There is no sense of panic coming down to the wire, only a strange sense of inevitability
This time around, the issues appear to be straightforward. Some commentators will still demand that nurses be viewed as "live and kicking angels" (as one already has), thereby attempting to place them and their actions above normal accountability. Some nurses, due to some old "angel" conditioning, will still feel unable to state baldly that what they want is more money. But nurses generally will not thank them for the fudge.
They kicked off the angel tag several years ago, refusing to be patronised any longer by employers or the public.
It was a long time coming. The Irish Nurses' Organisation - traditionally dominated by matrons - is still an adolescent in trade union terms. It got full union status only 11 years ago. But people like the former general secretary, P.J. Madden, and his successor, Liam Doran, seized the moment, recognising that the new deal for women generally, meant a new era for nurses.
They were seeing the first generation of women who saw nursing as a career - and not as doctors' handmaidens. Mr Madden and Mr Doran worked on the members' sense of self-worth, confidence and industrial muscle, raising it to such a pitch that everything seemed possible.
Agitation that stopped hours short of a strike in 1997 produced substantial gains. It fattened wage packets by some 23 per cent, triggered a high-powered Nursing Commission whose 200 recommendations include a future leap to graduate status, and put nurses' issues on the map to the extent that they devoured more of the Labour Court's time than any other in recent years. Fundamental, far-reaching changes began trickling through the pipeline.
Yet it wasn't enough. A strike on Tuesday week seems virtually certain and the two sides remain so far apart that they haven't even met to discuss emergency cover. The last time they met to discuss money was in July. Yet there is no sense of panic coming down to the wire, only a strange sense of inevitability, a feeling that the adolescent INO has to be allowed its rite of passage. Some describe it as "unfinished business" from the last bout.
"After such a long period of being dormant, there's a need to assert themselves," said one trade unionist, "and they won't be convinced that they've done that until they've been on strike."
If this sounds like more patronising male cant directed at an overwhelmingly female-dominated alliance, it is, nonetheless, a commonly-held view. No one seems sure even what the dispute is about any more.
"It's not capable of being settled because nobody knows what the claim is anymore," said another union insider. "If Bertie were to pull another £60 million out of his pocket tomorrow to settle it, it couldn't be done, because like Topsy, the demands have `growed and growed' and varied from one day to the next . . . They hop around all the time.
"One minute they're looking for parity with administrative grades, then with paramedics, then with teachers . . . They're always saying that they're at the bottom of the heap in the health service but I've yet to hear them say who should be the lowest paid in the sector. They just see themselves as `special cases' and proceed as if things like industrial relations machinery and the wider movement didn't exist."
The bottom line, say seasoned industrial relations negotiators on both sides, is that there is only so much that can be achieved at any particular time without "driving the whole thing through the roof". The problem, they suggest, is that the INO's general secretary has not faced up to this. Liam Doran is said to be a man who adopts absolute positions, traps himself into situations, leaving himself with little room for manoeuvre when crunch times come.
"Their stated demands and expectations were raised to totally unrealistic levels," said one insider, "so that no matter what the Labour Court came out with, there was always going to be a huge gap."
When the Labour Court's £60 million recommendation appeared in September after a six-month investigation, it is believed that Alliance officials around the table - including Liam Doran - felt that it was enough to resolve the dispute, but Mr Doran's position is said to have shifted dramatically when he was confronted and criticised by his troops.
Shortly after, he came out and rubbished the report in its entirety, not only announcing that he would ballot the three sections but would allow one to veto all.
The upshot is that this time round, the nurses' unions may have both a public relations and a credibility problem. Despite the undoubted advances of recent years and the radical changes in train on foot of the commission's report, their script sounds much the same.
On the airwaves, nurses as young as 25 sound as jaded as 50-year-olds: "Three hundred and sixty-five days a year . . . to us as nurses, all days are the same," complained one. To which a listening bus driver commented: "Yeah. Tell me about it."
The talk still is of burn-out, of intolerable pressure and responsibility, of 60-hour weeks, of abuse from patients and the public, of bullying, of the lack of recognition and respect, of increasingly high technology, of unhappy nurses leaving the profession in droves or taking off to Australia where nurses are properly paid, of being forced to fund their own courses, of allowances and differentials and long service payments.
Along the way, words and phrases are thrown up and left unquestioned. Asked by Marian Finucane to confirm that the strike was actually about money - as opposed to "overcrowding, understaffing, lack of facilities", which, one nurse tried to suggest, had been at the heart of all their disputes - the same nurse conceded: "Yes, it is about money. We want to be duly recognised for what we're giving to the health services like other comparable graduates within the profession. If we don't do this, there will not be nurses in the profession."
This does not impress existing graduate grades in the public health service, such as physiotherapists, who point out acidly that the first nurse-graduate grades will not come on stream for nearly seven years. Nor does it impress employers, aware that the number of nurses in the public health service - some 30,000 including job-sharers - is at an all-time high and that in the past two years, the numbers coming into the service have exceeded those leaving.
Or that to facilitate the transition from apprenticeship to diploma training models as recommended by the commission, an extra 1,500 trained nurses have had to be drafted in to replace those who used to learn on the job and provided an extra pair of hands, or that the number of applicants for nursing places has soared.
Furthermore, a 1998 survey of midwives who left their jobs at three Dublin maternity hospitals over the previous three years suggests that their reasons for leaving were little different to that of any other group of women in the mainly 2630 age group. They left Dublin to get married and/or return to their home town, to travel, to pursue a third-level qualification (mostly the one-year diploma in public health).
Only 3.8 per cent (including those categorised as "retired") left the profession for another career.
An interesting pointer to the mobility of young nurses is contained in the same survey over the same period, which shows that in one hospital, 31 per cent of the new entrants came from outside the Republic. Of these, 17 were from England, six from Australia, two from the US, two from Northern Ireland and one each from Bermuda, Denmark and Scotland.
The health services are also anxious to quash the perception that nurses are on permanent duty. They insist that while nurses do work unsocial hours, most work no more than a five-day, 39-hour week and those who work extra hours are paid for them. In any event, the gains, the breadth of the gap between the two sides and the scale of any award may be gauged by looking at the progress of staff nurses, who comprise some 20,000 of the 28,000 in dispute.
A couple of years ago, staff nurses were earning £17,747. Under the new deal, that would rise at the maximum end of the scale to £22,339. The union is seeking nearly £4,000 more.
The employers' case is that as of now, a nurse working unsocial hours - say, every second weekend and some nights, which 80 per cent of them do - could bring that £22,339 up to £27,000. Any overtime would be in addition to that.
Up to half the staff nurses would also benefit from the Labour Court award of a £1,000 allowance for working in specialised or stressful areas such as ICU, theatre, A & E, while many would also be eligible for the £1,500 allowance for additional qualifications. A one-off lump sum of £1,250 for all nurses has also been recommended by the Labour Court to take into account "the fundamental nature of the changes proposed for nursing".
Under the new deal, ward sisters earning £20,023 in 1997 would rise to £27,552. The union wants nearly £7,000 more. However, employers claim that with allowances and a possible 15 per cent extra for unsocial hours, ward sisters have potential earnings of up to £32,000.
By comparison, to take one of the groups with which nurses were claiming parity at one point, the maximum basic rate for a physiotherapist (after a fouryear degree course) is £22,925. For a physiotherapist in charge, a comparable grade to a ward sister, the maximum is £26,635. An expert group is already examining paramedics' pay and conditions.
A different point for comparison used by Brian Cowen this week was Irish nurses' pay compared with the rest of Europe. Different levels of support staff and working hours will skew the picture but in general terms, Ireland stands fourth in the European league of nurses' pay, ranking below France, Sweden and Denmark, almost on a par with Germany, and above the UK, the Netherlands, Spain and Portugal.
On a similar basis (and with an emphatic caveat in the area of support staff), it appears from a 1998 OECD report that in the mid-1990s, Ireland had the highest ratio in Europe of nurses to beds in the acute hospital sector.
Given a choice, most people who have ever passed a hospital door would grant Irish nurses their every wish. A 1998 survey carried out by the Irish College of General Practitioners confirmed that 93 per cent of patients questioned held nurses in high regard. The challenge is to show that appreciation in practical terms without sending every other public service union into orbit. The other difficulty is getting the nurses scatter-gun approach to the issues.
"Their hours are longer, for example, than any others in the sector," says one trade unionist. "If they could state their claim in terms like that, it could probably be resolved."
But this is a profession in transition and the growing perception is that it is not a profession at peace with itself. The confusion about with whom to claim parity suggests that nursing - long regarded as an invisible art - has no sense of identity or of its position visa-vis other professions.
While new nursing entrants look forward to new status in a new era, older nurses - trained to an almost military, hierarchical model - agonise about the emerging diploma/graduate nursing classes, and the implications for their authority and status and the nature of Irish nursing.
"I'm afraid that those militants trying to make nursing sound more hi-tech to `enhance' nurses' status are forgetting what distinguishes nursing from every other profession," said one senior nurse this week. "It's all theory in training these days," said another. "I shudder to think what's going to be looking after patients in 10 years time. Experience will count for nothing. I know of a diploma student who was asked by the sister to fetch a bedpan for a patient, and the girl said: `Oh, that's not on my curriculum'."
In such a climate, it is hardly any wonder that bullying routinely appears in any list of complaints. "It's got to a point where if you say `Oh, for God's sake, just get on with it', you're branded a bully."
The issue of bullying was one of the many addressed in the commission's report, but, said the same nurse, no culture would be upended in a day. Old trade union hands take the same view.
Money may well be a part of the answer, but only time, patience, leadership and the promised change of culture will remedy many of the issues at the heart of nursing's discontent.
