7 October 1999 Edition
Strike threat highlights health service crisis
BY ROISIN DE ROSA
The nurses are challenging the government to fund the health service, and those who work in it, so that patients can get the treatment they need and health workers the conditions they deserve
The Fianna Fáil/Progressive Democrat government dismisses the nurses' pay claim on the grounds that it is for parity, which will provoke leap-frogging pay claims, industrial unrest, ripping wage inflation and the threat of economic downturn.
Minister Cowen has added that nurses will be putting lives at risk by striking. But ministers for Health have been scaremongering like this this for years, despite on ongoing crisis in the health service caused by lack of government funding.
The nurses dispute has been going on since the government first started the health cuts in the 1980s. Above all, the nurses are fighting the conditions in the health service itself, which is in crisis.
There are 39,000 on hospital waiting lists, awaiting treatment which they can't get. Whilst they remain on the list, they are suffering pain, their health is deteriorating. A person with lung cancer, or heart disease, has only a certain amount of time before the condition becomes inoperable.
There have been ward closures in many, if not most hospitals, directly because of the shortage of nursing staff.
Dr Maurice Neligan, Director of the National Cardiac Surgery Unit in Dublin's Mater Hospital, warned back in March that two new specialist cardiac units could not open. The Mater's cardiac facility has the capacity to do 1,000 operations a year. It will only do 800 directly because of the shortage of nurses. It should have 16 nurses, but it has only seven. And the Mater is only one case in point.
The Secretary General of the Irish Hospitals Consultants Association, Finbarr Fitzpatrick, reported at the start of the year, that there is a shortage of 4,000 nurses in the 26 Counties. Life-saving operations were being cancelled directly as a result of the shortage of nurses.
It is a well published fact that waiting times to see a doctor in casualty can be hours. Patients may have to spend up to 72 hours in casualty, lying on trolleys, in passages. ``Fifteen emergency cases waiting for a bed in the hospital is not unusual in our casualty,'' one nurse explained.
Finbarr Fitzpatrick has referred to a case of a patient waiting in an ambulance outside the Mater Hospital because there wasn't enough room inside. He asked whether patients would be left on the street next.
It is an equally well publicised fact that junior doctors, who may hold your life in their hands, can work 72 hours shifts, during which time they are continuously on call, and the Minister of Health has no intention to end this practice in the immediate future.
The nurses' dispute, which after four years has come to a head, is centrally about this health service crisis. The nurses are challenging the government to fund the health service, and those who work in it, so that patients can get the treatment they need and health workers the conditions they deserve.
What good, after all, is a few pence off the income tax if you can't get treatment when you're sick or dying.
Mairead describes a typical night shift in geriatric.
``Most people come into nursing because they have been close to someone they love who is dying, or sick. They see nursing work and they think that is a worthwhile job. Five out of seven nurses asked if they would have chosen to be nurses had they known what nursing would be like, said no.
The night shift starts at 8pm. There are 55 patients in my ward who I have to care for. I have two attendants to help me. They are not nurses.
The night starts with a report from the day staff. All 55 patients then have to be checked. Then the drugs have to be handed out, with exact instructions, which must be signed for by the nurse. Only the nurse can do this, meeting complaints, abuse and even violence from some patients, who are often unhappy and lonely. Meanwhile, there are patients getting out of bed, or Alzheimer patients who might not know themselves what they are doing, patients with respiratory problems who can't breathe. There is always something.
After the drug round, the patients must be put to bed. Many are incontinent, need to be changed, washed, which involves commodes, bed pans, and fresh bed clothes for a large proportion of the 55 patients, some of whom can't move themselves. Every patient needs to be made comfortable, when most of them aren't.
Every 20 minutes patients have to be checked. There would never be a night when they all sleep quietly and stay in bed. Every two hours, patients have to be turned, all 55 of them. Maybe fresh bedclothes, clean pads, clean nightdresses. Then there are those with a tracheotomy, or a nasal gastric tube. They have to be fed. Each may take up to half an hour.
All the while there may be one or two who are in a most serious condition, who may be even dying. They need continuous observation. And there is always the one who is falling out of bed, getting out of bed, who can't sleep, who needs care, attention or just comfort. There is no time.
It is not unusual that a patient dies. In the midst of all the night's work, the nurse then has to notify all involved, console the relatives, and lay out the body. I've seen two patients dying in the one night.
At 6am, the morning routine starts. All the 55 patients need to be lifted, changed, cleaned, and their beds fitted with new sheets. Then there is the morning drug round, then the day staff come on. But at 8am you still aren't finished. The nurse has to write up and go through reports on every patient's condition during the night with the staff coming on. And then maybe your relief is late in arriving, or simply doesn't come on at all. You have to stay.
For 12 hours there is no break. The nurse cannot leave the ward, as she is the only medical staff on the ward. She is responsible. Three or four nights a week, at such a pace - you can't do it.
Every ward is different, but the problem is the same. There is not enough staff. One nurse doing the work of two or three.''
Conditions are so bad that it is impossible to get the nurses. There is no panel anymore.
A staff nurse, after four years training, starts at £7.54 and after eight years reaches a maximum of £11.02 per on a 39-hour week. A ward sister who is head of a department with between 5 and 40 staff reporting to her can reach a maximum, over ten years, of £13.57 per hour.
Nurses are leaving the profession. Some go abroad. Many take jobs as reps for the drug companies, where the pay is better, with starting rates of £18,000 or £19,000 and perks including bonuses and a car. With special qualifications, you could start at £25,000.
Many nurses leave and go to work for agencies, where you can choose where and when you work, and pay is a little better. It's £132 for a 12-hour night shift, £81 for an 8-hour day shift, with 10 per cent extra for Saturday working, and 50 per cent extra for Sunday shift work. But it's yellow pack workers, with no security, no contract, no pension rights, no maternity benefit or sick pay.
And Minister Cowan says we are putting lives at risk if we go on strike?''
The nurses are challenging the government to fund the health service, and those who work in it, so that patients can get the treatment they need and health workers the conditions they deserve
The Fianna Fáil/Progressive Democrat government dismisses the nurses' pay claim on the grounds that it is for parity, which will provoke leap-frogging pay claims, industrial unrest, ripping wage inflation and the threat of economic downturn.
Minister Cowen has added that nurses will be putting lives at risk by striking. But ministers for Health have been scaremongering like this this for years, despite on ongoing crisis in the health service caused by lack of government funding.
The nurses dispute has been going on since the government first started the health cuts in the 1980s. Above all, the nurses are fighting the conditions in the health service itself, which is in crisis.
There are 39,000 on hospital waiting lists, awaiting treatment which they can't get. Whilst they remain on the list, they are suffering pain, their health is deteriorating. A person with lung cancer, or heart disease, has only a certain amount of time before the condition becomes inoperable.
There have been ward closures in many, if not most hospitals, directly because of the shortage of nursing staff.
Dr Maurice Neligan, Director of the National Cardiac Surgery Unit in Dublin's Mater Hospital, warned back in March that two new specialist cardiac units could not open. The Mater's cardiac facility has the capacity to do 1,000 operations a year. It will only do 800 directly because of the shortage of nurses. It should have 16 nurses, but it has only seven. And the Mater is only one case in point.
The Secretary General of the Irish Hospitals Consultants Association, Finbarr Fitzpatrick, reported at the start of the year, that there is a shortage of 4,000 nurses in the 26 Counties. Life-saving operations were being cancelled directly as a result of the shortage of nurses.
It is a well published fact that waiting times to see a doctor in casualty can be hours. Patients may have to spend up to 72 hours in casualty, lying on trolleys, in passages. ``Fifteen emergency cases waiting for a bed in the hospital is not unusual in our casualty,'' one nurse explained.
Finbarr Fitzpatrick has referred to a case of a patient waiting in an ambulance outside the Mater Hospital because there wasn't enough room inside. He asked whether patients would be left on the street next.
It is an equally well publicised fact that junior doctors, who may hold your life in their hands, can work 72 hours shifts, during which time they are continuously on call, and the Minister of Health has no intention to end this practice in the immediate future.
The nurses' dispute, which after four years has come to a head, is centrally about this health service crisis. The nurses are challenging the government to fund the health service, and those who work in it, so that patients can get the treatment they need and health workers the conditions they deserve.
What good, after all, is a few pence off the income tax if you can't get treatment when you're sick or dying.
A Day in the life of a night nurse
Mairead describes a typical night shift in geriatric.
``Most people come into nursing because they have been close to someone they love who is dying, or sick. They see nursing work and they think that is a worthwhile job. Five out of seven nurses asked if they would have chosen to be nurses had they known what nursing would be like, said no.
The night shift starts at 8pm. There are 55 patients in my ward who I have to care for. I have two attendants to help me. They are not nurses.
The night starts with a report from the day staff. All 55 patients then have to be checked. Then the drugs have to be handed out, with exact instructions, which must be signed for by the nurse. Only the nurse can do this, meeting complaints, abuse and even violence from some patients, who are often unhappy and lonely. Meanwhile, there are patients getting out of bed, or Alzheimer patients who might not know themselves what they are doing, patients with respiratory problems who can't breathe. There is always something.
After the drug round, the patients must be put to bed. Many are incontinent, need to be changed, washed, which involves commodes, bed pans, and fresh bed clothes for a large proportion of the 55 patients, some of whom can't move themselves. Every patient needs to be made comfortable, when most of them aren't.
Every 20 minutes patients have to be checked. There would never be a night when they all sleep quietly and stay in bed. Every two hours, patients have to be turned, all 55 of them. Maybe fresh bedclothes, clean pads, clean nightdresses. Then there are those with a tracheotomy, or a nasal gastric tube. They have to be fed. Each may take up to half an hour.
All the while there may be one or two who are in a most serious condition, who may be even dying. They need continuous observation. And there is always the one who is falling out of bed, getting out of bed, who can't sleep, who needs care, attention or just comfort. There is no time.
It is not unusual that a patient dies. In the midst of all the night's work, the nurse then has to notify all involved, console the relatives, and lay out the body. I've seen two patients dying in the one night.
At 6am, the morning routine starts. All the 55 patients need to be lifted, changed, cleaned, and their beds fitted with new sheets. Then there is the morning drug round, then the day staff come on. But at 8am you still aren't finished. The nurse has to write up and go through reports on every patient's condition during the night with the staff coming on. And then maybe your relief is late in arriving, or simply doesn't come on at all. You have to stay.
For 12 hours there is no break. The nurse cannot leave the ward, as she is the only medical staff on the ward. She is responsible. Three or four nights a week, at such a pace - you can't do it.
Every ward is different, but the problem is the same. There is not enough staff. One nurse doing the work of two or three.''
Conditions are so bad that it is impossible to get the nurses. There is no panel anymore.
A staff nurse, after four years training, starts at £7.54 and after eight years reaches a maximum of £11.02 per on a 39-hour week. A ward sister who is head of a department with between 5 and 40 staff reporting to her can reach a maximum, over ten years, of £13.57 per hour.
Nurses are leaving the profession. Some go abroad. Many take jobs as reps for the drug companies, where the pay is better, with starting rates of £18,000 or £19,000 and perks including bonuses and a car. With special qualifications, you could start at £25,000.
Many nurses leave and go to work for agencies, where you can choose where and when you work, and pay is a little better. It's £132 for a 12-hour night shift, £81 for an 8-hour day shift, with 10 per cent extra for Saturday working, and 50 per cent extra for Sunday shift work. But it's yellow pack workers, with no security, no contract, no pension rights, no maternity benefit or sick pay.
And Minister Cowan says we are putting lives at risk if we go on strike?''