THE question clearly had been chewed over by the (traditionally male, militant) members of the Psychiatric Nurses Association. Had the general nurses (traditionally female, subservient) the bottle to strike?
In Cork last Monday night they got their answer. One of those traditionally subservient nurses stood on a chair "I want to be on strike because I know I won't get what I'm entitled to unless I go on strike".
In Galway on Wednesday the tone was more genteel, but the air of determination was no less palpable. The term militant nurse" was beginning to look less like an oxymoron and, by all accounts, the message was getting home. Until recently, Noel Dowling of SIPTU told the Galway rally, no politician seemed to have an interest in nurses or strikes.
The rallies had changed all that Now we have politicians phoning up asking if there's anything they can do to help" a theatrical pause the poor nurses".
The poor nurses The audience hooted and applauded, antennae keenly tuned for the familiar language of patronage and political opportunism. Nurses, they repeated over and over, are tired of being patted on the head by both politicians and patients, tired of praise and gratitude.
One young nurse said quietly that what she dreaded most was the box of chocolates from departing patients.
"I know they mean well, but for me it just sums up all those myths about nurses. For example, I have to run a car because of the unsocial hours I work. Chocolates won't pay for the petrol..." Underlying this is a serious challenge to cut out the tokenism. It's time for The Grateful Patient, alias The Taxpayer, to pay up.
"They call us ministering angels", said Lenore Mrkwicka, of the INO, to wild applause. "Well, we're ministering all right, but being angels won't pay the bloody mortgage".
On the face of it, nurses have a long shopping list lodged with the Department of Health. It encompasses career structures, further education, early retirement, pay differentials. But the bottom line is pay.
THERE has been no review of nurses' pay and conditions since 1980 when, significantly, nurses last took to the streets. The most on offer from the Department of Health is 3 per cent under the PCW. Unlike the vast majority of organisations, it may be enlightening to start at the top.
Josephine Bartley has reached the pinnacle of the nursing pyramid. As Director of Nursing at Beaumont Hospital, she is responsible for 900 nurses and a budget of £18 million. For that she is paid £27,542 a year.
"Money isn't everything, but you do like to see your work valued," she says mildly. "I think if the managing director of a private organisation was doing something similar, the salary might be closer to £100,000".
Ms Bartley is particularly conscious of the plight of ward sisters "You have no idea the responsibilities they take on. They have to be so alert, guarding young nurses and doctors, keeping everybody on the straight and narrow".
Yet the pay differential between them and their juniors is negligible. In fact, because of the extra allowances available to staff nurses and others for night duty, for example, ward sisters often see their juniors take home more money than they do.
Johanna Downes, a ward sister with 22 years' experience, now at University College Hospital, Galway, earns £19,000 gross "The week before last, a young nurse's aide doing night duty, with no experience, no training, no responsibility, took home £426 for two weeks' work. I take home £1,225 a month, and that includes the Sunday allowance".
It is 30 years since Eileen Hickey went into nursing. She is now a staff nurse in Cherry Orchard, where staff get an extra weekly allowance of £6 for working with infectious diseases cases.
Her gross salary is inflated by allowances for weekend work and night duty to around £19,000 gross, but her basic is just £16,500. The increments stopped after nine years, although there is talk now, she says, of taking them up to 15 years.
However, in exchange for this concession, first and second year staff nurses would face a reduction of around £2,000 a year, bringing them back to about £11,000.
With several diploma degree courses in nursing under way around the State, and the prospect of college based training for all, experienced nurses see this proposal as a further example of the contempt in which they are held.
"A social worker studies for four years in college and comes straight in with £19,000," says Des O'Toole, a staff nurse in Beaumont's casualty department, "but they're suggesting that a nurse after four years in college should start in at £11,000?"
Nurses generally are learning to avoid the trap of comparing themselves with other groups, such as teachers or gardai, believing that as a professional body (a description they fiercely defend), they should be able to stand alone.
BUT comparisons are hard to avoid. Jim Regan, a psychiatric nurse in Galway, remembers that 20 years ago his income was on a par with vocational schoolteachers. "Now I have £4,500 to £5,000 less in my pocket than them".
A basic grade primary school teacher earns about 45 per cent more than a basic nurse a PNA representative told the Galway rally, adding that teachers are by no means overpaid.
Des O'Toole will be working in Beaumont's casualty department this weekend. Mary Keane will be taking vital decisions in UCHG's intensive care unit.
Eileen Hickey will be working with geriatric as well as AIDS patients. They are at the centre of the wheel, as one of them put it, on their feet throughout the working day, on full alert.
It hurts that this work is equated to that of say, a secretary or assistant librarian, whose responsibilities, working hours and conditions are hardly comparable. They all talk about the increased workload and responsibilities they have taken on.
The introduction of day wards and five day wards means that full time wards now have a far higher concentration of high dependency patients. The development towards greater efficiency and streamlining has led to an increased workload.
The introduction of a Patients' Charter has led to a more questioning consumer and rightly so, the nurses concede but with the effect of putting greater pressure on ward staff to keep up to speed on new developments.
However, while nurses struggle to attend courses in further education to meet this need, the time required for lectures and study is rarely available during working hours. The bulk of the fees is their own responsibility. (This is the issue that most exercises Josephine Bartley). They increasingly have to defend their discipline against allegations of falling standards (exemplified by stories of elderly people left unattended in surgical wards), a casual approach to patients (thoughtlessly addressing older people by their first names, for example) and aggressive attitudes towards patients who are asking for what is only their due.
The nurses in turn claim that a major contributor to their new militancy is a new aggressiveness on the part of patients and their relatives.
"With particular categories of patients, we seem to be just caretakers in setting rules on how they should behave in hospital, says Eileen Hickey.
"Some of them are under a death sentence and are full of anger and we're in the front line when they want to lash out". Nearly 40 per cent of nurses surveyed in an INO stress study in 1993 said they had been assaulted by patients at some time in their career, with 5 per cent having been assaulted by visitors.
A damning study of nurses under stress, commissioned by An Bord Altranais in 1988, remains unpublished. But the INO stress study showed that a startling 40 per cent of the sample would be either "quite likely" or "very likely" to give up nursing if another job was available.
In it discipline with an over whelming majority of women, however, the most revealing study of all is probably Dr Pat O'Connor's Barriers to Women's Promotion in the Midland and Mid Western Health Boards, carried out last year.
The section on nursing unveils a catalogue of anger, bewilderment, cynicism and self blame.
Focus group discussions involving nurses from ward sister level and above revealed a sector of women locked into the classic female dilemma that those very characteristics and ways of behaving which had been positively valued and encouraged in them as women seemed to be working against them at an individual and group level.
While recognising that senior management posts were dominated by men, they blamed themselves for the poor career structures they saw in nursing, for what they saw as the lack of confidence and lack of motivation that inhibited them going for the (very occasional) promotional posts that did exist.
They jaw their training as destroying initiative and self assertiveness and as leaving them with a feeling that they could not change things, and that they had no awareness of career options. "Women just take it, they put up with it, they'll put up with anything," said one.
What they saw in short, concluded Dr O'Connor, was an organisational culture so biased in favour of men that it really was not possible for an equal competition to take place between men and women as things stood.
And like many of the State's 25,000 nurses, seriously bent on industrial action, they wondered whether the pay and working conditions of nurses would be better if there were "more men on the ground floor".
Even within nursing, the gender spread has telling repercussions. "Gender has a lot to do with it," says casualty staff nurse Des O'Toole, who began his career in psychiatric nursing. "It's hardly a coincidence that psychiatric nurses are paid more and have better career paths".
Trade union leaders have warned nurses about a probable backlash from "the self appointed guardians of the public purse" if the strikes go ahead.
But the word from within the hospitals so far is that support is solid as nurses prepare to cast off the "angel" tag along with the white gloves before joining battle in the rough, tough world of industrial relations.
For those seeking a straw in the wind, the voices to note are those of the moderates, such as Rose Glen, a staff nurse in St Patrick's Psychiatric Hospital. She loves her work, her responsibilities, the hospital itself.
But even she believes the time has come to take a stand "A strike is the very last thing nurses want to embark on, but we've been hard done by for far too long, treated as second class citizens despite the degree of responsibility we take on board. It's a last resort. What else are we to do?"
