to the concept, including those related to the various risks that are present when working in the different areas of the hospitals, where risk means any characteristic present in the workplace, which when acting on the worker can produce a response that it may be discomfort, pain or injury¹¹.

There is evidence that the work performed by nursing professionals within the hospitals is the one that poses more risks to health, compared to other groups of health professionals. The most important risks are psychosocial, biological, physico-chemical and ergonomic^{12, 13}.

Added to this, nursing, as a feminized profession, continues to present gender discrimination, which is reflected in the under-valuation of this type of work, lower wages compared to other health professionals and more intense scrutiny of their professional activity¹⁴.

Likewise, it is documented that within the Nursing staff there is a feeling of mistrust from the nurses to their heads of staff, mainly because the neglect and lack of support in relation to the permits requested in cases of special situations, which has repercussions within the leadership, teamwork and working environment, and negatively affects the proper operation of health services¹⁵.

Additionally, the work of nurses has been affected by some of the economic changes brought about by globalization. Although nursing is a profession with high demand in most countries, it is increasingly common to perform temporary contracting in public and/or private institutions, which affects the job stability and prevents nurses from claiming their rights because sometimes the fact of being hired as temporary worker or with indeterminate terms makes it impossible in some cases to have access to some basic employment benefits, such as joining unions, having vacation periods, illness leave, access to continuing education, promotions, and health services, among others, and in addition the contingencies are long lasting since there is little creation of new jobs.

The Nursing Professionals of some Central American countries are in a more difficult situation due to the fact that there is a shortage of employment opportunities, although in some of the Latin American countries there is work for nurses, their salaries are lower than those of other health professionals and their working conditions are not the most adequate; regarding labor rights, the creation of unions is still an accepted practice in some countries, but the trend is to remove them, especially in private health institutions, where creating a union becomes grounds for termination. In terms of social security, the trend is to remove the protection of the workers with outsourcing, a situation that has reached the profession of Nursing.

For example, in Mexico, the unemployment overall rate^d of nursing graduates is 410 people per 1000 people (16), while the migration of professional nurses to countries such as Spain, Canada and the United States is increasing, which has social and economic impacts, because of its negative effects on the population's health because nurses are the group of health professionals who achieve greater care coverage. However, the main reasons that have been identified for the migration to the aforesaid countries are low wages and a lack of professional status or low appreciation of the profession by society¹⁷.

Nevertheless, work issues in the nursing profession are alarming also in industrialized countries, since salaries within health services provided by the public sector have been decreasing. "Women, who represent 80% of workers in this sector, are at the lower hierarchical levels in terms of authority, payment and qualification", added to this, almost a quarter of violent incidents at the workplace are concentrated in this sector¹⁷.

The approach of the nursing profession agrees with ILO's, as the Nursing Profession can not be considered a commodity, the freedom of speech and association of nurses is essential for the advancement of their profession; poverty in any place is a threat to the prosperity of all human beings regardless of race, creed or sex; they have the right to pursue their material well-being and their spiritual development in conditions of freedom and dignity, with economic security and equal opportunity.

Final considerations

Nursing as a professional group within the health area is the largest human resource and performs very important functions, for example: they provide professional care, expand the coverage of the health services and contribute to the improvement of the public health of the population, and are also in direct and permanent contact with the users.

For this reason, and like any other health profession, the nursing work must comply with the characteristics of Decent Work, which means access to fair wages, social security, professional training, gender equality, low risk and labor rights in equal circumstances for everyone.

The Nursing work should also focus on promoting structural changes at public policy level that promote Decent Work for nurses and for all workers.

Governments, health institutions and Nursing Professionals must recognize that Nursing work is extremely valuable for the health of the population, so it is necessary to implement strategies that promote better work environments that decrease work risks, and that motivate people to enter and remain in the exercise of this profession.

References

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