The resistance of nurses to austerity measures in the health sector during the financial crisis in Spain

Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries—A systematic review

“…With regard to qualitative metrics, these tended to focus on staff well-being, for the most part. For economic crises, these studies often examined the impact of worsening work conditions, whether that was capturing changes to wages or contractual arrangements, or the intensification of workload and the knock-on effect this had on staff motivation, self-esteem, burn-out as well as the quality of care available for patients [ [28] , [29] , [30] , [31] ]. For the more recent COVID-19 shock, studies also focused on well-being capturing fear and anxiety amongst staff, heightened by external factors such as poor communication from decision makers [ 32 ].…”

“…Multiple economic crisis studies documented the negative effect on services and the factors contributing to poorer patient experiences and outcomes [ 28 , 29 ]. Karanikolos et al.…”

“…In terms of economic crises, the metrics related to governance during management stage reveal key shortcomings, such as corruption, lack of accountability, planning, transparency and stakeholder buy-in to decision making [ 29 , 56 , 57 , 66 ], although there was also evidence of opportunities for reform [ 57 , 66 , 68 ]. In terms of measuring impact, metrics related to staff not only measured the number of staff [ 30 , 66 , 84 , 85 ] but crucially the adverse impact of the economic shock on staff motivation, workload, burnout, emigration, turnover [ 28 , 29 , [86] , [87] , [88] ], supplemented by metrics that allude to adverse effects, such as restrictive policies in the delivery of care, rationing, quality of care, reduced infrastructure and patient outcomes [ 28 , 29 , 43 , 57 , 67 , 68 , 85 ].…”

High hiring rate of nurses in Catalonia and the rest of Spain hides precarious employment from 2010 to 2019: A quantitative study

“…The European Court of Justice has noted that Spanish legislation conflicts with the rule of law in the European Union, as it allows fixed-term contracts to systematically meet structural needs (EUR-Lex, 2016). Nurses throughout Spain have opposed the austerity measures implemented by the Spanish government, as they perceive that their workloads have increased and their working conditions and the quality of health services have deteriorated (Gea-Sánchez et al, 2021). In Catalonia in particular, nurses have also noted the deterioration of their working conditions, among which are the loss of economic remuneration, rotation to different departments, an increase in patient complexity and increased demand for health services, as well as an increase in the number of patients per nurse (Granero-Lázaro et al, 2017).…”

A scoping review on the impact of austerity on healthcare access in the European Union: rethinking austerity for the most vulnerable

“…Córdoba-Doña et al (2018) [35] Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain4 Dimitrovová & Perelman (2018)[36] Changes in access to primary care in Europe and its patterning, 2007-12: a repeated cross-sectional study5 Doetsch et al, (2017) [21] Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: a qualitative case study in Lisbon, Portugal 6 Gea-Sánchez et al (2021)[37] The resistance of nurses to austerity measures in the health sector during the financial crisis in Spain7 Gogishvili et al (2021) [38] A qualitative study on mixed experiences of discrimination and healthcare access among HIV-positive immigrants in Spain 8 Heras-Mosteiro et al (2016) [39] Healthcare austerity measures in times of crisis: The perspectives of primary healthcare physicians in Madrid, Spain Doetsch et al International Journal for Equity in Health (2023) 22:3…”