There can be no real winners from the first national nurses' strike, just casualties. Government partnership policy has been attacked, the reputation of the nursing profession has been partially damaged, patients have suffered and the fabric of the health service has been torn.
Time will be needed to heal the wounds. For some, nurses will never again be viewed in the same light. That change is not exactly a bad thing. This strike was always about more than pay and conditions: it was also for public recognition that nursing is now a real profession.
There is surely some irony also in the fact that much of the extra money now being offered to nurses can for this year at least be set aside against the tens of millions of pounds that the State has saved in nurses' pay over the nine days of the industrial action.
What is now on offer to nurses, on top of the three previous recommendations from the Labour Court, amounts to around £190 million. By any standards, that is a massive deal. Not everything has been achieved, but there is potential for much more in the years ahead, especially arising from the Commission on Nursing report.
The four unions in the Nursing Alliance have secured 4,850 new nursing post grades, increased allowances for nurses in psychiatry, mental handicap and public health and a mechanism to secure the implementation of the Commission on Nursing's 200 recommendations, only three of which related to pay.
Just days before the strike, the Minister for Health, Brian Cowen, told the Dail that the threatened industrial action was "a blind alley, leading nowhere" and he added: "There is no possibility of improving upon the terms of the Labour Court finding."
In fact, the Government has conceded a significant increase in pay and conditions, and there remains a real threat of knock-on claims, despite the efforts of all to suggest that the deal is within partnership.
The Government has some serious questions to answer. Why did the public and patients have to endure a long strike when the rhetoric of the Government that it could not improve on the original offer was just that, rhetoric?
The new pay offer could have been concluded before a strike, if the Government, ICTU, the Health Minister and the Nursing Alliance had displayed some realism earlier. The ultimate responsibility for the crippling of the health service must rest, however, with the Minister and the Government. They took on the nurses, and lost.
However, the Government will argue that by adopting a tough stance it has managed to limit the level of increased pay for nurses, and thereby any potential knock-on effects for other sectors such as gardai, teachers and prison officers. That may be so, but at what price?
Since 1993 successive governments have invested over £90 million in reducing waiting lists from the all-time high of over 40,000. This strike has massively set back that achievement.
For nurses there is a substantial deal now on offer, which also recognises that nursing is a true profession, not a vocation. However, the taking of industrial action meant they crossed a Rubicon.
While emergency cover in many areas was adequate, there were serious problems, especially for children, cancer care, psychiatric patients and some pregnant women. The strike resulted in major tensions between doctors and nurses and also problems between nurses and health service management.
When it emerged that some children and pregnant women were being transferred to Glasgow and Belfast for urgent care, it became clear that in some areas the enthusiasm for action had gone too far. The threat to withdraw all cover if there was no progress in the direct talks between the alliance and Government was also wrong.
Industrial action of any degree is a strategy of last resort, but can be justified in professional terms if taken against a sub-standard health service. That is the traditional ethical view espoused by industrial relations experts.
Patients should never be used, either by government or health professionals, as pawns in a battle for better pay.
In my view, there was no justification for the refusal last Tuesday of nurses to provide extra support care for cancer patients at St Luke's Hospital in Dublin, given the genuine concerns of doctors and with a substantial new deal within hours of being issued.
Also, during the strike nurses made much of the fact that they worked without pay. Yet yesterday some nurses were looking to be paid for their time on strike. To come out with fresh demands on the eve of a real settlement is unacceptable.
The nurses went into their first national strike with major public support. However, own-goals, such as refusing extra cover for cancer patients, children and other areas that were under intense pressure, did damage to their cause.
Yesterday calls from some nurse representatives for a ballot before the suspension of action was also a sign that some militancy remains. It also raises fears that, even with the Nursing Alliance decision to defer the strike, some nurses may fail to comply with this direction.
Similar strikes in the health service must never be allowed to happen again. And yet there looms the threat of a strike by non-consultant hospital doctors over excessive hours, unless the Government displays better skills than it did in the last few weeks. NCHDs took to the pickets in 1987 over the same issue.
Meanwhile, the nursing unions need some days to explain the new offer to their 27,500 members and to conduct a fair vote. Otherwise, there is the risk of a rejection due to ignorance of the detail of what has been achieved for the profession. The coming days will test the leadership of the nursing unions.
Fergal Bowers is news editor of Irish Medical News