Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic?

Human Resources for Health - Tập 19 - Trang 1-11 - 2021
Alba Llop-Gironés1,2,3, Ana Vračar4, Gisela Llop-Gironés5, Joan Benach1,6,7, Livia Angeli-Silva8, Lucero Jaimez9, Pramila Thapa10, Ramesh Bhatta11, Santosh Mahindrakar12, Sara Bontempo Scavo13, Sonia Nar Devi14, Susana Barria15, Susana Marcos Alonso16, Mireia Julià1,2,3
1Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET) Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
2Escola Superior d’Infermeria del Mar (ESIMar), Barcelona, Spain
3Social Determinants and Health Education Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
4Organization for Workers’ Initiative and Democratization, Zagreb, Croatia
5Nurse and Midwife Consultant, London, UK
6The Johns Hopkins - UPF Public Policy Center (JHU-UPF PPC), Barcelona, Spain
7Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
8Universidade Federal da Bahia, Salvador, Brazil
9Nurse Consultant, Mexico City, México
10Nurse Consultant, Kathmandu, Nepal
11Yeti Health Science Academy, Kathmandu, Nepal
12Innovative Alliance for Public Health, New Delhi, India
13Nurse Consultant, Bologna, Italy
14Nurse and Midwife Consultant, Dublin, Ireland
15People’s Health Movement, New Delhi, India
16Nurse Consultant, Barcelona, Spain

Tóm tắt

Nurses and midwives play a critical role in the provision of care and the optimization of health services resources worldwide, which is particularly relevant during the current COVID-19 pandemic. However, they can only provide quality services if their work environment provides adequate conditions to support them. Today the employment and working conditions of many nurses worldwide are precarious, and the current pandemic has prompted more visibility to the vulnerability to health-damaging factors of nurses’ globally. This desk review explores how employment relations, and employment and working conditions may be negatively affecting the health of nurses in countries such as Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom. Nurses’ health is influenced by the broader social, economic, and political system and the redistribution of power relations that creates new policies regarding the labour market and the welfare state. The vulnerability faced by nurses is heightened by gender inequalities, in addition to social class, ethnicity/race (and caste), age and migrant status, that are inequality axes that explain why nurses’ workers, and often their families, are exposed to multiple risks and/or poorer health. Before the COVID-19 pandemic, informalization of nurses’ employment and working conditions were unfair and harmed their health. During COVID-19 pandemic, there is evidence that the employment and working conditions of nurses are associated to poor physical and mental health. The protection of nurses’ health is paramount. International and national enforceable standards are needed, along with economic and health policies designed to substantially improve employment and working conditions for nurses and work–life balance. More knowledge is needed to understand the pathways and mechanisms on how precariousness might affect nurses’ health and monitor the progress towards nurses’ health equity.

Tài liệu tham khảo

Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8:e790–8. ICN. COVID-19 Update: Mass trauma experienced by the global nursing workforce. Geneva; 2021. https://www.icn.ch/sites/default/files/inline-files/ICN%20COVID19%20update%20report%20FINAL.pdf. WHO. National Health Workforce Accounts: implementation guide. Geneva; 2018. https://www.who.int/publications-detail-redirect/national-health-workforce-accounts-implementation-guide. ICN. ICN confirms 1,500 nurses have died from COVID-19 in 44 countries and estimates that healthcare worker COVID-19 fatalities worldwide could be more than 20,000; 2020. https://www.icn.ch/sites/default/files/inline-files/PR_52_1500%20Nurse%20Deaths_FINAL-3.pdf. Hughes MM, Groenewold MR, Lessem SE, Xu K, Ussery EN, Wiegand RE, et al. Update: characteristics of health care personnel with COVID-19. MMWR Morb Mortal Wkly Rep. 2020;69:1364–8. Kambhampati AK. COVID-19–associated hospitalizations among health care personnel—COVID-NET, 13 States, March 1–May 31, 2020. MMWR Morb Mortal Wkly Rep. 2020 (cited 2020 Nov 28);69. https://www.cdc.gov/mmwr/volumes/69/wr/mm6943e3.htm. Amnesty International. Exposed, silenced, and attacked: failures to protect health and essential workers during the COVID-19 pandemic. London; 2020. https://www.amnesty.org/en/documents/document/?indexNumber=pol40%2f2572%2f2020&language=en. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C-G, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020;5:e475–83. Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. A critical care Societies collaborative statement: burnout syndrome in critical care health-care professionals. A call for action. Am J Respir Crit Care Med. 2016;194:106–13. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901–7. Er F, Sökmen S. Investigation of the working conditions of nurses in public hospitals on the basis of nurse-friendly hospital criteria. Int J Nurs Sci. 2018;5:206–12. WHO. State of the world’s nursing 2020: investing in education, jobs and leadership. 2020. https://www.who.int/publications-detail/nursing-report-2020. Julià Pérez M. Precarització de les condicions d’ocupació a la Unió Europea: Precarietat, informalitat, i associació amb la salut (Ph.D. Thesis). TDX (Tesis Doctorals en Xarxa). Universitat Pompeu Fabra; 2016 (cited 2020 Nov 26). http://www.tdx.cat/handle/10803/406084. Benach J, Muntaner C. Employment, work and health inequalities: a global perspective. Icaria Editorial; 2014. Benach J, Muntaner C, Solar O, Santana V, Quinlan M. Employment, work, and health inequalities: a global perspective. Geneva: WHO; 2007. https://www.who.int/social_determinants/resources/articles/emconet_who_report.pdf?ua=1. Aristizabal P, Nigenda G, Serván-Mori E. The precarization of the Mexican nursing labor market: a repeated cross-sectional analysis for the period 2005–2018. Hum Resour Health. 2019;17:87. Fité-Serra AM, Gea-Sánchez M, Alconada-Romero Á, Mateos JT, Blanco-Blanco J, Barallat-Gimeno E, et al. Occupational precariousness of nursing staff in Catalonia’s public and private nursing homes. Int J Environ Res Public Health. 2019;16:4921. Times of India. Delhi: Nurses make less than your plumber. 2019 Dec 5 (cited 2020 Nov 30); https://timesofindia.indiatimes.com/city/delhi/nurses-make-less-than-your-plumber/articleshow/72374665.cms. Lappin K. Frontline aged care workers warn WHO Western Pacific about horrific consequence of privately run aged care. 2020 Oct 8 (cited 2020 Nov 30); https://publicservices.international/resources/news/frontline-aged-care-workers-warn-who-western-pacific-about-horrific-consequence-of-privately-run-aged-care?id=11197&lang=en. Engelbrecht MC, Bester CL, Van Den Berg H, Van Rensburg HCJ. A study of predictors and levels of burnout: the case of professional nurses in primary health care facilities in the free state1. South Afr J Economics. 2008;76:S15-27. van der Doef M, Mbazzi FB, Verhoeven C. Job conditions, job satisfaction, somatic complaints and burnout among East African nurses. J Clin Nurs. 2012;21:1763–75. Baranda L. Estudi sobre la Salut, estils de vida i condicions de treball de les infermeres i infermers de Catalunya. Fundació Galatea; 2017. http://www.consellinfermeres.cat/wp-content/uploads/Salut-estils-de-vida-i-condicions-de-treball-de-les-Infermeres-i-Infermers-de-Catalunya.pdf. Cordeiro TMSCE, de Araújo TM. Work ability among primary health care nursing staff, Bahia, Brazil. Rev Salud Publica Bogota. 2018;20:422–9. Ansoleaga E, Toro CJP, Godoy CL, Stecher A, Blanch JM. Psychophysiological distress among health care professionals working in Chilean public hospitals. Rev Med Chil. 2011;139:1185–91. Triana-Palencia E, Cárdenas-Cárdenas LM, Juárez-García A, Quiroz-Muysina J, Idrovo AJ. Use of assessment scales, turnover and job strain in nursing staff: a study in a Colombian hospital. J Nurs Manag. 2019;27:42–51. Juárez-García A. Psychosocial work factors associated to blood pressure and cardiovascular symptoms among Mexican nurses. Salud Publica Mex. 2007;49:109–17. Zavala MOQ, Klinj TP, Carrillo KLS, Zavala MOQ, Klinj TP, Carrillo KLS. Quality of life in the workplace for nursing staff at public healthcare institutions. Revista Latino-Americana de Enfermagem. Escola de Enfermagem de Ribeirão Preto/Universidade de São Paulo; 2016 (cited 2020 Nov 29);24. http://www.scielo.br/scielo.php?script=sci_abstract&pid=S0104-11692016000100355&lng=en&nrm=iso&tlng=es. Rodarte-Cuevas L, Araujo-Espino R, Trejo-Ortiz PM, González-Tovar J. Quality of professional life and musculoskeletal disorders in nurses. Enferm Clin. 2016;26:336–43. Kunaviktikul W, Wichaikhum O, Nantsupawat A, Nantsupawat R, Chontawan R, Klunklin A, et al. Nurses’ extended work hours: patient, nurse and organizational outcomes. Int Nurs Rev. 2015;62:386–93. Davidson JE, Proudfoot J, Lee K, Zisook S. Nurse suicide in the United States: analysis of the Center for disease control 2014 National Violent Death Reporting System dataset. Arch Psychiatr Nurs. 2019;33:16–21. Davis MA, Cher BAY, Friese CR, Bynum JPW. Association of US nurse and physician occupation with risk of suicide. JAMA Psychiat. 2021. https://doi.org/10.1001/jamapsychiatry.2021.0154. Taha AA, Westlake C. Palestinian nurses’ lived experiences working in the occupied West Bank. Int Nurs Rev. 2017;64:83–90. Maraqa B, Nazzal Z, Zink T. Palestinian health care workers’ stress and stressors during COVID-19 pandemic: a Cross-Sectional Study. J Prim Care Commun Health. 2020;11:2150132720955026. ICN. COVID-19 and the international supply of nurses; 2020. https://www.icn.ch/system/files/documents/2020-07/COVID19_internationalsupplyofnurses_Report_FINAL.pdf. Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I, et al. Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. Int J Nurs Stud. 2020;111:103637. Zhan Y-X, Zhao S-Y, Yuan J, Liu H, Liu Y-F, Gui L-L, et al. Prevalence and influencing factors on fatigue of first-line nurses combating with COVID-19 in China: a descriptive cross-sectional study. Curr Med Sci. 2020;40:625–35. Machado MH, Filho WA, De Lacerda WF, De Oliveira E, Lemos W, Wermelinger M, et al. Caracteristicas gerais da enfermagem: O perfil sócio demográfico. revenf. 2016;7:9. Conselho Federal de Enfermagem. COFEN. Observatório da Enfermagem. 2020. http://observatoriodaenfermagem.cofen.gov.br/. The University Times. Report finds 60% of Midwifery Students Bullied on Placement, and Breach of Working Hours Agreement. Dublin; 2015 Jun 5 (cited 2020 Nov 26). http://www.universitytimes.ie/2015/06/report-finds-60-of-midwifery-students-bullied-on-placement-and-breach-of-working-hours-agreement/. The University Times. Responses to midwifery bullying report set for implementation across health science. 2017. http://www.universitytimes.ie/2017/04/responses-to-midwifery-bullying-report-set-for-implementation-across-health-science/. Hogh A, Carneiro IG, Giver H, Rugulies R. Are immigrants in the nursing industry at increased risk of bullying at work? A one-year follow-up study. Scand J Psychol. 2011;52:49–56. Irish Nurses & Midwives Organisation. “Stop exploiting student nurses and midwives.” Dublin; 2020 Oct 16 (cited 2020 Nov 26); https://www.inmo.ie/Home/Index/217/13640. Paudel S, Menge J. Under pressure: health care workers fighting at the frontlines in Nepal. The Friedrich-Ebert-Stiftung; 2020. https://www.fes-asia.org/news/already-under-pressure-health-care-workers-fighting-at-the-frontlines-in-nepal/. NYTimes. ‘Health Care Kamikazes’: how Spain’s Workers Are Battling Coronavirus, Unprotected; 2020. https://www.nytimes.com/video/world/europe/100000007051789/coronavirus-ppe-shortage-health-care-workers.html. ANA. Update on nurses and PPE: survey reveals alarming conditions; 2020. https://www.nursingworld.org/~4a558d/globalassets/covid19/ana-ppe-survey-one-pager---final.pdf. Gouda D, Singh P, Gouda P, Goudra B. The demography of deaths in healthcare workers—an overview of 1004 reported COVID-19 deaths (Ahead-of-print). American Board of Family Medicine. 2020 (cited 2020 Nov 28). https://www.jabfm.org/sites/default/files/COVID_20-0248.pdf. Sampaio F, Sequeira C, Teixeira L. Nurses’ mental health during the Covid-19 outbreak: a cross-sectional study. J Occup Environ Med. 2020;62:783–7. Chow A, Htun HL, Kyaw WM, Lee LT, Ang B. Asymptomatic health-care worker screening during the COVID-19 pandemic. Lancet. 2020;396:1393–4. Bielicki JA, Duval X, Gobat N, Goossens H, Koopmans M, Tacconelli E, et al. Monitoring approaches for health-care workers during the COVID-19 pandemic. Lancet Infect Dis. 2020;20:e261–7. Grassly N, Pons Salort M, Parker E, White P, Ainslie K, Baguelin M, et al. Report 16: Role of testing in COVID-19 control. Imperial College London; 2020. http://spiral.imperial.ac.uk/handle/10044/1/78439. CDC. Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2. Centers for Disease Control and Prevention. 2020 (cited 2020 Nov 28). https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-healthcare-personnel.html. Regione Emilia-Romagna. COVID-19: Modifiche tecniche al percorso di screening sierologico regionale—E-R BUR 214/2020; 2020. https://bur.regione.emilia-romagna.it/dettaglio-inserzione?i=3cb4b669baeb4ba9a32b15b2253a2e82. Agren D. Understanding Mexican health worker COVID-19 deaths. Lancet. 2020;396:807. Manoj P. Frontline health workers in Kapilvastu deprived of risk allowance. The Kathmandu Post. Kathmandu; 2020 (cited 2020 Nov 28); https://kathmandupost.com/province-no-5/2020/09/07/frontline-health-workers-in-kapilvastu-deprived-of-risk-allowance. Medecins Sans Frontières. Israel and Palestine: the despair of cruel vaccination inequalities; 2021 (cited 2021 Mar 24). https://www.msf.ie/article/israel-and-palestine-despair-cruel-vaccination-inequalities. Wright EO. Class counts: comparative studies on class analysis. New York (NY): Cambridge University Press; 2000. Nimmon L, Stenfors-Hayes T. The, “Handling” of power in the physician-patient encounter: perceptions from experienced physicians. BMC Med Educ. 2016;16:1. Boletín Oficial del Estado (BOE). Decreto-ley 24/2020, de 16 de junio, de medidas extraordinarias en materia de personal. https://www.boe.es/boe/dias/2020/08/12/pdfs/BOE-A-2020-9554.pdf. Government of the United Kingdom. Pay rises for doctors, police and more in the public sector. London; 2020 (cited 2020 Nov 28); https://www.gov.uk/government/news/pay-rises-for-doctors-police-and-more-in-the-public-sector. Babu NM. Dormitories, hostels and shared bathrooms for nurses on COVID-19 duty. The Hindu. New Delhi; 2020 (cited 2020 Nov 30); https://www.thehindu.com/news/cities/Delhi/dormitories-hostels-and-shared-bathrooms-for-nurses-on-covid-19-duty/article31293511.ece. The News Minute. From lack of PPE to discrimination: Nurses working in Delhi hospitals on official apathy. 2020 (cited 2020 Nov 30); https://www.thenewsminute.com/article/lack-ppe-discrimination-nurses-working-delhi-hospitals-official-apathy-122969. The Guardian. Indian doctors being evicted from homes over coronavirus fears. The Guardian. 2020 Mar 30 (cited 2020 Nov 26); http://www.theguardian.com/world/2020/mar/30/indian-doctors-being-evicted-from-homes-over-coronavirus-fears. Buscaglia G. Rimini, danneggiate settanta auto. "E’ un attacco a medici e infermieri". il Resto del Carlino. 1603686611000 (cited 2020 Nov 26). https://www.ilrestodelcarlino.it/rimini/cronaca/auto-danneggiate-medici-infermieri-1.5647731. Caldera-Villalobos C, Garza-Veloz I, Martínez-Avila N, Delgado-Enciso I, Ortiz-Castro Y, Cabral-Pacheco GA, et al. The Coronavirus Disease (COVID-19) challenge in Mexico: a critical and forced reflection as individuals and society. Front Public Health. 2020;8:337. WHO. Delivered by women, led by men: A gender and equity analysis of the global health and social workforce; 2019. ILO. Improving Employment and Working Conditions in Health Services: report for discussion at the Tripartite Meeting on Improving Employment and Working Conditions in Health Services. 2017. https://www.ilo.org/sector/activities/sectoral-meetings/WCMS_548288/lang--en/index.htm. Budwig M. The fatherhood bonus and the motherhood penalty: parenthood and the gender gap in pay. Third Way NEXT; 2014. https://www.thirdway.org/report/the-fatherhood-bonus-and-the-motherhood-penalty-parenthood-and-the-gender-gap-in-pay. Newman C, Stilwell B, Rick S, Peterson K. Investing in the power of nurse leadership: what will it take?. IntraHealth International; 2019. https://www.intrahealth.org/resources/investing-power-nurse-leadership-what-will-it-take. ILO. Decent Working Time for Nursing Personnel: Critical for Worker Well-being and Quality Care. Geneva; 2018. https://www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/publication/wcms_655277.pdf. The Guardian. Pregnant nurse’s death adds to concern among health workers. the Guardian. 2020 (cited 2020 Nov 26); http://www.theguardian.com/world/2020/apr/15/pregnant-healthcare-workers-pressured-into-covid-19-frontline. Bleich MR, MacWilliams BR, Schmidt BJ. Advancing diversity through inclusive excellence in nursing education. J Prof Nurs. 2015;31:89–94. Nair S, Healey M. A profession on the margins: status issues in Indian nursing. Centre for Women’s Development Studies; 2006 (cited 2020 Nov 30); http://archive.nyu.edu/handle/2451/34246. Rogers TN, Rogers CR, VanSant-Webb E, Gu LY, Yan B, Qeadan F. Racial disparities in COVID-19 mortality among essential workers in the United States. World Med Health Policy. 2020;12:311–27. OECD. Health Workforce Migration: Migration of nurses. 2020. https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_WFMI Schilgen B, Nienhaus A, Handtke O, Schulz H, Mösko M. Health situation of migrant and minority nurses: a systematic review. PLoS ONE. 2017;12:0179183. Walani SR. Global migration of internationally educated nurses: experiences of employment discrimination. Int J Afr Nurs Sci. 2015;3:65–70. Liem A, Wang C, Wariyanti Y, Latkin CA, Hall BJ. The neglected health of international migrant workers in the COVID-19 epidemic. Lancet Psychiatry. 2020;7:e20. Williams G, Maier C, Scarpetti G, de Belvis A, Fattore G, Morsella A, et al. What strategies are countries using to expand health workforce surge capacity during the COVID-19 pandemic? Eurohealth. 2020;26:51–7. Muntaner C, Chung H, Solar O, Santana V, Castedo A, Benach J, et al. A macro-level model of employment relations and health inequalities. Int J Health Serv. 2010;40:215–21. Weber T, Nevala A. Employment and industrial relations in the health care sector|Eurofound. Dublin: Eurofound; 2011. https://www.eurofound.europa.eu/publications/report/2011/employment-and-industrial-relations-in-the-health-care-sector. El Universal. Pasantes de enfermería acusan que son forzados a mantenerse en hospitales. México; 2020. https://www.eluniversal.com.mx/nacion/coronavirus-pasantes-de-enfermeria-acusan-que-son-forzados-mantenerse-en-hospitales. UNISON National. Unions announce COVID-19 support for nursing students. 2020 (cited 2020 Nov 28). https://www.unison.org.uk/news/2020/03/unions-announce-covid-19-support-nursing-students/. Hayter M, Jackson D. Pre-registration undergraduate nurses and the COVID-19 pandemic: students or workers? J Clin Nurs. 2020;29:3115–6. Public Health England. COVID-19: Infection prevention and control guidance. 2020. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control. Sandal A, Yildiz AN. COVID-19 as a recognized work-related disease: the current situation worldwide. Saf Health Work. 2021;12:136–8. Gunn V, Muntaner C, Villeneuve M, Chung H, Gea-Sanchez M. Nursing professionalization and welfare state policies: a critical review of structural factors influencing the development of nursing and the nursing workforce. Nurs Inq. 2019;26:e12263. Gunn V, Muntaner C, Ng E, Villeneuve M, Gea-Sanchez M, Chung H. The influence of welfare state factors on nursing professionalization and nursing human resources: a time-series cross-sectional analysis, 2000–2015. J Adv Nurs. 2019;75:2797–810. Herdman E. The deskilling of registered nurses: the social transformation of nursing work in a New South Wales hospital, 1970–1990. University of Wollongong Thesis Collection 1954–2016. 1992; https://ro.uow.edu.au/theses/1729. India Today. Inside PM Modi’s COVID-19 task force. India Today. 2020 (cited 2020 Nov 30). https://www.indiatoday.in/india-today-insight/story/inside-pm-modi-s-covid-19-task-force-1665239-2020-04-09. Alameddine M, Baumann A, Laporte A, Deber R. A narrative review on the effect of economic downturns on the nursing labour market: implications for policy and planning. Hum Resour Health. 2012;10:23. Friganovic A, Režić S, Kurtović B, Vidmanić S, Zelenikova R, Rotim C, et al. Nurses’ perception of implicit nursing care rationing in Croatia—a cross-sectional multicentre study. Journal of Nursing Management. 2020 (cited 2020 Nov 4);n/a. https://doi.org/10.1111/jonm.13002 Butkovič H, Samardzija V, Skazlič I, Čavar I. Nonstandard work in Croatia: challenges and persepctives in selected sectors. Zagreb: Institute for Development and International Relations; 2016. Squires A, Juarez A. A qualitative study of the work environments of Mexican nurses. Int J Nurs Stud. 2012;49:793–802. Baru RV. Privatisation of Health services: a South Asian perspective. Economic Political Weekly. 2003;38:4433–7. Araújo-dos-Santos T, Santos HS, Moraes M de A, Mussi FC, Araújo-dos-Santos T, Santos HS, et al. Nursing Comiittee to Coping with COVID-19 in Bahia. Revista Brasileira de Enfermagem. Associação Brasileira de Enfermagem; 2020 (cited 2020 Nov 26);73. http://www.scielo.br/scielo.php?script=sci_abstract&pid=S0034-71672020001400503&lng=en&nrm=iso&tlng=en. The Times of India. Careless Mumbai’s Wockhardt Hospital compromised 10 nurses, says union; hospital refutes charges. The Times of India. 2020 (cited 2020 Nov 30). https://timesofindia.indiatimes.com/city/mumbai/careless-mumbais-wockhardt-hospital-compromised-10-nurses-says-union-hospital-refutes-charges/articleshow/74976093.cms. Barria S. Health unions raise issue of protection for health workers to the Indian National Human Rights Commission. 2020 (cited 2020 Nov 30). https://publicservices.international/resources/news/health-unions-raise-issue-of-protection-for-health-workers-to-the-indian-national-human-rights-commission?id=11116&lang=en. Irish Nurses & Midwives Organisation. INMO welcomes commitment to graduate jobs. Dublin; 2020 (cited 2020 Nov 26); https://www.inmo.ie/Home/Index/217/13604. Sørensen A. Kvindefag i historisk skruetvinge: En analyse af tjenestemandsreformens betydning for hierarkiet i offentlige lønninger fra 1969 til 2019. Copenhagen: Institut for Menneskerettigheder; 2020.