Ambulance staff at the Mid-Western Regional Hospital provided tea, coffee and chocolate biscuits for 40 accident and emergency nurses who staged a two-hour protest yesterday. When an ambulance passed later, the nurses suddenly upped the ante. "A bit of dinner now," one cried.
Earlier a passer-by had wondered if anybody was going to die. It was a ludicrous question, according to Ms Sarah Watkins, secretary of the strike committee. "The public perception of nurses must be poor if it is anticipated we would watch somebody collapse, walk over them and go out to a picket line."
Nobody was left in the resuscitation room, she said, and four nurses had provided emergency cover. "At 12 p.m., we handed over the keys to the A&E department to two consultants and the casualty doctors who were on duty," she said.
The Mid-Western Health Board had requested that doctors restrict referrals and the public limit attendances. The particular problems at the hospital were an escalation of the number of people left on trolleys in A&E indefinitely, Ms Watkins added.
"Six to eight months ago, it would have caused some sort of managerial stir if there were six people on trolleys. In the last six months, it has escalated from an average of six to the mid-20s."
Part of the problem was the number of people attending A&E who should not be there and the readiness of some GPs to refer patients there. There were also not enough beds. "It is not that we decided to whimsically down tools. It has been a conscious decision by ourselves. A short-term realistic plan was what we wanted. They seem to be doing everything except fund new beds," she said.
Ms Helen Rouine, the INO's industrial relations officer in the region, said there had also been protests at St John's, Limerick, and at hospitals in Nenagh and Ennis. "There are no statistics maintained on a day-to-day basis about the number of people who are in casualty. Once they are admitted, they go through the system of in-admission, but they could still be in casualty."
Mr Coleman O'Leary, a consultant and president of the Irish Association for Emergency Medicine, said he was solidly behind the concepts about which the nurses were in dispute. The system had been in a downward spiral since the mid-eighties and was at implosion level. "It is quite simply unbearable," he said.
Protests were also held in Cork University Hospital, the South Infirmary and the Mercy Hospital without any serious hitch, said Mr Mick Dineen, the INO's industrial relations officer for the Southern Health Board.
Mr Tony Fitzpatrick, an INO official in Waterford, said there had been protests at the regional hospital in the city and in Kilkenny, Cashel and Clonmel. "The emergency response teams were in place. The pickets went well, they went as planned.
"The public is pretty supportive of the whole issue because it is they who are affected at the end of the day. This is not a major issue in the south-east in itself but there can be delays of up to 12 hours in getting a bed."
Anne Lucey in Tralee, Co Kerry, adds:
Three nurses provided emergency cover at Tralee General Hospital in Co Kerry yesterday while their colleagues went on the picket lines for two hours from noon.
Administrative staff from other departments were brought "to assist wherever possible". They would continue to be deployed during the work-to-rule action, a hospital spokesman said.
The hospital is closed for non-emergency admissions because of an outbreak of the winter vomiting virus. The A&E department admitted eight cases during the strike. Two people required resuscitation and the emergency response team treated them immediately, according to the spokesman.
GPs were also not referring patients to A&E unless they had to and were themselves carrying out emergency procedures such as stitching, the hospital spokesperson said. "A lot of GPs are conscious A&E units are under pressure."
Meanwhile, the North Western Health Board reported no major problems at casualty departments at their two general hospitals during yesterday's two-hour work stoppage.
A spokesperson for the board said the A&E departments at both Sligo and Letterkenny hospitals had been "very quiet". Up to 20 nurses from the casualty unit at Sligo General Hospital staged a protest outside the two entrances to the hospital and outside the casualty department itself.
"It's all for patient care, that's why we're out here," said one of the striking nurses, Ms Patricia Looby. "We want patients to have the best care that we can give them and this is very hard because of the excessive workload that is forced upon us. None of us want to see patients left on trolleys overnight."
At Letterkenny General Hospital in Donegal, about 20 nurses protested. The North Western Health Board had advised patients who were scheduled to attend both hospitals for non-emergency surgical procedures yesterday to contact the hospitals to see if the procedures were going ahead.