Health service management believes that the work-to-rule to be implemented by 40,000 nurses around the State from today could be "as bad as a strike" and could have a severe impact on patient care.
However, the unions maintain that the action is "measured" and will actually increase the amount of time nurses can spend with patients by minimising the time they spend carrying out clerical or non-essential duties.
In an internal briefing document prepared last week for Minister for Health Mary Harney, the Department of Health suggested that the nursing unions were planning "maximum disruption".
The department said that in the event of work-to-rule going ahead, "there will be a severe disruption of services very quickly".
"The situation is high risk and health service managers believe that action has to be taken immediately to minimise the risk," the document states. "Bed management services will be severely disrupted in many hospitals, quickly leading to a backlog in A&E. The ban on the use of telephones and IT systems could have severe repercussions for vulnerable patients/clients. Day services for intellectual disabled/psychiatric patients may be cancelled in some areas."
In a statement last night, Brendan Mulligan, assistant chief executive of the Health Service Executive (HSE) Employers Agency, said the work-to-rule would put patient care and safety at risk. He said services "will gradually be terminated and people awaiting health services will not be treated, leading to further ill health".
In a statement last night, the HSE said the nursing unions had characterised the work-to-rule as nurses not undertaking duties that were perceived as non-nursing duties. "However, the reality is much more stark and in many instances the work-to-rule represents a withdrawal of nurses from their core functions," it said.
"In critical care areas, such as oncology, neurology and diabetes, patients are managed at home and are reliant on telephone contact with nurse specialists. Withdrawal of telephone services compromises patients' welfare and could have serious adverse implications for patient care."
The HSE said the refusal of bed managers to attend meetings would represent a refusal to fulfil a core function of the grade. It said that if the bed management function was compromised, it could lead to congestion in A&E departments and back-ups in wards throughout hospitals.
The HSE also warned that the proposed ban on the use of IT systems could see nurses refusing to use IT-based triage systems in A&E departments or to enter clinical data into automated systems in intensive care units, cardiac care units and dialysis units.
The HSE said: "The scheduling of theatre lists in some services is IT-based and the work-to-rule will have the impact of severely compromising the efficiency of this system, leading to delays in procedures."
It also maintained that ordering essential laboratory tests and diagnostic procedures could be affected, and the proposed action would "frustrate the return of results of clinical examinations, eg where urgent lab results are telephoned through to wards/units, as well as causing delays in picking up abnormal results".
Management suggested that a refusal by nurses to answer telephones in community-based centres could result in delays in assessing vulnerable clients, while some intellectual disability services could be cancelled.
The work-to-rule, to be put in place by 40,000 members of the Irish Nurses Organisation and Psychiatric Nurses Association, will involve:
Ban on all clerical/ administrative/IT duties; nursing/midwifery notes to be maintained manually.
Ban on all meetings at local, regional and national level, except those involving consideration of named individual patients/clients, their welfare and case management.
Ban on all telephone work except that deemed essential, on clinical grounds, by the nurse/midwife.
Ban on opening/securing all community-based facilities.
