Strike could change public's attitude to nursing forever

`This is the time, this is the hour," declared the Nursing Alliance chairman Mr Liam Doran, to wild applause from the 10,000 …

`This is the time, this is the hour," declared the Nursing Alliance chairman Mr Liam Doran, to wild applause from the 10,000 nurses who descended on the GPO in Dublin, on Thursday.

It was an extraordinary sight, not just the size of the rally, but these were nurses like we'd never seen before. Angry. Vocal. Defiant. Their time has come, they said. Nursing would no longer be seen as a vocation; it was a profession and the chairman of the Nursing Alliance was leading the fight on their behalf.

Slowly, the nurses appear to be getting their way. Talks are likely to continue over the weekend and it seems if there is any deal it will be an improvement on the Labour Court package rejected by the unions last month.

But also public perceptions of nurses are changing. Their centrality to the health care sector has been underlined. The level of responsibility which they hold has been highlighted.

READ MORE

They are being drawn into the mainstream of the State's workforce, but that comes with a cost, for the esteem in which nurses have been held has, to an extent, been dependent on them being above things such as strikes. It all seemed unthinkable a week ago. The threat may have been there but nurses had threatened to strike before and they had always backed down.

And that seemed to be happening again as an olive branch held out by the Minister for Health on Sunday was swiftly seized upon by the alliance.

Mr Cowen, who had been adopting a tough stance since the Labour Court ruling was rejected by the unions on September 22nd, told RTE's This Week radio programme that "if the Nursing Alliance unions recommit themselves to social partnership . . . there's a whole range of possibilities open to them to pursue their agenda".

Bertie Ahern also used his address at Bodenstown to reiterate that "we have proposals to move this on, but that can only be with collective agreement".

Neither the Taoiseach nor the Minister were shouting into a vacuum. Senior trade union leaders such as SIPTU vice-president Des Geraghty, who had 8,000 nursing members about to join the picket lines, were busy seeking a means of getting the two sides together.

By Monday, the Minister and alliance leaders finally met for the first time since the countdown for a strike began almost a month earlier. Both sides agreed to seek the advice of their respective social partners "to devise a process" that would allow talks to begin.

It was far too late, however, to avert the strike. Local committees were already finalising contingency plans, asserting their industrial muscle like never before. Among many nurses there was a feeling they would never be taken seriously in pay negotiations without at least once going out.

As the two sides met, the public relations battle began in earnest. The Government had taken out advertisements in the national newspapers: "The nurses feel they deserve a better deal - we agree." It set the tone for the week ahead. The Government would merely state the facts as it saw them but, under no circumstances, would it criticise the striking nurses.

The first rumblings of dissent among the other medical professions also surfaced. GPs, consultants and hospital doctors expressed concern that they would bear the brunt of the nurses' action. Yet on the whole they remained united behind the nurses, placing the blame squarely on the Government.

And so, at 8 a.m. on Tuesday, the walk-out began. Up to 1,000 pickets were placed on hospitals, health centres and clinics.

Four out of every five hospital nurses rostered were off duty. Only one in 10 community nurses turned up for work. Doctors urged the public to stay away from A&E wards, and the State held its breath.

Within minutes, the system had its first serious test. An ambulance arrived at University College Hospital Galway with two casualties from a road accident at Claren bridge. They were seen to immediately with nurses providing the usual assistance in operating theatres and intensive care. The emergency cover promised by the local strike committee had help up.

A reassuring picture began to emerge as the story was repeated elsewhere. Indeed, hospital consultants began to wonder what all the fuss was about. "A damp squib," is how one surgeon, somewhat gleefully, described the day.

GPs were also left wondering where the scores of patients who heeded the advise to stay away from A&E departments had gone. If there was anything to learn from the strike, it had shown that much of what passes through casualty wards on any particular day are neither urgent nor worthy cases.

But while emergencies, in general, were being dealt satisfactorily, fears began to grow for the welfare of vulnerable people in the community.

The elderly and people with disabilities normally serviced by public health nurses were left to fend for themselves as home visits were cancelled. Their suffering and that of parents whose mentally disabled children had been discharged from residential centres would become more acute over the next days, health boards warned.

More immediate problems were reported at St Luke's cancer hospital in Dublin where chemotherapy and radiotherapy programmes had been seriously disrupted. Management expressed concern over the level of emergency cover.

Right from the start, reports also started filtering through of problems at Our Lady's Hospital for Sick Children in Crumlin, a hospital already stretched to the limit, where junior doctors routinely work 100-hour weeks, where intensive care beds are lying idle due to staffing shortages, and where waiting lists for heart surgery are so long that over 40 children a year are sent to Britain for operations.

Accident and emergency consultant Dr Roisin Healy told of stressed hospital doctors having to "stab" children with needles as nurses refused to administer intravenous antibiotics. She said it was "absolutely inevitable" mistakes would occur and that medical staff did not feel they were able to provide emergency service to a medically acceptable standard.

As these problems surfaced, the Cabinet and the Irish Congress of Trade Unions gave their blessing to the peace initiative which began the previous day. The general secretary of Congress, Peter Cassells, and SIPTU's Des Geraghty were now joined in the intensive effort to find a way forward by IMPACT general secretary Peter McLoone, who was chairman of the critical public service committee of ICTU.

All three were at a critical ICTU meeting with Nursing Alliance leaders on Wednesday. So was the INTO leader Joe O'Toole and the ICTU president Inez McCormick, who travelled from Belfast to attend. With around 11,000 nurses in her own union, Unison, she had been briefed on the situation in advance by Mr Cassells.

The alliance was told it would have the full support of ICTU, but only if the nurses' leaders were prepared to keep within the framework of Partnership 2000, the settlement between employers and unions which currently fashions pay agreements. At the ICTU executive meeting earlier on Wednesday, some of the private sector union leaders said their members were becoming increasingly sceptical about what they saw, more and more, as "a public service agreement".

That evening, talks began at Government Buildings between ICTU's general purposes committee and senior civil servants, led by the secretary general of the Taoiseach's department, Paddy Teahon. As the ICTU delegation went in, Mr Cassells said they would not leave until they had a process in place. In the event, talks had to adjourn at 1.15 a.m. on Thursday for more tic-tacking with the Government and Nursing Alliance. Back on the wards, reports of people being left in beds without sheets being changed and of children going unfed began to emerge.

The North Western Health Board warned "visits to elderly people including those who need continence assistance, laundry assistance, respite care and those who live with mentally ill individuals have been drastically cut back".

And the Mid-Western Health Board expressed concern for the parents of mentally handicapped children, 161 of whom were discharged from three residential facilities in the region.

Any criticism aired on radio shows, however, was responded to swiftly by well-organised strike committees. For every person that rang up to complain there were three or four nurses on to defend the cause.

Dublin's five main hospitals issued their strongest statement on the strike, saying the primary clinical concern was beginning to shift to patients whose attendance at hospital had been deferred.

"While they do not strictly meet emergency designated criteria, many of these patients have conditions, such as known or suspected cancers, which if not diagnosed or treated very quickly could deteriorate greatly with serious consequences for patients," said a statement from the five hospitals - St Vincent's, St James's, Beaumont, the Mater and the Adelaide and Meath Hospitals.

The Irish Cancer Society warned psychological and physical damage could be caused to new cancer patients, 50 of whom were diagnosed each day, if the strike continued.

Immeasurable damage was also said to have been caused by the cancellation of up to 30,000 outpatient appointments, and the postponement of as many as 3,000 non-urgent operations this week.

Questions also began to be asked about the nurses' tactics in picketing only public hospitals. The medical board of Our Lady's Crumlin, noted in a statement the divergence between private hospitals, where nurses and management agreed not to curtail services, and their own hospital where "no such agreement has been reached in relation to protecting very ill children . . . from the suffering associated with the dispute".

Dr Healy went a step further on RTE's Morning Ireland yesterday when she said she "cannot understand how nurses can ethically defend what is happening". The hospital was considering sending a number of seriously ill children to hospitals overseas due to the reduction in services, she said. In the humdrum world of collective bargaining, the ICTU leaders returned to Government Buildings on Thursday for more talks. This was largely the work of Des Geraghty, working closely with Peter McLoone and Peter Cassells. Paddy Teahan, from Mr Ahern's office, and John Hurley, the secretary general for Public Service Development at the Department of Finance, found it harder and harder to shoot holes in the draft. By 9 p.m., they had a "process" document.

One of the least contentious issues was finding someone to preside over the process. The only question was if Kevin Duffy, vice-chairman of the Labour Court, could find the time to do it.

Mr Duffy is to industrial relations what George Mitchell has been to the Northern Ireland peace process. If anyone could fix it, he would. By midnight he already had the Nursing Alliance and health employers in for preliminary talks. He made no secret of the fact that he wanted a settlement as quickly as possible.

That would suit all sides as relations between nurses and medical staff can only go down from here. Hospital doctors are also warning that the system won't be able to cope with a serious accident over the bank holiday weekend.

Concluding Thursday's rally at the GPO, Liam Doran shouted: "I remind you of the U2 saying - we still haven't found what we're looking for."

If they don't find it soon, attitudes to nurses in Ireland may change irrevocably and not necessarily for the good.

Joe Humphreys is at jhumphreys@irish-times.ie Padraig Yeates is at pyeates@irish-times.ie