The 1999 Irish nurses' strike: nursing versions of the strike and self-identity in a general hospital

AIM: The aim of this paper is to report findings from a study investigating nurses' experiences of strike in one public general hospital in the Republic of Ireland. BACKGROUND: October 1999 heralded the first nationwide nurses strike in the Republic of Ireland. The strike reflected an international shift towards industrial action in a profession which had previously viewed such action as the antithesis of professional behaviour. METHODS: A focused ethnographic approach studied a group of striking Registered Nurses, not as a culture per se, but as a collection of individuals sharing a common human experience. A purposive sampling approach identified eight information-rich cases from a modified quota structure. Semi-structured interviews were carried out immediately prior to, during and at the end of the 1999 strike. The participants also maintained journals which were explored during the interviews. Data were analysed using a constant comparative approach, seeking to achieve category saturation. FINDINGS: Four strike versions were identified. The anticipatory version is constructed as an inevitable protest, the orientation version as history-making solidarity and the performing version as a job of work. The withdrawal version is constructed as a conspiracy from which nurses are excluded. These versions portray ongoing tension that is experienced between conflicting self-identities of Registered Nurses as nurses and as strikers. The analysis revealed strategies adopted to resolve tensions between these identities within the dimensions of carer, patient advocate, multidisciplinary team member and professional. CONCLUSIONS: Debate on such potentially contentious issues by individual nurses, hospital managers and union leaders may facilitate awareness and preparation in advance of any future industrial action. Strategies that may be helpful in the event of a strike include a prestrike orientation programme for the entire organization, a support system for staff during the strike and informal de-briefing among all staff in the context of a social gathering when the strike is over.     

Story of a strike

In the summer of 1983 the Finnish Nurses Federation, a nursing organization in membership with the Union of Health Professionals (TEHY) and within the Confederation of Salaried Employees (TVK) of Finland found themselves in dispute with the employers (KSV). A limited strike, supported by all political parties and the majority of members of parliament. The strike resulted in an increase in salaries. This is an account of events.     

Takotsubo cardiomyopathy following lightning strike

Lightning strike is the most common environmental cause of sudden cardiac death, but may also be associated with a myriad of injuries to various organ systems. Direct myocardial injury may be manifest as electrocardiographic alterations or elevation in cardiac-specific isoenzymes; however, significant electrical cardiac trauma appears uncommon. A case is presented of severe acute cardiomyopathy in a "Takotsubo" distribution causing cardiogenic shock following lightning strike in a previously healthy 37-year-old woman. Although rarely identified in this context, Takotsubo cardiomyopathy (also known as "transient left ventricular apical ballooning syndrome") is characterised by transient cardiac dysfunction, electrocardiographic changes that may mimic acute myocardial infarction and minimal release of cardiac-specific enzymes in the absence of obstructive coronary artery disease. The condition is associated with a substantial female bias (up to 90% of cases) in reported series, and despite occasionally dramatic presentations recovery of left ventricular function is almost universal over days to weeks. In rare instances, however, the syndrome has been associated with more catastrophic complications such as papillary muscle or cardiac free wall rupture, necessitating emergency surgical intervention to preserve life. In clinical practice, non-lethal lightning strike-induced cardiac injury is frequently associated with small elevations of cardiac isoenzymes without overt clinical sequelae; however, the incidence of silent myocardial mechanical dysfunction remains unknown. Cases such as the one presented highlight the potential for serious, albeit usually transient, cardiac sequelae from lightning strike injury and remind us that our mothers' advice to remain indoors during thunderstorms is probably worth heeding.     

Severe stunned myocardium after lightning strike

OBJECTIVE: To report the development of myocardial stunning and severe heart failure after lightning strike with total recovery of function. DESIGN: Case report. SETTING: Coronary care unit at Medica Sur Clinic, Mexico. PATIENT: A 42-yr-old woman who was hit by lightning developed rapid and progressive hemodynamic deterioration manifested by cardiogenic shock that required invasive monitoring. Twenty-four hours after the strike, intravenous levosimendan and intra-aortic balloon pump were initiated because the patient demonstrated no significant response to management with conventional inotropic agents. Two days later, echocardiographic signs of systolic and diastolic dysfunction improved markedly. Dual-isotope-imaging myocardial perfusion testing with technetium-99m-sestamibi and thallium-201, performed 9 days after admission, showed normal perfusion and normal left ventricular systolic function. The patient exhibited complete recovery of function. The exact mechanism of abnormal contractility in the absence of direct electrofulguration is unknown but may be explained by release of oxygen free radicals, proteolysis of the contractile apparatus, and cytosolic overload of intracellular calcium, followed by reduced myofilament sensitivity to calcium. These abnormalities are consistent with stunned myocardium. CONCLUSIONS: Lightning strike may cause serious contractile dysfunction in the absence of irreversible myocardial injury, but the exact mechanism of this phenomenon remains unknown. We propose that lighting strike can cause myocardial stunning resulting in severe but reversible left ventricular dysfunction. The patient's recovery was facilitated by support treatment including administration of levosimendan, which increases the intracellular sensitivity to calcium, a mechanism disturbed in patients with myocardial stunning.     

Don't strike out in union negotiations

Examine a case study to see how nurse leaders should proceed in case of a strike.