The State’s 34,000 nurses have been relatively quiet compared with doctors and hospital consultants in recent years, but the Irish Nurses and Midwives Organisation (INMO) conference will show whether this state of affairs is likely to change.
Early signs are that nurses, in common with other grades in the health service, are running out of patience with what they see as the chronic underfunding of the HSE, and the knock-on effect on their working conditions.
And with trade unions generally becoming more vocal on the need for pay rises after years of recession and cuts, the stance of the INMO, one of the biggest and most cohesive public-sector unions, will be watched closely.
“Understaffing on wards is the big issue for many nurses,” says the union’s deputy general secretary, Dave Hughes.
“It’s leading to massive overworking, chronic stress and absenteeism. Many of our members go into work fearing they may do more harm than good because of the pressures upon them. Meanwhile, patients don’t get the human touch because nurses have so many to care for.”
Staff ratios
One motion before the conference calls on the union to initiate a sustained, nationwide campaign for improvements in staffing ratios in nursing and midwifery.
The motion, proposed by the Roscommon branch and the executive council, says midwifery staffing levels should reflect the Royal College of Midwives approved ratio of 1:29.5 births. It says one nurse should be staffed for every four patients on general wards at times of high activity.
Another motion calls for additional bed capacity in emergency departments to tackle continuing overcrowding, as well as a comprehensive examination of existing staffing levels and skill mix arrangements.
Hughes says staff ratios in maternity hospitals in Ireland vary from 1:32 up to 1:52 in the hospital with the worst level of understaffing, Midland Regional in Portlaoise.
Meanwhile, on general hospital wards, ratios vary from one nurse to seven patients in the mornings, 1:8 in the afternoons and up to 1:11 at night. In the UK, anything above 1:8 is considered a danger zone, he says.
A number of recent reports on medical mishaps in Irish hospitals have linked problems to staffing issues. Hughes also points to the report of the Mid-Staffordshire NHS Foundation Trust public inquiry in the UK, which cited understaffing as one reason for the unnecessary deaths of patients.
“You can’t put people into an impossible situation and not expect things to go wrong sometimes,” he says.
On pay, he says the INMO would be happy to see nurses’ pay restored to pre-cut levels as the economy improves, “but we won’t be going out on our own on this”.
While the Haddington Road agreement covers pay levels up to the end of 2016, in recent weeks some unions have been calling for the restoration of pay cuts before then because of improvements in the economy.
The increase in hours required under the agreement was a huge blow for nurses, Hughes says, as for them it meant up to nine extra shifts a year and longer shifts. The abolition of the one-sixth premium for working on the “twilight shift” was also a loss.
Chronic problems
Hughes rejects the notion that nurses are quieter than other professions in the health service. "They're not getting the limelight. We have highlighted the chronic problems of the health service with overcrowding through Trolley Watch, but when it's there every day, it becomes less newsworthy.
“The provision of safe care is what matters to our members in the current environment of understaffing. It’s what’s in front of them every day at work that matters.”
The INMO fought hard against the introduction of the graduate nursing scheme, as a result of which it received a bare trickle of applications at first. Currently, about 350 places have been filled under the scheme, well short of the 1,000 originally planned.
Hughes says the scheme has had a demoralising effect on his members, many of whom have chosen to emigrate after finishing their training.
Some 360 delegates will debate more than 60 motions at the conference, which will be addressed by Minister for Health James Reilly. The agenda includes a number of familiar themes from previous years, such as a call for more midwifery-led maternity units and another seeking a greater focus on anti-bullying policies in the workplace.
