The Power of Organised Nurses: Collective Actions for Change

As we observed International Nurses Day on May 12, governments were still debating whether a new instrument to address future pandemic preparedness, prevention, and response – commonly referred to as the Pandemic Treaty – should recognise trade union rights and ensure adequate staffing for health workers. Many governments seem to have forgotten the sacrifices made by health and care workers, who have risked their own time, health, and well-being to save lives. However, nurses' unions are not backing down. They are fighting for, and winning, their rights, demonstrating the strength of collective power.

In celebration of the collective power of nurses, we share with you several inspiring stories from the Asia Pacific region. These narratives highlight how nurses have united and organised to secure the working conditions they deserve and to uphold the quality public health system to which we are all entitled. This article offers a glimpse into the power of unity and collective action among nurses.

Fiji Nursing Association Runs Successful Pay Rise Campaign

For more than a year, the Fiji Nursing Association campaigned for fair pay for all nurses. In April, at FNA’s annual general meeting, Minister of Health Dr Atonio Lalabalavu, delivered the stunning news that the government had agreed to their demand for pay increase for nurses across the board, with the highest being a 41.3% increase for nurses in two bands (B and G).  

As the last pay rise for nurses in Fiji happened in 2018 this was long deserved and due. 

The low salary and overwork meant many were leaving the profession. Last year, FNA found their membership reducing to an all-time low of 800 nurses. In August last year, the more worker friendly government, announced a pay-rise for nurses and interns. However, the union felt the increase was inadequate and did not compensate the workforce for their hard work and dedication. Nurses had started to leave not only the union, but also the profession itself. Many were migrating overseas to work in care. At this point  the union decided to ramp up their organising approach and take action.

The union decided industrial action would need to be considered. But they knew that they would need a majority of nurses to take action. Through structured and planned organising that involved mapping hospitals, charting workers, and developing a tight communication strategy, the union grew their membership over the last year.

From less than 800 nurses since the start of the campaign, FNA increased their membership to more than 1500 nurses. Once the membership increased, the union successfully administered the secret ballot for industrial action. More than 70% of the total nurse's workforce voted in favour, forcing the Fiji government to enter negotiations with the union. As the General Secretary of the FNA, Filomena Talawadua, shared, at the end of the day, “it was all about patience, dialogue, and providing evidence on the ground.”

The union’s efforts culminated in a substantive pay rise announced last month. This achievement marks a major milestone, and the campaign now continues through bargaining on other working conditions, with the nurses pushing for further improvements in their working environment.

Sri Lankan Nurses Fight for Basic Allowances

The Public Services United Nurses’ Union (PSUNU) has demonstrated the strength of collective action. With a membership of around 28,000 out of the 40,000-strong public sector nursing workforce, PSUNU has long been advocating for better working conditions for its members. In 2021, the government had agreed to meet five out of the seven demands that the union had been raising for several years. However, they remained unmet and the economic crisis in Sri Lanka worsened the situation. 

“We recognise that there is a big economic issue here that we are all facing in this country. But even in this crisis, doctors managed to double their allowance and have been receiving the raised allowance every month. That is not fair. Does that mean that other health and care workers are less important? If doctors can receive raised allowances in an economic crisis, so should we. We have equally stood by our people and done our duties with full commitment,” remarked a PSUNU member.

Earlier this year, PSUNU decided to launch a series of protest actions for their demands that included among others, increasing the existing uniform allowance, increasing the existing inventory allowance, and overtime payments. Starting with wearing black bands on their uniforms to work, the nurses escalated their protest in February by reporting to work in civil attire instead of uniforms. This widespread action, with a remarkable participation of around 95% of the entire nursing workforce, sent a powerful message to the government. The government, faced with unwavering solidarity of the nurses, had no choice but to take notice. Negotiations were finally initiated, as the authorities recognised the strength and determination of PSUNU members. So far, the government has agreed to increase uniform allowance from 15,000 LKR to 25,000 LKR. The government also assured an increase to 30,000 LKR from next year. Other demands are also being negotiated. 

By standing united, the nurses of PSUNU were able to compel the government to address their long-standing demands, demonstrating the true power of workers' solidarity.

Contractual Nurses Unionise in Indian Primary Health Centres

In India, nurses working in the Urban Public Health Centres (UPHC) in the city of Nagpur in Maharashtra were not unionised prior to the pandemic. But during the pandemic their frustrations grew, and they contacted PSI affiliate, the Nagpur Municipal Corporation Employees’ Union (NMCEU) for help. This workforce comprises the Auxilary Nursing and Midwifery (ANM) and General Nursing and Midwifery (GNM) cadre, all contractual, women workers, in the primary healthcare facilities serving the urban population. Since they began unionising, they have followed a structured organising roadmap including by mapping workplaces, identifying issues and creating workplace leaders. PSI supported NMCEU to enhance the capacities of the workers most interested in unionising.

“During the pandemic, we worked under a lot of stress and felt harassed and traumatised. We used to work almost all day and even at night still did not get proper protection kits, nor did we get our salaries on time. The frustration was mounting but no one really knew what to do. We had heard of NMCEU, and vaguely knew that they had unions of sanitation workers in Nagpur. We reached out to the NMCEU leadership and  decided to undertake protest actions with their guidance. We demanded PPE kits and our due wages from the government. It worked. We now want to unionise staff from all the UPHCs in Nagpur so that we are powerful. If all the UPHC staff come under one union, then the government will have to listen to us," said a GNM, who is also a NMCEU member.

Though the union is still actively organising to build their union base, their successful action at their worksites last year demonstrates the power of collectivised workers. They protested a new online application introduced by the government for ANMs  to record vaccination targets. The ANMs faced challenges with the app due to lack of training, unreliable internet at their workplace, and increased work burden. Despite threats of being fired by the Medical Officer (MO), the ANMs, supported by union members and others, refused to use the app. Eventually, the MO relented and stopped pressuring them. While the government has not withdrawn the work responsibility, the ANMs continue to abstain from using the application.

The union has now expanded to include other health workers, recognising that solidarity amongst health workers is the key to building power at work. Their key demands include regularisation, better pay, increased leave entitlements, and better working conditions.

Australian Nurses Keep Entitlements

The New South Wales Nurses and Midwives Association (NSWNMA) repeatedly achieved significant wins by organising both nurses and communities that care about quality health care. In February, the NSWNMA secured an agreement in which, for the first time, the NSW will have minimum and enforceable shift by shift nurse-to-patient ratios implemented in specific clinical areas of public hospitals. The win didn’t come easily. In 2022, the union held four historic strikes that shaped the 2023 state election and helped bring in a Labour government. 

On May Day, the union shared another important announcement that demonstrates the power of organising nurses and midwives and gaining community support.

The management of the Hawkesbury hospital, which had previously been outsourced, is being taken over by the NSW government. Yet nurses were going to lose leave entitlements and pay. The workers and community rallied to ensure nurses' conditions were kept. 

“So many healthcare workers and their families came together to support our own-time rally last week, and it really demonstrated what a fantastic community we have in the Hawkesbury,” said Ann Jackson, a workplace union delegate.The solidarity forced the administration to accept nurses’ demands.

The solidarity forced the administration to accept nurses’ demands, which the union announced on May 1.

“It’s a complete turnaround. In early March, we were facing a forced leave payout, a loss of accrued sick leave entitlements and a drop in take-home pay due to changes in salary packaging arrangements. We’ve now been assured that all our sick leave will be transferred, our current salary packaging arrangements will continue for another two years, and members will have the choice to transfer their long service and annual leave entitlements.” said Ben Wright, Branch Secretary, NSWNMA Hawkesbury District Health Service. 

Filipino Nurses Run Successful Campaigns 

Around 50% of the membership of the Alliance of Filipino Workers (AFW) is nurses. A separate platform, called the AFW Registered Nurses Task Force, was created to ensure nurses can address nursing specific issues. The Task Force has been actively involved in successful campaigns that address not just concerns of nurses but all health and care workers, such as 105 days Maternity Leave, Universal Healthcare Act, and the more recent ratification of the ILO C-190 on Violence and Harassment in the World of Work.

The Philippines ratified the ILO C190 in 2023, after a powerful campaign by the trade unions that began in 2019.  PSI affiliates and  global trade union federations campaigned together to demand the ratification of the convention that protects workers, especially women workers, from violence and harassment. In the health and care sector, nurses, who are  primarily women,  have been raising the issue of violence at work for years. Nurses in the Philippines have shared stories of mental, physical and verbal harassment that they have been subjected to by seniors, peers, patients, and patient families. The AFW Registered Task Force Nurses remained an integral part of this successful campaign from its inception to its success.

Currently the Task Force is actively involved in campaigning for the passing of the bill on “Philippines New Nursing Practice Act”. The Act that aims to improve working conditions and salaries of nurses, particularly in private hospitals.

As the world continues to grapple with the challenges of the pandemic and beyond, the resilience and determination demonstrated by the nursing workforce is an inspiration to workers everywhere. When health and care workers come together, they possess the power to transform the industry and improve quality of patient care.  

PSI stands in solidarity with our affiliates in the region and with nurses everywhere and congratulate them on this International Nurses Day on their actions and their wins.