PRESENTATION SUMMARY Nurses’ Perceptions of Health Care and Their Profession (Zambia) New York Philadelphia Los Angeles Düsseldorf Beijing

2 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Introduction The purpose of this global survey is to provide an objective overview of nurses’ perceptions of health care, the nursing profession and their role in society today Survey information areas include measurements of current satisfaction with their profession, future expectations, perceptions of the range of participants in health care systems today, the relative importance of specific problems and issues facing nurses and their professional associations in the future The ultimate goal of this research project is to provide actionable guidelines for operating and communications strategies aimed at responding to the interests and priorities of the profession as a whole and in specific regions and countries

3 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Research Methodology In line with those objectives, Consensus Research Group conducted telephone interviews among a random sample of 1,000 nurses distributed equally across 10 countries: Argentina, Canada, China, Germany, Japan, South Africa, Turkey, UK, United States of America and Zambia  Analyses by regions included: North America(USA + Canada) Europe (UK + Germany) Africa (South Africa + Zambia) Asia (China + Japan) Interviews were conducted during the period January 3–25, 2007 A supplementary online survey was conducted among nurses recruited from the International Council of Nurses website. Findings from the supplementary survey will be reported separately.

4 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Conclusions and Implications As might be expected from survey research across countries with developed vs. emerging health care systems, significant differences in perceptions of health care and nursing issues emerge from this analysis. The International Council of Nurses is faced with the task of establishing and maintaining a global leadership role in the nursing profession, while responding to the specific needs and interests of members and associations in selected regions.

5 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Conclusions and Implications (cont’d) A number of observations are consistent across all countries:  Significant numbers of nurses are dissatisfied with their careers today and pessimistic about the probability of improvements in the future  Nurses in China tend to be positive about their careers and futures in nursing --- more so than those in Japan and other regions  In North America, satisfaction levels are also positive but nurses in Germany and in some African countries register significant concerns about their profession  Older, more experienced nurses [age 50+], either as a function of professional experience or higher standards based on longer tenure, are more critical of health care trends. With 32% reporting declines in the quality of health care during the past l0 years compared to only 14% among younger nurses  Projecting to the future, however, nurses across all age/experience groups express similar forecasts of expected satisfaction with their profession: 34% expect greater satisfaction from their careers, but the 66% expecting no improvement includes a substantial 25% who think they will be less satisfied with nursing during the next ten years

6 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Conclusions and Implications(cont’d) Current dissatisfactions focus on workload issues — the numbers of patients nurses are responsible for, long work hours, inadequate compensation, the shortages of qualified medical professionals, the loss of skilled nurses to migration/relocation to other countries — and nurses’ lack of recognition and respect in society. A significant proportion sense that many patients and other medical professionals are unfamiliar with or confused by the special skill levels, titles and special designations assigned to nurses. To a somewhat lesser extent, nurses are dissatisfied with their lack of opportunities for career advancement and the difficulties they encounter in accessing continuing education and job opportunities. In African and Asian countries, nurses are more likely to complain about difficulties in accessing the medicines and equipment they need for their patients — than in North American or Europe.

7 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Conclusions and Implications (cont’d) On the other hand, nurses are satisfied with the relationship of mutual respect they have with doctors, and feel that in most situations, doctors and nurses work well together in the best interests of their patients. Nurses express strong anti-government sentiment in connection with the lack of improvement and perceived declines in the quality of health care in recent years. Contrasting with those negative perceptions, nurses assign significant credit to pharmaceutical companies for research and discovery of new medicines and react favorably to the concept of joining a new health care alliance — one that includes pharmaceutical companies, doctors, educators, scientists, government officials and patient organizations to influence health care policy in the future.

8 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Conclusions and Implications (cont’d) The issues, concerns and goals that are most important to nurses today vary significantly by country but fall into four basis clusters:  Influence: their inability to participate in the development of health care policy they need for their practices and patients  Economic: increased compensation  Workload: working conditions that don’t allow them enough time to spend with their patients and the shortage of skilled medical personnel  Organization: inadequate representation and effectiveness of existing nursing associations

9 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Conclusions and Implications (cont’d) Members of nursing associations assign relatively low scores to their association on effectiveness in “influencing policy and improving the quality of health care in their country.” Nurses look to their associations for training/practice/licensing standards and guidelines and as information sources — rather than as advocates. To some degree, nurses do not identify their professional associations with their priority concerns: compensation, influencing government policy, increased recognition and respect for the profession.

Summary of Findings

11 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Trends in Quality of Health Care / Past 10 Years Improved (Improved a Great Deal + Improved Somewhat) Improved a Great Deal Has Not Changed Very Much Declined (Declined Somewhat + Declined a Great Deal) Declined a Great Deal Q1.Thinking about the last 10 years or so, would you say that the quality of health care in your community has improved a great deal, improved somewhat, hasn’t changed very much, declined somewhat or declined a great deal? Total A majority [58%] of nurses perceive improvements in the quality of health care in their countries during the past 10 years but only 23% see “significant” improvement – vs. 23% perceiving declines

12 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Improvements in Quality of Health Care / Past 10 Years Q1.Thinking about the last 10 years or so, would you say that the quality of health care in your community has improved a great deal, improved somewhat, hasn’t changed very much, declined somewhat or declined a great deal? Improved (Improved a Great Deal + Improved Somewhat)

13 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Decline in Quality of Health Care / Past 10 Years Q1.Thinking about the last 10 years or so, would you say that the quality of health care in your community has improved a great deal, improved somewhat, hasn’t changed very much, declined somewhat or declined a great deal? Declined (Declined Somewhat + Declined a Great Deal)

14 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Q2.[IF “IMPROVED” IN Q1, ASK] If you had to assign credit for improvement in the quality of health care to each of the following representatives of the health care system, how would you divide l0 credits among these groups – I mean, how many of those credits would you assign to: Global Credit for Improvements in Health Care Total Nurses Hospitals Doctors Local or National Government Universities and Educational Institutions for Health Professionals Pharmaceutical Companies Other Health Professionals Pharmacists Improved (Improved a Great Deal + Improved Somewhat) Nurses reporting improvements in health care quality in recent years assign only 10% of the credit for those improvements to pharmaceutical companies – compared to 19% of credit assigned to their own profession and 14% each to doctors and hospitals

15 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Q2.[IF “IMPROVED” IN Q1, ASK] If you had to assign credit for improvement in the quality of health care to each of the following representatives of the health care system, how would you divide l0 credits among these groups – I mean, how many of those credits would you assign to: Credit for Improvements in Health Care / Zambia Nurses Hospitals Doctors Local or National Government Universities and Educational Institutions for Health Professionals Pharmaceutical Companies Other Health Professionals Pharmacists Improved (Improved a Great Deal + Improved Somewhat) Zambia

16 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Responsibility for Lack of Improvement in Health Care Total Nurses Hospitals Doctors Local or National Government Universities and Educational Institutions for Health Professionals Pharmaceutical Companies Other Health Professionals Pharmacists Q3. [IF “UNCHANGED” OR “DECLINED” in Q1] If you had to assign responsibility for lack of improvement in the quality of health care to each of the following representatives of the health care system, how would you divide l0 units of responsibility among these groups – I mean, how many of those credits would you assign to: No Improvement (has not changed very much + declined somewhat + declined a great deal) Nurses express strong anti- government sentiment in connection with the lack of improvement and perceived decline in the quality of health care in recent years. Among nurses perceiving no improvements in health care quality during the past 10 years, 37% of that responsibility is assigned to “government” compared to only 10% assigned to their own profession, 10% to doctors and only 9% to pharmaceutical companies

17 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Responsibility for Lack of Improvement in Health Care / Zambia Nurses Hospitals Doctors Local or National Government Universities and Educational Institutions for Health Professionals Pharmaceutical Companies Other Health Professionals Pharmacists Q3. [IF “UNCHANGED” OR “DECLINED” in Q1] If you had to assign responsibility for lack of improvement in the quality of health care to each of the following representatives of the health care system, how would you divide l0 units of responsibility among these groups – I mean, how many of those credits would you assign to: No Improvement (has not changed very much + declined somewhat + declined a great deal) Zambia

18 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Credit for Discovery of New Medicines Total Hospitals Doctors Local or National Government Universities and Educational Institutions for Health Professionals Pharmaceutical Companies Other Health Professionals Pharmacists Q4.How would you distribute the credit for the discovery and introduction of new medicines that save lives, improve the quality of life, and keep people well and living longer -- it you had l0 credits to divide among these same groups? Mean Percent Nurses Potential support for pharmaceutical companies among nurses is linked to the discovery of new medicines. Where research and discovery of new medicines is concerned, nurses are more apt to credit pharmaceutical companies than any other participants in health care systems. 22% of credit for new medicines is assigned to pharmaceutical companies compared to 14% assigned to university medical centers, doctors [13%] and government [13%]

19 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Credit for Discovery of New Medicines / Zambia Hospitals Doctors Local or National Government Universities and Educational Institutions for Health Professionals Pharmaceutical Companies Other Health Professionals Pharmacists Q4.How would you distribute the credit for the discovery and introduction of new medicines that save lives, improve the quality of life, and keep people well and living longer -- it you had l0 credits to divide among these same groups? Mean Percent Zambia Nurses

20 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Crediting Pharmaceutical Companies for Discovery of New Medicines Q4.How would you distribute the credit for the discovery and introduction of new medicines that save lives, improve the quality of life, and keep people well and living longer -- it you had l0 credits to divide among these same groups? Percent of Credits Assigned to Pharmaceutical Companies

21 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Doctors Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

22 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Other Nurses Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

23 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Hospitals Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

24 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Schools for Health Professionals Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

25 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Pharmacists Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

26 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Other Health Professionals Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

27 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Pharmaceutical Companies Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

28 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Nurses Perception of Government Health Agencies Q5.For each of the following, please rate your impression using a scale from 0 to 10 – where 10 means you, as a nurse, have a “very favorable” impression and 0 means you have a “very unfavorable” impression of the group. You may choose any number between one and ten. Favorable (8, 9, 10 on a 0 to 10 scale)

29 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Dissatisfaction With Role in Health Care System Q6.All things considered, as a nurse how satisfied are you with your current role in the health care system these days, on a scale from 0-10, with l0 meaning very satisfied and 0 meaning very dissatisfied. Satisfied (8, 9, 10 on a 0 to 10 scale)

30 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Dissatisfaction With Role in Health Care System Q6.All things considered, as a nurse how satisfied are you with your current role in the health care system these days, on a scale from 0-10, with l0 meaning very satisfied and 0 meaning very dissatisfied. Dissatisfied (0, 1, 2, 3 on a 0 to 10 scale)

31 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Reasons for Career Satisfaction Ratings Q7.What makes you say that? Overworked / too much work Understaffed / staff shortages Underpaid / low salaries Bad working conditions Lack of adequate medical supplies and equipment Nurses do not have enough influence on the system Total Enjoy the work / satisfying / rewarding Good working conditions Nurses are doing an important job Positives Negatives Top 3 Box Bottom 7 Box 56% 25% 18%                     20% 17% 16% 14% 10% 7%

32 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Reasons for Career Satisfaction Ratings / Zambia Q7.What makes you say that? Overworked / too much work Understaffed / staff shortages Underpaid / low salaries Bad working conditions Lack of adequate medical supplies and equipment Nurses do not have enough influence on the system Zambia Enjoy the work / satisfying / rewarding Good working conditions Nurses are doing an important job Positives Negatives Top 3 Box Bottom 7 Box* 40% 27% 7%        13%  30% 36% 16% 17% 47%  *Base inadequate for statistical reliability

33 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Future Expectation of Satisfaction with Role in Health Care Q8.Thinking ahead to the next ten years or so, will nurses like yourself be more satisfied with their role in the health care system, about as satisfied as they are now or less satisfied? More Satisfied About as Satisfied Less Satisfied Total Overall expectations regarding satisfaction with the nursing profession are somewhat pessimistic, with only 34% of all nurses studied anticipating increased satisfaction in the future but those expectations vary significantly across regions and countries

34 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Future Expectation of Satisfaction with Role in Health Care / Zambia Q8.Thinking ahead to the next ten years or so, will nurses like yourself be more satisfied with their role in the health care system, about as satisfied as they are now or less satisfied? More Satisfied About as Satisfied Less Satisfied Zambia

35 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Future Expectation of Satisfaction with Role in Health Care Q8.Thinking ahead to the next ten years or so, will nurses like yourself be more satisfied with their role in the health care system, about as satisfied as they are now or less satisfied? More Satisfied Nurses in China express greater optimism regarding their satisfaction with their profession in the future than in any other country. More moderate expectations are expressed by nurses in the U.S., Turkey and Argentina – and greater pessimism among nurses in African countries, Japan, Canada and the UK. The consistently negative perceptions of nurses in Germany is confirmed by the finding that only 4% of nurses in that country today expect increased satisfaction from their profession in the future

36 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Future Expectation of Satisfaction with Role in Health Care Q8.Thinking ahead to the next ten years or so, will nurses like yourself be more satisfied with their role in the health care system, about as satisfied as they are now or less satisfied? Less Satisfied Stated conversely, while 25% of all nurses expect to be less satisfied with their roles in the health care system in the future, the proportion in Germany totals 72%

37 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Health Care Proposals Q9.How would you rate the importance of each of the following health care proposals or issues to you personally, on a scale from 0-10, with l0 meaning that it’s very important to you personally, and 0 meaning not at all important? Important (8, 9, 10 on a 0 to 10 scale) A School-Based Anti-Obesity Campaign to Raise the Awareness of Children, Parents and Teachers of the Importance of Diet and Exercise for a Healthy Lifestyle

38 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Health Care Proposals Q9.How would you rate the importance of each of the following health care proposals or issues to you personally, on a scale from 0-10, with l0 meaning that it’s very important to you personally, and 0 meaning not at all important? Important (8, 9, 10 on a 0 to 10 scale) Creation of an Alliance Composed of Doctors, Nurses, Educators, Health Care Officials, Scientists, Pharmaceutical Companies and Patient Organizations That Influences the Development of Government Health Care Policies and Decisions

39 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Health Care Proposals Q9.How would you rate the importance of each of the following health care proposals or issues to you personally, on a scale from 0-10, with l0 meaning that it’s very important to you personally, and 0 meaning not at all important? Important (8, 9, 10 on a 0 to 10 scale) Professional Nurses Associations in Your Country Increasing Their Communication and Political Efforts in Order to Exert Greater Influence on Government Health Care Policy

40 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Health Care Proposals Q9.How would you rate the importance of each of the following health care proposals or issues to you personally, on a scale from 0-10, with l0 meaning that it’s very important to you personally, and 0 meaning not at all important? Important (8, 9, 10 on a 0 to 10 scale) A Centralized Help Wanted and Job Placement Information Source for Qualified Nurses

41 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Health Care Proposals Q9.How would you rate the importance of each of the following health care proposals or issues to you personally, on a scale from 0-10, with l0 meaning that it’s very important to you personally, and 0 meaning not at all important? Important (8, 9, 10 on a 0 to 10 scale) Increase Government Programs and Medicines to Help People Quit Smoking

42 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Health Care Proposals Q9.How would you rate the importance of each of the following health care proposals or issues to you personally, on a scale from 0-10, with l0 meaning that it’s very important to you personally, and 0 meaning not at all important? Important (8, 9, 10 on a 0 to 10 scale) Strategies That Encourages Nurses to Remain in Their Present Positions and Not Relocate to Other Countries

43 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Health Care Proposals Q9.How would you rate the importance of each of the following health care proposals or issues to you personally, on a scale from 0-10, with l0 meaning that it’s very important to you personally, and 0 meaning not at all important? Important (8, 9, 10 on a 0 to 10 scale) Health Guides or Manuals to Help Families Maintain Accurate Health Records, Follow Their Prescriptions, and Create Nutritional, Exercise and Lifestyle Programs for All Family Members

44 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Perceptions of Health Care and Nursing Today Q10. Would you say you agree strongly, agree somewhat, disagree somewhat or disagree strongly with each of the following statements? There is easy access to continuing education in the nursing profession in this country The general public understands and respects the role of nurses in health care Doctors and nurses work well together in most situations The relationship between doctors and nurses is one of mutual respect There is ample opportunity for advancement within the nursing profession in this country Because of a shortage of qualified professionals, nurses in this country are currently overworked TOTAL

45 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Perceptions of Health Care and Nursing Today (cont’d) Q10. Would you say you agree strongly, agree somewhat, disagree somewhat or disagree strongly with each of the following statements? Patients are confused by the different descriptions assigned to nurses* Qualified nurses in your country are leaving the profession because of low wages and an unsatisfactory work environment Keeping up to date with job openings and advancement opportunities is easy for most nurses For the most part, nurses in this country find working conditions and access to necessary medicines and equipment satisfactory for their purposes The quality of nursing care in the country is reduced by the relocation of qualified nurses to other countries Skill levels and titles in the nursing profession are clear and understandable by patients and professionals alike TOTAL * Like “ registered nurse, ” “ physician assistant, ” “ nurse practitioner, ” “ practicing nurse, ” “ nursing supervisor ” or “ operating room nurse ”

46 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Perceptions of Health Care and Nursing Today / Zambia Q10. Would you say you agree strongly, agree somewhat, disagree somewhat or disagree strongly with each of the following statements? The quality of nursing care in the country is reduced by the relocation of qualified nurses to other countries Qualified nurses in your country are leaving the profession because of low wages and an unsatisfactory work environment Doctors and nurses work well together in most situations The relationship between doctors and nurses is one of mutual respect The general public understands and respects the role of nurses in health care Because of a shortage of qualified professionals, nurses in this country are currently overworked ZAMBIA

47 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Perceptions of Health Care and Nursing Today / Zambia (cont’d) Q10. Would you say you agree strongly, agree somewhat, disagree somewhat or disagree strongly with each of the following statements? There is easy access to continuing education in the nursing profession in this country Skill levels and titles in the nursing profession are clear and understandable by patients and professionals alike Patients are confused by the different descriptions assigned to nurses* There is ample opportunity for advancement within the nursing profession in this country Keeping up to date with job openings and advancement opportunities is easy for most nurses For the most part, nurses in this country find working conditions and access to necessary medicines and equipment satisfactory for their purposes ZAMBIA * Like “ registered nurse, ” “ physician assistant, ” “ nurse practitioner, ” “ practicing nurse, ” “ nursing supervisor ” or “ operating room nurse ”

48 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Satisfaction With the Nursing Profession Q11.How would you rate your overall perceptions of each of the following aspects of the nursing profession in your country on a scale from 0-10, with l0 meaning that you are very satisfied with that aspect of the nursing profession today and 0 meaning very dissatisfied? The Availability of Needed Medicines and Equipment The Quality of Nurses Graduating and Entering the Profession These Days Nurses ’ Access to Information About New Medicines and Treatments The Recognition and Stature of Nurses in Society The Reliability and Value of Information About Medicines That Healthcare Professionals Receive From Pharma Co's The Time Nurses Have Caring for Patients Current Working Conditions The Effectiveness of Professional Nursing Assoc. and Their Impact on Government Health Care Policy The Compensation Nurses Receive for Their Services The Effectiveness of Organizations Created to Help Nurses Bargain or Negotiate for Increased Compensation The Extent to Which Nurses Take an Active Role in Influencing Government Health Care Policies The Extent to Which Nurses Can Influence Government Health Care Policy Satisfied (8, 9, 10 on a 0 to 10 scale) Rating their profession as a whole, nurses assign their lowest satisfaction scores to the extent of their influence on government health care policy---their compensation, and the minimal effectiveness of their professional associations in negotiating salary increases---and their working condition, including the limited time they can spend caring for patients. At best, nurses express only moderate satisfaction with the ability to obtain the medicines and equipment they need for their patients, access to information about new medicines and treatments and their lack of standing and respect in society.

49 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Satisfaction With the Nursing Profession / Zambia Q11.How would you rate your overall perceptions of each of the following aspects of the nursing profession in your country on a scale from 0-10, with l0 meaning that you are very satisfied with that aspect of the nursing profession today and 0 meaning very dissatisfied? Satisfied (8, 9, 10 on a 0 to 10 scale) Zambia

50 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Perceived Effectiveness of Nursing Associations [Among Association Members Only] Q12.How would you rate the overall effectiveness of your nursing association---in terms of influencing policy and improving the quality of the health care in your country – on a scale from 0-10, with l0 meaning very effective and 0 meaning not at all effective? Significantly Effective (8, 9, 10 on a 0 to 10 scale) Overall effectiveness ratings for nursing associations in terms of influencing health care policy and the quality of health care are relatively low by normative standards, with only 22% of all nurses assigning significantly positive ratings – from a high of 53% in Canada to 18% or less in the U.S., UK, African countries, Germany and Turkey

51 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Relative Importance of Association Functions Provides You With Standards and Guidelines for Training and Practice Q13. Thinking about your nursing association, which of the following functions or responsibilities of the association are most important to you as a member – on a scale from 0-10, with 10 meaning very important and 0 meaning not important at all? Help You Keep Up-to-Date with the Latest Information Providing Training and Licensing to Maintain High Standards in the Nursing Profession Successfully Influences Nurses’ Compensation and Working Conditions Represents Nurses’ Views on Health Care and Their Profession to Government (8, 9, 10 on a 0 to 10 scale) In rating the importance of the functions and achievements their professional nursing associations provide, nurses assign higher scores to providing standards, guidelines and information – than to addressing governmental, societal or doctor/nurse relationship issues

52 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Relative Importance of Association Functions (cont’d) Speaks Out on Health and Social Issues Q13. Thinking about your nursing association, which of the following functions or responsibilities of the association are most important to you as a member – on a scale from 0-10, with 10 meaning very important and 0 meaning not important at all? Acts as an Effective Voice to Enhance Recognition of Nurses and Their Contribution to Society Increasing the Number of Qualified Individuals Enrolled in Nursing School Preserving and Improving the Nurse/Doctor Relationship Increasing Retention Within the Profession (8, 9, 10 on a 0 to 10 scale)

53 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Association Functions / Zambia Q13. Thinking about your nursing association, which of the following functions or responsibilities of the association are most important to you as a member – on a scale from 0-10, with 10 meaning very important and 0 meaning not important at all? (8, 9, 10 on a 0 to 10 scale) Zambia

54 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Relative Importance of Association Functions / Zambia Q13. Thinking about your nursing association, which of the following functions or responsibilities of the association are most important to you as a member – on a scale from 0-10, with 10 meaning very important and 0 meaning not important at all? (8, 9, 10 on a 0 to 10 scale) Zambia

55 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Better Salaries Increase Time and Care for Patients Better Training and Education in Nurses Schools More Medical Staff / Reduce Patient to Nurse Ratio Better Working Conditions for Nurses Opportunities for Educational and Career Development Maintaining and Increasing the Level of Nurses Increase Funding of the Health Care System Increase Respect for Nurses Investment in Medical Supplies and Equipment Discovery of New Medicines, Technologies Reduce Paperwork and Bureaucracy % Important In rank order of priority issues in the future, nurses are most concerned about compensation issues, better working conditions including the need for more time to spend with patients, the need for staff increases and opportunities for career development

56 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Better Salaries

57 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Increase Time and Care for Patients

58 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Better Training and Education in Nursing Schools

59 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? More Medical Staff/Reduce Patient to Nurse Ratio

60 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Better Working Conditions for Nurses

61 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Opportunities for Educational and Career Development

62 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Maintaining and Increasing the Number of Nurses

63 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Increase Funding of the Health Care System

64 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Increase Respect for Nurses

65 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Investment in Medical Supplies and Equipment

66 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Discovery of New Medicines, Technologies

67 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Most Important Issues for Nurses in the Future Q14. What for you is the most important issue for the future of nursing? Reduce Paperwork and Bureaucracy

68 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Membership of Professional Nursing Organizations Q15. Are you a member of a professional nursing organization?

69 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Time Spent with Patients Q17. How much time do you spend with patients in a typical day? Total

70 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Time Spent with Patients / Zambia Q17. How much time do you spend with patients in a typical day? Zambia

71 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Gender of Respondents Q19. Gender

72 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Age Bracket of Respondents Q20. What is your approximate age bracket

73 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Respondents’ Highest Level of Education Q22. What is the highest level of education

74 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Global Income Levels of Respondents Q23. What of the following categories represents your total annual income from your profession? Total

75 02/20/07 - 9:15ameSlide - P Nurses' Perceptions of Health Care Income Levels of Respondents / Zambia Q23. What of the following categories represents your total annual income from your profession? Zambia