1. Mason, Diana J. PhD, RN, FAAN


A conference in Japan shines a light on some disturbing problems.


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Four days ago, I hit a deer while driving to the mountains on the first day of my vacation. I'd driven the road many times. And while I like to think of myself as a driver who's prepared for the unexpected, I didn't see this deer until she was a few feet ahead of me. As a nurse, I often dealt with the unexpected: finding a patient in cardiac arrest or discovering on a home visit that a member of a large family had tuberculosis. But no matter how much training or experience you have, sometimes you're caught off guard. The unexpected event seems too irrational.


I've been thinking about "the unexpected" since attending a conference called "Nurses at the Forefront: Dealing with the Unexpected," sponsored by the International Council of Nurses (ICN) in Yokohama, Japan, at the end of May. Many of the sessions focused on natural disasters such as the 2004 tsunami and Hurricane Katrina in 2005. Strides are being made in preparing nurses to respond to such disasters (see On the Road with AJN, "The ICN Report," page 38). But I was unprepared for the stories I heard at the meeting of the Council of National Representatives (CNR), the ICN governing body, that preceded the conference.


Leah Primitiva G. Samaco-Paquiz, president of the Philippine Nurses Association, spoke about the 26 Filipino nurses who were recruited to work in nursing homes in the New York City area. When the terms of their contracts were allegedly violated by the contractor-and when they felt that working conditions jeopardized patients' safety-the nurses quit their jobs after completing their shifts. Ten have been indicted on charges of endangering the well-being of patients. (See In the News, page 17.) One nurse said the situation was "a kind of human trafficking."


Ruben Etcheverry, president of the national association for nurses in Uruguay, reported that nurses there are paid about $300 per month, physicians have been filling nursing leadership positions in hospitals, and the government developed plans for health care reform that, ostensibly, don't include nursing. "We feel alone as nurses; we feel alone as a nurses' association," said Etcheverry.

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Hussein Maghrabi was an observer for the Palestinian National Nursing Association, which is expected to apply for ICN membership. He said that Palestinian nurses' annual salary should be $7,500, but sometimes they are not paid and receive only about $1,500 a year. One nurse, he said, told him she had $4 left; she could use it to get to work or feed her children.


Also unexpected was the announcement that the World Health Organization (WHO) now employs more nutritionists than nurses in its central and regional offices. Physicians make up more than 91.6% of the WHO staff; I had wrongly assumed that the WHO understands the importance of nurses to its mission of promoting global health. Senior WHO officials told the CNR that the matter is being studied.


Etcheverry said that nurses recently demonstrated against their exclusion from Uruguay's health care reform plans. The Filipino nurses are fighting the seemingly unjust charges aimed to intimidate. Such actions shed light on nursing's invisibility and the many injustices nurses endure in their work. That's one benefit of encountering the unexpected-it can spark new ways of seeing, thinking, and acting.


Nurses worldwide continue to be invisible, devalued, and exploited. Many work in societies that exploit women and are mired in conflicts that prevent them from promoting health. Why? It seems that ignorance and denial are significant factors in many cases. And that might be true of me, too. If I'd kept in mind that deer frequent the road I was traveling that night, I would have turned on my high beams and perhaps seen the deer before it was too late.