Nurses point way to easing crisis but it's a thorny path

What will come out of the nurses' strike apart from photo opportunities for the Opposition?  Padraig O'Morain , Health and Children…

What will come out of the nurses' strike apart from photo opportunities for the Opposition? Padraig O'Morain, Health and Children Correspondent, looks at what might emerge.

Nurses echo public discontent as they start strike action in Accident & Emergency departments today.

The lengthy wait to be seen and the even lengthier wait for a bed have come to symbolise a desperately overstretched hospital service.

But what is likely to come out of the action by the Irish Nurses' Organisation and SIPTU? A look at the specifics of the nurses' demands provides a clue to what might emerge.

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These demands have been outlined in detail in a 10-point plan by the INO.

At the heart of this plan is a bed manager who would be a nurse and who would have powers likely to cause apoplexy in many consultants.

This would include the power to cancel planned surgery without the approval of consultants to make way for emergency cases.

The bed manager could also insist that consultants do extra rounds to see if patients were fit to leave the hospital, thus making beds available for emergency admissions. Essentially, senior doctors would do two rounds a day, including Saturdays, to see if patients could be discharged.

Working alongside the bed manager would be a liaison manager who would know what beds were available in nursing homes or in non-acute hospitals. The liaison manager would be in constant contact with relatives of patients who were to be transferred to nursing homes or non-acute hospitals "with a view to ensuring such transfers can take place at short notice".

All available nursing home beds would be bought by the health boards for patients leaving acute hospitals, beds in private hospitals would be bought for both emergency and elective patients, and minor injuries units would be set up in all big hospitals.These units would take much of the pressure off the A&E departments.

These proposals are by no means problem free. They seem quite at odds with the views of doctors as expressed by the Irish Medical Organisation. Far from a bed manager going around cancelling surgery and freeing elective beds for emergencies, the IMO would like to see "protected" elective and "protected" emergency beds.

Such a system would prevent the bed manager doing what the Irish Nurses' Organisation wants the bed manager to do.

The IMO is also wary of increased pressure to discharge patients. Early discharge simply leads to more readmissions, it says.

Indeed, relatives who feel that hospitals are too quick to push patients out the door might agree with the IMO on this.

Other measures proposed by the INO are less controversial. The purchase of nursing home beds would help acute hospitals to move patients on - but will this lead to a critical shortage of beds for people who are not hospital patients but who need nursing home places?

And will it lead to the use of nursing home beds for patients who really need more specialised rehabilitation beds?

The establishment of minor injuries units at the hospitals and the appointment of more A&E consultants would certainly help but both would take time.

That said, the Irish Nurses' Organisation has had the courage to spell out in detail what exactly it thinks can be done to address the A&E crisis in the busier hospitals.

The industrial action by the INO and SIPTU will place intense pressure on the Minister for Health and Children to do something about the nurses' demands.

At the core of these demands is a feeling that local hospital and health board managers are failing dismally to consult them and to work alongside them in resolving the problems.

Perhaps it is in such consultation - if necessary under the shadow of a big stick wielded by the Minister - that a solution lies.