Nurses undervalued and underpaid

In the week that Mary Harney addresses the nurses at their annual conference, low pay, poor working conditions and differences over the training of care assistants may lead to industrial action. Hilary Curley reports

Nursing is still among the lowest paid professions in the State (see panel) even though the nurses dispute during the 1990s resulted in a pay increase of 26 per cent. Pay has become an issue again as the Health Service Executive (HSE) has threatened to withhold salary increases, due to be awarded in June, claiming that the nurses have breached the conditions laid down in the national pay agreement.

"Nursing is now a degree course but nurses still start on a much lower salary scale than any of the other degree-based therapeutic medical grades such as speech therapists or occupational therapists," said Dave Hughes, Deputy General Secretary of the Irish Nurses Organisation (INO). "If you compare it to positions in the civil service, a nurse's starting salary equates to the salary of an administrative officer, one grade below the graduate entry level."

Nurses spoke to Village of anger building among front-line staff who feel that very little has been gained since the dispute in 1999. They feel under-valued by health managers and talk of a work-to-rule strike is circulating. The INO is seriously thinking about pulling out of the benchmarking process, which was introduced in 2000 as a way of comparing overall public service pay with the private sector. Pay increases were recommended for public servants as part of this process and were conditional on modernising and accepting new work practices. These new arrangements were negotiated as part of the social partnership agreement, 'Sustaining Progress'.

Dave Hughes of the INO said that whatever gains were made following the three-year dispute at the end of the last decade, they have been undermined by the benchmarking process, which he described as a "political exercise" that has relegated nurses back to where they were before the strike.

Along with the A&E crisis and the escalating pay dispute, the threat of nursing shortages is also looming on the horizon. Although a total of 55,000 nurses register in any one year, only 33,000 of these actually practice and 800 posts are currently vacant at this time. The degree course has been extended from three to four years and the next batch of graduates will now emerge in 2006 rather than 2005. As a result, there will be no newly-trained nurses entering the profession this year. Recruitment is already underway in India and the Philippines to add to the 3,000 foreign nurses already employed here.

The annual conference of the Irish Nurses Organisation is taking place this weekend and the dispute with the HSE on benchmarking is set to dominate the agenda along with the A&E campaign.

The dispute centres on the introduction of a new post of health care assistant, who will be charged with carrying out what is seen as the low end of nursing duties, leaving nurses free to concentrate on other high-end tasks. This new post was part of the national pay awards agreed between all parties under the benchmarking and social partnership agreement.

The INO said that it has "fully embraced" the introduction of the health care assistant post and, since last year, has been in discussion with the Department of Health about the training course. A dispute arose when, according to the INO, the Department introduced a new module on the course related to traditional nursing practices without consultation with the nurses organisation.

The INO objected to this and the Department delayed introducing the new module while it entered talks with the nurses union. On 1 April, a letter from the HSE was received detailing proposals on the new module. Three working days later (on 8 April), the union said it received another letter from the HSE citing them for non-cooperation over the new posts and therefore breaking with the conditions of the pay agreement. As a result, it said, the scheduled pay increases would be withheld.

"The issue should have been sorted through the proper channels but the whole issue was accelerated and pushed into the public arena as part of a manufactured dispute to discredit the nurses and deflect the heat from the A&E crisis," said Dave Hughes.

The HSE rejects the view that the dispute has been manufactured and said that the deadline for citation under the benchmarking process was Friday, 29 April. Problems had arisen well before the A&E campaign, a HSE spokesperson said, and the issue in fact was nothing more than a simple "good old fashioned" demarcation dispute.

The other bone of contention between the HSE and the nurses is the proposal by management to place additional beds in wards to address the A&E crisis. The INO "trolley watch campaign" has been very successful in highlighting the overcrowding at hospital A&E departments. The HSE spokesperson said that the INO claims about additional beds were "totally disingenuous".

"We didn't send out a dictat saying 'put beds in all wards'," he said. "We sent a letter to hospital managers asking them to look at the scope for additional hospital beds in wards where possible. It won't solve the crisis but it might help."

He criticised the nurses for their refusal to even consider this option given that a range of things need to be done, including implementing the 10-point plan. There is no health and safety issue, he added, because a recent risk assessment report stated additional beds in wards was a viable option.

But the INO said that wards are generally at their full capacity and much of it depends on the dependency level of patients and how much staff attention and care is required. For example, a cardiac recovery patient will require more attention than a flu patient. Fewer staff for more patients reduces the overall level of care.

An additional concern about extra beds in wards is around the spread of infection and more particularly, the spread of the hospital bug MRSA.

"I don't want to be alarmist about it," said Dave Hughes, "but the biggest killer in hospitals is the MRSA bug which is immune to most drugs and arises from cross infections. Extra beds in wards in hospitals was tried in the 1990s and abandoned because it was not acceptable practice."

The nurses are the not the only ones to threaten the HSE and the Health Minister, Mary Harney, with strike action. Hospital consultants have refused to re-negotiate their contract until the issue of medical insurance is addressed.

General Practitioners have refused to sign up to the "doctor only" medical card proposals introduced in the last budget, as they are faced with the prospect of increased workload and no extra money.

The health reform programme will have to negotiate a subtantial number of hurdles before any real change materialises. p