Annual Report 2008

Irish Nurses Organisation Cumann na nAltraí Gaelacha

Head Office Whitworth Building, Morning Star Avenue, North Brunswick Street, Dublin 7 Tel: 01 664 0600 Fax: 01 661 0466 Irish Nurses Organisation Email: [email protected] Web: www.ino.ie Cumann na nAltraí Gaelacha

INO annual report cover 5MM SPINE 2008.indd 1 30/03/2009 15:46:14 Irish Nurses Organisation Annual Report 2008

INO annual report Fly 2008.indd 1 27/03/2009 15:08:54 Contents

Notice of Meeting 3 – National Report President’s Foreword 4 – European Report – International Council of Nurses Executive Council 2008-2010 6 – International Project to Examine Forecasting Models for Manpower Planning in Nursing RN4CAST Introduction 7 – Branch Officers/Section Officers/Nurse 4: Online and Information Technology 55 Representatives – Library – Organisational Developments – Online and Information Technology Update – Executive Council Election/Activities – Information Technology – Major Policy Issues – Information Office – Department of Health and Children – Health Service Executive 5: National Section Reports 61 – An Bord Altranais – Overview – National Council for the Professional Development of Nursing and Midwifery – Assistant Directors of Nursing/Midwifery/ Public Health Nursing Section – Irish Congress of Trade Unions (ICTU) – Care of the Older Person Section – International Nurses’ Day – Clinical Placement Co-ordinators Section – International Midwives’ Day – Directors of Nursing/Midwifery/Public Health – Staffing Nursing Section – Emergency Department Section 1: Industrial Relations Review 15 – Midwives Section – Industrial Relations Review – Part 1 – Nurse/Midwifery Education Section – 37.5 Hour Week Historic Achievement – Occupational Health Nurses Section – Pay Claim – Operating Department Nurses Section – Towards 2016 – Orthopaedic Nurses Section – Nurses Representative Training – Overseas Nurses Section – ICN Workforce Forum – Practice Nurses Section – 2008 – A Year of Challenge – Public Health Nurses Section – Industrial Relations Review – Part 2 – Rehabilitation Nurses Section – Complaints Procedure – Retired Nurses/Midwives Section – Violence and aggression in the Workplace – Telephone Triage Nurses Section – Managing attendance – Extension of the working day 6: Press and Media 71 – Cancer strategy – Primary care Affiliations 79 – If and when required contracts – Regional Round-Up – Industrial Relations Officers For the Record 80 – Branch Development Project – Benevolent Fund – Educational Loan Fund 2: Organisation and Social Policy 37 – Irish Nurses Rest Association – Social Policy Committee – Publications – Cervical Screening Programme – Government Departments/Other Bodies – Transcultural Nursing – Press and Media – Conferences and Forums – Honorary Officers – Migrant Nurses – INO Staff – ICTU – Fitness to Practice 7: Appendices 81 – Skillnets I Branch Officers – Currently in Office II Section Officers – Currently in Office 3: Professional Development Centre 43 III INO Secretariat – 2008 – Overview IV Organisational/Grading Chart – Workshops 2008 and Statistics V Salary Scales Applicable from 1 Sept 2008 – Nurse and Midwifery Student Recruitment Campaign VI INO Private Nurses Fees – Distance Learning Courses VII Subsistence Rates

Contents(2).indd 2 27/03/2009 15:18:48 Notice of Meeting Notice is hereby given that the 90th Annual Delegate Conference of the Irish Nurses Organisation will be held on Wednesday, Thursday and Friday, 6, 7 and 8 May 2009, in the Gleneagle Hotel, Killarney, Co. Kerry

Wednesday, 6 May: 3.30pm to 6.30pm (Private Session) 1. Registration 2. Prayer Service 3. Invocation 4. Branch Roll Call 5. Appointment of Tellers 6. Adoption of Standing Orders and Standing Orders Committee Report No. 1 7. Minutes of Annual Delegate Conference 2008 8. Adoption of Annual Report 2008, incorporating reports from the Deputy General Secretary and Directors 10. Adoption of Accounts for period 1 January 2008 to 31 December 2008 11. Adoption of Budget 1 January 2010 to 31 December 2010 (to be taken with Motion No. 1 – Organisational) 12. Appointment of Auditors 13. Debate on Motions Group 1 Organisational 14. Second Report on Branch Restructuring – Mary Power

Thursday, 7 May: 9.00am to 1.30pm 15. Roll Call 16. Adoption of Standing Orders Report No. 2 17. Debate on Motions: Professional, Industrial, Social Policy, Educational 18. Keynote address 21. Debate on Motions continued

Friday, 8 May: 9.00am to 4.30pm 22. Debate on Motions continued 23. Address by Minister for Health and Children, Mary Harney TD 24. Presidential Address by Sheila Dickson, RGN 25. Formal closure of conference.

Liam Doran General Secretary

Special events during Annual Delegate Conference 2009

• Trade Exhibition Thursday afternoon and Friday, 7 and 8 May

• Presentation of Awards - Thursday 7 May

• 90th Birthday Celebrations - Dinner - Thursday 7 May

• Address by Mary Harney TD, Minister for Health and Children at 12.00 noon on Friday, 8 May; followed by

• Presidential Address by Sheila Dickson, RGN • Gala Dinner on Friday, 8 May at 7.30 pm for 8.00 pm

Notice of Meeting(3).indd 3 27/03/2009 14:59:02 President’s Foreword

It is a great honour for me, as ensured that their rights and entitlements were President, to present to you the recognised, understood and upheld. This is what being Annual Report, for the Irish Nurses a member of a trade union is about and this is what this Organisation, for the year 2008. Organisation will always strive to do on behalf of every member we represent. I must begin by expressing my appreciation and gratitude to Internally during 2008, the Organisation continued to everyone following my election, review and examine its existing branch structures to to the highest office of President, determine what changes are necessary to reflect the at our annual delegate conference, changing needs of our growing membership. At ADC a last May, in Co Cavan. I know that presentation was made which clearly demonstrates the

Sheila Dickson I follow in the footsteps of great need to focus upon the visibility of the Organisation at Presidents and leaders of the past workplace level, and the need to constantly update, with and it is my most sincere wish relevant information and knowledge, our local activists to during my term of office, that I will ensure they are fully equipped to deal with management’s continue to work, in this great tradition, in the interests in their workplaces. of every nurse and midwife as frontline clinicians and The Executive Council, in deliberating upon this project, regulated professionals. reaffirmed that the findings of the project should be given 2008, history will remember, as the year when nurses and to a small committee. At year’s end, this committee was midwives achieved a reduction in their working week to continuing to work on an action plan with short, medium 37.5 hours. While we all know that the journey to achieve and long term perspectives, with a view to mapping out this goal, which is only a step on our strategic objective how the Organisation needs to change in the years ahead of a 35-hour week, was long, arduous and challenging, to ensure that we have the highest possible relevance we must remember that we are the first individual and visibility to every nurse and midwife member. occupation, within the public service, to achieve such a Since my election I have had the pleasure of making many reduction in over 40 years. visits to members in their hospitals and community care While the journey towards a 35-hour week continues, centres all over the country. I wish to acknowledge, with and we will not rest until we achieve it, we must, at the deep appreciation, the kindness and hospitality shown to same time, recognise the achievement the one and a half me during my visits. I also want to record my admiration hour reduction is and how it reflects upon the energy for the excellence of the work that is done by nurses and and determination of every member within this fine midwives every day and night. Organisation. In these visits I found myself frequently having discussions The past year, as we expected, continued to be very with members about the critical issue of ensuring safe challenging with regard to protecting our members’ practice in environments when staffing levels have been interests and, as patient advocates, protecting standards reduced, patient acuity has increased and there is a of care. The HSE, regardless of being found in breach manifest indifference, by management, to the challenges of EU Directives and Towards 2016 early in the year, these changes bring. In response I tried, in my own way, continued to act unilaterally and to make decisions and to constantly reaffirm to every member the absolute need impose change, without the necessary consultation and to prioritise, from their own professional perspective, agreement with staff. the paramount need of performing competently, in a safe environment which maximises the likelihood of The only response to this dictatorial approach is for delivering safe and appropriate care. nurses and midwives, through this Organisation, to unite, strong and resolute, using every means at our I reminded every member that they cannot leave this disposal, to protect levels of patient care and terms decision to somebody else but they must exercise their and conditions of employment. At the end of the year own judgement, competence, knowledge and skill and to this struggle continues but I reaffirm this Organisation’s do so without fear or favour knowing that they will have commitment to stand side by side with every member in the full support of the Irish Nurses Organisation. every workplace, to defend their interests, their standards As we ended 2008 I felt that this was a critical issue of practice and the standards of care available to our affecting our members, that we must focus on and bring patients and clients. greater attention to in 2009 and I commit to do that, once Notwithstanding all of these challenges at national, again in the interest of safe practice equals safe care. regional and local level, the Organisation, in 2008, once Also during 2008 we had significant engagement with again demonstrated our ability, through procedures, to the Department of Health and Children on the draft succeed in defending the interests of individuals and Nurses and Midwives Bill. Earlier in the year we made small groups of members who found themselves in a very significant submission, to the Department of difficulties. Health and Children, on the Draft Heads, pointing out the I want to congratulate the determination and fortitude, inadequacies, as we see them, of their draft legislation of individual members, who, through the Organisation and the need for it to be significantly improved in such

Presidentsforeword(4).indd 4 27/03/2009 15:36:30 critical areas as membership of the board, fitness to of their colleagues and the entire Organisation. These practice and assisting with competency, on a continuous voluntary officers are the central core and foundation basis, of every nurse and midwife. At the end of the year block of this Organisation and we should all be grateful to we were still awaiting a further draft of the proposed their commitment, eternally in debt to their convictions legislation and I think this will be a pivotal issue for the and supportive of all of their actions as they strive to Organisation in 2009. represent their colleagues up and down the country. I would now like to take this opportunity to formally thank Finally, may I extend my sympathies to the families and every activist and representative on the ground for their friends of members of the Organisation who died during support, dedication and solidarity to their colleagues, the past year. I would also like to extend my sympathies their profession and the people in your care. Despite ever to any member of staff, and their families, who may have increasing difficulties, and ever decreasing resources, suffered bereavement during 2008. the nursing and midwifery profession has continued to I will close by again saying thank you for electing me represent all that is good about frontline health clinicians President and thank you for your kindness and hospitality and for this I say thank you. to me since I began my term of office. In return I will I would particularly like to thank Mary Forde, our First simply reiterate my total, unswerving and absolute Vice-President, and Teresa Hayes, our Second Vice- support for the Irish Nurses Organisation, every member President, and the entire Executive Council, for their in this Organisation and my unswerving commitment to tireless work, on your behalf over the past 12 months. the objectives of this Organisation. In difficult circumstances, and facing difficult decisions, In 2009, as the country’s economic difficulties mount, we they have never shirked from showing leadership, team will need, more than ever, to be united and supportive of work, patience and determination. Furthermore, I would each other and through this unity of purpose, within the like to commend all of the Industrial Relations Officers, Irish Nurses Organisation, I have no doubt that we will and every member of staff in the Organisation, for their protect our members, protect our patients and, in doing commitment, hard work and tireless dedication during so, do a great service for every citizen of this country. 2008. I commend this Annual Report to you, reflecting as In this context I also wish to thank Liam Doran, Dave it does a very challenging year for the Irish Nurses Hughes, Annette Kennedy, Clare Treacy and Phil Ní Organisation. Sheaghdha, for continuing to lead the Organisation in extraordinarily challenging times, with complete dedication, absolute commitment and tireless conviction. It is a simple reality that we have the best set of officials and support staff of any trade union in this country and while we continue to face challenges and difficult times we do so with confidence supported by this strong team. In addition I wish to thank every branch and section officer Sheila Dickson for their continued involvement and hard work on behalf President

Presidentsforeword(4).indd 5 27/03/2009 15:37:07 Executive Council 2008/2010

The Executive Council of the INO: (back l-r): Mary Connor; Jennifer Bollard; Eileen Mullane; Eileen Healy; Allison O’Connell; Claire Mahon; Lloyd McGree; Patrick Gallagher; Mary Barrett; Colette O’Sullivan; Collette Lynskey; Breege Scanlon; Catherine Doyle; Mary Cotter; Anne McGowan; and (front l-r): Annette Kennedy, director of professional development; Clare Treacy, director of organisation and social policy; Helen Buckley; Liam Doran, general secretary; Sheila Dickson, president; Mary Forde, first vice president; Dorothy Mullarkey, administration manager; and Phil Ní Sheaghdha, director of industrial relations

Office Bearers President: Sheila Dickson Senior Staff Nurse, St Columbanus Home, Killarney First Vice-President: Mary Forde CNMII, Cork University Hospital Second Vice-President: Teresa Hayes CNMII, Adelaide & Meath Hospital, Tallaght Clinical (16 seats plus 1 ex-officio seat) Mary Barrett Staff Nurse St Brendan’s Home, Loughrea, Co Galway Catherine Doyle CNMII St Vincent’s Centre, Lisnagry, Co Limerick Patrick Gallagher Staff Nurse Beaumont Hospital, Dublin 9 Eileen Healy Staff Nurse Aras Deirbhle, Belmullet, Co Mayo Collette Lynskey Staff Nurse University College Hospital, Galway Anne McGowan CNS Sligo General Hospital, Sligo Eileen Mullane Staff Nurse St Ita’s Hospital, Newcastle West, Co Limerick Allison O’Connell Staff Nurse Midland Regional Hospital, Portlaoise Colette O’Sullivan PHN Health Centre, Clonakilty, Co Cork Maureen Parke Staff Nurse St John’s Hospital, Sligo Breege Scanlon CNMI St John’s Hospital, Sligo Madeline Spiers (ex-officio) Senior Staff Nurse St Columcille’s Hospital, Loughlinstown, Co Dublin Judith Tabuena Staff Nurse St Vincent’s Centre, Lisnagry, Co Limerick Jo Tully Staff Nurse St James’s Hospital, Dublin 8 Administration (3 seats) Jennifer Bollard Director Public Health Nursing HSE Tivoli Road, Dun Laoghaire, Co Dublin Helen Buckley Assistant Director of Nursing Naas General Hospital, Naas, Co Kildare Claire Mahon CNMIII Waterford Regional Hospital Education (2 seats) Mary Connor Nurse Tutor Centre for Nurse Education, Galway Mary Cotter Acting Principal Tutor/ Adelaide & Meath Hospital, Tallaght Specialist Co-Ordinator Student (1 reserved seat) Lloyd McGree Student Nurse DCU Glasnevin

ExecutiveCouncil(6).indd 6 27/03/2009 15:41:40 Introduction

As General Secretary it is my midwives, as being in their best interests and in support privilege to invite you to read this, of them as professionals and employees. the 89th Annual Report, for the Irish This growth in membership has continued to bring Nurses Organisation, covering the with it the positive challenge of meeting the legitimate calendar year 2008. In the pages demands and expectations, of this large membership. that follow we seek to summarise The Organisation is now confirmed as the fourth largest the work, activities, initiatives trade union in the Republic of Ireland. During 2008 the and successes experienced by Organisation continued to develop our organisational the Organisation, during 2008, on and staffing structures to ensure that the services offered behalf of our 40,000 plus nurse met the ever increasing demands of our members in all and midwife members. Liam Doran, areas and disciplines of nursing and midwifery. 2008 was a year when the INO, General Secretary, INO I now invite you to read, study and reflect on the contents once again, continued to face great of this Annual Report which records, for posterity, the huge challenges, at national, regional level of activity of this great Organisation during 2008. and local level, particularly around the nationwide implementation of the 37.5-hour working week for all nurses and midwives. Branch Officers/Section Officers/ This historic achievement was made all the more difficult by the sudden downturn in the country’s economy which Nurse Representatives/Hospital resulted in the government, through the Health Service Committee Representatives Executive (HSE) and other health employers, attempting I must begin this report by immediately acknowledging, to impose cutbacks and renege on agreements while and praising the continued dedication, loyalty and work seeking to impose ever increasing intolerable workloads of our branch and section officers and our nurse/midwife upon frontline nursing and midwifery staff. and hospital committee representatives in workplaces Notwithstanding this, 2008 will, from an historical the length and breadth of the country. perspective, always be recorded as the year when nurses Recent national campaigns have had the effect, and midwives as a collective group achieved the first while being extremely challenging, of solidifying the reduction in the working week, by a single grade, group Organisation’s strength and presence in every workplace. or occupation, in over 40 years. This was a tremendous This is because of the diligence and effort of our local achievement and while the details are recorded elsewhere elected activists and representatives. I therefore wish to in this report this campaign success deserves to be noted acknowledge this tremendous work, which is a priceless at this early stage in this report. asset of our Organisation, and, on behalf of the President, Building upon the campaigning of recent years, and Executive Council and staff, to simply, and deeply, say a the tremendous spirit and integrity of our members, heartfelt thank you. local activists and staff, the Organisation faced these All great organisations must look forward and, in challenges with strength and commitment. that context, we look to 2009, and beyond, safe in the The record will show that while achieving the reduction knowledge that the INO is built on a solid foundation in the working week the Organisation was also actively of dedicated local activists and we can therefore look involved in numerous local issues, referrals to third forward, with confidence, to the challenges that the parties and other national initiatives all designed to coming years will bring. reflect the expertise, knowledge and skill of every nurse and midwife the Organisation represents. Organisational Developments This Annual Report will, therefore, act as a key historical record of the Organisation’s activities and, in doing so, it will record the tremendous work, commitment, 89th Annual Delegate Conference professionalism and expertise of our members, activists The Organisation’s 89th annual delegate conference and staff. took place in the Slieve Russell Hotel, Ballyconnell, Co Cavan, on 7, 8 and 9 May 2008. The conference, which Membership Growth Continues was attended by over 350 delegates, and on occasion, over 100 observers, again covered a range of motions, Once again, for the 10th year in a row, the Organisation debates and discussions on subject matter submitted by recorded a further growth in our membership base with, the Organisation’s 41 branches and 24 sections. at year end, almost 41,000 nurses and midwives in membership. Election of Officers This total membership represents, yet again, a new President: Sheila Dickson, staff nurse, St Columbanus historical high for the Organisation and is evidence that Hospital, Killarney, was elected by delegates as the the work of the INO at local, regional and national level, is incoming President for the two-year period 2008 to seen and understood, by the vast majority of nurses and 2010. In her address to conference, after her election,

Liamintro(7).indd 7 27/03/2009 16:29:12 Ms Dickson thanked all present and, in particular, reaffirmed her commitment to the Organisation’s core goals and activities and to work tirelessly on behalf of all nurses and midwives in the Organisation. First Vice-President: Ms Mary Forde, CNMII, A&E Department, Cork University Hospital, was elected to the post of First Vice-President for the period May 2008 to May 2010. Second Vice-President: Ms Teresa Hayes, CNMII, Adelaide and Meath Hospital, Tallaght, was affirmed in the post, as Second Vice-President for the period May 2008 to May 2010.

Other Conference Events Pictured above are Madeline Spiers (l) handing over the presidential chain of The conference also involved a packed three day agenda, office to the newly elected Sheila Dickson which covered a range of issues with the highlights including: the United Nurses of Alberta and the health service • Debate on over 70 motions on a range of issues from management, in Alberta, which governed and stipulated industrial, professional, educational and social matters the rights and entitlements, under many headings, for affecting members at this time nurses employed in that province. Ms Smith closed her address by inviting Irish nurses, to come to Alberta, • A keynote address from Rebecca O’Malley in which where there was great employment prospects. she called for nurses and midwives to reaffirm their advocacy, for patients, and, in particular, to have the strength and courage to act as whistleblowers in Address by Minister for Health and Children situations where services and standards drop below that Mary Harney TD, Minister for Health and Children, which is acceptable. Ms O’Malley received a standing addressed the conference, on Friday, 9 May 2008, on ovation from the delegates and outgoing President, behalf of the government. In her speech the Minister Madeline Spiers, praised the courage and strength, of covered a range of issues including: Ms O’Malley, in her own battle against serious illness. • The need to expedite progress on the introduction of the 37.5-hour week for nurses and midwives by the stated Emergency Motions date of 1 June There were three emergency motions, passed during this • The need to develop centres of excellence for cancer annual conference, covering the following issues: and other services • That conference supports the PNA/SIPTU dispute, which • A commitment to bring forward new legislation with was ongoing at that time, seeking a proper compensation regard to the Nurses and Midwives Act for nursing members who were injured in the course of their work • The need to further expand the practice of nursing and midwifery building on the progress made with regard • That conference sends its support and fraternal to drug prescribing, IV cannulation, order X-ray and best wishes to our sister union the Danish Nurses other roles. Organisation who were engaged in a national dispute, during the days of our annual conference Presidential Address – Madeline Spiers • A motion condemning the failure of HSE management to facilitate student nurses clinical placement and Madeline Spiers, in her fourth and final address to the provision of substantive posts following their conference, as the Organisation’s President, replied to qualification. the speech, from the Minister for Health and Children. Ms Spiers, in particular, focused upon the following: Fraternal Speaker • The unswerving commitment of the Organisation to realise the 37.5-hour working week for all nurses and Heather Smith, President of the United Nurses of midwives Alberta, Canada, also addressed conference outlining the challenges which her union is facing, at this time. Ms • The total commitment of the Organisation to the Smith’s address confirmed many common issues, facing Commission on the Introduction of a 35-Hour Week for both organisations, and, at the same time, suggested Nurses and Midwives ideas and strategies which might be used to the benefits • The need to breakdown the two tiered system, within of INO members. the Irish healthcare system, and, in particular, the need In particular Ms Smith gave the conference a detailed to reject the idea of co-located hospitals on the grounds briefing on a comprehensive agreement, reached between of public hospitals

Liamintro(7).indd 8 27/03/2009 16:29:28 Pictured at the presentation of the Gobnait O’Connell Award were (l-r): Liam Pictured at the presentation of the 2008 INO Research Award were (l-r): Nancy Doran, INO General Secretary; winner of the Award, Josie Ryan from the Dublin Layton-Cook, CJ Coleman; Ann Walsh, PHN Carlow – winner of the Award; Liam Northern Area Branch; and Madeline Spiers, outgoing INO President Doran, INO General Secretary; and Madeline Spiers, outgoing INO President

• The unswerving commitment of the Organisation to 10th anniversary of Liam Doran, as General Secretary of expanding the autonomous role of every nurse and the Organisation, and 25 years as a member of staff of the midwife, in the public health system, but for this to be Organisation.The DVD was very enjoyable and was viewed recognised in terms of pay and conditions as an excellent close to a vibrant annual conference. • The need to recognise the tireless work of local activists of the Organisation over the previous 12 months. Executive Council Election/ The President’s address was met by unanimous standing Activities ovation, of all members, delegates and observers present, and was generally regarded as being the finest speech to The Executive Council of the Organisation, in compliance annual conference in many years. with rule, held 11 ordinary meetings during 2008. Outgoing Executive Council Gobnait O’Connell Award for Outstanding Service The outgoing Executive Council, which governed the This award, which is presented annually to mark the Organisation for the period 2006 to 2008, met, for the final special efforts of a member, consistent with the traditions time, on 7 May 2008, to finalise the proceedings for the of Gobnait O’Connell, was awarded to Josie Ryan from imminent annual delegate conference. On behalf of the the Dublin Northern Area Branch. Josie is a long-standing staff of the Organisation, I would like to express my deep dedicated member of the Organisation who has tirelessly appreciation for all of the work and effort of the outgoing recruited new members and encourages members to Executive Council whose term of office expired at the become more involved in the Organisation’s activities. close of the annual delegate conference in May 2008.

INO CJ Coleman Research Award Incoming Executive Council The INO/CJ Coleman Research Award was presented to Following the nationwide ballot, as provided for in rule, Ann Walsh, public health nurse, Carlow. Ann won the the following members were elected to the incoming award for her paper on The Role of the Child Welfare Executive Council and will serve office for the period May Clinic – Perceptions and Expectations of Service Users 2008 to May 2010. and Service Providers. The award was presented jointly by Madeline Spiers, INO President, and Nancy Layton- Clinical Category: Cook of CJ Coleman & Company Limited, London. • Mary Barrett, Staff Nurse, St Brendan’s Home, Loughrea, Co Galway. Retirement of Dorothy Mullarkey • Sheila Dickson, Staff Nurse, St Columbanus Home, After 30 years of service, Dorothy Mullarkey, the INO’s Killarney, Co Kerry administration manager, advised that she would be retiring in September 2008. The President, Executive • Catherine Doyle, CNMII (CNS), Daughters of Charity, Council, delegates and staff made a surprise presentation St Vincent’s Centre, Lisnagry, Co Limerick. to Dorothy on the night of the annual dinner. • Mary Forde, CNMII, Cork University Hospital • Patrick Gallagher, Staff Nurse, Beaumont Hospital, Liam Doran – 10 Years as General Secretary Dublin 9 At the close of the business session of conference the • Teresa Hayes, CNMII, Adelaide & Meath Hospital, delegates were treated to a special video marking the Tallaght, Dublin 24

Liamintro(7).indd 9 27/03/2009 16:29:44 • Eileen Healy, Staff Nurse, Aras Deirbhle, Belmullet, Co • The Organisation’s response to imposed cutbacks, in Mayo staffing and services, by the HSE • Collette Lynskey, Staff Nurse, University College • A&E overcrowding Hospital, Galway • Changes to major policies proposed by the HSE including • Anne McGowan, CNS, Sligo General Hospital attendance at work, cancer strategy and extension of • Eileen Mullane, Staff Nurse, St Ita’s Hospital, the working day Newcastlewest, Co Limerick • Issues forwarded to it from the 2007 annual delegate • Allison O’Connell, Staff Nurse, Midland Regional conference. Hospital, Portlaoise, Co Laois Nursing and Midwifery Education and Practice • Colette O’Sullivan, PHN, Health Centre, Clonakilty, Co Committee Cork This committee, which is chaired by the Second Vice- • Maureen Parke, Staff Nurse, St John’s Hospital, Sligo President, is serviced by Annette Kennedy, Director of • Breege Scanlon, Staff Nurse, St John’s Hospital, Sligo Professional Development, met on 10 occasions during • Madeline Spiers (ex-officio), Staff Nurse, St Columcille’s the year. Hospital, Loughlinstown, Co Dublin The primary focus of the committee, during 2008, • Jo Tully, Staff Nurse, St James’s Hospital, Dublin 8 involved: • The work of the Commission on the Introduction of a Administration Category: 35-Hour Week for Nurses and Midwives • Jennifer Bollard, Director of Public Health Nursing, HSE • The introduction of drug prescribing, for nurses and Tivoli Road, Dun Laoghaire, Co Dublin midwives, and the implications of same • Helen Buckley, Assistant Director of Nursing, Naas • The role of the healthcare assistant; General Hospital, Co Kildare • The preparation for the proposed nurses and midwives • Claire Mahon, CNMIII, Waterford Regional Hospital legislation • Motions referred to the committee from annual Education Category: conference. • Mary Connor, Nurse Tutor, Centre for Nurse Education, Galway Social Policy Committee • Mary Cotter, Acting PrincipalTutor/Specialist Co-Ordinator, This committee which is chaired by Jo Tully, Executive Adelaide and Meath Hospital, Tallaght, Dublin 24 Council member, met on 11 occasions during 2008 and is serviced by Clare Treacy, Director of Organisation and Student Reserved Seat: Social Policy. • Lloyd McGree, Student Nurse, DCU Glasnevin. The core work of this committee is covered extensively, elsewhere in this report, but it is primarily focused on wider social and socio-economic issues, outside of the Finance and General Purposes Committee direct world of nursing and midwifery, about which the Organisation feels it should have policies and positions. This committee, which is required under rule, was chaired by the Presidents, Madeline Spiers (January to April 2008) and Sheila Dickson (June to December 2008) Other Major Policy Issues and met on 11 occasions during the year under review. In addition to the work of the committees, and the Its primary function is to monitor all financial, logistical management of the introduction of the 37.5-hour week and staffing issues, affecting the Organisation and, and constantly reviewing the work of the Commission on where appropriate, to make recommendations to the full the 35-Hour Week, the Executive Council, reflecting upon Executive Council on these matters. the decisions of annual conference and developments nationally, was also very actively involved in the Industrial Committee following: The Industrial Committee, which is chaired by the First Vice-President, and serviced by Phil Ní Sheaghdha, Outstanding Pay Issues Director of Industrial Relations, met on 11 occasions, Arising from the failure of the second Benchmarking body for ordinary meetings, and on four other occasions for report, to address the outstanding pay issues, affecting special meetings during 2008. In the year under review the Staff Nurse, CN/MMI, CN/MMII and PHN grades, the the committee was particularly concerned with: Executive Council continued to monitor the progress of • The implementation of the 37.5-hour week for nurses these claims following their referral to the Labour Court. and midwives Full details are covered in the IR section of this report.

Liamintro(7).indd 10 27/03/2009 16:29:59 Health Service Cutbacks The A&E Forum continued to meet, on an ongoing basis, but the outcome of discussions/deliberations was Although covered extensively elsewhere in this Annual very disappointing with the HSE continuing to withhold Report it should also be noted that the Executive Council critical information while rejecting the INO’s trolley watch spent considerable periods, during 2008, examining the figures. implications of the health service cutbacks and agreeing appropriate responses, sometimes in conjunction with other health service unions, to protect staff and patients Department of Health and from the negative effects of the cuts in services. Children In particular the Executive Council was concerned at During 2008 the Organisation continued to have regular, the apparent ability of the HSE to reduce its levels and ongoing, contact with many officials, and divisions, of expenditure, through non-replacement of staff, of the Department of Health and Children. In particular curtailment of services and other initiatives, without the Organisation held discussions, with the Department, there being any requirement, on the HSE, to demonstrate on the following: the implications, for patients/clients and staff, of these imposed changes. Commission on the Introduction of a 35 Hour Working At the end of the year work was continuing, at national Week level and in conjunction with other unions, in agreeing a draft health accord which would require the HSE, and any The Organisation had a number of discussions, with other health employer, to demonstrate: the Department, with regard to the establishment of the Commission on the Introduction of a 35 Hour Week • The impact of any imposed cutback upon health services for Nurses and Midwives, and, in particular, the chair • The amount to be saved of the Commission and the administrative support to be supplied. The Commission finally commenced, in • The impact upon the income of nurses/midwives and the spring of 2008, and, at year’s end, was continuing other staff its detailed consideration of all issues leading to the introduction of a 35 hour working week. • What annualised saving will accrue from the proposed change. Nurses and Midwives Legislation Health Service Reform In the first quarter of 2008 the INO submitted a detailed commentary, on the Draft Heads of the Nurses and The Executive Council also continued to maintain a Midwives Bill published in November 2007 and, in March, watching brief on the second phase of health service met with the Department on this issue. The Organisation’s reform announced, during 2008, by the Health Service commentary, on the proposed Bill, can be found on the Executive. In particular the Executive Council focused INO website (www.ino.ie) and, at the end of the year, upon the implications, for the professions of nursing we were awaiting a further draft, from the Department, and midwifery, arising from the reform with particular on this critical legislation. In our initial commentary, on reference to: the first Draft Heads, the Organisation pointed out the • The implications for senior nurse/midwife management following shortcomings: • The effects of any changes upon established nursing • The proposed size of the new An Bord Altranais structures, ie. the Nursing Services Directors office • The format proposed for the fitness to practice process within the HSE • The need to ensure employers assist, individual nurses • The need to strengthen the nursing and midwifery and midwives, in maintaining their competency for voice, at corporate level, in any further reform initiative ongoing registration. put forward by the HSE. Nurse/Midwife Prescribing A&E Overcrowding The Organisation continued to liaise, with the Department For the seventh year in a row the Executive Council of of Health and Children, on the nationwide rollout on the the Organisation spent considerable periods examining, initiative with regard to nurse/midwife prescribing. and monitoring, the continuing crisis arising from overcrowding in A&E departments in many hospitals all During these discussions much progress was made and over the country. the Organisation continues to acknowledge the leadership, on this issue, given by Mary Harney TD, Minister for At the year’s end the INO’s trolley watch figures confirm Health and Children over the past two years. that the level of overcrowding, and the number of hospitals experience overcrowding, was continuing Nursing Policy Division to increase, due to the health service cutbacks, after a period when some positive progress had been made on The Organisation would particularly like to record its this blight on the Irish public health service. appreciation to all of the staff in the Nursing Policy

Liamintro(7).indd 11 27/03/2009 16:30:13 Division of the Department of Health and Children. The • Work in relation to nurses involvement in discharge policy division, which is now led by Sheila O’Malley as planning Chief Nursing Officer, continues to carry out a range of • Work in relation to the expansion of the role of the staff studies and work associated with the further development nurse/midwife by agreement at ward/service level of nursing and midwifery and for this we are grateful. • The review of specialist nurse/midwife education Health Service Executive programmes including public health nursing. The Organisation would like to acknowledge the work It must be recorded, in this annual report, as it was in of the Nursing Services Office and the commitment of 2007, that relationships continue to be strained between the office to the development of the nursing/midwifery the Health Service Executive (HSE) and this Organisation. professions. While there were many meetings, between the HSE and the INO, in the year under review, it has to be noted that much of these discussions took place in a negative An Bord Altranais context particularly with regard to such issues as: In 2008 the INO had ongoing contact, with An Bord • The continued actions of the HSE in imposing Altranais, on a range of issues affecting the regulation cutbacks, staffing restrictions and employment control and education of nurses and midwives in all disciplines. arrangements without any prior discussion with health service unions In particular, during 2008, the Organisation had a number of discussions, with An Bord, on the following: • The continuing policy position, of the HSE, that health unions were obstacles to change and should be ignored • The perennial issue of fitness to practice proceedings or avoided if at all possible and, in particular, the costs arising from same • The continued failure of the HSE to accept partnership • Issues arising from the commencement of the new as a way to address issues in the workplace curriculum, and eligibility requirements, for entry to the student PHN programme • The failure of the HSE, at corporate level, to involve the health unions in discussions about HSE reform and • The proposal, by An Bord, to increase its registration reconfiguration fees, by up to 20%, in order to meet increasing costs particularly those arising from fitness to practice • The failure of senior corporate HSE management to proceedings. actively, and continuously, engage on critical policy issues with health service unions at national level • The constant need to ensure nursing/midwifery National Council for the involvement in corporate decision making. Professional Development of At the end of 2008 many of these difficulties continued Nursing and Midwifery against a background of a changed, and very challenging, economic environment. The Organisation, in 2008, continued to have a number of contacts with the National Council to discuss matters New Director of Human Resources of mutual concern and interest. In particular matters discussed included: On a more positive note the HSE did appoint, during 2008, a new Director of Human Resources, Sean McGrath. • The publication, by Dr Siobhan O’Shea, Chief Executive In his early period in office Mr McGrath repeatedly of the National Council, of her studies Nursing and reaffirmed his commitment to active, constructive and Midwifery in Ireland – A Strategy for Professional ongoing engagement, with the INO and other health Development in a Changing Health Service service unions, and the Organisation looks forward to • Ongoing publications regarding the further integration this change in perspective being demonstrated by the of specialist and practitioner posts in various areas of actions of Mr McGrath’s senior management colleagues. the health system • Issues arising from nurse/midwife prescribing. Office of the Nursing Services Director At the end of the year the INO continued to note, with The Organisation, during 2008, continued to have some concern, the need for further clarity with regard to ongoing, direct and progressive contact with Dr Siobhan the future of the National Council, arising from both the O’Halloran the Director of Nursing Services, in the HSE, draft nurse/midwife legislation and, more specifically, and her entire office. During 2008 a range of issues were the stated intention, of government, to amalgamate a discussed including: number of public bodies including the National Council. • Further expansion of the nurse/midwife prescribing This issue had not been clarified, at the end of 2008, and • Positive work on nurses involvement in ordering it was expected that there would be further discussions, ionising radiation on this very important and critical issue, during 2009.

Liamintro(7).indd 12 27/03/2009 16:30:27 Irish Congress of Trade Unions Children, the HSE and the health unions for the purpose of addressing the many changes and challenges arising During 2008 the Organisation’s General Secretary, Liam for the public health service at this time. Doran, and Director of Organisation and Social Policy, Clare Treacy, continued to sit on the ICTU Executive Council. Members Decision

Social Partnership Talks Following a nationwide ballot members of the INO, voted by a majority of 94%, to accept the above terms. Following After an initial breakdown, in July, the social partners this decision the INO’s delegation, to the ICTU special finally agreed the second module, to the current national delegate conference held on 17 November 2008, voted social partnership agreement Towards 2016, in September to accept the agreement and, overall, the agreement was 2008. The details of this agreement include the following: accepted by a large majority. At the end of the year the terms of this agreement were under increasing scrutiny Public Service Pay (Cost of Living) in view of the downturn in the economy and the marked deterioration in the public finances. The agreement involved an increase of 6% over 21 months payable as follows: National Implementation Body – 37.5-Hour Week • An initial pay pause for 11 months The Organisation, in particular, wishes to express, in the • 3.5% increase – 1 September 2009 (first phase) pages of this report, its appreciation to the Irish Congress • 2.5% increase – 1 June 2010 (second phase). of Trade Unions, and in particular its General Secretary, Dave Begg, and the Chairman of the Public Services The pay agreement will expire on 30 June 2010. Committee, Peter McLoone, for their invaluable assistance with regard to the work of the National Implementation Outstanding Increases from Benchmarking Report Body (NIB) in introducing the 37.5-hour working week For directors of nursing/midwifery (and related grades), with effect from 1 June 2008. assistant directors of nursing/midwifery (and related The NIB was extensively involved in the process, which is grades) and clinical nurse manager three grades: detailed elsewhere, but the work and support of Mr Begg • 5% of the awards given by the second benchmarking and Mr McLoone is recognised and appreciated. report will be payable from 1 September 2008. The full increases, from benchmarking, due to these grades are: – Directors/assistant directors (and related grades) – 10% International Nurses Day – CNMIII grade – 6.8%. The INO, as an affiliate of the International Council of • The payment of the balance of these awards, after the Nurses (ICN), participated in the International Nurses Day 5% referred to above is paid, will be the subject of further which had as it’s theme Nurses Leading Primary Health discussions in 2010. Care – Delivery Quality, Serving Communities. This arises from the government’s decision to defer all The International Council of Nurses (ICN) believes increases arising from the review of salaries of higher that equity and access to primary health care services, grades until that time. particularly nursing services, are key to improving the health and wellbeing of all people. Other Aspects of the Proposed Agreement Together with its member associations, ICN advocates for The proposed agreement also provided for a joint review the rights of all people to equitable and effective health of the benchmarking process which, while acknowledging care services, and endorses the Alma Ata Declaration 1 that the principal of benchmarking remains appropriate, on primary health care (PHC) as a means for attaining a would consider: level of health that will permit people to lead a socially • The manner in which benchmarking is operated and economically productive life.

• The terms of reference for future reviews Nationally and internationally, ICN and its members • The methodology to be used collaborate with governments and nongovernmental organisations to ensure more effective implementation • The basis for comparisons between remuneration in the of primary health care. In planning and implementing public and private sector PHC services, ICN urges a multisectoral approach and • Other concerns expressed by the Public Services adherence to the following principles: Committee of the ICTU in relation to benchmarking. • Health services are made equally accessible to all, encouraging to the maximum: individual and community Health Forum participation in services planning and operation; a focus The agreement also provided for the formally established on illness prevention and health promotion; appropriate, Health Forum, which is a joint body comprised of the affordable technologies; and a multisectoral approach Departments of An Taoiseach, Finance, and Health and necessary for wellbeing in a society.

Liamintro(7).indd 13 27/03/2009 16:30:50 • The focus of health care is the individual, family positive birth experience, through breastfeeding support or group in need of services, whether for health and nutritional education, through assistance with family promotion, protection from illness and disability, cure planning and spacing, and through encouragement of and rehabilitation, or care for peaceful, dignified death. women’s knowledge of their own bodies. • Health provider education is both scientific and ethical and The International Day of the Midwife offers the recognises the primacy of social determinants of health. opportunity each year to celebrate midwives’ work and the profession of midwifery: this year the special focus is • Healthcare providers respect the rights of the individual, on the family and its future generations – Midwives help family and community to make an informed decision to build healthy families – in the midwives’ hands is the about care and related treatment. key to the future. • Research findings and evaluation of technologies are of direct benefit to patients and the public. Staffing • In support of Primary Health Care ICN views it critical that PHC concepts be integrated into all levels of nursing The following staffing changes took place during the year education and that the nurse’s role in PHC leadership be under review: strengthened and articulated at all levels nationally and • Phil Ní Sheaghdha was appointed Director of Industrial internationally. Relations. The President of ICN, Hiroko Minami, said that: “Today • Petrina Donnelly and Fionuala McCusker were with nurses leading Primary Health Care we can ensure appointed as Researchers to the Commission on the 35- that every individual and community have access to Hour Week. essential healthcare based on practical, scientifically • Albert Murphy was appointed Industrial Relations Officer sound and socially acceptable methods and technology. for the HSE-Eastern Region, Dublin City Hospitals. Nursing practice is the very essence of primary health care. Nurses deliver services wherever people are found • Derek Reilly was appointed Industrial Relations Officer and, in virtually all countries, constitute the largest health for the Midland Region. care provider group”. • Noreen Muldoon, IRO, HSE-Western Region commenced The International Nurses Day toolkit was distributed to all a three-day week. ICN member associations and to nursing representatives • Regina Durcan was appointed IRO (part-time) for the worldwide. A copy of the toolkit can be downloaded from HSE-Western Region. www.icn.ch. • Mary Cradden was appointed PA to the Director of Industrial Relations. International Midwives Day • Cathriona Lacey was appointed PA/Research Assistant The INO, as part of its affiliations to the International to the Director of Professional Development. Confederation of Midwives (ICM) acknowledged • Niamh Adams was appointed Locum Section International Midwives Day which took place on 5 May Development Officer for the duration of Jean Carroll’s 2008. The theme for this year was Healthy Families: The maternity leave. Key to the Future. The aim of the day is to celebrate midwifery and to bring awareness of the importance of • Tina Sweeney was appointed as Admin Support to midwives’ work to as many people as possible. Head Office. The Alma-Ata Declaration 3 says: “Primary hea lth care is • Oona Sugrue was appointed as Secretary to the essential health care … made accessible to individuals and Executive Council/ADC Co-Ordinator. families in the community through their full participation • Margaret O’Donoghue was appointed Admin Support …. It is the first level of contact of individuals, the family for the Galway Office. and community with the national health system bringing • Lisa Curran was appointed, on a part-time basis, as health care as close as possible to where people live additional Admin Support for the Galway Office. and work. … [It] includes at least: education concerning prevailing health problems; proper nutrition; a supply • Claire Morahan was appointed as Accounts Assistant of safe water; maternal and child health care, including for the duration of Kylie Matterson’s six month career family planning; … [and it] relies, at local and referral break. levels, on health workers, including physicians, nurses, • Dorothy Mullarkey retired from the Organisation after midwives, auxiliaries and community workers’. almost 30 years of service. Midwives’ commitment to families, within a functioning • Kathy Foy-Newman retired from the Organisation. health system and supportive environment, is a core • David Miskell resigned as Information Officer to take up element of primary healthcare. Midwifery care is a post with Mandate Trade Union. unique in the way it can influence the health of future generations through giving new parents the physical • Maria Moynihan resigned as PA to the Director of well-being, confidence and self-esteem that arise from a Professional Development.

Liamintro(7).indd 14 27/03/2009 16:31:05 Industrial Relations Review Section 1

1. Industrialrelationssection.indd 1 30/03/2009 09:41:45 1. Industrialrelationssection.indd 2 30/03/2009 09:42:19 Industrial Relations Review – Part 1

2008 saw the end of almost two social partnership agreement Towards 2016 by failing to decades of sustained economic consult with a view to reaching agreement prior to the growth for the Irish economy implementation of the staffing restrictions. The Labour plummeting in the midst of a Court heard the case on 28 January. global economic downturn and On 15 February the Court issued its findings which the decimation of stock markets determined that the HSE had breached the terms of and international banking in the Towards 2016 and had contravened the minimum legal developed world. requirements of the Irish State and European Union with Amidst all of this, history will record regard to consultation with its staff. The HSE was the first the year as a milestone in the Irish employer to be found guilty of transgressing the

Dave Hughes, progress of nurses and midwives employee (Provision of Information and Consultation) Deputy General in Ireland achieving recognition as Act 2006 and European Directive 2002/14/EC which has Secretary, INO professions through the reduction direct effect on emanations of the state such as the in the working week to 37.5 hours. HSE.

Internationally, the crash of the major international The submission made on behalf of the health service American banks Freddie Mac and Fannie May along with trade unions was prepared by INO and although the Lehman Brothers and the rescue of AIG, the world’s largest Court did not impose any particular punishment for the insurance underwriter, signalled a major crisis for world breach of legislation, further or subsequent breaches governments as the foundations upon which much of the could lead to substantial fines and the law even provides growth had been built crumbled from the domino effect of for imprisonment in certain circumstances. reckless lending policies and ravishing stock market greed. In spite of the findings of the Labour Court the HSE’s A greed that exposed the weakness of neo-liberal political requirement and commitment to living within its budget philosophies, which allowed the dismantling of systems saw cutbacks continuing apace. In an effort to comply with of high regulation in the belief that free markets and the findings of the Court they met the unions in April and competition could impose a self regulation and would be advised that at the end of the first quarter the demand for sufficient to secure sustainable growth while, at the same services had exceeded targets in both community and time, benefit and protect consumers. national hospitals office and the drug refund schemes. A e In Ireland the health services, faced with a massively saving of 30 million which they had expected to receive increased population, greater life expectancy for both from a plan to reduce the wholesale cost of drugs had men and women and ever advancing medical treatments not been realised and it too must be comprehended in and drug science, struggled in spite of increased overall their cutback of other services. financial resources to cope with the demands placed They advised the unions that the HSE figures recorded upon the services. for February indicated it as being the sixth month in a The insistence by government that the Health Service row to show reductions in overall employment levels Executive live strictly within its budgets had weighed since the end of August 2007. A total of 2,603 whole time heavily on the HSE in 2007 to the point where they equivalent posts had, at that point, been taken out of the imposed a recruitment embargo in September of that system. year. At the beginning of 2008 the HSE instructed the The HSE programme of cost containment and cutback local employers that positions which had not been filled continued apace throughout the year and even a dispute by 31 December could not be filled in 2008 and they thus by one of the major unions in the health service IMPACT, institutionalised the lower staffing level which had been which lasted right across the summer and public protests imposed since September 2007. involving staff and patient groups failed to dissuade the Additionally, under their employment control measures HSE from its programme of cutbacks and government they had introduced an employment monitoring group to from its policy of promoting private medicine at the review each and every vacancy that occurred and which expense of the public health service. served along with its local version to delay and frustrate Towards the end of the year the HSE, at national level, the replacement of important and key frontline staff. commenced discussions with the trade union group on While some relief was achieved through the engagement an accord aimed at providing for the orderly management of agency nurses and overtime many services struggled of the cost containment programme while observing the with less than adequate staff and nurse managers endured requirements for consultation with a view to reaching the continuing frustration of living with uncertainty with agreement. regard to the staffing levels from one shift to another. As the economic situation for Ireland worsened The trade union group in the health service had referred throughout the first half of the year increased levels of a complaint that the employers action of September 2007 unemployment placed further heavy demands on an had breached both the Information and Consultation already burdened health service budget. The issue of Agreement (which had the force of law under the medical cards to unemployed persons and the entitlement Information and Consultation Act) and the national to drug refund schemes meant that expenditure in

1. Industrialrelationssection.indd 17 30/03/2009 10:03:39

those areas increased and thereby put pressure on the The incremental reduction in the working week has remaining budget for the rest of the health service. occurred at such a slow rate that its significance far out weighs any monetary value to which it can be equated From an INO point of view the agreement made in May and it genuinely has a longer lasting impact because of of the previous year had given a commitment to the the shift it makes in the work life balance of the individual introduction of a 37.5-hour week from 1 June 2008. The worker or nurse or midwife. requirement in the agreement to achieve the reduction in hours on a cost neutral basis proved challenging against the backdrop of already depleted staffing levels and Irish nurses and midwives were required to work a 39 pressure at ward level. hour week and in doing so were out of line with all of the other professions for the public service and white collar workers generally who work either 37.5 or 35-hour 37.5-Hour Week Historic weeks. The professions of nursing and midwifery require Achievement both mental and physical effort and increasingly through the decades have become more knowledge based It is often said that the taste of success is all the more sweeter with the attendant onerous education and minimum because the effort or struggle to get it has been harder. The requirements. achievement of the 37.5-hour working week for Irish nurses and midwives in retrospect will rank high among the In spite of all of this until the agreement to implement achievements of trade unions in terms of advancing basic the 37.5-hour week in 2008 they were treated as being terms and conditions of employment in this country. outside the general group of public servants and regarded as professional or in the white collar category. From 1 June all of the major acute hospitals in Dublin and The achievement of the reduction in the working hours many outside of it were in a position to fully implement the is all the more remarkable for the fact that it was a 37.5-hour week. In spite of the difficulties faced by the health campaign pursued by two of the four unions who purport service and the downturn in economic circumstances the to represent nursing and midwifery professions, the Minister for Health and Children, in April, had convened a Irish Nurses Organisation and the Psychiatric Nurses national meeting of nurse managers and representatives Association. for the purpose of encouraging compliance with the The agreement also provided for a Commission on agreement. the further reduction in working hours to 35 and it However, under the prevailing national agreement commenced its programme of work in the latter half of Towards 2016 her department had insisted upon an the year. The reduction in working hours can be equated unprecedented level of sign off before any location could to an effective 4% increase in the hourly rate of pay which receive the 37.5-hour week. This proved to be a major in terms of the hourly comparison of pay between the frustration and delaying factor. nurse/midwife and social care worker addresses some of the anomaly which has been the source of serious Essentially up to eight managers from ward level to CEO grievance to the professions. of the HSE had to sign confirmation that the reduction in working hours was achieved on a cost neutral basis The primary benefit is, however, not in terms of pay but and without a diminution in patient services before it rather in terms of time off and the Organisation, in spite could be passed to the Performance Verification Group of depressed economic times, is looking forward to the established under the national agreement for sign off. progressive reduction in the working week to 35 in the coming years. In spite of the obstacles placed in its way INO nurse representatives at local level and full time officials worked tirelessly constructing efficient rosters, identifying costly Pay Claim overtime or agency hours which could be converted into full time positions and improving direct nurse patient Pay claims which sought parity with the therapeutic time through the elimination of some non nursing duties grades and which the Public Service Benchmarking Body to achieve compliance with the 37.5-hour week in up to had indicated did not fall within its terms of reference 95% of locations before the end of the year. was referred back to the Labour Court for consideration. The full findings of the Benchmarking Body’s report The tedious process of implementing the 37.5-hour week which were outlined in the 2007 annual report were on involved continued engagement at national level with the whole disappointing to the INO even though they the National Implementation Body of the Towards 2016 provided for a 10% increase for directors and assistant agreement and the most problematic of locations required directors of nursing and midwifery, and a 6.8% for the the assistance of the Labour Relations Commission in order grade of CNMIII. to bring them over the line and establish the new contractual hours for all nurses and midwives employed in Ireland. On the parity claim the court held a number of meetings with INO, PNA and the employers commencing in May. Reductions in the working week for large groups of Through that process there was an emerging consensus workers are relatively rare and have been at the core of that the pay of the grades of nurse and midwife could some of the many milestones in labour history globally. best be addressed in the context of expanded practice

1. Industrialrelationssection.indd 18 30/03/2009 10:23:06 with demonstrable benefits to patients and efficiencies Unimplemented Agreements within the health service. Failure of the HSE to implement agreements it freely As the year came to an end tedious discussions were entered into with trade unions along with a number of still in progress as to how this issue could be eventually Labour Court recommendations and determinations addressed in time. remained a problem throughout the year 2008. By September up to 70 agreements right across the trade union group had not been implemented and High Towards 2016 Level Group engagement commenced with a view to The fist module of the national social partnership restoring some level of trust between the parties on the agreement Towards 2016 was due to end on 30 implementation of agreements. September 2008. The final phase of 2.5% was paid from From an INO point of view there were 40 unimplemented 1 September. Because the public service runs up to nine agreements many of which related to staffing reviews months behind elements of the private sector and semi- which had recommended improved staffing particularly states, the pay elements of the social partnership 10 year in care of the elderly institutions. Agreement was agreement fell due for review during the first quarter of reached that all outstanding agreements would be the year. implemented in 2009. A special committee comprising Discussions at national level between the social partners, an independent external chair, a HSE representative and the trade unions represented through the ICTU following a the Deputy General Secretary of the INO was put in place number of false starts broke down in July and resumed in to examine staffing review recommendations, establish September. Ultimately a transitional agreement emerged how much, if any, had been implemented and to make which was put to the ICTU affiliates on 17 November and recommendations for their full implementation. That was accepted by a large majority. committee’s work was intense and was still in progress at the end of the year. The agreement provided for a 6% increase over 21 months with a pay pause of three months applying in Among the unimplemented agreements was the the private sector and an 11-month pause in the public full implementation of a legally binding equal pay sector. The deal also contained important measures to determination that the directors of nursing were entitled combat exploitation and to strengthen employment to equal pay with the directors of mental health nursing. rights. It provided for a ban on the use of agency workers The HSE had only partially implemented the finding by to replace striking workers and changes to competition adjusting the pay rates but failing to give retrospective law to allow freelance journalists and session musicians effect as was a requirement of the judgement – (Circular to bargain collectively. letter 14/2008). The Labour Court determination was EDA0720. Importantly the agreement provided a commitment to restore the spirit of the 2001 and 2004 Industrial The INO, in view of the failure of the HSE to fully Relations Acts (following the Supreme Court judgement implement the award, was forced to register a complaint in the Ryanair case in 2005) along with new measures with the High Court for implementation in November. The to ban the victimisation of trade union activists and HR manager of the HSE issued a further circular advising organisers. full payment of the award in December. From an INO point of view the agreement provided for Meanwhile, the Organisation lodged follow on equal pay the implementation of the outstanding benchmarking claims for the assistant directors of public health nursing awards in part. Under it directors of nursing/midwifery and was in discussion regarding other grades of director and assistant directors were entitled to 5% of the 10% and assistant director at the end of the year with a view awarded by the Benchmarking Body with effect from 1 to other gender based equality claims. September 2008. CNMIIIs who had been awarded 6.8% by the Benchmarking Body were also entitled to receive 5% of that award from the same date. Nurse Representative Training The Organisation provided seven basic nurse/midwife Although only agreed in November the worsening representative training courses during the year and one government revenue position was leading to media advanced course which was held at INO Head Office. speculation that employers and government might Additionally two full time officer training courses were abandon the pay agreement. This was in spite of held throughout the year. the fact that the first phase would not fall due for payment in the public sector until 1 September 2009. A delegation comprising members of the Executive Additionally, the money owing to nurse managers at Council and some full time staff participated in a study trip director, assistant director and CNMIII level, as a result to Canada for five days from 28 April to 1 May which was at of the agreement from 1 September, had not been paid the invitation of the Canadian Nurses Association and the as the year came to an end and INO were, once again, Canadian Nurses Union. This involved an intensive study put in a position of having to press government to day with the CNA on the subject of expanding nurse roles, honour the agreement. clinical nurse specialisms, cancer and coronary care.

1. Industrialrelationssection.indd 19 30/03/2009 10:24:17 Delegates paid a visit to the Ottawa General Hospital and the challenge of having the agreement implemented in received a presentation from nurse management and the most difficult of circumstances. There was an evident representatives on a participative management strategy and highly visible deterioration in the economic fortunes which has shown great efficiencies and satisfaction levels of the country, a tightening of the purse strings with among patients, staff and management at the hospital. regard to the amount of money available for the health service with an absolute insistence that it live within its Such is the success of the programme that the hospital budget and a most onerous set of requirements placed now markets it to other health providers in Canada and upon the implementation of the reduction in the working the USA. week for nurses and midwives. ICN Workforce Forum Nurse representatives at local level and industrial relations officers of the Organisation worked relentlessly The International Council of Nurses held its 14th ICN in achieving the Organisation’s objectives throughout workforce forum on 15 and 16 September in Washington. the year. The implementation of the 37.5-hour week was The forum covered a wide range of issues and this year hugely time consuming and required major efforts on heard reports of industrial action taken by nurses in behalf of all. The cutbacks created many challenges with Denmark, Finland, Norway and in parts of the USA. Many regard to inadequate staffing, ward closures, accident delegates to the forum reported that their health services and emergency department overcrowding and the were under pressure and the combined policies of HSE management displaying increasing hostility to the increased privatisation and reluctance by governments to entitlement of staff to be fairly represented or given a increase public health service spending. The forum also voice in the services they are so committed to. dealt with the issue of nurse migration and noted that both Canada and the USA are still predicting shortages for the The resilience shown by our nurse representatives to next decade but had revised the numbers downwards. fend off the worst impacts of the cutback agenda and the professionalism and vigour with which our industrial The forum was particularly impressed and noted the relations officers approach the never ending demands progress of nurse prescribing in Ireland. The Irish of recruitment representation of individuals and groups, legislation was reviewed and there was a general organising and campaigning is unparalleled in the trade consensus that it was among the most enabling for the union movement in Ireland. professions globally. The forum complimented the Irish Nurses Organisation on the achievement of the 37.5-hour The Organisation over the past two decades has been a week. visible vocal and campaigning force for better conditions for nurses and midwives in Ireland. Even in these The American Nurses Association reported on a major chastened economic times which many outside observers quality initiative which they have embarked upon in believed to be worse than any economic challenge recent years. They also reported a fracturing in the previously faced by the country, the INO is committed representation of nurses within America and difficulty to progressing its objectives on behalf of nurses and achieving unity within the professions. The Association midwives and improving the quality of the patient care was also committed to supporting Barack Obama in the they provide. upcoming Presidential election and was looking forward to developing a progressive health strategy with his new The Organisation faces into the new year confident administration, if elected. The INO sent congratulations that when all else is under pressure in the health to the American Nurses Association on the election of services nurses and midwives will rise to the challenge Barack Obama in November. of providing the best quality patient care even if under the most trying of circumstances. Through expanding roles and getting a voice at the table for better quality 2008 – A Year of Challenge services the Organisation remains confident that it will Having come through the turbulent year of 2007 which saw not only achieve the 35-hour working week in the coming the culmination of the INO campaign for better working years but that in doing so patients as well as nurses and hours and pay for nurses and midwives, 2008 presented midwives will be better off for that effort.

1. Industrialrelationssection.indd 20 30/03/2009 10:24:39 Industrial Relations Review – Part 2 Advanced Nurse considering the majority of our members work in the front line and have to deal with all manner of complaints raised Practitioners by the public whether or not they are directly responsible (ANPs) or in a position to deal with the issues raised. The INO believes that the interests of its members was The matter of pay for advanced protected in respect of this policy document, in that nurse practitioners was presented there is now a clear policy in which complaints, or other by the INO to the Labour Court on matters, raised by service users, or their relatives, or behalf of the group. The claim was visitors, are to be progressed and dealt with. for a salary scale for advanced nurse practitioners that reflected Complaints officers have been appointed to deal with Phil Ní Sheaghdha, their work and not the area in matters consistently throughout the HSE. All matters Director of Industrial relating to clinical complaints will be dealt with, in the Relations, INO which they worked. first instance, by reference to the heads of discipline, in The INO argued that the role of the case of nursing, the director of nursing. Complaints the ANP was seen as a pathway to advance the clinical relating to Trust in Care or Dignity in the Workplace, will careers of nurses and midwives and was totally separate be dealt with under those previously agreed policies. to the management career stream to which it was linked for the purposes of pay. Individual advanced nurse practitioners were required to demonstrate clinical Violence and aggression in the competence in their particular area of nursing practice having completed a masters degree and they would then workplace have to seek accreditation with the National Council for The INO was represented on formulation of the policy the Professional Development of Nursing and Midwifery. document regarding the management of aggression and All of this criteria is not dependent on their area of work. violence in the workplace. It does not differ dependent on which band of hospital INO members were represented with a view to ensuring they work in, therefore the payment structure should that management’s focus should be on the prevention, not be based on the criteria that is not relevant to their as far as is possible, of any incidences of violence, (be it qualification or work. verbal or physical in nature), occurring in the workplace. The employer/HSE argued that it was a cost increasing In the event that such events do occur, follow up care and claim and in breach of Towards 2016 and that the salary support has to be made available and training for staff is structure could not be altered. a priority in all aspects of the policy. The Labour Court considered the submissions and made This comprehensive policy document is underpinned their decision on the basis that the advanced nurse by a recommendation to have a specific department practitioner is a clinical rather than a management role established to oversee the implementation of the policy and for which there is a specific training regime which and evaluate its effectiveness with a view to prioritising is not dependent on the size of the hospital or level of the safety of workers and support of them, in the event management responsibility. The Court recommended of an adverse incident occurring in the workplace. The that the unions claim for payment of advanced nurse interest of the frontline worker was paramount in all of practitioners at assistant director of nursing band 1 scale these discussions on their behalf by the INO. be conceded with effect from 1 July 2004 or from the date of their appointment if later than 1 July 2004. The INO and its advanced nurse practitioner members Managing attendance were delighted that this issue, which had been ongoing For the period of September 2008 through January since management unilaterally placed advanced nurse 2009, the INO, in conjunction with other trade unions, practitioners on two different salary scales, has finally has sought consultation on a managing attendance been concluded satisfactorily for INO members. The policy which is being introduced by the HSE. The unions recommendation was issued by the Labour Court on 20 had a number of consultations and a number of draft May 2008 and is available on the Labour Court website. documents were produced which the unions amended and sought to influence. The INO’s participation on this group centred around Complaints procedure protecting those that are genuinely sick from a recent National agreements have been concluded in respect development which was the application of the disciplinary of the management of complaints in the HSE. The INO process to those who were genuinely sick, regardless of was an active participant in the Trade Union Reference the nature of the illness. Group which resulted in the policy document outlining With this policy, the INO also ensured that supports were how complaints or compliments will be managed when made available to employees who cannot attend work received by the HSE. due to ill-health and that these supports are made known This is an area in which the INO invested a lot of time, to them by managers.

1. Industrialrelationssection.indd 21 30/03/2009 10:24:53 The focus of this policy is to promote attendance at work employment for nurses who had specialised in the area and ensures that managers discuss supports that could of cancer care particularly and the maintenance of their be put in place with employees on their return from sick right to continue to work in that service if they so wished. leave. This has been achieved and under this framework document, the employee is entitled to receive 30 days The unions were critical of the practice that had developed notice prior to any transfer of service, a comprehensive of the back to work interview being used as a disciplinary written offer outlining all conditions of employment from process and are happy to confirm that this Managing the perspective designated centre and also a written Attendance Policy is specific in that disciplinary sanction document outlining the options that would be available can only apply if the policy is breached. Managers should were they to remain in the original non-designated have a discussion in an informal manner with employees centre. on their return as opposed to a formal back to work interview. All of the employment conditions of the employees affected will be protected inclusive of salary, grade and It is important that INO members become familiar with seniority. The document covers areas of compensation this policy and the unions have sought the right of which will be made available to nurses who transfer, participation in the training of line managers to ensure nurses who choose not to transfer and nurses who work that the employee’s perspective is clearly identified in across two sites. These are: any training programme. • Where an individual is relocating on a part time or full Extension of the working day time basis they shall receive the hourly equivalent of a day worked in the location to which they transfer in each The INO was an active participant in the discussions of the first three years worked commencing in 2009. surrounding the introduction of clause 30.4 of Towards These hours may be accumulated and taken together 2016. This is the clause which refers to expansion of after three years with the proviso that the dates on services in the health service outside of normal nine to five which the leave is to be taken will be by agreement with working. The agreement puts in place a comprehensive the relevant manager, to minimise, as far as possible, framework to ensure that employers cannot just decide the disruption to the service to extend a service without comprehensive evidence to support firstly the need for this expansion of the service • To assist those transferring to the designated centres a e based on a national circular or strategy and secondly special one off grant of 1,000 will be provided by the look at the resource implications of such and take into NCCP for training/up skilling related to the provision of account staffing levels prior to any decision being made cancer treatment/care. Approval for the programme will to expand service. be provided through the manager designated by NCCP. This grant may be utilised over the two-year period This framework document also differentiates between 2009/10 and if not availed of during that period, will those that are currently employed and new entrants. lapse New entrants are those that would have been employed and issued with contracts on or after 16 December 2008. • Travel time in lieu – The agreements reached in respect The INO sought to ensure that individuals would not of those locations/individuals which transferred prior be asked to extend their working day as it is, in fact, to 31 December 2008 will continue to apply to those the service that is extending. The framework document individuals who concluded those agreements. However is quite clear in respect of this and places an onus on there will be no new time in lieu arrangements for management to adhere to specific negotiating and staff transferring either on a full or a part-time basis consultation procedures prior to any proposed changes apart from these individuals. Those personal to holder being introduced. arrangements will cease when those individuals leave the cancer service or cease to work in two locations, for This framework document ensures that a comprehensive whatever reason. The list of those who will retain local consultation and evaluation process has to be engaged agreements, and the terms of those agreements are to upon prior to the service being extended. be recorded between the NCCP and the relevant trade unions Cancer strategy • Travel and subsistence – Those staff who will be relocating on a full time basis (ie. for their full working The INO sought and initiated discussions with the hours) to a location 35km or more from their previous employer regarding the human resource implications base will be entitled to the subsistence allowance of the National Cancer Control Programme and the applicable for five to 10 hours for each of the first 40 reconfiguration of cancer services in the Republic of days worked in the new location, after which time such Ireland. These discussions commenced in September a payment shall cease. Those who will be relocating 2008 and with the assistance of an independent on a part-time basis (ie. working in two locations) will chairperson, Janet Hughes, a comprehensive framework receive mileage when required to work away from document has now been agreed. their designated base, in accordance with the normal The INO sought the protection of conditions of regulations and rates which apply in the HSE

1. Industrialrelationssection.indd 22 30/03/2009 10:25:10 • Compensation for loss of earnings – Any claim for an transitional arrangements for our members working assessment of losses shall only be submitted after at in the community, particularly public health nurses, least one year of working in a new location. In the event community general nurses and practice nurses. of their being any dispute regarding a claimed loss or These discussions are ongoing with particular emphasis compensation for such a claimed loss, the matter shall on job descriptions for the grades in question and the be referred to a third party for binding arbitration. maintenance of their role and function in the community The focus of the National Cancer Control Programme, as setting. it has indicated to the INO, is to retain all the expertise within the cancer services. Individuals who had negotiated specific terms prior to this document being If and when required contracts agreed will maintain those terms on a red-circle basis The INO made representations to the employer regarding until they retire or leave the service. the use of if and when required contracts for nurses. These contracts did not afford any stability or obligation Nurses who work in any of the eight designated centres, on the employer to provide employment to the nurse which will be moved in order to allow cancer services in question and had previously been found to be of no occupy those particular locations, will also be included in standing by the Labour Court. the terms of this particular framework. Therefore, the INO referred the matter to the Labour Relations Commission and at that forum the employer Primary care agreed to withdraw these contracts and agree with the The INO has engaged with management of the primary trade unions a replacement contract. These discussions care division of the HSE with a view to influencing the are ongoing.

1. Industrialrelationssection.indd 23 30/03/2009 10:25:24 Regional Round-Up (IROs)

outstanding and are subject to efforts by the LRC to HSE - Eastern Region – conclude this exercise. Private hospitals (Mount Carmel Dublin City Hospitals and SVPH) both went live within the agreed timeframe. Albert Murphy I would also like to acknowledge the efforts of two outstanding INO representatives who retired in recent months: 37.5 hours: The majority of employments in this area introduced • Eileen Kelly has been an INO stalwart for many years in the 37.5 hours in line with the 1 June, Clonskeagh Hospital, and has served as treasurer of the 2008 deadline. However at years end Dublin East Coast Branch the National Maternity Hospital and Our Lady’s Hospital • Maureen McCarthy was a long serving and loyal for Sick Children, Crumlin, remained outstanding. I would representative in Sir Patrick Duns Hospital. like to thank all of the INO representatives for their hard work in achieving implementation of the 37.5-hour week. Both nurses are well known for their informed contributions to previous ADCs, and I join all members Mater Private: Following a dispute over the agreement and activists in the East Coast Branch in wishing both on the 37.5-hour working week the INO referred the Eileen and Maureen a long and happy retirement. matter to the Labour Court. The Court did not recommend the concession of this claim in the absence of an overall St Colman’s Hospital, Rathdrum: Intervention was national agreement. Following a ballot for industrial required on a number of occasions to progress members’ action intense discussions were held which culminated concerns due to inadequate staffing levels, efforts to in an agreement on 37.5 hours and a bursary of e10,000 limit access to premium payments and regularisation towards nursing education. A further commitment by the of temporary contracts to permanent status under an hospital is to introduce 35 hours following the Report on agreed conversion process. A number of members were the Commission of the 35-Hour Week also represented with a satisfactory outcome, in an investigation regarding patient care. Mater Public: The INO is pursuing claims for the transplant co-ordinators for similar arrangements in St Dalkey Community Unit: Members succeeded in ensuring Vincent’s. The INO is also in dispute with the hospital on that an independent staffing review was implemented behalf of the site nurse managers regarding out of hours via the use of agency staff. Efforts to introduce internal pharmacy. Both issues are currently with the Labour rotation for nurses was resisted. Relations Commission. St Columcilles Hospital: Member succeeded in having St Michael’s House: Following representations from the full pay restored following management’s refusal to allow INO on section nursing structures in St Michael’s House, her return to work when certified by her GP following management have accepted, in principle, the appointment recovery from a back injury. Management claimed that of a director of nursing post. A working party has been they could not provide lighter duties and insisted our established with a view to implementing same. member remain on the sick pay scheme. Resolution of this dispute included payment of potential premia Our Lady’s Hospital for Sick Children: Following ongoing payments and compensation. Our member’s sick leave difficulties with the budget allocation in Our Lady’s record was also amended accordingly. Hospital for Sick Children, Crumlin, the HSE and Our Lady’s Hospital, have agreed cost containment measures. Wicklow District Hospital: Members succeeded in The INO was slightly critical of the hospital with the lack ensuring that safer staffing levels were delivered of consultation/engagement with the Organisation. The following discussions to ensure that vacant posts were hospital has agreed to full consultation going forward filled promptly. and all permanent jobs are not under threat at this time. Baggot Street Hospital: Inpatient beds closed in Dublin Maternity Hospitals: Activity levels in all the Dublin December 2008 following a damning Fire Officer’s report. Maternity Hospitals continued to increase last year. The Thirty members were affected by the consequent move Birthrate Plus Report on staffing is to be implemented. In to Clonskeagh Hospital. A small number of members one hospital the report recommends the appointment of moved by agreement to alternative locations closer to an additional 100 midwifery/nursing posts. their home. Members voted unanimously to accept a relocation package which included monetary payment, extra annual leave and new uniforms. Revised rosters HSE - Eastern Region resulted in members having extra days off each month. East Coast Area Eglinton House: Closed in November 2008. Members Philip McAnenly voted unanimously to accept a relocation package which included payment, extra annual leave and uniforms. A number of members relocated to alternative employment Overall, a great deal of effort went into closer to their home. assisting members in the introduction of the shorter working week by 1 June, Community Care Areas 1, 2 and 10: Representations 2008. A small number of areas remain continue to ensure that members concerns are protected

1. Industrialrelationssection.indd 24 30/03/2009 10:25:38 in ongoing attempts to roll out the primary care initiative. and the Organisation in every single work location to Staffing levels and workload concerns remain to the fore facilitate the introduction of a reduced working week of negotiations. was remarkable in the extreme. Early agreement was achieved in most locations within the Northern Area, St Vincent’s University Hospital: A new INO in- most notably the first band one hospital agreed nationally house committee was formed recently which, with the was Beaumont Hospital which was finalised well ahead assistance of the LRC research and advisory service, of the implementation date and was used as a template continue to address members’ concerns. Efforts to reduce for many other locations around the country. access to premia payments have been stoutly resisted to date. A member had underpayment of e28,000 restored However, within the Daughters of Charity Services, there following referral to LRC. Another member was awarded was an extreme delay and only following intervention nine months salary and related terms and conditions of from the Labour Relations Commission and an employment by Rights Commissioner. Our member had independent facilitator, was agreement possible. It was been put off duty without pay following her refusal to also necessary to take a ballot for industrial action in accept a dictat to change an agreed roster. this location to spur management into action relating to agreement on this matter. Mount Carmel Hospital: Members have elected a new in- house committee that has already progressed concerns Beaumont Hospital: I am saddened again to report, the regarding the superannuation scheme. Members also persistent and unacceptable situation which exists in introduced the 37.5-hour week in November 2008 with the A&E department of this hospital. This is peculiarly retrospective effect to June 2008. related to the failure of the HSE to provide adequate step down facilities for patients and little more can be done in St Vincent’s Private Hospital: Members have had to relation to this department until such time as the health respond to unilateral efforts by management to introduce service makes good on its promise to provide appropriate change without discussion or adequate consultation. accommodation for patients who are fit to leave the acute Access to car parking was restricted due to development system but have nowhere to go. of the new hospital. Additional car parking was provided for members adjacent to the hospital. Efforts to reduce Beaumont hospital has established a very vibrant the annual leave provided to a small number of members representative committee in the hospital and this is a was subject to an LRC referral. Members in the theatre significant achievement for 2008 which will assist in department resisted efforts to withdraw the provision building and maintaining an effective INO presence in of free meals. Free meals had become a contractual the hospital. Management within this hospital once more entitlement 21 years earlier. attempted to place additional beds on inpatient wards to cope with the A&E difficulties, and again, this year we Royal Victoria Eye and Ear Hospital: Vacant CNMI and have been successful in preventing this. CNMII posts were filled following referral of a related dispute to the LRC. A claim for clerical support on a The most recent challenges which have presented number of units remains in progress. themselves are proposals to remove 550 car parking spaces from the hospital. The INO is spearheading the St Luke’s Hospital, Rathgar: Member successful in defence of our members’ position in the face of the loss pursuit of upgrading to CNMII following independent job of such a large parking facility. Finally, management evaluation. intend to introduce directorate management structures St Catherine’s ID Service, Wicklow and Sunbeam House within the hospital and the INO has been foremost in ID Services: Members at both locations have resisted advocating the concerns of nurses arising out of this efforts to reduce access to premia payments as a result most substantial change process. of budgetary short fall. Connolly Hospital: The Organisation was successful in Sisters of Charity, Blackrock: Member was paid e18,000 achieving the removal of a performance and appraisal in compensation following relations becoming irreparably system which had been introduced without agreement damaged. Also assisted in rebuilding her career in a new in this hospital. We have also been active in ensuring location. adequate staffing levels in a number of departments and where these were not possible, demanding closure of beds. Finally, we have been instrumental in the HSE – Eastern Region – establishment of an Information and Consultation Forum Northern Area which seeks to ensure that staff views are borne in mind Edward Mathews prior to any major decisions being taken regarding the hospital.

2008 marked another busy year for the HSE Northern Area: Management in this area had taken a Organisation in the north Dublin area. unilateral decision to refuse to allow the accrual of annual Of particular emphasis in the earlier leave during periods of sick leave. We were successful, part of the year were negotiations with the assistance of the Labour Relations Commission, to facilitate the introduction of the 37.5-hour working in having this decision reversed and ensuring that our week. The work carried out by local representatives members continue to accrue annual leave during periods

1. Industrialrelationssection.indd 25 30/03/2009 10:25:51 of sick leave. We were also successful in having leave Hospital already applied the allowance to another ward returned to persons retrospectively. with the same set up but refused to pay the full allowance in these two areas. Community Care Areas: The Organisation was very active in ensuring that premature developments did not Management attempted to introduce a new roster in the take place in relation to the implementation of primary paediatric accident and emergency department without care teams. Notably, our members’ solidarity in certain the agreement of staff. Previously, this department areas ensured that developments, which were being used recruited twilight nurses specifically to work this shift as a subterfuge to mask the implementation of primary only. The nurses who worked this shift left and the hospital care teams, were not successful. was unable to replace them. Our members agreed, out of goodwill, to undertake this twilight work pending the The Organisation successfully assisted family recruitment of twilight nurses. This would see a maximum development nurses across the Dublin area in pursuing of one twilight shift per month. The hospital then an upgrading claim. This grade was at public health produced rosters with a second twilight shift, despite the nurse level, and following a job evaluation review, staff rejecting it. This issue was referred to the LRC after recommendations are in place to allow these members local discussions were exhausted. Management agreed access points on the assistant director of public health at conciliation, to vigorously pursue filling the post. They nursing scale in light of the responsibilities they hold as have failed to honour this commitment and this post part of their job. remains vacant. A Labour Court hearing in scheduled for Beaumont Convalescent Home: The Organisation early 2009. successfully negotiated the implementation of a Labour The HSE sanctioned, and funded, one additional WTE Court recommendation which provided for the payment clinical placement co-ordinator post for Tallaght in 2006. of all retrospective monies owed under Sustaining Management, however, utilised this funding to fill a Progress and Towards 2016 to our members working different post. After negotiations broke down at local level in this location. We have also ensured that all future pay this matter was referred to the LRC. Management would agreements will be applied to these members. not concede to this claim at conciliation and so the case A considerable number of individual issues were was adjourned. On the week of the second scheduled progressed within the area during 2008. Of particular LRC hearing management wrote to the INO agreeing to note was a settlement of e60,000 for a member who fill this post, bringing the number of approved CPCs in was the victim of maladministration of the grievance Tallaght from 6.5 WTE to 7.5 WTE. procedure on the part of an employer. We were also A number of individual issues are currently ongoing successful in ensuring that a member working in an including an investigation into CNMIII regarding Institute of Technology could access appropriate annual management irregularities, application of the injury at leave, where she had been allocated an insufficient leave work grant to a nurse injured at work, and a Dignity at entitlement. Work complaint. There has been a considerable number of disciplinary, Our Lady’s Hospice, Harolds Cross: A number of Trust in Care and Dignity at Work investigations and individual issues have arisen which are currently in procedures throughout the year. These, by their very process. In October the Hospice announced reduction in nature, do not allow for individualised reporting. However, bed capacity over the winter months, 43 in all. All our they involve significant periods of the Organisation’s time members’ entitlements have been protected and various in ensuring that each member is adequately represented meetings with members took place. and that their position is advocated appropriately. Peamount Hospital: The Organisation agreed an independent staffing review of the Age Rehabilitation Unit HSE Eastern Region with management. However, management have since South West Area reneged on this commitment. At the LRC, management were unwilling to proceed with such a review. An interim Joe Hoolan arrangement was concluded which provides for an additional 2.5 WTE (two support staff, 0.5 nurse) assigned Adelaide and Meath Hospital to the unit by Easter 2009; a commitment by management (AMNCH) Tallaght, Peamount Hospital, to fill recent vacancies; and an assurance that long term Our Lady’s Hospice Harolds Cross, absences will be covered to as maximum a degree as Cheeverstown House Ltd, possible. Members have accepted the interim agreement Moore Abbey on the understanding that the staffing review has not been abandoned and discussions relating to same will be revisited at a later stage. Tallaght Hospital (AMNCH): Location allowance was Moore Abbey (Sisters of Charity, Jesus and Mary): secured, via a Labour Court hearing, for Maguire and Meetings took place between management and the Webb wards. Both wards have designated oncology/ group of unions to discuss a ‘breakeven’ plan for 2008. haematology beds are not stand alone units. Tallaght Essentially Moore Abbey were looking for job cuts of

1. Industrialrelationssection.indd 26 30/03/2009 10:26:11 between 40 and 70 posts. No agreement was reached. deadline as did St James’s hospital in Dublin. Last over The union side proposed that local management consult the line were community care area Longford/Westmeath with staff and, in collaboration, formulate new rosters if and Offalia House, Edenderry. All nursing staff in the possible that would lead to savings. Further meetings are midlands region now work a 37.5-hour week. planned. Midland Regional Hospital, Tullamore: The main focus The INO recently held an LRC with Moore Abbey on of attention during 2008 was the move to the new the issue of Venalink. Moore Abbey wish to introduce hospital. Negotiations took place throughout the year Venalink of which, without doubt, the long term goal is which resulted in the opening of three departments of to allow non nursing staff medicate. No agreement was the new hospital in April. All remaining departments reached on the day. We stated this is not an IR matter but opened in December 2008. Over 100 beds remain closed a professional issue. Management now wish to refer this throughout the hospital due to a lack of resources matter to the Labour Court. to provide adequate staffing levels. The cutbacks of September 2007 hit Tullamore particularly hard and the Clane General Hospital: INO members that commenced INO’s aim was to ensure the hospital opened with safe employment in Clane Hospital one year ago were advised and adequate staffing levels. that they would be eligible for sick leave after completion of one year’s service. However their new permanent Midland Regional Hospital, Portlaoise: Represented contracts provide that sick leave will only apply two an individual member whose temporary contract was years from the date of being made permanent, ie. three discontinued while on maternity leave. The member who years in total after commencing employment. In addition had achieved number one on an interview panel was the duration of sick leave under this new contract has denied the post due to the fact that she was unable to work been changed from six months full pay/six months half as she was on maternity leave. Detailed negotiations with pay, to just four weeks full pay. Furthermore a number HR resulted in the member having her contract renewed of stipulations have been included in the policy, eg. and receiving retrospective monies due to her. sick pay scheme will not cover absences in relation to A new emergency department opened in December 2008 traffic accidents, dangerous sports, etc. After the INO following prolonged negotiations and conciliation. A intervened, management offered to increase sick leave to receptionist was appointed to work office hours for the four months full pay, four months half pay and remove first time. A CNMIII is now appointed along with two the stipulations as mentioned above. We continue to additional triage nurses and an additional nurse on night pursue this issue to get the full entitlement as agreed duty. upon when members commenced employment. Problems due to continued cutbacks remain in the On a personal note, now that I have resigned from the hospital. Staff are redeployed on a regular basis. Reduced Organisation, I would like to express my sincere thanks hours and family friendly initiatives are generally being to the management team for their support and guidance denied by management. Members believe this will lead over the last few years and as a future INO member, I to problems with retaining nursing and midwifery staff. take solace in the fact that our union is in superb hands. This problem is also replicated in other hospitals in the I would also like to thank my IRO colleagues, whom no- region. one will ever know how much work they actually do, their effort and sacrifices they make, all in order to advance Midland Regional Hospital, Mullingar: Inadequate the cause of nurses and midwives. Thank you all for staffing levels and cutbacks continue to affect the hospital everything. with staff being redeployed with little regard to skill mix and experience. Issues arose regarding inadequate staffing levels and poor skill mix in the maternity unit. Reduced HSE - Midland Region staffing levels also continue in the general wards. In the St James’s Hospital, Dublin 8 latter half of the year the numbers of patients admitted to Derek Reilly trolleys in the emergency department increased. St Mary’s Hospital, Delvin: Discussions ongoing with 37.5 Hour Week: The early part of 2008 management regarding transfer of staff and clients to the was dominated by the introduction community. of the 37.5-hour week. Reps and staff St Josephs Hospital, Longford: Rotation of staff were particularly busy drawing up throughout the hospital was introduced by management and reconfiguring off-duty. There was this year after prolonged and protracted negotiations disappointment in the midland region when the three with unions. Agreement was reached after protection was acute hospitals failed to meet the 1 June deadline despite put in place for premium pay and annual leave. Members staff having rosters agreed with local management. continue to work their approved hours and the system of The roster was agreed over the summer following an rotation is to be applied equally to all staff. agreement to curtail the cost of agency staff by employing regular staff thus meeting the cost neutrality element of Irish Blood Transfusion Service: Negotiations continue in the agreement. The care of the older persons hospitals in relation to opening hours for clinics and the changing of Longford/Westmeath, PCCC Laois/Offaly met the 1 June working hours of staff. Agreement was reached at Labour

1. Industrialrelationssection.indd 27 30/03/2009 10:26:27 Relations Commission to pay nursing staff holiday One of the issues members at the hospital had sought premium pay for the first time. Retrospective payments resolution of for many years finally happened in March for four years was awarded to members. Conciliation 2008, with the HSE assigning one additional nurse to the ongoing in relation to staff pension fund and sick leave emergency department roster. This occurred after a ballot benefits. for industrial action. Additionally the HSE had to reinstate a nurse on night duty which was previously agreed. St Mary’s Hospital, Mullingar: There is no night duty management structure in place. At the Labour Relations Reconfiguration of Acute Hospitals Services: The Commission, management conceded that the current Horwath Teamwork Report was finally published by the situation is unsatisfactory and cannot continue. Due to HSE. While the report was the source of lots of rumour continuing cutbacks management state they are not in a throughout 2008 its publication demonstrated that the financial position to put a structure in place. HSE were attempting to unilaterally implement significant changes without ensuring that the appropriate support Individual member employed as a clinical nurse specialist structures outlined in the report were in place. by HSE Mid-Leinster regraded to CNMII from CNMI after prolonged negotiations with management. The specific concerns of our members were all highlighted to the HSE in particular the absence of an additional 135 St James’s Hospital: A member was threatened with beds and 24-hour, consultant-led emergency department demotion after informing the occupational health cover in the Mid Western Regional Hospital, Limerick. department that she was suffering from stress due to her management responsibility. Following representation Brothers of Charity, Bawnmore, Limerick: Following by the INO, management put appropriate systems in the assistance of the Labour Relations Commission a place to address the genuine concerns the member had group of nurses received an additional two days annual for her department. They also maintained the member leave following the resolution of a long standing working in her current role and salary. This highlighted the issue hours anomaly. The INO was also successful within the of reporting relationships between occupational health service in securing the upgrade of night managers from and management and the issue of confidentiality for the CNMII to CNMIII. The INO also succeeded in securing employee. from management agreement to fully comply with the Represented members at disciplinary hearings in relation Department of Health and Children circular on the annual to sick leave. Management were making concerted leave entitlement for nurses, retrospective to 1999. efforts throughout the year to reduce sick leave within Daughters of Charity, Limerick: The INO achieved, on the hospital. Numerous meetings throughout the year behalf of members, an enhanced security presence with management negotiating staffing levels and at night on the campus of the Daughters of Charity, reconfiguring rosters to suit staff and patient needs. Lisnagry. This followed a number of security breaches and a refusal by members to exit buildings at night to cover relief for breaks, etc.

HSE – Mid-West Region St Anne’s Service, Roscrea: In 2008 this service transferred Mary Fogarty to the Daughters of Charity without any obstacles. The new management team are planning to implement all the terms and conditions of employment of their service but require some changes in work practices from some Mid Western Regional Hospital, employees. Limerick: The hospital remained St Munchin’s Maternity Hospital: The INO was satisfied in 2008 a difficult location for the that a HSE commissioned review of midwife staffing conduct of industrial relations, many levels at the hospital in 2008 identified a shortage of issues affecting members remain unresolved and in an 20 midwives based on the increasing birth rate. For industrial relations deadlock. These include the opening many years the union had sought additional midwives of a new paediatric high dependency unit, upgrading of but management insisted that the hospital would be night sisters claim and a dispute over the payment of the more appropriately staffed with additional healthcare dual qualified salary scale to a group of 50 nurses. assistants. This report has so far not been implemented The matter has been raised at the National Joint Council by the HSE. with a request for an IR/HR review. To date the hospital Milford Care Centre: The INO agreed with management has rejected any attempts to have a review undertaken. revised nursing management structures which will have Ennis General Hospital: The hospital was in the media a positive impact for promotional prospects for members spotlight for most of 2008 with particular focus on quality within the service. Management agreed to put in place and safety of patient care. The INO welcomed the decision permanent night managers at CNMII grade with an of the Health Information and Quality Authority to conduct independent review after 12 months to decide on upgrade a review at the hospital as our members have for many to assistant director of nursing or CNMIII. Additionally on years raised such issues. The INO fully cooperated with day duty further upgrades to CNMII were agreed through the review. confined competition.

1. Industrialrelationssection.indd 28 30/03/2009 10:26:48 Shannondoc: A number of difficulties arose in Shannondoc Also planned is the opening of a medical assessment unit in 2008 relating to parity of terms and conditions of at Cavan General Hospital. Negotiations are ongoing. employment with other grades of staff within the service. However progress is slow and it is planned to involve the Following a series of meetings with local management LRC in early 2009. agreement was reached on the introduction of the HSE The Organisation has grave concerns about the impact of sick pay scheme, payment of salary on maternity leave these plans on patients and staff at both hospitals and revised contracts of employment. The emergency departments of acute hospitals in the Third Party Outcomes: In December the Labour Court North East remained in crisis throughout 2008. Drogheda issued a binding determination in favour of the INO in and Cavan, both deemed unfit for purpose, were worst relation to a decision taken by the HSE to refuse to allow affected and the focus of media attention throughout the a nurse who was on certified sick leave when a public year. Despite understaffing, under resourcing and poor holiday fell, receive any benefit under the Organisation infrastructure, staff endeavoured to provide quality care of Working Time Act, 1997. to patients. The situation worsened at year end due to bed closures at other sites. The Labour Court determined that if a nurse or any other HSE employee is on certified sick leave with pay on a We continue to engage with management in an attempt public holiday that payment under the sick pay scheme to improve conditions. A transit unit was opened in is a contractual entitlement. Therefore this paid day off December 2008. However, due to the ongoing rise of cannot be considered as benefitting from a public holiday attendances, shortage of beds, lack of step down beds and and the employee must be given an additional days pay primary care, the situation is likely to remain perilous. or an additional day of annual leave. The Organisation, as ever, pursued a large number of Several individual grievances were resolved at the Labour individual and collective claims in 2008. Many of these Relations Commission and Rights Commissioner Service are ongoing. However several successes were achieved. during the year on behalf of members. There were also a • LRC agreement for the payment of e450 to 26 members small number of disciplinary issues including dismissal who had not received their holiday premiums as per and suspensions. Some of these individual cases required their entitlement at Cavan General the assistance of third parties and took up a significant part of the workload in the Limerick Office in 2008. • The Pensions Ombudsman determined that the HSE North East had maladministered the superannuation scheme as it applied to an individual nurse. He determined HSE – North East Region that the HSE should complete a new assessment of the Tony Fitzpatrick member and retrospectively pay pension rate of pay to March 2006.

The Organisation represented members affected by the change proposed by the National Cancer Control 2008 was an extremely busy year for Programme. This involves the redeployment of staff from the Organisation in the North East. Our Lady of Lourdes Hospital in Drogheda to Beaumont The introduction of the 37.5-hour week Hospital. The transfer of services is due to occur in 2009 dominated time and focus. However and the Organisation is involved in negotiations at the Organisation was actively engaged on many other national level under the chairmanship of Janet Hughes. fronts. The majority of work in 2008 involved representing The focus in early 2008 was the introduction of 37.5-hour individual members in disciplinary, grievance, Dignity week by 1 June, 2008. Despite intensive local and regional at Work or Trust in Care processes. These processes engagement with the HSE the majority of locations did generated a considerable amount of work. As ever the not have a reduced working week by the implementation Organisation was attentive to these members ensuring date. Following protests and the involvement of the LRC that they were well represented in whatever process they and NIB, the vast majority of members were working a found themselves. reduced week by year end. We continue to endeavour to resolve difficulties for the outstanding members. I wish to acknowledge the marvellous work done by the members of the Cavan Branch who were part of the local The reconfiguration of acute hospital services for Cavan organising committee for the ADC in Ballyconnell. Their and Monaghan was high on the HSE North East agenda hard work ensured an extremely well organised, smoothly in late 2008. The unions combined to form the Cavan/ run and a successful ADC in Cavan. Also my sincere Monaghan Health Service Union Alliance which is to thanks to all branch officers and local representatives for act as the conduit for negotiations on changes. The HSE their diligent work in 2008. North East plan to reconfigure services by closing 50 medical beds, six special care beds and reducing the 24- Finally, I wish to acknowledge the excellent administrative hour treatment room to a 12-hour minor injuries unit at support provided by Ann O’Brien to the North East in Monaghan General Hospital. 2008.

1. Industrialrelationssection.indd 29 30/03/2009 10:27:03 Anecdotally, the majority of these went to London and HSE – North West Australia. No doubt the INO will be engaged in further Region negotiation in respect of service provision for 2009. Noel Treanor In spite of the above there were areas where the INO Maura Hickey was engaged in negotiating additional staffing or indeed reconfiguration or expansion of service in 2008. Aras Breffni, Manorhamilton: The INO is pursuing a claim in respect of additional staffing through to the Labour Court. This may be a late hurrah for this sort of claim, but unquestionably, Aras Breffni is one of the poorest staffed As with all other areas in the country, there were two of any such elderly care locations in the country. themes dominating the agenda in the North West Sean O’Haire Unit, Stranorlar, Donegal: Through the throughout the year – the introduction of the 37.5-hour LRC, the INO and other nursing unions were able to week and the INO response to prospective cutbacks in agree a process for the development of this intellectual service. disability service into more appropriate and client- Introduction of 37.5-hour week: Even in locations where centred housing. the preparatory work was done well in advance of the 1 Sligo General – Orthopaedic Services and Acute June start date, the introduction of the new roster was Admissions Unit: The reconfiguration of these units was not a pain free process. However, within a month of the based on a reduced requirement for orthopaedic beds and start date, both band one hospitals in the region, Sligo a need for development of an acute assessment unit. The and Letterkenny General, had been signed off and the INO negotiated terms with management throughout. rosters introduced. Cregg House, Sligo: Following a Labour Court Within two months, over 90% of nurses employed by the recommendation for additional posts in 2006, the INO HSE in the North West were working the new hours. At the have referred the issue of non-implementation to the time of going to press, the roster has been implemented Court at the end of 2008. This is based on the HSE’s in all HSE locations with a couple of voluntary and private failure, as the funding body, to engage in the required locations outstanding. process. Cutbacks: It appears, as of January 2009, that there has Community Hospitals: At national level a review of been much more talk of cutbacks than any actuality. Of nurse staffing requirements in the community hospitals course, this is likely to change as the year progresses in the North West is being undertaken, with a view to and the true nature of the financial crisis becomes more implementing the additional staffing requirements apparent. While members have expressed a realisation Dignity at Work: The number of individual cases in that it is likely that some cuts will come, there is also a respect of Dignity at Work claims appears to have more caustic view being held. levelled out. Although by their very nature they take up This is the frustration that frontline nurses feel at a considerable amount of time it is notable that fewer of attempting to sustain a service and yet they can identify such cases seem to be going as far as investigation. areas where money is spent with no apparent service The process in such cases is as drawn out as ever with benefit. The failure of politicians to keep their own house some claims taking as long as seven years from the point in order has the effect of converting this caustic view into a claim is lodged to a final resolution. cynicism. Third Parties: There were several successes at third Notwithstanding that, it was again the acute services parties. One, negotiated through the LRC, finalised where there were some cutbacks in 2008. For nursing, agreement in respect of the implementation of concession this took the form of failing to appoint rather than any days for all nursing grades working in the community in major release of staff. This ‘invisible’ form of saving the North West. money necessarily has an impact on workload and there have been a number of instances where this has led to A second case, won at a Rights Commissioner Service, individual grievances against the employer. sustained the annual leave entitlement available to clinic public health nurses. At the time of going to press, the Letterkenny General had to put in a financial recovery HSE have appealed this to the Labour Court. plan from late summer. In effect, the short stay ward and a number of orthopaedic beds were closed. At the same I would like to place on record my sincere thanks to Maura time there were was some recruitment of nurses. This is Hickey, who looked after the area tirelessly while I was because many of the newly qualified nurses who were on leave. I also want to wish Maura every success in her in a position to do so chose to leave the country to take new role as (Acting) Director of Nursing in Letterkenny up posts. General Hospital.

1. Industrialrelationssection.indd 30 30/03/2009 10:27:18 • Agreement reached on CNMIIIs paediatrics HSE – Southern • With nurse management, we placed the integrated/ Region paediatrics and general undergraduate programme Michael Dineen on a firm footing by agreeing the appointment ofa Patsy Doyle dedicated nurse practice development co-ordinator for the integrated programme • Advocated successfully for fair and equitable study leave packages for the higher diploma students. The hospital finally agreed to the implementation of the 37.5 hour week in September on the basis of conversion Health Service Executive (South): The INO was pleased of 32 agency/overtime positions. to support three Cork based nurses in their robust challenge to their exclusion from application for senior Cork University Maternity Hospital: The HSE finally staff nurse grade. The HSE sought to justify this exclusion delivered on the education and training grant with the on the basis that the nurses failed to comply with the pre- assistance of an independent chair in December 2008. determined criteria as set out in 1999 and 2001: This benefited all midwives/nurses who moved to CUMH on 31 March, 2007. • Six out of the last 20 years must be with the Irish public health service Implementation of the March 2007 agreement continues and was evidenced this year by the appointment of • Three out of the last six years must be with the Irish neonatal shift leaders, three midwife skills facilitators, a public health service ‘Cois Ti’ home liaison CMMIII and offers of permanency • One year with current employer. for all student midwives. The INO advised that: “Such a regime operates to We await the publication of the Birthrate Plus analysis the detriment of migrant workers who are nationals of the soaring delivery rates of 8,800 per annum. The of member states...where the workers are refused hospital is only staffed at 376 midwife/nurse posts for an recognition of periods of service completed in those anticipated 7,000 deliveries. states on the sole grounds that those periods were not We are currently challenging the new entrant status completed in an Austrian University”. of former Bon Secours midwives with the Pension On 17 November 2008, having lodged four INO appeals Ombudsman. in this case (the final appeal was lodged directly to the National Director of HR, the HSE confirmed their Primary community and continuing care immediate commitment to rescind all previously St Finbarr’s Hospital: We were pleased to welcome a applied restrictions for all nurses and midwives with newly appointed director of nursing and we delivered 20 years genuine experience in response to the INO’s conversions for long term actors. This is a very positive comprehensive submission. step. The three claimants secured the award and have, by their Children’s Unit: Two years’ loss of earning was awarded robust challenge, opened the door for many more nurses for six nurses who were compulsory redeployed to a and midwives who come and work in this country. paediatric clinic. Cork University Hospital: 2009 was another challenging St Patrick’s Hospital, Fermoy: The INO worked hard with year for INO members in CUH. As a result we have two newly appointed nurse reps to implement: strengthened the membership base through our involvement in: • 37.5-hour week against all odds • Establishing an Industrial Relations Forum which meets • Acting up pay on night duty six weekly with nurse management and the CEO. This • Retrospection for CNMI group. forum is further supported by our INO committee Heatherside Hospital: Improvement in staff relations • Overseeing implementation of parental leave in units during 2008: of days or weeks following a positive Labour Court • Positive reports from the Leeds University initiative on recommendation staff empowerment • Employment of all graduate nurses • Secured agreement on the provision of a new nurses’ • Conversion of long term actors with over three years station service • We await the publication of the Hannah Comber • Roll out of four ANP posts for emergency department independent review. • Confirmation of mainstreaming of the Chair Pilot Off Shore Islands (Cork): Following discussions with the Programme HSE, Labour Relations Commission and Labour Court

1. Industrialrelationssection.indd 31 30/03/2009 10:27:35 involvement, we finally concluded the implementation of Cork/Kerry the ‘theatre on call’ agreement which is operational on the off shore islands (Galway/Mayo). 37.5-hour working week: The past 12 months has seen a considerable amount of time being invested in The nurses are now aligned to a supportive package which achieving the reduction in the working week for nurses includes: enhanced time off for liability to be on the island to 37.5 hours. This was achieved with varying degrees of on Saturday, Sunday and public holidays; theatre on call difficulty. Ironically some of the larger hospitals achieved rates and clarity on mileage and subsistence. We await a its introduction on the due date whilst some of the smaller return to the LRC to seek application of retrospection and community hospitals still await its introduction. the responsibility allowance in recognition to the nurses being the only clinicians on the island. The three outstanding community hospitals within Cork/ Kerry which have failed to achieve the introduction of Challenge to student public health nurse competition: the 37.5-hour week are all areas in which we sought to The members in Cork were extremely aggrieved at progress staffing claims through the LRC in recent years the manner in which this competition was run which without any degree of success. The concentration of served to disadvantage many applicants and deny them management in preventing the introduction of the 37.5 opportunities to secure PHN training. hour week in these locations, could, I suggest, have been used more productively in supporting our previous Several of the Cork applicants challenged the ethics of the claims for enhanced staffing levels. competition under Section 8 Public Service Appointments Commission and the outcome yielded recommendations Mercy University Hospital: The significantly enhanced to be followed in 2009: accident and emergency unit in the Mercy University Hospital eventually opened at the latter end of November • Every effort should be made to have place numbers 2008. The delayed opening of this facility attracted a lot available prior to advertising of media attention and negative comment with regard to • Restriction of candidates to two LHO choices should be the reasons for its delay. The primary reason for the delay reviewed immediately was related to resources, in that the INO has launched a claim for significant staffing numbers within the • The mechanism for offering placements from the panel enhanced facility to reflect the greater physical lay out should be outlined in detail and the increased attendances within the unit. The INO • Particular effort should be made to maintain adequate withstood a concerted media campaign initiated at the and appropriate communications with people on the highest levels within the HSE in their attempts to achieve panel as offers are made/accepted, etc. the opening with the current staffing levels. Day Care Co-ordinators – Day Centre Nurse Managers At one point it was suggested that the new facility open (CNMI): The INO sought standardisation of this grade in on a 12-hour basis. This was rejected by our members Cork to assume the majority national grade of CNMII. The and nurse management of the hospital. Agreement was Labour Court has backed the claim and we await national finally reached which allowed for a curtailed opening of implementation of CNMII. the new facility until such time as the agreed staffing numbers could be achieved to enable its full opening. Superannuation – spouses and children: We have been It is anticipated that this recruitment process will be working with two anomalous situations namely: completed by spring 2009. • Where delayed notification of obligation to pay spouses Overall, 2008 was a difficult year for our members and children on past temporary service precipitated a employed within the Mercy University Hospital due large unannounced deduction from a member’s lump to the financial constraints placed upon the hospital. sum on retirement. This case is still before the Pensions This resulted in the closure of a 31-bed surgical ward, Ombudsman. curtailment of day services and closure of the operating theatres for specified periods during the year. It is difficult • Where members in the South have discovered that to see how this situation will improve as the current the HSE has not deducted spouses and children (1.5%) specialities available in the hospital may be transferred from their salary on the basis that the HSE contends to the Cork University Hospital. the members waived the rights to the scheme. This presumption is being hotly contested by the INO as Despite this the INO has successfully negotiated a proof of waiver cannot be established to date. We await number of upgrades for various members from CNMI to the views of the Pensions Ombudsman in these cases. CNMII and CNMIII in infection control and occupational health. Community Nurses Forum: The INO held our inaugural meeting in October to offer support, guidance and advice The South Infirmary/Victoria University Hospital to all our community nurse members, many of whom (SIVUH): The South Infirmary also faces an uncertain work in remote settings. Together we compiled a list future given the proposed realignment of services within of professional and industrial relations guidelines for the greater Cork area. This is further compounded with meeting the needs of PCCC clients over winter 2008. We the proposed move of breast services from the SIVUH plan to meet again to review progress in March 2009. to Cork University Hospital (CUH). This is against the

1. Industrialrelationssection.indd 32 30/03/2009 10:27:50 background of some 400 symptomatic breast cases Dingle Community Hospital: The INO referred a being dealt within the SIVUH as opposed to a number of claim on behalf of our members working in Dingle in excess of 100 within the CUH. It is difficult to reconcile Community Hospital to the Labour Court. This related to the logic behind the move given that the breast services the application of the Gaeltacht allowance to all nurses in the SIVUH are adjacent to the breast check services who work within the Gaeltacht area. The Labour Court which are housed in the same campus. issued a recommendation in April which was less than definitive and suggested that both parties should meet Successfully represented a number of members on to discuss the matter further at national level. Despite individual claims as diverse of application of sick pay national discussions the HSE remains of the position that schemes, on call rates and Trust in Care. there is no merit to our members’ claim. Therefore, the Brothers of Charity, Lota: The Brothers of Charity in Lota issues will have to be referred back to the Labour Court is currently undertaking a transfer of services from a for recommendation. campus base setting to a community based environment. This has been the subject of 10 Labour Relations Conciliation conferences and was eventually brought HSE – South East Region back to local discussions at the latter end of 2008. Liz Curran Significant progress has been made with regard to the proposals surrounding the move to the community and this includes the creation of a CNMII on night duty. Wexford: This will give a nursing management structure within • In Wexford General Hospital, the the Brothers of Charity for the first time in that there dispute over the non-implementation is currently no nurse manager within the management of the independent staffing review hierarchy. of the A&E unit was referred by the INO to the Labour South Doc: Due to the reduction in the monies allocated Court, who recommended that the HSE should provide to the South Doc out of hours service from the HSE, the the funding to immediately implement the outstanding company sought to curtail the number of nurses working elements of the review. The Labour Court also upheld a within the service. This resulted in a three tier settlement Rights Commissioner recommendation that the INO claim for our members which entailed the following: for upgrading of the A&E CNMII to CNMIII be decided at national level between the INO and the HSE. • Those members who were employed to provide a bag only service would have their position made redundant • A comprehensive independent review of the staffing and they would be compensated to the tune of six weeks levels and grading structures in the maternity unit of redundancy per year of service Wexford General Hospital was recently completed. The report and recommendations have issued to the HSE, • Those that had a dual function, ie. bags and weekend but not to the INO, who have sought a copy of same. treatment centre hours would be compensated for the loss of their bags hours as per the terms of the • Arising from a successful Rights Commissioner case on redundancy offered to those solely providing the bags behalf of a member in the gynae ward of the hospital, function and they would also receive compensation all midwives in the gynae ward will now be paid the for loss of hours due to the realignment of services at specialist qualification allowance, retrospective to weekends May 2008. Negotiations are ongoing regarding the re- designation of the ward into an obstetric-gynae unit. • Those providing a service in the treatment centres at weekends only would receive compensation up to two • Negotiations on the opening of the phase two buildings years actual loss of the reduction in their hours even are ongoing at present. though in some instances they would not incur any • Negotiations regarding the future of Ely Hospital, actual loss as additional hours would be made available Wexford, have continued throughout the year. The INO mid week. Therefore these members would receive six claim for compensation for loss of premiums for our months compensation up front and their actual loss members in the service was heard by the Labour Court, would be reviewed on a six monthly basis in future. who favoured the INO position, and the payments are Kerry General Hospital: In Kerry General Hospital (KGH) currently being processed. Members are currently the roll out of the Edna Cobain staffing review is still considering proposals for a reduced service. awaited and is now the subject of national discussions Waterford: presently being conducted by David Hughes, Deputy General Secretary. KGH is another location whose future • In Waterford Regional Hospital, lengthy discussions is far from clear and it is uncertain what services may were held regarding the sleep time for theatre staff on be realigned or transferred off site to Cork. Meetings call at weekends, and the INO secured a more beneficial are awaited with NHO, network manager regarding arrangement than previously had been in place. Also, their plans for 2009. Claims lodged for an upgrade of a additional benefits for theatre staff (including extra time CNMII post within the A&E facility to CNMIII and a similar off in lieu) was negotiated in response to management’s upgrade sought for the CNMIIs on night duty to CNMIII. request that the theatre staff do a second night on call

1. Industrialrelationssection.indd 33 30/03/2009 10:28:04 for a nine week period, to facilitate the refurbishment of • In the Sacred Heart Hospital in Carlow, an additional the obstetric theatre. nurse on nights was also negotiated, and a compensation package for loss of premiums and for the loss of some • In St Patrick’s Hospital, Waterford, proposals have issued time in lieu was negotiated by the INO and accepted by regarding the closure of a ward in 2009, and the INO will the members there. commence negotiations on this matter. The INO is pursuing a number of unimplemented • The upgrading of the night CNMII in Belmont Park, agreements/Labour Court recommendations in the Waterford, was the subject of three conciliation region at national level with the HSE, including: conferences of the LRC, as part of a national claim. Whilst the upgradings were achieved in three other • Unimplemented staffing reviews in: St Patrick’s areas, agreement has been reached that the upgrading Hospital, Cashel; St Brigid’s Hospital, Carrick-on-Suir; St in Belmont may proceed when the services expand into John’s Hospital, Enniscorthy and the A&E department in the community in the near future. Wexford General Hospital Tipperary: • Unimplemented national agreements: second assistant director of nursing in Kilcreene Hospital; theatre CNMII • In South Tipperary General Hospital, Clonmel, proposals posts in St Luke’s Hospital Kilkenny and Wexford General have issued regarding the reconfiguration of services Hospital, bed managers gradings at the hospital in 2009. The INO will shortly commence discussions with management regarding same. • Unimplemented Labour Court recommendation regarding premium pay in Ard Aoibhinn, Wexford. • In Damien House Services, Clonmel, agreement was reached regarding the staffing levels required for an A large number of individual issues were successfully additional, newly constructed residential house in the resolved at local level and some were successfully services. resolved with the assistance of the Rights Commissioner Service of the LRC. Many more INO claims continue to be • Negotiations are ongoing with management of Our pursued locally and via the LRC. Lady’s Hospital in Cashel to further develop the services provided to patients there, but the staffing levels agreed for phase one have not been implemented by the HSE. HSE – Western • In South Tipperary Community Care, the INO secured the Region upgrading to assistant director of public health nursing Noreen Muldoon grade, of a PHN member organising home help services. Regina Durcan Kilkenny and Carlow: • In St Luke’s Hospital, negotiations regarding additional staffing for a number of areas of the hospital (eg. A&E and maternity) are ongoing. An additional 25 nursing hours were secured for the A&E department at a conciliation conference of the LRC, but no additional resources were Labour Court Recommendations: One of our members, provided to the maternity unit at conciliation. Staffing a retired principal midwifery tutor in Galway, has been claims for both areas have been referred to the Labour awarded e15,000 net by the Labour Court. The INO Court and a date is awaited for same. referred the member’s claim, regarding the payment of the qualification allowance to the Rights Commissioner • Discussions are ongoing with management to ensure Service, who awarded her e15,000. The member accepted the closure of the MAU unit at 9pm each night, with the compensation. HSE West appealed the Rights a focus on prevention of overruns in the department. Commissioner recommendation to the Labour Court. Additional ‘twilight’ hours have been provided at night The decision of the Rights Commissioner was upheld by to assist with this process. the Court. • Discussions have commenced in Kilcreene Hospital Bon Secours Hospital, Galway: The Labour Court regarding the amalgamation of two wards at weekends. recommended that our members working in the surgical • In Aut Even Hospital, Kilkenny, discussions are ongoing day ward of the Bon Secours Hospital would be paid the regarding subsidies for staff meals, and the introduction same as their colleagues in theatre and endoscopy when of a new staff handbook, policies and procedures. The working on Saturdays, caring for the National Treatment 37.5-hour week also commenced on 1 June, 2008. Purchase Fund patients (NTPF). • A staffing review has been completed in both St The claim arose when a solution could not be found for Columba’s Hospital in Thomastown, and in the Sacred our members, who only worked on Saturdays when Heart Hospital in Carlow. Both reviews recommend there was an NTPF list, similar to their colleagues in the extra nurses and care assistants and the INO are operating theatre and endoscopy. They were treated less seeking implementation of the recommendations of favourably than their counterparts. The Labour Court both reports. recommendation outlined that the claimants should be

1. Industrialrelationssection.indd 34 30/03/2009 10:28:33 paid parity with their colleagues in the other departments that they had been rough with a patient. Another on Saturdays when treating the NTPF patients. member was found not to be in breach of the Trust in Care policy, following an allegation that they had spoken Portiuncula Hospital, Ballinasloe: Industrial action by inappropriately to a patient. INO members commenced in Portiuncula Hospital on 17 November, 2008 in support of two of their senior nurse Galway Acute Services: A member was found not to be manager colleagues who were suspended on full pay for in breach of Trust in Care policy following an allegation an eight week period. Our members in dispute viewed that they had inappropriately touched a patient. this action as an inappropriate use of the disciplinary Two of the above members were suspended from work procedure. The dispute took the format of no acting with full pay, until the investigations were complete. up to assistant director of nursing level, initially for a They are now all back to normal working. one week period. A lunchtime protest took place on 18 November, 2008 which was exceptionally well attended Brothers of Charity Services, Galway: The INO was by INO members and very well supported by colleagues successful in having the night CNMII upgraded to CNMIII and supporters from other unions, including SIPTU, level and the CNMI upgraded to CNMII and consequently IMPACT, IMO, IHCA and others both from Portiuncula to CNMIII level, with retrospection, at the Brothers of and elsewhere. Agreement was reached to resolve the Charity Services, Galway. dispute and the industrial action was called off on 24 November, 2008. Non-National Nurse: The INO was successful in getting compensation of e1,000 for one of our non-national Mayo General Hospital: Agreement was reached in 2008 members working in a nursing home group. The member to appoint a CNMIII for support services in Mayo General was recruited from abroad in January 2008 to work as an Hospital. The INO referred the claim to the LRC in 2007. RGN. On arrival this member was given a nurse’s contract Agreement was reached throughout that service and a but worked, and was paid, as a healthcare assistant CNMIII for support staff has now been appointed (HCA) by the group. Four months later the contract was PHNs – Off-Shore Islands: Retrospection, dating back changed to that of a HCA. The INO was successful in to January 2003, has been calculated and paid to our having the contract changed to staff nurse, all monies PHN off shore island members in Co Mayo, for their repaid including all expenses incurred by the member, in e commitment to provide an on-call/call-out service to addition to the 1,000 compensation, and an increase in the islanders. This completes the agreement for Mayo the hourly rate of pay. This member was being exploited following protracted negotiations with the INO including by the employer and was not aware of their rights until referral to the Labour Court. The retrospective aspect of contacting the INO. the deal is currently being calculated for our Galway off University College Hospital Galway (UCHG): The shore PHN members. emergency department opened a paediatric area within St Francis Community Nursing Unit, Galway: An the unit in 2008. The INO members objected on the additional six nursing and four support staff have been grounds that the area was unsatisfactory and a directive appointed to enable the existing six beds to reopen. was issued by the HSE West. Our members opened the unit ‘Under Protest’. Currently the INO are awaiting a date Áras Mháthair Pól Community Nursing Unit, to review this service. The numbers of patients awaiting Roscommon: Negotiations are continuing, including admissions to UCHG has increased throughout the year, referral to the Labour Court, regarding the INO’s claim for with the numbers going over 40 on a number of days for additional nursing staff. Currently there is only one nurse the first time ever. This is exacerbated by the closure of on night duty in the unit to care for 34 patients. a number of beds both in UCHG and Merlin Park and the Plunkett Community Nursing Unit, Boyle, Co cut-backs. Roscommon: Negotiations continue to have an 37.5-hour week: The 37.5-hour week has been introduced independent review and Labour Court recommendation in all health area settings in the west. A number of key implemented. areas introduced the new roster in June and throughout Almost all other elderly care facilities in the west 2008. Others followed in January 2009, including Galway require additional nursing and healthcare personnel. University Hospitals. Negotiations are ongoing. The Brothers of Charity also introduced the new roster Independent investigations: A number of independent in early 2009 completing the introduction of the 37.5- investigations were carried out during the year, mostly hour week in the west. All the hard work, dedication under Trust in Care, involving individual members, all and commitment of our members is graciously represented by the INO. acknowledged. Galway Elderly Care: A member was found not to be in Feedback from our members indicated that the 37.5-hour breach of the Trust in Care policy following an allegation week is working very well and is very much appreciated.

1. Industrialrelationssection.indd 35 30/03/2009 10:28:49 Branch Development Project

The evolving environment in which the INO operates since its INO MEMBERSHIP – Dec 2008 inception in 1919 has impacted 40,000 on the nursing and midwifery 40,000 profession as well as on the 35,451 35,000 Organisation’s members as individuals. 30,000 27,834

While the INO has continued to 25,000 successfully recruit, retain and 21,862 increase membership throughout 20,000 its 89 years of existence, with Mary Power, 15,000 14,500 Branch Development, a high density in the public 10,102 INO health sector – see diagram, it 10,000 was deemed appropriate by the Executive Council to review the effectiveness of the root 5,000 437 1,128 and branch structures within the INO. 0 1929 1941 1988 1993 1998 2000 2006 2008 In September 2007 the Branch Development Project was established to determine what was good with the INO systems, requirements for review/remodelling and to identify relevant changes to ensure the greatest In October 2008 an organisational development project participation of membership within the INO from the committee (ODP) was formed from the many INO perspective of the grass roots member. The ultimate stakeholders, ie. President, General Secretary, Executive objective of the project being to build an effective, Council, IROs, branch officers and reps. Work has democratic and self sustaining local Organisation. commenced on identifying the priorities for progression, which can be broadly summarised under the following Much research was conducted including members headings: and activists discussions, presentations, interviews, questionnaires, national workshops, coupled with many • Provide strong leadership and relevant vision to pilot projects engaged in at the different sites, over the members life of this project. • Be an all embracing and inclusive union with real Some of the pilot projects included: engagement and involvement • Development of branch/hospital committees focused on • Be accessible to members locally promoting strength raising local profile and bringing the INO to the member in numbers at their workplace • Provision of a more enhanced two way communication • Creation and circulation of local branch/hospital system newsletters aimed at increasing membership awareness • Developing a strong motivated representative and of local activities branch officer structure complemented by the provision • Regular hospital walkabouts by local activists of dedicated, appropriate mentoring, training and up- skilling • Collation and dissemination of specific INO information folders for each unit in pilot hospitals • Develop relevant facilities for students and young members • Trialled a pilot training programme for experienced activists • Proactive support in development of the profession, as well as protecting and improving the members’ terms • Using enhanced communication tools to ensure speedy and conditions of employment and timely information dissemination • Moving the union collectively forward into the future in • Piloting dedicated regional youth councils for members a positive meaningful way for all nurses and midwives. under 35 years All the research completed to date suggests that the INO • Provision of specific educational seminars at branch/ must first focus on the relationship between the member hospital level and the Organisation. When the relationship is enhanced, • Organising specific social events for branch members. the structural changes required will subsequently evolve. The final report produced many recommendations which Work continues to be progressed and the ODP committee were unanimously adopted by the Executive Council for will be making a presentation of work to date to the 2009 progression. ADC.

1. Industrialrelationssection.indd 36 30/03/2009 10:29:07 Organisation and Social Policy Section 2

2. Organdsocpolicysection.indd 1 30/03/2009 11:15:11 2. Organdsocpolicysection.indd 2 30/03/2009 11:16:25 Organisation and Social Policy

There were a number of new maintain human rights based principles, in providing developments in the area of social care for asylum seekers/migrants. The paper outlines policy in 2008. The committee the establishment of a children’s play therapy facility for worked closely with ICTU, refugee accommodation centres, and a men’s support Immigrant Council of Ireland, HSE, group for male asylum seekers in accommodation, and government departments and highlights the pivotal role that nursing can play in and participated in a number of leading on the importance of transcultural approaches to projects. healthcare in an Ireland that has changed greatly over the past decade. The ever increasing number and complexity of cases before the

Clare Treacy, Fitness to Practice Committee Conferences and Forums Director of Organisation ensured a busy year, which The INO was represented at the following conferences and Social Policy, INO included the rollout of an education by the Director of Organisation and Social Policy and programme for members and a Executive Council members: detailed response to the proposed Nurses and Midwives Bill. • Social Policy Conference – “Who Pays? Access and Equity in the Irish Healthcare System” – September Social Policy Committee 2008 • ICTU Women’s Conference – “Women in Leadership” – The Social Policy Committee is a sub-committee of March 2008 the INO Executive Council, and includes Mary Barrett, Helen Buckley, Maureen Parkes, Breege Scanlon, • National Women’s Council of Ireland – “Marriage Madeline Spiers, Judith Tabuena, Jo Tully, and Colette Equality”– September 2008 O’Sullivan. The committee dealt with a number of issues • ICTU Lesbian/Gay Bisexual Transgender Inaugural throughout 2008, and received reports from the Director Conference – June 2008 of Organisation and Social Policy, as well as representing the INO at a number of external forums. The committee • ICTU Disability Seminar, Derry – November 2008 considered matters relating to the following: • Social Inclusion Forum, Croke Park – November 2008 • Green Cards Employment Permit Legislation • Trocaire Conference “Equalities and Developments in • Immigration, Residency and Protection Bill Globalised World”, Dublin – June 2008 • Trafficking of people and exploitation • The Women’s Health Council “The Menopause and Me” – This conference was held in April and was opened by • Migrant nurse research (RCSI Project) Minister for Health and Children, Mary Harney TD • HSE Intercultural Health Strategy • “Health, Faith and Equality” – This conference was held • Privatisation and co-location in Trinity College in April and was launched by Emily O’Reilly, Ombudsman • The challenges of an ageing workforce. • National Women’s Council of Ireland “Women and Cervical Screening Programme Financial Inclusion”, Dublin – December 2008 • Immigrant Council of Ireland “What is being done to In response to an ADC motion the Director wrote to prevent trafficking in women and to assist victims?” – the Minister for Health and Children, Mary Harney October 2008 (speakers from the European Women’s TD, seeking a national rollout of the cervical screening Lobby Nordic-Baltic Project, Rosa Project in Norway and programme. Although she responded positively to our the Irish Anti-Trafficking Unit) correspondence she omitted to confirm the date when such a programme would be rolled out on a national • Immigrant Council of Ireland “Ireland and Council basis. Subsequent to this, Ms Harney announced that of Europe Convention on Action against Trafficking the programme of vaccination for 12-year-old girls would in Human Beings: Protecting Victims: What Next?” – not commence due to budget cuts. This was strongly April 2008 (speakers from the Council of Europe and condemned by the INO and the ICTU. Ireland). Transcultural nursing Migrant nurses The first European Transcultural Nurses Association 2008 saw the full replacement of the Work Visa (Harney Conference took place in Turkey. The INO part-funded PJ Visa) with the Green Card System. There were a number Boyle, CNS (Asylum Seekers Health) to attend. Mr Boyle of concerns raised by the INO in this regard. The Green presented a paper examining the role of the CNS (Asylum Card is only available to individuals who earn in excess Seekers Health), which included practical examples of of e30,000 per year. Obviously, nurses who work full time nurse-led interventions and projects that attempted to fit into this category. However it restricts the ability of

2. Organdsocpolicysection.indd 39 30/03/2009 11:17:54 a nurse to reduce their hours, and if a nurse does so, • 2001, 2005 and 2006 were bumper years for recruitment, there are potential immigration ramifications. The new with approximately 2000 working visas issued to nurses legislation also prevents a nurse from working through each year an agency, thus limiting the number of hours which a • 2000-2007, 41% of new entrants to the Irish Nursing migrant nurse can work. This has potential ramifications Register were non-EU (a further 11% were EU). The for the health service as the availability of agency nurses research reveals that overseas nurse migration did not will obviously be decreased. Other additional restrictions reduce following the ‘gap’ year of 2005 are also in place which limits the rights of nurses’ children to attend third level education. • Increase supply of nursing graduates in recent years has not reduced Ireland’s need for migrant nurses The INO submitted a detailed response to the Immigration, Residency and Protection Bill 2008, and raised a number • Only 44% of new qualifications registered in 2007 were of concerns including: from Irish nurses. • Lack of provision of a right to family reunification The INO, together with the Department of Health and Children, Department of Enterprise, Trade and • No provision for permanent residency Employment, Department of Justice, Equality and Law • Requirement for health services to confirm patients Reform and An Bord Altranais, are key stakeholders in immigration status. this project. We expressed particular concern with Section 6 of the The key research findings in 2008 are extremely significant, Bill which limits access to services provided by the HSE and identify that Ireland is the most dependent country in to people who are ‘unlawfully present’ in the State. the OECD on migrant nurses. This raises a question of the Notwithstanding the exception to provide ‘essential long term sustainability of Ireland’s reliance on overseas medical treatment’ we interpret that nurses and other nurse recruitment. health personnel will be required to assume the role of The research has also indicated that over half of the immigration officers before agreeing to provide treatment migrant nurses interviewed intend to leave Ireland to migrants. The INO views healthcare as a right for all within the next five years. A desire to be settled in Ireland individuals regardless of political, geographical, racial was high on migrant nurses list of priorities, and it or religious considerations, and we do not endorse the outweighed career related considerations in determining possibility of nurses identifying a patients immigration future plans. status prior to providing care. Countries such as Canada and Australia are proving to An INO delegation met with representatives from the be much more attractive for migrant nurses as they have Department of Enterprise, Trade and Employment, and a more transparent immigration and residency process the Department of Justice, Equality and Law Reform to which treat the children of migrant nurses equal to other discuss the impact of the Green Card and the immigration citizens with regard to access to education and other legislation. We argued that nurses should be allowed to services. avail of long term residency after two years rather than five years. We believe that this will help to minimise the uncertainty which nurses now have, with regard to Irish Congress of Trade Unions their immigration status, and will contribute to retaining recruited nurses from overseas, in the Irish healthcare The Director of Organisation and Social Policy is a system. member of the Executive Council of the Irish Congress of Trade Unions and represents the ICTU on the following We will continue to work closely with officers from the ICTU, committees: and the Immigrant Council of Ireland, to campaign for a more seamless, transparent and ‘family friendly’ legislation • The National Women’s Strategy Monitoring Committee which will provide stability and the basis to maintain the • The National Anti-Trafficking Committee. integrity of the family unit of migrant nurses in Ireland. The INO is also represented on a number of ICTU Nurse Migration Project (Royal College of Committees: Surgeons) • Women’s Committee The Nurse Migration Project is a four year project due to • Global Solidarity Committee be completed in November 2009. A significant amount of • Strategic Implementation Committee for Equality work was carried out in 2008 which included qualitative Initiatives. research in collaboration with the INO. ICTU Women’s Committee: June 2008 saw the INO The project aims to address the workforce planning successfully contest the position of chairperson of the issues that face Ireland in the coming years. Some of the ICTU Women’s Committee. Clare Treacy was appointed for interesting findings to date are as follows: a two year term. Although the INO has been represented • 2000-2008, 11,240 working visas issued to non EU nurses, on the committee for many years this is the first time that 90% issued to nurses from India and the Philippines it has held the position of chairperson.

2. Organdsocpolicysection.indd 40 30/03/2009 11:18:22 The committee will be working closely with the officers organisations and members of the civil society. It also of ICTU, and the Northern Ireland Women’s Committee recognises that victims of trafficking must not be to ensure that the equality agenda for women remains a treated as criminals, and must be afforded international priority for ICTU. fundamental rights. Ireland has been identified as a country with an increasing number of people being It is important that we encourage greater participation trafficked for sexual and labour exploitation. from unions and ensure that we have strategic alliances with senior women in the trade union movement. The National Women’s Strategy Monitoring Committee: committee will focus on issues for women at work, This committee is chaired by John Moloney TD, Minister including childcare, pensions and leadership. for State, and includes representatives from all government departments and social partners, including the voluntary Overarching all of these areas is the continual widening pillar. The National Women’s Strategy resulted from of the gender pay gap. The Women’s Committee the 1995 Beijing platform for action, with each country participated in a European wide programme to develop required to develop a national women’s strategy. The Irish strategies around reducing the gender pay gap, which is strategy focuses on three key themes of: currently 17%.As chair of the Women’s Committee, the Director represents the ICTU at the European Trade Union • Equalising socio economic opportunity for women Confederation (ETUC). • Enhancing the wellbeing of women Global Solidarity Committee: Clare Treacy and • Engaging women as equal and active citizens. Breege Scanlon (INO Executive Member), are the INO representatives on the Global Solidarity Committee. This Although the ICTU warmly welcomes the development of committee promotes co-operative relations with the trade this strategy, we expressed serious concerns with regard unions in other countries, for the purpose of furthering to its progress in certain areas, in particular health. We the common interest of workers in all countries. were particularly concerned with the slow rollout of breast check and the withdrawal of the cervical cancer The principle objective is to bring international solidarity vaccination. We also expressed concerns with the poor into the main stream of the work of Congress, and its level of progress in relation to work on the gender pay affiliated Organisations. In 2008, the Global Solidarity gap. We welcomed the progress with regard to proposals Committee participated in projects in Cuba, Columbia to increase the representation of women in decision and Zambia. Further information is available on www. making areas, including government organisations. ictuglobalsolidarity.org. Strategic Implementation Committee for Equality Initiatives: This North/South Committee of ICTU co- Fitness to Practice ordinates activities in the area of discrimination across The number of nurses and midwives represented by the all nine grounds. Issues such as disability, work-life INO at fitness to practice continues to increase with 37 balance, and the national action plan against racism nurses represented in 2008 in comparison to 29 in 2007. and anti-racism workplace week are key issues for the Five of these cases were considered under Section 44 of committee. We worked very closely throughout the year the Nurses Act 1985. This is a draconian section within the with the Equality Authority and coordinated the ICTU legislation which allows An Bord Altranais to immediately responses to all changes in this area. The committee apply to the High Court to temporarily remove a nurse actively supported the campaign to oppose the massive from the Register, in order to protect the public. cuts inflicted on the Equality Authority, the Human Rights Obviously the cost of attending High Court proceedings Commission, and the Combat Poverty Agency. can be significant, and it again reinforces the absolute Anti-Trafficking Committee: This national committee importance for all nurses and midwives to be members under the auspices of the Department of Justice, of the INO to ensure professional and effective Equality and Law Reform was established following representation. the introduction of the Criminal Law (Human Trafficking Due to the volume of complaints, we continue to Act 2008), which aims to prevent, suppress and punish experience delays which the INO raised with An Bord trafficking in persons, especially women and children, Altranais. The INO has also strongly objected to the and to prevent labour and sexual exploitation. massive increase in registration fees, which has been Trafficking in human beings is a major problem in levied on all nurses and midwives by An Bord Altranais, Europe. Every year an increasing number of people in order to pay for the increasing costs of fitness to fall victim to trafficking, mainly for sexual exploitation, practice. Despite our strong protests, An Bord Altranais but many as underpaid or illegal labour in farms, sweat have refused to reverse its decision. shops and private households. The International Labour In 2008 An Bord Altranais published its revised policy on Organisation estimates the number at over 2.45 million, publication. In effect, it has confirmed that it will publish most of them women and children. Trafficking is seen as the names and details of the conduct of the nurse on its the modern form of the old slave trade. website, following a finding by the Fitness to Practice This committee recognises the importance of co- Committee. Although the INO has confirmed its support operation between public authorities, non-governmental for transparency with regard to fitness to practice, we

2. Organdsocpolicysection.indd 41 30/03/2009 11:18:37 have concerns with regard to the publication of certain details such as a nurses medical/psychiatric history. The INO believes that in most occasions this should be seen as a private matter and one that is not published. The complaints made against nurses and midwives in 2008 range across a number of areas including: • Alleged unfitness to practice, due to alcohol and/or drug abuse • Use of drugs at work in the absence of appropriate prescription • Alleged failure to provide an appropriate level of nursing care, and alleged incompetence • Misappropriation of prescription drugs for personal use • Alleged sexual assault of a patient Participants in the 2008 Women At Work Skillnets programme with their certificates • Alleged breach of confidentiality • Alleged physical abuse of a patient This project called Women at Work is funded through • Alleged unfitness to practice due to a sight disorder. Skillnets, and is a unique programme which allows for As is evident from the above, the allegations against trade unions to work together to identify the needs of nurses are varied and often extremely serious. their members, and to provide training free of cost throughout the country. The programme in 2008 was Education sessions: In response to the increasing number extremely successful, culminating in December with an of nurses being reported to fitness to practice, the INO award ceremony, with Mary O’Rourke TD, presenting rolled out a significant number of education sessions certificates to all participants. This project has proven that throughout the year. These were delivered to branches, networking between different unions has been extremely nurse representative training courses, section meetings, advantageous and the Women at Work Skillnets Project and lunchtime lectures in larger hospitals. These sessions has been identified as one of their most successful proved extremely popular and highlighted the importance programmes. of accurate and professional report writing, as well as an The programme of training in 2009 will include courses outline of the principles of writing a statement. of interest to practice nurses, migrant nurses, and those working in private nursing homes and hospitals. The Skillnets Project Women at Work Skillnets Programme is supported by a number of employer groups including the GP section of The INO together with IBOA (the finance sector union), the IMO and the Nursing Home Association. MANDATE, CWU, and IMPACT successfully applied for funding to upskill women in the private sector, by Clare Treacy is a member of the management committee providing an opportunity to enhance their skills through and Mary Power represents the INO on the steering professional training and development courses. committee.

2. Organdsocpolicysection.indd 42 30/03/2009 11:18:54 Professional Development Centre Section 5

3. PDCSection.indd 1 30/03/2009 11:33:14 3. PDCSection.indd 2 30/03/2009 11:33:40 Professional Development Centre

The Professional Development • Delegation and Clinical Supervision Centre (PDC) faced a number of • ECG Interpretation challenges in 2008 in supporting members in their professional • End of Life Care for Older People: Pain and Symptom development through workshops Management and conferences, due to the • Healthcare: Risk and Safety Management restrictions in funding of education programmes by the HSE and • Heartsaver Healthcare Provider AED the difficulties for employers in • Heartsaver Healthcare Provider CPR releasing staff to attend education programmes. • How to Confidently Prepare For a Selection Interview Annette Kennedy, Director of Professional Whilst attendance at in-house • Introduction to Palliative Care Development, INO workshops decreased or had to be cancelled, organisation specific • Leading Ante-Natal Classes workshops increased and allowed • Leg Ulcer Study Day members to attend workshops without the added cost of travel and time. • Management Development Programme 2008 The PDC continuously seeks to develop new programmes • Management Competencies for CNMs in accordance with specific requests, member needs and • Management Skills for CNMs and Staff Nurses service developments. • Pressure Ulcer Prevention and Management The library and the N2N website remain busy particularly in term time. The library remains popular • Pregnancy Loss due to personalised support and assistance provided to • Providing a Framework for Delegating Responsibility to members. Healthcare Assistants The PDC’s main activity centred around the Commission • Principles of Best Practice in the Use of Restraint for on the Implementation of a 35-Hour Week and the INO Older People undertook major research to support its submission to the Commission. • Promoting Evidence Based Practice Two researchers were seconded from clinical practice to • Retirement Planning Seminar support the INO research activity and assist in writing the • Research Workshop report through funding from the Department of Health and Children. • Risk Management The researchers are Petrina Donnelly, a CNMIII from • Understanding the Basics of Adult Respiratory Care Beaumont Hospital and Fionuala McCusker, a CNMII from • Wound Care St Vincent’s Hospital, both of whom worked tirelessly to provide an invaluable source of information, both in • Writing Skills. terms of informing the Commission, but also to provide The PDC in conjunction with the Retirement Planning exemplars of good practice to members. Council of Ireland and Cornmarket Group organised a Retirement Planning Seminar which proved to be Workshops 2008 very popular and is an important service to members, including spouses/partners who are planning to retire. The demand for customised programmes which are held both in-house within the PDC and in hospitals, continue A popular six day management programme was held in to be popular as these courses are provided for a specific January/February 2008 for nurses and midwives in the price per day which saves on the costs of participants PDC, which included: Leadership Development, Team travel, accommodation and expenses. Based Management, Negotiation-Problem Solving, Quality Improvement in Healthcare, Empowering The following are a list of workshops provided by the and Enabling Employees, Achieve Greater Personal PDC in 2008: Fulfilment and Aliveness and Creativity in your Life. • Assessment and Care Planning for Older People in Residential Care • Assertiveness Workshop Nursing and Midwifery Student • A Practical Approach to Approaching Research for Recruitment Campaign 2008 Nurses and Midwives A very successful nursing and midwifery student recruitment campaign took place again this year during • Clinical Audit for Nursing Practice which an estimated 1,231 nursing and midwifery students • Clinical Incident Reporting were attracted into the Organisation (see Table overleaf).

3. PDCSection.indd 45 30/03/2009 11:34:26 College No Students Recruited Distance Learning Courses Certificate in Health Service Management - INO/ GMIT Castlebar 32 University of Limerick – Distance Learning Programme: Waterford IT 120 This Certificate in Health Services Management by distance learning programme continues to be highly NUI Galway 41 successful. During the academic year of 2007-2008 a total UCD 69 of 27 students undertook and graduated with a Certificate in Health Services Management. The Dublin study centre DCU 226 had 12 graduates and the Limerick study centre had 15 Letterkenny IT 64 graduates. Dundalk IT 118 Diploma/Degree in Health Services Management - INO/ University of Limerick – Distance Learning Programme Trinity 250* – Honours BA in Health Services Management: UCC 199 This four year programme is aimed at the managerial competencies required by nursing and midwifery Tralee IT 52 managers in health service organisations and focuses Athlone IT 39 on developing core managerial competencies. It requires attendance at college one day every three weeks. This UL 101 year 20 graduated from the diploma programme and 19 graduated from the degree programme.

Total Recruited (estimated) 1,231

* Trinity College is estimated as the recruitment was not due to take place until February ‘09 National Report Commission on the Implementation of a 35- Hour Week for Nurses and Midwives Conferences The Commission for the Implementation of a 35-Hour Working Week for Nurses and Midwives was established Conferences Attendance as part of settlement proposals put forward by the Operating Department Nurse 159 National Implementation Body (NIB) to end a national 4 & 5 April 2008 industrial dispute involving all nurses and midwives Occupational Health Nurses Conference 111 which lasted over a six week period between April and 27 November 2008 May 2007. From an INO perspective this was the most important achievement resulting from the dispute and second only Winner of the 2008 INO Research Award to the original Commission of 1998. The INO, conscious of the importance of the Commission’s work, not only The 2008 Research Award was won by Ann Walsh, public in finding a solution to a reduction in the working week health nurse from Bagenalstown Health Centre, Co Carlow but recognising that any reduction should be part of a for her research entitled The role of the Child Welfare comprehensive reconfiguration of how nurses and Clinic – Perceptions and Expectations of Service Users midwives work and how they interface with other front and Service Providers. The award was sponsored by CJ line staff, undertook comprehensive research to inform Coleman & Company Ltd. the process, in order to provide a written submission to The aim of the research was to examine the role that the Commission. child welfare clinics play in the provision of child health information, developmental assessment, advice and Establishment of the Commission support to parents and families and to gain insights into The inaugural meeting of the Commission took place parents and public health nurses views of the services on 26 March 2008 and the Commission met on a weekly provided. basis until December 2008. Child health surveillance is an important feature of public The terms of reference for the Commission were: health nurses work. The surveillance and monitoring of child health, growth and development has long been • To examine the international experience of best practice regarded as good practice throughout the western world. in the activities and deployment of nurses/midwives The provision of the child welfare clinic is just one aspect and the type of flexibility and change which would be of this role. necessary to achieve a 35-hour week.

3. PDCSection.indd 46 30/03/2009 11:34:42 • To take account of the submission from HSE management, based on the analysis which it is initiating, and the nursing unions who should elaborate to the Commission on the changes they believe would facilitate the 35-hour week. • To produce an independent assessment of how a 35- hour week for nurses/midwives can be achieved, having regard to the issue set out in Labour Court recommendation 18763. • To report to the Minister for Health and Children within six months having reviewed the evidence and engaged with nurses/midwives and management at national and Members of the Commission on the Implementation of a 35 Hour Week for local level. Nurses and Midwives (l-r): Nicky Jermyn; Sandra Walsh; Philip Della; Annette Kennedy; Professor Tom Collins; Dr Siobhan O’Halloran; and Ben Weathers Membership of the Commission The chairperson is Professor Tom Collins, Head of the Education Department at the National University of • An impact assessment on occupational grouping which Ireland, Maynooth and Dean of the Faculty of Social are cognate to the nursing and midwifery disciplines and Sciences. From 2001 to 2006, he was Director of the which would be affected by change in the deployment Dundalk Institute of Technology. arrangements. Professor Collins has chaired a number of committees • A detailed overview of the nature of the daily work of the including the Post Registration Nursing and Midwifery nurse and midwife showing how this work is distributed Education Review Group. over the typical day in the clinical context. Members of the Commission include: • A reflection on a hierarchy of roles associated with nursing and midwifery and the provision of evidence of • Professor Alan Maynard, Professor of Health Economics, the time allocated to each element of this hierarchy. University of York • An exploration of the possibilities for reallocation of • Dr Siobhan O’Halloran, Director of Nursing Services, duties and the economic implications of same, having HSE regard to (a) the training and expertise levels of nurses, • Ben Weathers (ICTU nominee) midwives and other affected occupational groups, and (b) current legislative provision. • Nicky Jermyn, Chief Executive, St Vincent’s Hospital (IBEC nominee) International nursing/midwifery experts were invited to present to the Commission their views on the changing • Professor Phillip Della, Chief Nurse, Western Australia role of nurses and midwives and reconfiguration of • Annette Kennedy, Director of Professional Development, nursing work. is the INO representative on the Commission. The Commission was confronted with certain The Commission engaged in a series of consultations challenges: with nurses and midwives in regional venues throughout • Positioning any changes within the overall transformation the country on two separate occasions and invited programme and direction of health policy with a written submissions from all interested parties. It met particular emphasis on the integration of acute, primary, with key stakeholders including HSE, nursing unions, community and continuing care (PCCC). Departments of Health and Children and Finance, regulatory bodies, education sectors, specialist groups • The changing economic climate and the deterioration of and nurse and midwifery managers. public finances. Comprehensive research was also undertaken by York • Changing the working pattern of nurses and midwives Consortium which included: to allow for the reduction in hours while protecting the quality of patient care. • A comprehensive literature review on the issues surrounding the deployment of nurses and midwives. • Ensuring the maximum efficiency and effectiveness in terms of the nursing and midwifery resource. • A typology of nursing and midwifery practice with particular reference to differential levels of clinical The Commission realised that any solution has to take practice and judgement. into consideration: • An overview of the deployment of nurses and midwives • Changes in nursing and midwifery in terms of skill in Ireland with reference to a number of international mix and related efficiencies in the system through cases. appropriate allocation and rostering of the workforce.

3. PDCSection.indd 47 30/03/2009 11:34:58 • Maximising the skills and competencies of a highly • Section 1 provides an introduction and sets out the educated nursing and midwifery workforce in terms of policy and other drivers affecting nursing and midwifery expanding the scope of practice to include such activities practice, roles and deployment. as prescribing, IV cannulation, nurse and midwifery • Section 2 provides an overview of the consultation and led units and a more active involvement of nurses and research activity undertaken by the INO to inform this midwives in diagnosis, admission and discharge. submission. • Empowerment of nurses and midwives allowing • Section 3 draws on examples of good practice in Ireland for greater involvement by clinical nurse/midwifery and internationally to show how effective workforce managers in decision making. planning can be factored into the achievement of a 35 • Environmental factor changes, which are required hour week. in order to increase efficiency, ie. technology, • Section 4 discusses methods for the effective deployment housekeeping, administration and maintenance. of nurses and midwives to meet patient needs. The INO believes that the findings of the Commission • Section 5 looks at how flexible working time can be used have the potential to deliver systematic change and to introduce a 35-hour week, through the introduction of improve the efficiency and effectiveness in the delivery new working time schedules in areas such as rostering, of patient care services into the future. annualised hours and flexible working time policies. At the time of going to press the Commission on the • Section 6 sets out a strategy and framework for Implementation of a 35-Hour Week was reaching its final the implementation of a 35-hour week for nurses deliberations and it was expected that a report would be and midwives, including recommendations for the issued to the Minister for Health and Children in March establishment of a National Implementation Forum, 2009. the use of action research and learning to support the process of change to a 35-hour week, and the use of a INO Submission to the Commission on Nursing general framework that can be applied at a local level. and Midwifery The INO emphasises the need to acknowledge the This submission outlined the proposal from the Irish multidimensional factors involved in the implementation Nurses Organisation (INO) for the implementation for a of a 35-hour week and the requirement for quality and 35-hour week for nurses and midwives. safety of patient care. Moreover, the INO recommends the use of innovative and dynamic approaches, drawn The INO consulted widely both within the union and from existing exemplars of practice and aimed at the with nurse and midwife members, carried out field work efficient and effective use or deployment of the nursing through observational studies of nurse deployment, and and midwifery resource in Ireland. collated examples of good practices nationally and from other countries. The outcomes of these activities are This is an essential component in ensuring that the described in this submission. nursing and midwifery resource is ‘fit for purpose’. The deployment of nurses and midwives is affected by a In approaching any reduction in the working week range of drivers. of nurses and midwives, the INO has consistently acknowledged that the reduction should come about as However it is important that deployment is realistic and part of a comprehensive reconfiguration of how nurses evidenced based, and is rooted in a co-ordinated and and midwives work and a realignment of how they planned approach involving all key stakeholders. interface with other front line staff. Figure 1 provides a diagrammatic representation of This willingness to embrace reform, through the nurse/midwife deployment in the Irish context. This expansion of their roles and the realignment of duties, shows the main drivers affecting deployment that have was comprehensively presented to the NIB in the course been identified by nurses and midwives, including the of lengthy engagements with the Body in April/May overall policy context, changes in professional roles and 2007. requirements, as well as demographic, cultural and other factors. It also shows the evidence base for the effective Indeed the recent actions of the INO, and nursing and utilisation of nursing and midwifery resources. midwifery generally, demonstrate the willingness of nurses/midwives to push out the boundaries of practice Review and Feasibility Analysis of Nursing and in the interest of patients and better efficiency. This is exemplified through the introduction of nurse/midwife other Related Staff Resource Deployment in the prescribing, mainstreaming IV cannulation, ordering HSE diagnostics and integrated discharge planning. The Health Service Executive (HSE) commissioned This submission aims to inform the decision making Horwath Consulting Ireland Ltd and Teamwork process of the Commission and provide a road map for Management Services Ltd to conduct a national review the realisation of a 35-hour week in the shortest possible of current nursing, midwifery and other related staffing timeframe. The following is a summary of the main resources deployed within clinical units across statutory themes contained in the submission: and voluntary healthcare providers in Ireland.

3. PDCSection.indd 48 30/03/2009 11:35:13 • Maximising the skills and competencies of a highly • Section 1 provides an introduction and sets out the educated nursing and midwifery workforce in terms of policy and other drivers affecting nursing and midwifery expanding the scope of practice to include such activities practice, roles and deployment. as prescribing, IV cannulation, nurse and midwifery • Section 2 provides an overview of the consultation and led units and a more active involvement of nurses and research activity undertaken by the INO to inform this midwives in diagnosis, admission and discharge. submission. • Empowerment of nurses and midwives allowing • Section 3 draws on examples of good practice in Ireland for greater involvement by clinical nurse/midwifery and internationally to show how effective workforce managers in decision making. planning can be factored into the achievement of a 35 • Environmental factor changes, which are required hour week. in order to increase efficiency, ie. technology, • Section 4 discusses methods for the effective deployment housekeeping, administration and maintenance. of nurses and midwives to meet patient needs. The INO believes that the findings of the Commission • Section 5 looks at how flexible working time can be used have the potential to deliver systematic change and to introduce a 35-hour week, through the introduction of improve the efficiency and effectiveness in the delivery new working time schedules in areas such as rostering, of patient care services into the future. annualised hours and flexible working time policies. At the time of going to press the Commission on the • Section 6 sets out a strategy and framework for Implementation of a 35-Hour Week was reaching its final the implementation of a 35-hour week for nurses deliberations and it was expected that a report would be and midwives, including recommendations for the issued to the Minister for Health and Children in March establishment of a National Implementation Forum, 2009. the use of action research and learning to support the process of change to a 35-hour week, and the use of a INO Submission to the Commission on Nursing general framework that can be applied at a local level. and Midwifery The INO emphasises the need to acknowledge the This submission outlined the proposal from the Irish multidimensional factors involved in the implementation Nurses Organisation (INO) for the implementation for a of a 35-hour week and the requirement for quality and 35-hour week for nurses and midwives. safety of patient care. Moreover, the INO recommends the use of innovative and dynamic approaches, drawn The INO consulted widely both within the union and from existing exemplars of practice and aimed at the with nurse and midwife members, carried out field work efficient and effective use or deployment of the nursing through observational studies of nurse deployment, and and midwifery resource in Ireland. collated examples of good practices nationally and from other countries. The outcomes of these activities are This is an essential component in ensuring that the described in this submission. nursing and midwifery resource is ‘fit for purpose’. The deployment of nurses and midwives is affected by a In approaching any reduction in the working week range of drivers. of nurses and midwives, the INO has consistently acknowledged that the reduction should come about as However it is important that deployment is realistic and part of a comprehensive reconfiguration of how nurses evidenced based, and is rooted in a co-ordinated and and midwives work and a realignment of how they planned approach involving all key stakeholders. interface with other front line staff. Figure 1 provides a diagrammatic representation of This willingness to embrace reform, through the nurse/midwife deployment in the Irish context. This expansion of their roles and the realignment of duties, shows the main drivers affecting deployment that have was comprehensively presented to the NIB in the course been identified by nurses and midwives, including the of lengthy engagements with the Body in April/May overall policy context, changes in professional roles and 2007. requirements, as well as demographic, cultural and other factors. It also shows the evidence base for the effective Indeed the recent actions of the INO, and nursing and utilisation of nursing and midwifery resources. midwifery generally, demonstrate the willingness of nurses/midwives to push out the boundaries of practice Review and Feasibility Analysis of Nursing and in the interest of patients and better efficiency. This is exemplified through the introduction of nurse/midwife other Related Staff Resource Deployment in the prescribing, mainstreaming IV cannulation, ordering HSE diagnostics and integrated discharge planning. The Health Service Executive (HSE) commissioned This submission aims to inform the decision making Horwath Consulting Ireland Ltd and Teamwork process of the Commission and provide a road map for Management Services Ltd to conduct a national review the realisation of a 35-hour week in the shortest possible of current nursing, midwifery and other related staffing timeframe. The following is a summary of the main resources deployed within clinical units across statutory themes contained in the submission: and voluntary healthcare providers in Ireland.

3. PDCSection.indd 48 30/03/2009 11:35:13 Figure 1: Nurse/midwife deployment in the Irish context

Drivers

• Funding • Primary Care Strategy • Shift to Community Based Care • Cultural Diversity • Quality Improvement • National standards for various • Evidence Based Practice areas of practice • Clinical Governance • Demographics – Older • National Health Strategy • Transformation Programme population • New Health Legislation • Agenda • Clinical Audit, eg. Hygiene and • Building a Culture of Patient haemovigilance • Accreditation Safety

Deployment Needs

Nurses and Midwives who are ‘fit for purpose’ to meet the changing needs of and demands on the health services

Evidence

• What can nurses and midwives tell us from their • What national exemplars/initiatives can we learn experience at the frontline? from: • What Workforce Planning Models are in use and – EWTD Pilots what can we learn from them? – Specialist and advanced practice initiatives • How do we promote safe effective care? – Nurse led services • What international exemplars/initiatives can we – Expanded scopes of nursing and learn from midwifery developed for local needs – ‘Transforming care at the beside’ – Patient profiles – ‘Releasing Time to Care: Productive Ward’ –Patient acuity – ‘Chronic Care Model’

Deployment: Effective Utilisation of Nursing and Midwifery Resources

What needs to change and what is required for the change?

• Organisational barriers such as • Scope of Practice • Work Redesign support structures • Competency Development • Improvement of key processes • Environmental barriers • Education • Elimination of waste • Skill-mix • Continuing Professional • Rostering Systems • Role design/redesign Development

Evaluation

3. PDCSection.indd 49 30/03/2009 11:35:27 These objectives were set within the context of the The main findings were that the Irish CRGNs are almost industrial dispute by the INO and PNA in early 2007, unique in not having any mandatory educational which focused partly upon the demand for a reduction qualifications or induction prior to commencing work in in working hours from 39 to 35 hours/week, and the the community. commitment by the HSE to examine the feasibility of Irish studies tend to focus on the role of the public health such a reduction. nurse with little research on the role of the CRGN or the The study is based on reducing the contracted hours practice nurse. The questionnaire yielded a response rate from 39 to 35 hours and not on reducing from 37.5 to 35 of 37% (189 CRGNs). hours. The study portrayed an ageing profile for community The findings of the study concluded that by taking into RGNs which is a concern for workforce planning, 71% of account the HSE’s Transformation Programme, comparing respondents are 46 years and over and 50% of respondents the current acute health system at 2014 with the preferred are over the age of 51 years. There is a significant body acute health system at 2014, the model shows that the of experience and qualifications among these nurses and reduction in contracted working hours from 39 to 35 a perception that this resource is underutilised. There is hours in a ‘2014 scenario’ for the whole of the nursing contention among respondents about the lack of clarity workforce covering acute, PCCC and ID services, would of their role and function and also in relation to case load appear to be feasible on a ‘staff neutral’ and ‘cost neutral’ management. basis, only if the underlying assumptions of a reduction Respondents also stated that the archaic conditions in acute beds by 50% and a movement of the services to in which they work with little or no resources, lack of primary care were to be realised. administrative support, no IT infrastructure, leads to The staff side had no input into this study which is to duplication, inefficiency and difficulties in effective inform the Commission’s deliberations. communication. The CRGNs also perceive that they are ‘Jack of all Canadian Nurses Association Centenary trades’ filling gaps in service but with little recognition of their unique role and function in the front line of the The Canadian Nurses Association celebrated their community service. centenary in July 2008. They held many events throughout the provinces for nurses over the year which culminated in a major conference, awards ceremony and a video of Practice Nurses major events and achievements by their leaders over This study undertaken by the INO examined role, profile, the century. Founding members relatives were invited, education, job structure and pension schemes of practice many of whose ancestors came from Ireland. nurses. The respondents indicate an ageing profile Annette Kennedy, Director of Professional Development, similar to community RGNs and public health nurses was invited to participate in the celebrations on behalf with almost 40% over the age of 50 years. of the Irish Nurses Organisation. A Celtic picture with The majority of respondents have between six and 15 engraving was presented to the Canadian Nurses years experience as practice nurses with a number of Association. them holding specialist qualifications. Only 44% of respondents indicated that they had a pension Georgian Nurses Association scheme and of those 38% of respondents indicated that The INO hosted an educational trip for the Georgian they had an employer related pension scheme whilst Nurses Association’s President and Vice President in May 62% indicated that they held a private pension. 2008. They attended the annual conference and visited Respondents were asked if they would be interested in Beaumont Hospital as well as meeting with several staff a public sector pension scheme and 56% indicated that members of the INO who informed them about the role of they would whilst 44% said they would not. However the INO, nursing in Ireland and the role of the regulatory this conflicts with the response related to the interest in body, An Bord Altranais. having a private sector pension where 65% said yes and 35% said no. Study on the role of community RGNs This would indicate some confusion among respondents This study examined the role, profile and job structure of who currently are privately employed and would have the community registered nurses (CRGNs). Researchers to change employment status in order to hold a public undertaking an MBA programme collaborated with the sector pension. INO to conduct the study. Activities most commonly cited by practice nurses A literature survey was carried out to examine the work include patient assessment, wound care, chronic disease done in this area both in Ireland and internationally and management, venepuncture, referrals vaccination with a postal survey using a questionnaire distributed to INO many respondents setting up nurse led clinics. Practice members. nurse respondents indicated that they were interested

3. PDCSection.indd 50 30/03/2009 11:35:41 in prescribing, expanding their services and playing a benefit patients and service users in terms of efficient greater role in the primary health care teams. access to services.

Public Health Nurses Survey National Project on Venepuncture and A survey was carried out with public health nurse members IV Cannulation Education, Training and in 2008. The objective of the review was to identify the Competency Validation for Nurses and roles, responsibilities and perceptions of nurses working Midwives within the community setting and also to identify trends This project committee was set up in November 2008 and associated potential career pathways for nurses to oversee the training and education of nurses and working as public health nurses within the community in midwives in IV cannulation and venepuncture. Clinical terms of the transformation programme and the primary practice guidelines are being developed as well as a care units. A questionnaire was distributed to 1,236 public blended learning programme which is comprised of four health nurses and a total of 420 (34%) were returned. elements: The data indicated that public health nurses portray • E-learning programme with self assessment an ageing but experienced workforce which will pose problems for workforce planning into the future. Thirty • Written theoretical knowledge assessment seven percent of respondents are over 50 years and 39% • Skills demonstration and practice of respondents have in excess of 11 years experience as public health nurses. • Competency assessment. There is contention among respondents about the amount A service needs analysis was undertaken and is being of time given to non clinical activity, eg. administration, maintained. The implementation of this project is being clinical, housekeeping and archaic practices due to old rolled out under the office of the Nursing Services Director. fashioned structure and lack of IT infrastructure. Annette Kennedy, Director of Professional Development, is a member of the national working group. The majority of public health nurses do not have access to computers or mobile phones. This leads to ineffective and inefficient use of this valuable nursing resource and National Review of the Role of Healthcare has led to many respondents indicating that they work in Assistants excess of their contracted hours on a regular basis. The National Review was published in December 2008. Many respondents indicated an interest in pursuing The Review took place in 2007 and was designed further study to develop ‘specialist’ community roles around five independent work streams of workshops, and a majority of respondents reflect a positive view to questionnaires, observational studies, reflective journals the development of primary care teams. The complete and submissions. INO members and Executive Council research reports on community nursing can be accessed met with the researchers to share their views on the role on the INO website. of HCAs. The report clearly demonstrated that the successful Advisory Committee for the Implementation introduction of the role has made a positive contribution of Nurse Prescribing of Ionising Radiation to the delivery of patient care in clinical and community settings in Ireland. The legislative provisions have been put in place to facilitate the implementation of ionising radiation The report also indicates that the successful introduction (x-ray) prescribing by nurses. The Statutory Instrument of the role of HCAs who have completed the Level incorporated an amendment to the previous definition of 5 FETAC programme, requires integration, inclusive prescriber to include nurses as ‘prescribers’. communication, local organisational planning and clinical leadership at unit and service level. The contributing An Bord Altranais has developed requirements and factors to poor integration were clearly around the standards for education programmes for nurses with areas of organisational culture, resistance to change and authority to prescribe ionising radiation (x-rays). The professional fear. programme is open to all nurses who meet the criteria and undertake a programme of education. Implementation Group on Nurse and The advisory committee was established in December Midwife Prescribing 2008 and comprised of interested stakeholders to agree on the criteria for entry, the curriculum, clinical The Implementation Group on Nurse and Midwife governance and other issues. Annette Kennedy, Director Prescribing had its final meeting in December 2008. The of Professional Development, is a member of the advisory group will convene if necessary upon conclusion of the committee. external evaluation. The introduction of this expanded role will have Fifty-seven nurses and midwives from 15 separate implications for the health services as a whole and will organisations registered and work as registered nurse

3. PDCSection.indd 51 30/03/2009 11:35:57 prescribers. From January 2008 to December 2008, In 2008 many NNA members, in seeking to have pay and 2,962 prescriptions for 2,485 patients were written by working conditions improved, concentrated on the pay RNPs. There are 75 nurses and midwives registered gap between men and women which averages at 15% in as registered nurse prescribers and 225 nurses and the EU. midwives undergoing or have completed the education As the majority of nurses are women this is a serious issue programme. for EFN and member NNAs. The European Commission Liam Doran, General Secretary, and Annette Kennedy, is now examining this issue. Director of Professional Development, were members of The INO President and the Director of Professional this group. Development attend EFN meetings and participate in lobbying activities and the development of position Nursing and Midwifery Education Review papers. Committee The report of the Nurse and Midwifery Education Review Working Group of European Nurse Group was published in May. The main focus of the Researchers (WENR) 2008 review group was to prepare a comprehensive strategic framework for the future development, delivery and The WENR group had one group meeting, two evaluation of post registration nursing and midwifery teleconferences and a meeting of the scientific panel. education in Ireland. The group, which met throughout A patient safety report was completed for the European 2007 and 2008, was made up of various stakeholders Federation of Nurses Association to inform the including the INO. organisation’s activities with a Europe wide safety project by a subgroup of WENR. The report contains a strategic framework and 23 recommendations including a recommendation that Jacqueline Burke, University College Dublin, on behalf of an advisory committee be established to oversee the the INO, attended WENR meetings and was a member of implementation of the recommendations in the report. the subgroup. The advisory committee was established and will have The report is available on the WENR website at: www. had its first meeting in January 2009. wenr.org/fileadmin/sites/WENR/pdf/LNS_v2F_Patient_ Safety_in_Europe.pdf European Federation of Nurses A synopsis of the report was published in the Journal of Research in Nursing. Willman A, Burke WA, Smith JLN, (EFN) Sveinsdottir H.(2008) Report: A report on patient safety The EFN General Assembly held two meetings in 2008 in in Europe: medication errors and hospital-acquired Copenhagen and Cyprus. The priorities for EFN are: infection. J Res Nursing 2008; 13(5): 451-454 and an abstract has been submitted to ICN for the June 2009 • Patient Rights in Cross Border Healthcare Directive conference in Durban, South Africa. • Council Recommendations on Patient Safety and The 31st annual meeting of the WENR group was held Healthcare Associated Infections on 2 September, 2008 and was hosted by the Austrian • Green Paper on EU Workforce Nurses Association in Vienna, Austria. Herdis Sveinsdottir (Iceland) agreed to take on the role of chairperson of the • EU Quality Standards. group. EFN continues to lobby the EU Commission, Council Working subgroups were formed to rewrite a Position and Parliament representatives with regard to these and Paper on Nursing Research, to revise the information other issues. EFN is developing a position paper on skill on country reports and to revise the communication mix and skill need and task shifting in nursing, with the strategy. objective of lobbying the EU Commission on skill mix and workforce planning. Approximately 260 participants attended the 13th Research Conference of the WENR on Chronic Illness The Federation organised a very successful meeting Management which was held from 2-5 September, 2008 on Patient Safety Healthcare Associated Infections in Vienna. At least three Irish papers were presented and in Brussels with nursing and European Commission were very well received. representatives to provide feedback to the Commission on the role of nurses in quality and patient safety. Mary The Hellenic Nurses Association will host the WENR Kelly represented the INO at this meeting. Symposium on Cultural Factors Influencing Patient Safety from 8-10 October, 2009 in Athens Greece. The A European project on patient safety entitled EUNetPaS format will be similar to the previous WENR Symposium comprising of 27 EU Member States and EU stakeholders on Obesity in Copenhagen. will provide information on patient safety, culture, education and training across member states. EFN is an The Secretariat moved from Denmark to Utrecht. The associate member of this project group and will provide date and location of the next WENR meeting is 8 October advice to the project from a nursing prospective. 2009, in Athens, Greece.

3. PDCSection.indd 52 30/03/2009 11:36:14 International Council of Nurses The INO was represented by Mary Connor, Executive Council member, at the ICN second triad meeting that took place with the nursing regulators and the professional nursing organisations. The meeting was attended by representatives from many countries so the issues of both the first world and the third world were discussed. Dr Minami (ICN President) made the point that the WHO ‘needs a nursing voice’. The issue for the organisation is the dilemma of how to meet the WHO millennium goals with limited resources. A debate took place on the introduction of new cadres of healthcare workers who would be trained for specific tasks, cost less and meet current need versus the need to maintain standards, this is particularly a dilemma for the developing countries who do not have sufficient nurses/ midwives. The INO formed part of the ICN delegation at the first international conference on the Regulation of Health Professionals which was convened by World Health Professionals Alliance (www.whpa.org) and the Confederation of Physical Therapy. The two-day conference explored professional self Sheila Dickson, INO president, trying her hand at processing “Farmstead”, a staple of the Ethiopian diet regulation, its accountability to society as a whole, maintenance of standards and the globalisation of health workers. Following on from pervious work a document on Patient • To promote, collect, create and disseminate data and and Public Safety was launched which will be valuable to information on nurse migration. all nurses and midwives into the future. • To act as a resource centre on nurse migration. Also launched was Guidelines on Incentives for Health Professionals that was commissioned by the Global • To track trends and patterns of global policy options and Health Workforce Alliance that looked at the recruitment advocate for sound policy concerning nurse migration. and retention of health professionals (www.who.int/ • To promote, undertake and disseminate research on workforcealliance) nurse migration, particularly concerning the migrant Judith Oulton, Chief Executive of ICN retired and her nurse workforce. achievements over her 12 years in office were celebrated. • To provide consultation and expert advice on nurse The ICN conference welcomed David Benton as her migration. successor. David held the post of Consultant in Nursing and Health Policy at ICN since 2005 and previous to that • To offer continuing education about migration. held senior management posts in nursing in England and This group has a teleconference quarterly. Membership Scotland. of the group includes United Kingdom, Scotland, USA, Jamaica, Switzerland, Norway, Mauritius and Ireland. INO The International Centre on Nurse Migration Director of Professional Development, Annette Kennedy is a member of this group. The International Centre on Nurse Migration (ICNM) Further information is available on the internet at: was set up to advise the ICN on the establishment of www.intlnursemigration.org. dynamic, effective global and national migration policies and practices that facilitate safe patient care and positive practice environments for nurse migrants. Ethiopia – INO and Cornmarket Project The mission of the ICNM is to serve as a global resource A proposal to develop an education project in Addis for the development, promotion and dissemination of Ababa with Ethiopian nurses by the INO in collaboration research, policy and information on nurse migration. The with Cornmarket has been agreed. This would involve ethical recruitment and equitable treatment of migrating seeking Irish nurses/midwives and/or educators to give nurses is a fundamental principle of the International their holiday period to teaching nurses in Ethiopia. Centre on Nurse Migration. Robert Power, Director of Cornmarket met with the The goals are as follows: Minister for Health and the Ethiopian Nurses Association

3. PDCSection.indd 53 30/03/2009 11:36:29 in April to discuss the project. Annette Kennedy also met Poland, Spain, Sweden, Switzerland, United Kingdom, with the Ethiopian Nurses Association whilst she was in USA, Botswana, China and South Africa will commence Canada at the Canadian Nurses Association centenary. an important study on workforce planning in nursing in January 2009. The Ethiopian Nurses Association have concerns about the undergraduate education, training and the specialist The consortium were successful in achieving funding education. Degree level nurses currently earn a higher under the European Union Seventh Framework salary than the nurses who have a certificate/diploma Programme for this three year project. Linda Aiken and which is affecting the morale of nurses who are already her team at the Pennsylvania University are advising this poorly paid. The Association is concerned about the project. number of private colleges teaching nurses who are only interested in fees and not in whether students are The Irish Nurses Organisation will participate in the competent or even attend class. stakeholder’s advisory group with the Irish partner INO President, Sheila Dickson and Executive Council Dublin City University. The INO will also participate at a member Mary Connor visited Uganda and Ethiopia with European level through EFN in this major project. representatives from Skills Share and Cornmarket in an The first national meeting was held in DCU in December initial investigative tour in October 2008. 2008 at which Annette Kennedy, Director of Professional The group concluded that such a project of education Development participated. would be worthwhile, a great experience for Irish nurses and midwives who may also be able to access The study aims to collect data from approximately 15,000 a mentorship qualification. It would also be a very nurses in 300 hospitals internationally and link this worthwhile endeavour for the Irish Nurses Organisation. data to patient outcome data extracted from routinely collected hospital discharge information. In this way the Nurse and midwife members have already written in impact of the nursing work environment and deployment to the INO expressing interest in the project and it is of nursing staff on nurse recruitment, retention and proposed to have a meeting with them early in 2009. The productivity and/or consequences for patients can be INO will establish a project team to develop modules of investigated. education which can be accredited by a third level college in Ireland and a process of implementation in Ethiopia. DCU would like to develop the study further at a national level to track in real time the impact of nursing interventions on nurse sensitive patient outcomes using International Project to the Irish nursing minimum Data Set developed by DCU Examine Forecasting Models for and UCD. Manpower Planning in Nursing To date this has never been achieved internationally RN4CAST and research in this area would provide the supporting evidence necessary to portray the value of the nursing An international consortium comprising of leading nurse contribution to patient care. This extra dimension to the researchers in 15 countries which includes Belgium, project will require extra funding and DCU are currently Finland, Germany, Greece, Ireland, the Netherlands, seeking sponsorship for this research work.

3. PDCSection.indd 54 30/03/2009 11:36:44 Online and Information Technology Section 4

4. onlineITsection.indd 1 30/03/2009 11:57:31 4. onlineITsection.indd 2 30/03/2009 11:57:53 Online and Information Technology

The library and information service continued to be system which allows the library staff to manage work developed during the past 12 months. As can be seen relating to journals, inter-library loans and invoices. Staff from the figures below, there has been a big increase in in head office can now access the library catalogue to the number of online facilities we are now supplying to search for books and reports, etc. from their desktops. nurses. Photocopying and Document Supply Library While articles may be photocopied in the library, a postal The library holds a very comprehensive range of nursing, photocopying service is also provided. All documents healthcare and industrial relations material including: required by members not held in the INO library are available to members via the Irish Healthcare Journal • 60 Journal Titles Holdings Co-operative, The Nursing Union of Journals (UK) or the British Library Document Supply Centre. • 887 E-Journals The numbers of inter-library loans has increased during • 5,700 Books, Reports and Official Publications 2008, which is due to us housing An Bord Altranais’ • Directories Journal Collection. A continuing phenomena for the library in the past 12 months has been the increase in • Newsletters the number of articles which nurses themselves are • Online Databases. downloading from the full text material available online thereby cutting down on the number of articles which the Services offered by the INO library during 2008 nurse has to order via the library. The library staff have included: been able to fulfil many of our inter-library loan requests from our own collection due to new subscriptions to Journal Collection Internurse, Intermid and the high availability of full text During 2008 the library increased its collection of online nursing journals on the nursing database (CINAHL). journals available to members, thereby giving nurses full text access via www.nurse2nurse.ie at any time. The Literature Searches library continues to provide access to a comprehensive In serving our geographically dispersed membership, the journal collection of print journals in all the core areas of library staff assist nurses and midwives who may otherwise nursing and industrial relations. not have the possibility of acquiring the information they require to complete their studies. Searching for On-Line Services information on many of the nursing databases included Access to a host of online reference databases: on N2N has become more streamlined and easier for the user making it possible for many nurses to do simple • Cumulative Index to Nursing and Allied Health searches themselves. As a result, the majority of search (CINAHL) queries to the library during 2008 were less overall than • Medline (Clinical) previous years, but the searches/queries requested were of a much more complicated nature. • Internurse and Intermid • Cochrane Library (evidence-based research, some full Current Awareness Services text) The Current Awareness Bulletin containing contents • Maternity and Infant Care (MIDIRS). pages of all the journals received into the library during the previous month continues to be compiled monthly Free online connection to CINAHL, and full-text journal and circulated among the staff and members who literature was provided for every member during 2008 subscribe to this service. via www.nurse2nurse.ie plus access to the newly added full text journals. Other resources, such as the daily newspapers, journal articles and websites are scanned on a regular basis in Book Collection order to keep staff and members up-to-date on current events and information. With an increase in the amount The library holds a comprehensive collection of books, of full text information available on the Internet, scanning reports and official documents on nursing, medicine, websites has become increasingly important. health, industrial relations and related areas. Various sections of the catalogue have been expanded including User Education the pharmacology section to meet with demands in relation to nurse prescribing. During 2008 a number of workshops were held on information and library skills including planning literature Our library management system was further developed searches, journal literature, references and referencing, during 2008. In December the library management system and computerised information retrieval. was upgraded to a newer version with extra features. The catalogue is only a small part of this library management User education is offered on an ongoing basis to all

4. onlineITsection.indd 57 30/03/2009 11:58:29 nurses, midwives and other librarians who visit the Most popular pages ordered by page views library. Home Page 196,051 Statistics January-December 2008 Salary Page 41,499 The following statistics have been recorded in the library Your Rights 33,346 from January 2008 to December 2008. Media News 27,624 Inter-library loans (requests made to other 667 World of Irish Nursing and Midwifery 24,241 libraries on behalf of members) Professional Development 16,013 INO photocopying requests 1,067 Membership 15,457 Queries received by telephone/post/fax/email 490 Library 13,870 Queries relating to Nurse2Nurse 574 About the INO 12,708 Publications 12,521

Online and Information Technology Update Top countries visiting INO website Jan-Dec 2008 Country User sessions INO website (www.ino.ie) Ireland 193,935 The INO Website, now in its 12th year, has continued to United States 18,813 be a great success, both at home and abroad, particularly during the industrial dispute when hits to the INO site United Kingdom 13,860 were very high (see Figures 1 and 2 and details below). Canada 3,001 Statistics from 1/1/2008-31/12/2008 show page views on Australia 2,560 INO site was 1,096,201 with an average of 28,000 single users on a monthly basis with an average of 10,000 users Poland 1,655 returning to INO site (see Figure 1). India 1,172 Busiest days and hours in terms of page views Philippines 905 The busiest hour on average 15:00-15:59, (249 page views) Pakistan 829 The busiest weekday on average Wed, (3,709 page views) Germany 758 The busiest day 10-Jan-2008, (7,031 page views) New Zealand 653 The busiest hour 15:00-15:59, 15-Jul-2008, (705 page views) Finland 581 Portugal 579

What has been most interesting is to see the countries from which users are visiting the INO site, with the The website is updated on a daily basis with the latest United States, United Kingdom, Canada and Australia news and happenings in the world of Irish nursing and being our highest visitors, followed by Poland, India and health care. Pay campaigns are highlighted and promoted the Philippines. extensively via our website. Our trolley watch figures are Irish visitors mainly come from Dublin, Cork, Galway, heavily accessed by the media. Members who visit the Waterford, Limerick and Kerry. website at www.ino.ie are provided with a broad range of information about all of the INO services. The INO The INO Website currently has 5,537 pages in total and Website gives the Organisation a very valuable presence is referenced in over 9,000 Internet pages globally. The in today’s online world providing answers to queries 24 main sites referring to www.ino.ie are Google, Eircom, hours a day, seven days a week. Yahoo and MSN. The INO website is one of the only industrial relations Nurse2Nurse Website www.nurse2nurse.ie websites providing a comprehensive industrial relations (N2N) question and answer section with traffic to this section continuing to rise. The most popular sections on the (N2N) is the website/one-stop shop for up to date education website are: and research information for nurses/midwives in Ireland.

4. onlineITsection.indd 58 30/03/2009 12:02:14 Figure 1: Number of page views Jan-Dec 09

INO WEBSITE – number of page views from 01 Jan 2008 to 31 Dec 2008

120,000 110,000 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 Page views 20,000 User sessions Returning users 10,000 0 Jul-2008 Jan-2008 Jun-2008 Sep-2008 Feb-2008 Apr-2008 Aug-2008 Oct-2008 Mar-2008 May-2008 Dec-2008 Nov-2008 Month

Figure 2: Visits by country for www.ino.ie

INO WEBSITE visits by country Jan-Dec 2008

Ireland

Ireland United States United States United Kingdom Canada Australia Other United Kingdom Canada Australia Other

N2N content is comprehensive, credible, convenient and username and password at year end was 15,500. There current. INO members are provided with the opportunity were a total of 665,554 hits to the front page of N2N with to search for information from work, home or from any the largest figures in numbers of users during January, location the nurse/midwife has Internet access. February and March mostly during busy college periods. During 2008 the library staff continued working on [email protected] and [email protected] which is updating the N2N thesaurus and subject heading list to the N2N email system currently has 7,262 nurses using streamline the most used headings and update these their @nurse email address on a regular basis. 2008 has areas with the latest research and full text material. seen an increase in the usage of this email services. N2N continues to prove very popular with our members with new registrations showing approximately 200 Information Technology (IT) nurses joining monthly. The total user population varies The INO, as an Organisation, has grown both in staff between 10,000 in summer with up to 15,000 during numbers and in membership. Over the past two years winter months. it has seen much activity on all fronts in relation to IT. The total number of users registered on N2N with a valid Unlike the past, the majority of internal and external

4. onlineITsection.indd 59 30/03/2009 12:02:34 communication is via email, website and voice. Few universities and other organisations to see what was the would deny that electronic mail has become a mission- best system available, many systems were analysed and critical computer application for the INO. vendors interviewed. At the beginning of 2008 an extensive review of the IT Valentia Technologies were assigned the contract to build infrastructure in HQ and in the county offices in Galway, a membership system that would see INO way into the Cork, and Limerick was undertaken. The right network future, taking into account all of the current IT changes infrastructure plays a key role in controlling IT costs. and the ones which may come into focus in the next few During this period much time was spent on securing all years. The new system will give us a greater opportunity of our networks against virus threats. for two way communication – INO to its members and the members to staff of INO. The new system is due to go Today’s IT network has become a critical component of live during March/April 2009. business success enabling new applications, enhancing productivity, and providing a multitude of services to staff and members. Information Office As the network continues to be a mission-critical business During the year 2008, the staff of the information system for our organisation, a top priority for our staff office continued in their efforts to develop and deliver and members is securing their information assets and a comprehensive industrial relations research and minimising the impact of unauthorised intrusions and information service to both members and staff of the viruses and worms. Attacks can hit faster than the news INO. of them. This means that we need a pro-active pervasive security approach. Work is continually being undertaken Throughout the year, the information office staff to secure our network. responded to a significant and increasing number of requests for information and advice on a broad range All of this work is undertaken with an end goal in mind of topics including employment and equality legislation, of allowing all staff to safely access the HQ servers from pay and pensions, and nurses’ and midwives’ conditions wherever they work. Two new servers were installed in of employment. HQ in July plus all old PCs were rebuilt to act as servers for such software as Flexi-Time and Print Servers. Information was collected and collated from a wide variety of sources and disseminated to the different Breakdown in broadband was overcome with new groups within the Organisation. A variety of methods wireless points installed throughout HQ. New backup was used to communicate information directly to INO procedures were rolled out – the old system of using staff and members, including: tapes was replaced with daily and weekly backups. New updated networks were setup in our county offices, laying • A direct telephone/email ‘same day response’ down all the essential work needed for all county offices information and advice service to work more closely via IT with HQ. The INO network has • The rights and entitlements section of the INO website a comprehensive infrastructure designed to provide fast, reliable and secure access to applications and services • The World of Irish Nursing and Midwifery over a single network. • Explanatory leaflets and publications detailing nurses’ The information technology department continued and midwives’ rights and entitlements at work. to develop information systems within INO including Both the website and explanatory leaflets were updated putting in place a new Email Server which has given all throughout the year to take account of developments and staff working on the road and in our regional offices an changes in both employment legislation and conditions updated email system also allowing for SMS messaging. of employment. New systems are continually being developed in order to meet with all the information demands of our members. In addition to the provision of research and information services, the staff of the information office continued Membership System to support the training activities of the Organisation, providing training in information skills and employment Work started on upgrading our membership system of and equality legislation to both INO staff and branch 28 years. Research was undertaken amongst unions, activists.

4. onlineITsection.indd 60 30/03/2009 12:02:52 National Section Reports Section 5

5. NationalSections.indd 1 30/03/2009 12:22:35 5. NationalSections.indd 2 30/03/2009 12:22:54 National Section Reports

communication during meetings in order to open the Overview meetings up to members who cannot physically attend. The opportunity exists for our The Accident and Emergency Section took the decision members working in specialist during the latter part of the year to change their name. areas of nursing and midwifery to The section will now be called the Emergency Nurses link up with colleagues who have Section. The section made their decision based on the similar professional interests belief that the term ‘accident and emergency nursing’ through their aligned national is out of date and in order to keep up with international sections. These special interest trends thus ensuring the section remains relevant to its groups of members, who have members. The Emergency Nurses Section hopes to re- been grouping together since launch the section at its workshop in 2009. Jean Carroll, the 1950s, are from a given field Section Development of practice, specific nursing or A new sub-section of the Emergency Nurses Section was Officer, INO midwifery grade or organised to created in October of this year. The GP Liaison Nurses pursue social and cultural issues. Sub-Section held its first introductory meeting and was National sections hold meetings attended by the chairperson of the Emergency Nurses at regular intervals throughout Section. This enthusiastic group’s main aim is to come the year, both in Dublin and together to network and share information. The sub- across the country, to facilitate the section is due to hold their AGM in February 2009 where networking between members, they will formally elect the officers and get working on sharing of knowledge and plans for the year. expertise, bringing forward joint The Orthopaedic Section’s vice-chairperson presented a work and to campaign on issues paper at the International Nursing Research Conference of concern on a regional, national in Jerusalem in July. The theme of the conference which or international level. ran from 30 June to 3 July was Facing the Challenge of Niamh Adams, Currently there are 24 active Health Care Systems in Transition and was attended by Locum Section sections within the Organisation. nurses from all over the globe. The title of the research Development Officer, INO Some of these sections also have presented was A Survey of Nurses and Midwives sub-sections aligned to them as well as a small number of Knowledge of Risks and Lifestyle Factors Associated national network groups which have been developed in with Osteoporosis. the recent past. All members are encouraged to affiliate to Members of the Overseas Nurses Section have been their relevant section, which is an additional value added involved in three research projects in the area of nurse service provided to you through your membership. migration in Ireland. The research is being undertaken As has been the custom over the last number of years, a by researchers in universities in Ireland and the United number of requests were received from national sections States. The involvement of the section members will throughout the year to host workshops, seminars and continue into 2009. conferences for their section members during 2008. The Retired Nurses/Midwives Section have had a very These included: busy year. Some of the events included outings within • Operating Department Nurses Conference – April – Ireland and Europe, workshops and meetings. The attended by 165 chairperson of the section was re-elected as a member of the Irish Senior Citizens Parliament in early 2008. • CNM/CMM Education Day – May – attended by 30 The Midwives Section is into its fourth year of publishing • Telephone Triage Section – Annual Conference – their own newsletter which is aimed at keeping the September – attended by 76 midwifery members up to date on all relevant issues • RNID – Legal Issues Day – October – attended by 50 of both a national and international nature. This is sent quarterly by the officers of the section to their members. • Retired Nurses/Midwives – Computer Class – April/ October – attended by 20 The maintenance of effective communication between and within the national special interest groups continues, • Retired Nurses/Midwives – CPR Workshop – November and has been further enhanced by ongoing development – attended by 25 of the section’s web pages. The section page within • Occupational Health Nurses/OHNAI Conference – the World of Irish Nursing and Midwifery continues November – attended by 160. to be one of the main mediums through which section members communicate, and has continued to grow from Many national sections are in the process of planning strength to strength. The contributions received from our to host further educational events for 2009. Meetings dedicated national section officers relating to their issues continued throughout the year for nearly all sections and and activities continue to attract enormous attention. attendance was good. Many of the meetings included educational presentation on a huge variety of topics. A An SMS mobile phone texting service is also in place, number of sections have availed of technology to aid whereby members can be reminded of their forthcoming

5. NationalSections.indd 63 30/03/2009 12:23:25 meetings directly to their mobile phones. This service has at meetings. A feature in the January 2008 edition of received very positive feedback. World of Irish Nursing and Midwifery magazine aimed to generate a greater interest in the Section and to get A very big thank you to all our national section officers commitment from affiliated members to attend meetings. and activists, both outgoing and incoming without Unfortunately the response was poor. whom the sections would not continue to succeed. They continue to work tirelessly and effortlessly on behalf of Two further meetings scheduled for June and October their special interest groups both nationally and in a were cancelled when members were contacted and number of instances internationally. Their dedication and indicated their inability to attend the meetings. The AGM enthusiasm is greatly appreciated. for the CPC Section is due to take place in February 2009. It is proposed to again assess the viability of continuing with the Section and/or look at alternative methods of Assistant Directors of Nursing/ linking with our CPC colleagues around the country. Midwifery/Public Health Nursing There were four meetings of this group held during Directors of Nursing/Midwifery/ 2008. We had a number of guest speakers including Dr Public Health Nursing Section Siobhan O’Halloran. The main issues dealt with during the year were: Four meetings took place in 2008. The issues brought to the meetings over the year were. • The concerns of the public health assistant directors about how the primary care teams were being set up and • The derogation process with specific reference to vacancy the lack of consultation or involvement of themselves in rates, poor communication and maternity leave cover. this process. • The poor attendance at Section meetings was discussed • The lodging of the claim by both the assistant directors and teleconferencing is now being provided to the in public health and non-band 1 hospitals for parity with Section to improve participation. colleagues in mental health. • Discussions took place on benchmarking and banding • The Section was represented at annual conference and for directors of nursing/and the lack of progress to date. had a motion put forward. • The Section congratulated the PHN directors of nursing on their success in achieving their claim for parity of Care of the Older Person Section pay with the directors of mental health nursing. The mechanism for progressing this equality claim for other The Section had a very quiet year. We had one meeting in directors of nursing/midwifery was explored and will be INO head office on 12 February 2008 and another one at progressed in the coming year. the ADC in May 2008. We were unable to hold a study day as people were not released due to the HSE cancelling • Issues in relation to the HIQA standards for older person study leave. This is likely to be regular occurrence given units were discussed and issues clarified. the current cutbacks. • A major issue for the Section is the erosion of the The Section’s motion to annual conference Conference director of nursing/midwifery role, and non-replacement declares that the HSE be accountable for the lack of director of nursing/midwifery positions. Linda of progress in implementing their transformation McLoughlin, management consultant, was sourced by programme and their failure to deliver a world class the INO to explore the director of nursing/midwifery health service was passed. In September the Section, role with members of the Section and this work will through the World of Irish Nursing and Midwifery, continue in 2009. issued an open letter to section members inviting them to network using email and seeking suggestions as to how to keep the section alive. However, to date, the response Emergency Department Section has been very poor. The next meeting of the section takes (Formerly Accident & Emergency Section) place in February 2009. The Section changed its name this year from the Accident and Emergency Section to the Emergency Department Clinical Placement Co-ordinators Section. Attendance at Section meetings was down on previous years. The Emergency Department Section Section actively addressed the continuing bed crisis at national The AGM of the Clinical Placement Co-ordinators level striving to promote dignity, respect and equality for (CPC) Section was held on 24 January 2008. Catherine all patients. Unfortunately, overcrowding in emergency Conlon was returned as chairperson and Mary Fergus departments continues to remain at crisis point. The as secretary. Items of interest for the Section include the audit on the violence and aggression towards nurses in current CPC job description, CPC student ratio and the emergency departments continued. However this yielded introduction of internship for student nurses. However the a poor return in 2008. The Section has a lot planned for main challenge facing the Section is the low attendance 2009 including three meetings and a study day.

5. NationalSections.indd 64 30/03/2009 12:23:41 Midwives Section hoped that the INO Midwives Section members will be appointed to this advisory group. In the spirit of accessibility and equity, the Midwives In 2007 the Heads of Bill for the proposed Nurses and Section meetings take place quarterly in Cork, Galway, Midwives Act were published and the Midwives Section Limerick and Dublin. Current serving officers are Sally was delighted to be able to make a submission in response. Millar (Chair), Margaret Carroll (Vice-Chair), Colm O’Boyle We await the progress of the Bill with great interest. (Secretary) and Mary Higgins (International Officer). Finally, we look forward to the proposed change in the International Day of the Midwife, 5 May Annually: INO title to reflect the membership of the Organisation Individuals and hospitals efforts to highlight and celebrate by including midwifery. the role of the midwife were enhanced by balloons and stickers provided by INO Midwives Section members. Nurse/Midwifery Education International Confederation of Midwives (ICM) Section Conference: This was held in Glasgow in June 2008 The Section held four meetings – January, April, June and gathering over 3,000 midwives from 80 countries. October. Attendances from the different education grades Twenty five midwives from Ireland attended from clinical for these meetings ranged from six to 13 participants, and education practice. Sally Millar and Mary Higgins which is inclusive of teleconference facilities being made attended as delegates and Ann L Mulhall and Sheila available. Core issues coming from these four meetings Sugrue as observers. Section chair Sally Millar organised last year bear a consistent theme throughout this report, a very successful Irish night which was an opportunity for which are as follows: many midwives, both Irish and international, to meet and form supportive working relationships. We are delighted Liam Doran, General Secretary, informed all present at to announce that Mary Higgins was elected as ICM Board the January meeting of recent developments and pay member for the Central European Region. entitlements coming as a result of the benchmarking process. He also spoke of the possible impending European Midwives Association (EMA): Deirdre Daly changes to roles coming from the roll out of the HSE continues to act as President of the EMA seeking transformation programme. In addition, discussion opportunities, within existing legislation, to strengthen took place regarding possible structural changes to the midwifery throughout Europe including the new NMPDUs and the CN/MEs. Proposed reconfigurations for accession countries. the four NMPDUs suggested the appointment of four area directors and eight directors. Issues regarding remaining Between these two high profile ICM and EMA positions, staff in the NMPDUs appear to be ongoing. Mary Connor the INO Midwives Section is kept abreast of, and has and Mary Cotter were re-elected as the nurse education influence in, midwifery issues at European level. representatives for the INO Executive Council. The annual joint North South INO/RCM Midwifery The annual delegate conference for 2008 was held in Conference was deferred due to the triennial ICM the Slieve Russell Hotel in Cavan and the Section’s conference. The conference will resume again in the motion was passed. The Post Registration Education Slieve Russell Hotel, Cavan on 15 October 2009. Report was issued at annual conference. This report is a The Midwives Section is sorry to lose the very capable comprehensive report outlining the strategic framework support of Kathy Foy Newman who has administered and for the future development, delivery and evaluation of facilitated this very popular and informative conference. post-registration nursing and midwifery education. We wish to thank her for her years of service. Two international conferences of significance were In 2008 INO insurers eventually withdrew indemnity discussed at the Section’s meetings. Margaret Burke, insurance cover for independent midwifery home birth specialist co-ordinator from Portiuncula Hospital, practice. The INO and Midwives Section were involved attended the FINE conference in Bulgaria in October. in negotiations with the Department of Health and Mary Cotter reported on her three-day visit to Canada Children and the HSE Domiciliary Birth Implementation regarding their nursing system review. It is understood Group (DBIG) with regard to obtaining a Memorandum that the Canadian situation is similar to the Irish system of Understanding (MOU) to ensure indemnity cover for in terms of education, skill mix and cancer services. One independent midwifery home birth practice. The MOU is issue also reported on was the skill mix of the: to be renewed on an annual basis and we trust the INO will continue to represent home birth midwives in the • Registered nurse and regulated healthcare assistant continuance and improvement of the terms of the MOU. • Practice nurse and unregulated healthcare assistant. It is unfortunate that the DBIG has now been disbanded. Overall it appears that the Canadian system appears to The proposed Maternity Services Expert Advisory Group be favouring the skill mix of the registered nurse and the is unlikely to focus on community midwifery and home unregulated healthcare assistant. birth given the dominance of the acute, hospital based maternity services model in Ireland. It is, however, The outstanding issues regarding the CNE 2002 agreement

5. NationalSections.indd 65 30/03/2009 12:23:54 still holds the same concerns. Meetings resumed much meetings were held – one in Copenhagen in May 2008 later in the year between the HSEA/HSE/INO and the and the second was hosted by the European Agency for representatives from the Section to discuss and progress Safety and Health at Work in Bilbao, Spain in October these issues further. Phil Ní Sheaghdha, Director of 2008. The chairperson, Una Feeney, attended these Industrial Relations, joined the October meeting and meetings. The next board meeting will be held on 21, 22 reported on these outstanding issues, which are: and 23 May 2009 in Bucharest. More information can be obtained on www.fohneu.org. • Governance Goals for 2009 • Budgeting • Broaden audience of regional section workshops • Staffing and accountability. • Submit articles to World of Irish Nursing and Midwifery It was acknowledged that the 2002 options were not working and alternatives need to be examined. • Submit motion to ADC. In December, the HSE confirmed that it intends to save e5 million in 2009, from within the e117 million spent Operating Department Nurses on undergraduate and postgraduate/post registration nurse education programmes. The HSE has indicated Section that it intends to make a further saving of e1.35million, It has been an eventful year for the Operating Department by reducing places on specialist post registration courses Nurses Section. and discontinuing funding for the part time nursing degree Annual Delegate Conference: At the ADC in May the programme. The implications of these proceedings are chairperson represented the section.The motion proposed currently being considered. by the section was on-call payments be recognised for The Section is very aware of the difficult issues it faces in pension. This motion was successful and now goes back the months ahead. Nonetheless the Section believes and to the INO Executive. anticipates if we can work together we may progress the Achievements: The section was represented at a number following issues: of fora throughout the year namely: • Participation in the independent review of the CN/MEs • Annual delegate conference in May – Sandra Morton lead by Isobel Butler • EORNA board meetings: Two meetings are held annually • Funding for continuing and specialist post registration and took place in the spring in Geneva, and the autumn education. meeting in Tel Aviv. Both were attended by Marie Woulfe and Caroline Higgins Occupational Health Nurses • The section funded two section members to attend an Section overseas conference this year. As part of our ongoing campaign to engage proactive European Operating Room Nurses Association involvement and networking within the group, the OHN (EORNA): Caroline Higgins, St Vincent’s University Section continues to encourage regional workshops and Hospital, Dublin and Marie Woulfe, Limerick are our two meetings. Having regional workshops throughout the representatives on the EORNA board and they continue year allows occupational health nurses to meet, network to work very hard as ambassadors of Irish ODN nursing. and continue to address best practice within the area of Caroline Higgins has been elected as the EORNA President occupational health. Three meetings were held in the commencing in September 2009. The Section would like southern region with a large attendance at each meeting. to take this opportunity to congratulate her on her election Workshops included: which is a wonderful achievement for the hard work of • Cognitive Behavioural Therapy ODN Section members in Europe over the years.

• Supporting the Bereaved Employee Annual Conference: The annual conference themed Power and Potential in Perioperative Nursing, held • Employee Case-Management and Record Keeping in Ballinasloe on the 4 and 5 April, was a successful • ‘Passion for Work – Loving the Job You Do’ educational conference. • Getting employers to encourage employees “Walk the Cleaning in Theatres: This item came up as an agenda Talk – Be Fit for Life”. item over the year. A questionnaire was handed out at We are hoping that we will see the Eastern region develop conference and the response rate was 40%. Location these workshops and networking opportunities in 2009. of employment was optional and 54% took this option. However, the remainder were from Dublin 14%; Galway Our annual OHN conference Accountability and 9%; and the balance between 2% and 6% from Cork, Workability was jointly held with the OHNAI on 27 Limerick, Sligo, Drogheda, Kerry and Kildare. November in Maryborough Hotel and Spa in Cork with 115 members attending the day. Two FOHNEU board The findings were as follows:

5. NationalSections.indd 66 30/03/2009 12:24:11 Q1. Do you currently have non nursing staff employed in your department to undertake non nursing duties? 97% said yes. Duties undertaken by non nursing staff: • Cleaning: 90% • Ordering: 25% • Transferring patients: 90% • Stocking: 60% • Catering: 45% • Moving equipment: 85% Q2. What grade of staff are they? • Porters: 70% • Housekeeping: 50% Pictured at the opening of the Operating Department Nurses Conference in Ballinasloe were (l-r): Sandra Morton, national section chairperson; Teresa • Catering: 25% Cummins, section sectretary; Councillor Mike Kelly, mayor of Ballinasloe; and • Contract cleaner: 50% Kaye Nagle, planning committee member • Healthcare assistant: 35% Q3. What level of training is required if any? • Cleaning floors • Admin duties • FETAC: 25% • Central Sterile Supplies Department (CSSD) duties • In house training: 30% • Maintaining changing rooms • Mandatory training, BLS, MHL: 12% • Cleaning scrub sinks • Trained by nurses: 2% • Cleaning cupboards and shelves Q4. What hours are covered by these grades? • Washing dishes, cleaning up after doctors • Waste management. 24/7 cover to as little as 1hr/day for some specific cleaning staff. Breakdown of hours by grade: Q7. What time per day/ week do nurses spend on these duties? • Portering: Start time: 6-9am; Finish Time: 4.30pm- midnight; Night cover: only in two locations, but some • Daily: 30 minutes to four hours locations had no porter at night; Weekend cover: some • Weekly: Five to 15 hours. had limited or no cover. High sick leave in this group This questionnaire gave us a comprehensive view of was reported by some respondents. the non-nursing/non-value activities still performed by • Housekeeping hours: Start time: 6-8am; Finish Time: a highly skilled cohort of professionals, and indicates 3-11.30pm; Night cover: no; Weekend cover: some valuable time which could be dedicated to improving locations reported limited or no cover. patient care and leaving nurses to nurse. • Cleaning staff: Hours covered: some had 24 hour cover and some only one hour per day. Orthopaedic Nurse Section • Contract cleaners: Six hours on call cleaners available This group was established in 2005 to provide a forum for four hours. Actual hours available were from one to for orthopaedic nurses to network, to exchange practice four hours when theatre closed for the day, or only after information and to promote education events relevant to 9pm. Some respondents reported having cleaners on this specialist area. weekdays but no weekend cover. Its main objectives are to: Q6. If nurses perform the cleaning, can you list the types of non nursing duties the nurses perform? • Protect and promote the professional interests of members More frequently performed duties: • Ordering and stocking of supplies: 20% • Meet twice yearly (once in Dublin and to rotate the • Answering phones and bleeps: 10% second meeting to various areas around the country) • Cleaning patient equipment: 15% • Network with colleagues locally/nationally/internationally • Household cleaning: 15% • Cleaning trolleys: 10% • Promote study days/conferences • Lifting and moving heavy equipment: 12% • Provide financial assistance to attend conferences/study • Damp dusting: 12% days • Transferring patients and pushing trolleys: 8% • Present/discuss pertinent research relevant to Less frequent duties performed less than five times: orthopaedic nursing • Cleaning fridges • Sending equipment for repair • Promote developments in orthopaedic practice • Emptying bins nationwide

5. NationalSections.indd 67 30/03/2009 12:24:32 ➢• Establish links with other areas of interest, eg. rheumatology, rehabilitation, Irish Nurses Practice Development Association. It is open to all nurses who are engaged in orthopaedic nursing and/or any related speciality, as well as members who have an interest in orthopaedics irrespective of their work location. During 2008 our meetings were held in Cork and Dublin. Meetings for 2009 are planned for Mayo and Dublin (see World of Irish Nursing and Midwifery for further details). As a group we continue to update our web page on the INO site and continually request that information is sent Pictured at At the Overseas Section AGM were (l-r): Clare Treacy, INO director of to us to ensure that information is current. human resource and social policy; Emmanuel Etcheri, vice chairperson; Dr Niamh Humphries, RCSI; Judith DC Tabuena, secretary; and Cres Abragan, Three members of the Section travelled to RCN Society of chairperson Orthopaedic Trauma Nursing conference in the UK – two received partial funding and one went as the Section’s International Collaboration of Orthopaedic Nursing Power gave an opportunity to attend branch meetings (ICON) representative. Feedback will be provided at the and to be part of the conference delegation of the Dublin June meeting in 2009. East Coast Branch. Plans for 2009 include the continual raising of awareness Research Involvement Updates: The Overseas Nurses of the section at orthopaedic educational events, the Section is continually involved in the nurse migration undertaking of an orthopaedic article review which we project of the Royal College of Surgeons in Ireland plan to publish on the web page. (RCSI). The project researcher, Dr Niamh Humphries, was invited to our 2008 Section AGM on the policy briefs and result of the nurse migration project qualitative research Overseas Nurses Section and the Section chairman was among those invited to the stakeholders roundtable meeting at the RCSI, together The Overseas Nurses Section continued to be a vital part with the Director of Organisation and Social Policy of of the Organisation through the increase in membership the INO. The next phase is a national survey of migrant of our overseas colleagues and a strong voice through nurses that will start in the first quarter of 2009. involvement in different levels of decision making. The election of our Section secretary Judith Tabuena to the The Section was actively involved with the dissertation Executive Council is a confirmation of how strong the research focused on the Transnational Lives of Filipino INO organisation and how international nurses influence Nurses in Ireland by Florio Arguillas, from Cornell organisational and social policies, at both national and University, New York, and his online survey entitled the international levels for the benefit of its members and the 2008 Filipino Nurses in Ireland Survey will start in early nursing profession in general. 2009. The Section also supported Hazel Finlay from the Waterford Institute of Technology in her research entitled Meetings, Referrals and Conferences: The Section Filipina Nurses in Ireland and the Globalisation of Care. held three section meetings in 2008 that focused on its involvement in research in nurse migration and Immigration, Residency, Citizenship Updates: The experiences of overseas nurses here in Ireland especially Section, for the past five years, has been lobbying, and for the past eight years. Immigration, residency and actively co-ordinated with the Organisation and other citizenship issues have always been part of the agenda agencies, in improving immigration status of overseas and regular consultations was done with the involvement nurses and their families. We greatly welcome the news of the Immigrant Council of Ireland, Migrant Rights that a number of overseas nurses, especially Filipino Centre in Ireland, Philippine Honorary Consul John Ferris, nurses who worked here for more than eight years, have Department of Justice and Department of Enterprise, already been granted their application for citizenship. The Trade and Employment especially with the Green Card Irish Born Child (IBC) Section of the Department of Justice Permit for nurses and other agencies. All this facilitated is continually considering some parents’ residency status. with the assistance from the office of Organisation and We are happy to hear that some of our overseas workers’ Social Policy of the INO headed by director Clare Tracey children, who are dependents, were granted residency who is also looking after fitness to practice concerns. status. We are looking forward, to nurses holding the Work related concerns of members are referred to the Green Card Permit, being changed to residency status. industrial relation officers assigned in their areas. We wish all the best to our fellow overseas nurses who worked for many years here in Ireland and opted to This is the fifth time the Overseas Nurses Section actively work and live in other countries like Canada whatever participated in the annual delegate conference by sending their reasons be. We thank them for their service and a delegate and observer. The Section chairperson’s support to the Section and Organisation and how they involvement in the Branch Development Project of Mary influenced researchers and policy makers in improving

5. NationalSections.indd 68 30/03/2009 12:24:50 our immigration status and working conditions. Finally, the first year of PHN students, without a midwifery whatever grades, area of specialisation and wherever we qualification, being trained. This was a challenging time are working or volunteering here and abroad, we always for both the students and the PHN preceptors. The PHN continue the pursuit of nursing service excellence. We Section made representation to An Bord Altranais about are always ready to respond to whatever challenges we the concerns and issues arising, especially the fact will face in the coming years. that the midwifery module was too late in the course and should be done before placements in community settings. An Bord Altranais did a clinical audit of four Practice Nurses Section Higher Education Institutes (HEIs) offering PHN student The Practice Nurses Section boasts approximately 800 placements. The timetables of the module will be members. However 2008 was a quiet year for us due to changed for 2009 according to An Bord. The report of a change in committee. We look forward to 2009 and our this audit has been distributed to the section members main focus will be to address the terms and conditions and will be discussed at the January 2009 meeting. of practice nurses working throughout the country in • The 37.5-Hour Week Changeover: Following a number order to bring them in line with our HSE colleagues. of meetings with management and HSE the change to We acknowledge the interest and the work that Phil Ní a 37.5-hour week within the PHN setting went relatively Sheaghdha has done on our behalf and we hope to smoothly. continue along the same lines. • Extending Core Working Day of Community Nurses: A joint union and HSE committee with an independent Public Health Nurses Section chairperson, Janet Hughes, has been set up to look at how this framework can be implemented. PHNs and The Public Health Nurses Section held five meetings in community nurses employed on or after 15 December 2008, with the AGM being held on 29 March 2008. At the 2008 will have this phase in their contracts. How this will AGM there was a change of Officers, the newly elected rollout will be decided by the committee. Discussions officers are: chairperson – Eileen O’Farrell, PHN Dublin are ongoing. West; vice-chairperson – Eilish Fitzgerald, PHN Cork; and secretary – Ann O’Neill, PHN Dublin West. Written submissions were made by the PHN Section to the Nurses and Midwives Draft Bill in March 2008, and All Section meetings were held in the INO headquarters the officers of the section were asked to comment on the as agreed by the Section, with video line to Donegal draft copy of An Bord Altranais Guidance Standards for at most of the meetings. The Cork branch looked into Care of the Older Person in December 2008. attempting the video link but could not arrange same to date plus only one video link is possible at a time. The five meetings were in January/March/June/September Rehabilitation Section and November of 2008. The main issues discussed and which are ongoing include the following: The Rehabilitation Section AGM took place on 1 February 2008. Other Section meetings were held on 23 May 2008, • Primary, Community and Continuing Care (PCCC): 10 October 2008 and 10 December 2008. This year was There is now a National Partnership Transformation spent planning the Rehabilitation Section’s Conference Forum (NPTF) headed by Pat Donnelly, chief executive 2009. The conference is planned for 22 May 2009 and in charge of the PCCC transformation. The nursing will be held at the Rehabilitative Training Unit, National unions met with this forum on two to three occasions Rehabilitation Hospital, Rochestown Avenue, Dun and agreed that an IR group be established to look Laoghaire. at the IR issues such as job descriptions/gradings/ reporting relationships, etc. This IR group consists of Unfortunately, nobody from the Section attended the INO, SIPTU and PNA representatives, management and ADC conference in 2008 as the planned delegates had to the partnership forum group. The first meeting on the pull out at the last minute. The Section did, however, fund 16 June 2008 did not go well as the HSE has been using two members to attend the International Rehabilitation the new job description for PHNs that was not agreed Conference in England. The members enjoyed it very upon. The unions asked same to be withdrawn ahead of much, the feedback was positive and they found it very the meeting on 26 June 2008. The subcommittees which beneficial as a networking process. We are a small were established to look at the other aspects of PCCC dynamic group and are currently seeking new interested have been put on hold until progress is made on the key active members to join the Rehabilitation Section. IR issues. A new proposed PHN job description is being put forward from the INO with input from the Section. Retired Nurses/Midwives This will be put to the management side in early 2009. Until there is agreement on the job description other Section issues are on hold. PHNs are advised to work as normal, The Section started the year with an excellent attendance co-operate and liaise with the Primary Care Teams of 44 members at the AGM on the 14 February 2008. The (PCTs) within their current job description. Section welcomed the INO librarian Muriel Haire to the • PHN Training and An Bord Altranais Audit: 2008 saw AGM who gave a presentation on the use of computer

5. NationalSections.indd 69 30/03/2009 12:25:02 visit to the hotel to wish all present a Happy Christmas. The members were delighted that he took the time to say hello out of his busy day. Ena O’Mahoney, the Section chairperson, welcomed all to the lunch and thanked the social committee, Patrice O’Sullivan, Gretta Rabbitte and Margaret Mason, for planning so many trips in 2008 which were very successful and very well attended. Telephone Triage Section 2008 saw Mary Burke in her first year as chairperson Members of the Retired Nurses/Midwives Section on a trip to Galway of the Telephone Triage Section. It was an exciting year for us, it saw the launch of the first ever, in the south of technology and Gertie Cull guided the members through Ireland, telephone triage nurse education programme in a relaxation session which was very well received. Further DCU in February. Ten telephone triage nurses graduated meetings were held in May and September in 2008 with a from the course in 2008. Throughout the year, at our good attendance at each meeting. section meetings, positive feedback was received from a number of course students. The chairperson and two members represented the Retired Section as delegates at the Annual Parliament of the Irish In February our first meeting of the year was held in Senior Citizens Parliament (ISCP) meeting in April. Limerick. This meeting attracted a large attendance and the speaker on the day was Jeff Costello, senior child care The Section is delighted to announce that Ena O’Mahoney, social worker with the HSE, who gave a very informative chairperson of the Retired Section was re-elected as an talk on child protection and the Children First Act. Executive Committee member to the Parliament. Ena is again a member of the Health and the Pensions Sub- In May we travelled to the INO offices in Galway for our Committees of the ISCP. second meeting of the year. Again a good attendance and our speaker was Alison Van Haar, triage nurse Two members from the Section attended the ADC as psychiatric services. Alison’s topic for discussion was observers in May 2008.The Section held three educational “Mental health and telephone triage” which gave rise to programmes, two computer sessions and a CPR session, a lively discussion and interest in the area. for members during the year. On 16 September our fourth annual conference was held Particular issues of concern to our members that were in Portlaoise. We were honoured to have the conference raised during the meetings in 2008 were forwarded to opened by the President of the INO Shelia Dickson. The the Executive of the INO. These issues included pension topics and speakers on the day included meningitis anomalies, medical card and other social welfare and meningococcal decease in Ireland, paediatric and entitlements. Issues raised with government departments adult life support and emergency care. Melissa Corbally, and the HSE centred on breast and prostate screening lecturer in nursing, DCU, outlined advancing education for the older person. Replies received overall were in relation to telephone triage. Other topics covered supportive and positive. were breastfeeding advice and recognition of migraine The members went on several trips during the year. headaches. The feedback from those who attended the day was very positive and the social networking evening • Twenty-four members went on the Section’s annual prior to the conference proved very popular again this trip for an ‘Active Young At Heart’ break to Galway Bay year. Hotel in April. It was a lovely companionable trip for the members. Our final meeting of the year was our AGM which was held on 11 November in Tullamore. The speaker was Maria • The members travelled to Clonmacnoise in July and Purcell, nurse adviser with Reckitt Benckiser. Maria spoke following a guided tour through the historic site, on the popular topic of fever management in infants. It continued on to the Radisson Hotel in Athlone for was with sadness we saw Angela Tysall step down from dinner. It was a beautiful day as the sun shone and her position as vice chair after a number of years, due to members relaxed in the hotel beside the Shannon for increased work commitments. Mary Burke paid tribute to a few hours. Sheila Dickson, President of the INO, and read out Shelia’s • Twenty-three members visited Farmleigh House in the article which was published in the November issue of Phoenix Park on the 6 November 2008. The members WIN magazine in support of telephone triage nursing in enjoyed the historical ambience as they were guided Ireland. New officers were elected at this meeting as our through the house and were delighted with this visit. secretarial and vice chair positions were vacant.. • Twenty-four members met in Jury’s Inn, Parnell Street We look forward with anticipation to 2009 which in for a pre-Christmas outing where they had a delicious the current economic climate will bring challenges to lunch. General Secretary, Liam Doran, paid a surprise ourselves and our nursing colleagues nationally.

5. NationalSections.indd 70 30/03/2009 12:25:19 Press and Media Section 6

6. Pressandmedia.indd 1 30/03/2009 13:00:28 6. Pressandmedia.indd 2 30/03/2009 13:00:48 Press and Media Benchmarking The Benchmarking Body finally published its report on 10 January. Zero pay increases – it’s war on wages – Outrage as almost 300,000 lose out in benchmarking was the headline in the Irish Independent (11 January). General Secretary, Liam Doran said “We were told that Ann Keating, benchmarking was the only game Media Relations Officer, in town. But now the report says INO that the benchmarking process cannot deal with our claim”. The Irish Times on the same day ran with the headline – Pay Pictured at the press conference to announce the next steps in the INO/ increases recommended for only a small minority of PNA joint pay claims were (l-r): Dave Hughes, INO deputy general secretary; nurses. Liam Doran said: “The nurses ‘campaign for Madeline Spiers, INO president; Des Kavanagh, PNA general secretary; and Mary Conneely, vice-chairperson, PNA justice’ would continue but he said it was too early to say what the next steps in that campaign would be.” He said “if the claim for pay rises by most nurses was outside the matters in question are unfinished business which arise benchmarking body’s terms of reference the Government in circumstances where both employer and trade unions, had to find another way to deal with it if conflict is to be having followed the course advocated by the Court and avoided.” the National Implementation Body, are still left with a major unresolved dispute.” The INO and PNA held a joint press conference on 16 January following meetings of their executives and this A&E was widely covered in the media. Nurses give Labour Court ‘last chance’ to deliver pay hike was the headline The perennial A&E crisis continued throughout the in the Irish Independent (17January). Dave Hughes said year. The numbers of patients lying on trolleys in A&E “the Benchmarking body…had effectively rubbished Departments awaiting inpatient beds showed a stark the NIB statement. He said nurses have had enough of rise especially in the Dublin area, when the INO did a industrial relations bodies playing “pass the parcel.” Mr comparative analysis of the trolley watch for December Hughes was also quoted in the Irish Examiner under 2007 compared to December 2006. The story was carried the headline – Angry nurses to give Labour Court last in the Irish Daily Mail (9 January) – Patients waiting chance. He said “it would be one last chance for the on trolleys double – Liam Doran said “One of the most industrial relations procedure to show it could provide disappointing aspects of this development is that it justice in relation to a genuine grievance and that nurses was entirely predictable the moment the HSE imposed and midwives, who had never taken all-out industrial cutbacks and restrictions upon the very measures which action without providing significant cover, would never have been brought forward, by agreement, in the past 12 have to consider such drastic action.” In the Irish Times to 18 months to alleviate A&E overcrowding.” – Nursing unions in ‘last chance’ return to Labour A headline in Kerry’s Eye (17 January) demonstrated Court over pay – Dave Hughes commented that “after the usual response from the HSE to the A&E crisis – HSE 20 years of social partnership, it is quite incredible that dispute trolley figures. However, if anyone was in doubt the mechanisms for avoiding industrial conflict have all about who was providing the correct figures, aPrimetime regarded the basic claims of nurses and midwives as Report on the crisis on RTE 1 on Thursday,17 January put being too hot to handle and have instead passed them that to bed! A&E nurse and Executive Council member from one to another, refusing to adjudicate upon them Alan O’Riordan was interviewed, among others, and the based on their merit alone.” programme concluded that our trolley figures were the Liam Doran spoke to Industrial Relations News (14 most accurate. February) about our pay claim – INO seeks similar pay The Cavan Voice (12 February) carried a story – Cavan for change process to consultants. He said “nurses General is at breaking point – INO representative warns should have a similar specific independent process of A&E crisis at hospital. IRO Tony Fitzpatrick said “The to deal with their pay claims as that made available to first thing with any problem is that you have to realise hospital consultants outside benchmarking/national that there is a problem and they seem to be completely agreements/pay review bodies. He said “the INO has aloof and detached from the situation. The staff are telling noted the recent agreement between the HSE and us that at the moment it is dangerous and unsafe within hospital consultants on a new contract, under which they A&E departments in the North East, especially in Cavan will be paid upfront for work practice changes not yet and Drogheda, because of the over-crowding.” delivered.” Mr Doran went on “We are seeking, at this point, a renewed investigation by the Court given that the Moving on to Beaumont hospital – the Irish Examiner

6. Pressandmedia.indd 73 30/03/2009 13:01:10 (7 March) reported – Long-term bed crisis blamed as sustained investment must be made.” Liam Doran said 50 on trolleys. According to IRO Edward Mathews “At “The INO will not accept that it becomes a framework one stage yesterday there were 54 patients on trolleys.” for discussions about 2020 in the absence of a concerted He pointed out that “the number of patients on trolleys effort to deal with today’s problems in the interests of at this time of year was almost double what they were today’s patients.” during the same period in 2005. He went on “five to six long-stay residential care beds must be made available Non-EU nurses to the hospital every week to relieve pressure on A&E. The only person who believes there are enough beds in Changes in employment legislation introduced last the system is HSE chief executive Prof Brendan Drumm. year for non-EU nurses were written about in Metro Everyone who works for him does not think so.” Eireann (31 January) – Dramatic ramifications’ over employment laws – nurses’ union. Clare Treacy, Director Overcrowding at University Hospital Galway hit the of Organisation and Social Policy said the INO “is to seek headlines in the Tuam Herald (October 9) – Urgent a meeting with the Health Service Executive over what meeting sought to solve casualty chaos at Galway it describes as increasing frustration among nurses hospital. There were 44 patients waiting overnight in the regarding green card regulations.” She went on “Recently Emergency Department of the hospital for admission and arrived nurses are forbidden from earning extra money 30 of those were still on trolleys the next morning. IRO through agency work, are tied to their initial employment Noreen Muldoon called for “the immediate opening of for 12 months – even if they are unhappy in their working all closed beds in UHG and is seeking an urgent meeting environment – and their category of residency stamp has with management to discuss the crisis.” She said resulted in refusals of bank loan applications.” She said “The department can neither accommodate nor cope “Canada and other nurse-recruiting nations are ready physically from a staffing perspective with this on-going to capitalise on the restrictive measures experienced unacceptable situation.” by nurses who have arrived in Ireland since early 2007”. A headline in the Evening Herald (November 22) read – She commented that “because of HSE cutbacks, the full Now 40% more patients are left on trolleys. “Patients extent of the new regulations have not yet been felt, but left on trolleys were this week up nearly 40% on 2006 – that dramatic ramifications for the health service could when Health Minister Mary Harney declared the situation be in store.” a “national emergency”. According to General Secretary, Liam Doran “Home-care packages are being cut, the Wexford General Hospital nursing home subvention scheme is in trouble and A&Es The Wexford People (20 February) carried a story on the are bearing the brunt of what’s happening…This is the Maternity Ward at Wexford General Hospital – Maternity real impact of the cost containment strategies that are ward ‘totally stretched’. “The understaffed maternity being put in place.” department at Wexford General Hospital was stretched to the limit last weekend with a record nine babies born in Labour Court Win a 12-hour period…An independent six month review of activity and staffing levels in the Wexford Maternity Unit The Irish Times Health Supplement (15 January) is due to start on March 3.” IRO Liz Curran “is confident reported on a recent Labour Court win for the INO which the review will demonstrate what it has said all along – “declared the system which set the pay of all nurse that the maternity services in Wexford General Hospital managers to be discriminatory against the exclusively are critically under-staffed and have been for a number female directors of public-health nursing.” – Ruling set of years.” to lead way to further pay claims – “As a result of this decision directors of public health nursing now stand to gain a pay adjustment of around e16,000 retrospectively Tullamore Hospital to 2002 as previously directed by the Equality Tribunal.” In the Offaly Express (27 February) – HSE own goal – INO Deputy General Secretary, Dave Hughes said “the Tullamore hospital lay offs costing more money – In Labour court finding had major consequences for the pay a bid to save money by the non renewal of contracts of all nurse managers and the whole payment structure the HSE has ended up costing itself more money. “The could change following this judgement.” INO has revealed that a number of nurses who were let go from the hospital are now back working there doing Bed Capacity Review agency work, which actually costs the HSE more money.” IRO Joe Hoolan said “These nurses didn’t have their A report by the HSE on bed capacity in acute hospitals contracts renewed because they were told they weren’t was covered in the Evening Echo (19 January) – Health needed. Now they are back doing agency work which is report recommends use of day centres and community much more expensive for the HSE.” care. “A new report warned e4 billion is needed over the next 12 years to fund 20,000 new beds – a hospital a CUH year – unless the focus of care shifts to the community.” The INO said “regardless which formula the Government The Evening Echo (28 February) gave space on the front chose for the health service additional significant and page to the on-going story of the cut-backs in the health

6. Pressandmedia.indd 74 30/03/2009 13:01:24 Marchers on O’Connell Street in Dublin taking part in the protest on the state of the health services

services – Nurses claim 300 job vacancies at CUH. General Hospital’s Accident and Emergency Unit on a According to IRO Patsy Doyle “The union has drawn up 24 hour basis. Donegal News Derry People (28 March) a 10-point action plan, which it wants the Health Service – Call for uniformed security at LGH’s A&E. Director Executive to implement, to address the risks presented of Industrial Relations, Phil Ní Sheaghdha said “We by staffing shortages. The INO has asked that the HSE appreciate that generally most attendees of A&E conduct close down six beds in each of 10 wards to help alleviate themselves in a proper manner and those who offend the pressures on staff.” are in the minority. Nonetheless it is important to have constant security staff there to protect the staff and other Recruitment Ban members of the public.” In an article in the Sunday Business Post Careers (9 March) – Fewer jobs available in health service – the Public protest HSE has cut back on the recruitment of health. Liam Up to 14,000 people marched for a better public health Doran said “There are over 1,000 vacant nursing posts in service in Dublin on 29 March. It was covered in the the public health sector. In theory these posts have been Irish Daily Star Sunday (30 March) – Patients runs out. dropped because they were vacant posts on December President Madeline Spiers said “The health service is 31, 2007.” He said “There is a critical need to fill all of being run by accountants and economists who know the these vacant posts as well as other staffing shortfalls, so price of everything but the value of nothing.” we have a very serious situation regarding staffing levels in the public health service.” Annual Delegate Conference The Irish Examiner (13 March) also highlighted the Once again the Annual Delegate Conference received a recruitment ban – Posts lie vacant as private sector lot of media coverage this year despite the fact that Brian attracts nurses. “A shortage of 77 nurses in the mid- Cowan took over as Taoiseach on Tuesday, 6 May and west region, as a result of the staff embargo, is having a announced his new cabinet on the Wednesday, 7 May. severe impact on patient services.” The HSE has agreed to provide funding for nurses from agencies in the mid- No confidence in the HSE west. But Mary Fogarty said “it is having little success. She went on “The irony of all of this is that the INO warned The Irish Daily Mail (8 May) carried the headline – the HSE in the mid-west last September of the impact the Nurses set for HSE ‘no confidence’ vote. Liam Doran employment curtailments would have, because nurses said that “if the motion, tabled by the INO Waterford and and midwives would seek alternative employment in the Sligo Branches, is passed the INO will notify the Health private sector. The situation now is that the recruitment Minister…and the head of the HSE Professor Brendan campaign is yielding very few applicants and hospital Drumm and request a meeting to discuss the matter.” He wards are closing and public waiting lists are growing.” said “the most important thing to the HSE was budgets not patient care.” Violence/abuse Address by Rebecca O’Malley An increase in the amount of violence and verbal abuse that hospital staff have to endure prompted a call for The Irish Examiner (9 May) covered the address to uniformed security staff to be put in place at Letterkenny conference by Rebecca O’Malley – Call for mandatory

6. Pressandmedia.indd 75 30/03/2009 13:01:41 reports of medical errors. “Rebecca O’Malley, the President’s address Tipperary mother-of-three who was wrongly given the all Ms Spiers was quoted in the Irish Times (10 May) – clear for breast cancer, called for the mandatory reporting Nurses’ group tells Harney HSE not working. She of medical errors”. She said “Protections must be put in “accused the HSE of spending tens of thousands of euro place to protect nurses from victimisation, and I firmly looking for bad news stories to undermine the INO during believe that the introduction of mandatory reporting of last year’s industrial dispute. The HSE approach towards medical errors would be a huge help in this regard.” “ nurses was nothing short of disgraceful.” Ms O’Malley also spoke of her disappointment at the way Health Service Executive chief executive, Prof Assaults Brendan Drumm, turned the Health Information Quality An assault on a young nurse was reported in the Irish Authority’s investigation into her botched breast cancer Examiner (10 May) – Young nurse ‘badly shaken’ after test into a “good news” story. This demonstrated at the teen patient head-butt. “A young nurse was recovering very highest level the culture of spin and the lack of after being head-butted by an abusive teenage patient openness, honesty and transparency that exists within whilst working a shift at the A&E Department at Cork’s our healthcare service.” Mercy University Hospital.

On-going pay campaign Speaking during the conference, Liam Doran said “the incident was typical of the dangers faced by nursing Meanwhile the Irish Times (9 May) concentrated on a staff.” He said “The biggest problem is that our members debate about where our campaign should go if the Labour endure it so commonly now that they under report it.” Court fails to deliver on our claims – Ballot on industrial action gets go-ahead. “The campaign could include what History is made as working week is reduced the union’s Deputy General Secretary, David Hughes, labelled “the most dramatic action ever contemplated”. to 37.5 hours “However, following a lengthy debate, it was decided A 37.5-hour working week for nurses and midwives that a forthcoming Labour Court recommendation must commenced on June 1, 2008. This story was covered in first be rejected by the union’s members before the ballot the Irish Independent (31 May) – Nurses secure shorter on industrial action takes place.” working week. Deputy General Secretary, Dave Hughes said “the agreement was “historic” and would act as an No Jobs for new graduates incentive to nurses to stay and work in Irish hospitals.

Also in the Examiner on the same day under the headline – Nurses accuse HSE of reneging on commitments – New President, Sheila Dickson Dave Hughes said “the Organisation had an agreement The recent election of Sheila Dickson as new INO with the HSE that newly qualified nurses would have two President was reported in the Kingdom (20 May) – Kerry year’s employment after qualifying. That’s very necessary, nurse is aware of hard times in store. Sheila was quoted both in terms of the nurse getting the relevant experience “I believe that our voice is critical to ensure nurses and to do the job better and the state getting a return on its midwives remain central in the delivery of quality care in investment.” a working environment which treats us equitably, fairly This story continued in the Evening Echo (12 May) – Nurse and the same as all other health professionals.” jobs pledge broken. “Some 30 student nurse graduates who were promised jobs at the Mercy University Hospital Mercy Hospital, Cork have been told the positions are no longer available due to cutbacks at the hospital.” The issue was raised The dispute over the proposed opening of the new Mercy under an emergency motion at the annual delegate University Hospital on a part-time basis was written about conference of the INO in Cavan on Friday which called in the Sunday Business Post (25 May) – Unions angry on the Government to intervene in a row with the HSE over part-time A&E units. IRO Michael Dineen said “the over jobs for newly qualified nurses. Cork nurse Collette dispute preventing the opening of the new unit, which, at O’Sullivan said “The nursing and midwifery services rely full capacity, could cater for 30,000 patients a year, was on our new bright graduates who are more precious than “ludicrous and totally unacceptable.” diamonds. We need to support them.” There’s currently a six hour wait (in the Mercy’s existing A&E), which means anyone presenting after two o’clock Mary Forde (CUH) said “The retention of staff was one of in the afternoon would be told the facility was closing for the biggest problems facing the nursing industry.” She the day.” went on “Last year 140 nurses left CUH and we conducted a number of exit interviews to find out why. The reasons New Mercy A&E is falling into ‘chaos’ was a headline in they gave us for leaving included stress, not being happy the Evening Echo (11 December) – IRO Michael Dineen with their workplace and wanting a better quality of life.” said “The reality is that all that is in existence is a facility She said “just two people said they were leaving to go that is similar in size to that of the old department with abroad.” no extra staff.”

6. Pressandmedia.indd 76 30/03/2009 13:01:54 Crumlin Hospital story was carried in the Clare People (30 September) – Nurses welcome proposed services review. IRO Mary Our Lady’s Children’s Hospital, Crumlin hit the headlines Fogarty said “Members anticipate that this review will towards the end of May as cut-backs were announced. finally, throw light on the severe understaffing, under The story was covered in the Irish Examiner (30 May) resourcing and concerns on patient safety and outcomes – Nurses ‘learned of job cuts from the media’. IRO that have prevailed for too long at the hospital.” Albert Murphy said “It shows a complete disregard for the status of industrial relations procedures. They had a legal obligation to consult with us.” He said “Agency Rally against health cuts cover might not now be provided for nurses on sick or Speaking at a press conference ahead of the march holiday leave, at a time when the hospital already has 25 against health cuts in Dublin in October, Liam Doran nursing vacancies.” said in the Irish Times (9 October), under the headline - Grieving family backs march against health cuts – “Even Cutbacks in these difficult financial times the Government has got to learn from the lessons of the past.” On 13 October, The Western People (9 September) ran a story on following the rally, and again in the Irish Times – Patients cutbacks at Mayo General Hospital – Mayo General put and workers call for better public health service – Liam in cutback mode. Management at the hospital plan to Doran said “he wanted to remind the Government that, bring in cost cutting measures due to a e2m overspend just like in the 1980s, health cuts would still hurt the old, and a number of nursing staff have had their hours cut. the sick and the disabled.” He went on “We must tell Prof IRO Noreen Muldoon said she is “gravely concerned at Drumm he is wrong when he says he has got to reduce the situation in Mayo, and said it is only a matter of time the number of public beds in the health service.” before essential patient services will be cut.”

Letterkenny General Hospital More cutbacks The Donegal Democrat (7 October) covered a joint union The Irish Examiner (9 October) reported on more meeting at Letterkenny Hospital which was held to discuss proposed cutbacks by the HSE – HSE warns of e120m the unions’ joint campaign for opposing health-service slash in costs by year-end. Liam Doran said “These are cuts at the hospital – Union reps meet at Letterkenny serious cutbacks that are being proposed, and if they are General to fight health cuts. IRO Noel Treanor said planning to save almost e120m by the end of the year, that’s “members at the meeting expressed a mixture of anger e40m a month, then we are talking about extended ward and frustration in respect to cutbacks that have taken closures, staff cutbacks, even more A&E overcrowding, place already and expressed fear of further reductions, and the end of nursing home subventions.” not just for themselves but for the services for the people of Donegal.” Budget Mr Treanor said “unions will continue to meet with local The INO’s response to the Budget was carried in the management and will lobby local politicians to get them Evening Echo (17 October) – Budget 2009: Health experts to sign up to ensure that cutbacks are prevented or say increase of 2.1% will damage frontline services. precluded. He said unions also intend to organise a local Medical Unions lash out at Budget’s health spend. The protest in Letterkenny in the next few weeks.” INO said “2008’s health allocation has already proven to be inadequate and this will see some services reduced, Cancer Misdiagnosis others terminated and a general negative impact on the health of those most in need. The INO has insisted that The Irish Examiner (12 September) reported on another the 2009 allocation is ‘most inadvisable’ and amounts to story of cancer misdiagnosis – Misdiagnosis a systems ‘an effective’ abandonment’ of the previous declaration ‘meltdown’. “It was an entire systems failure that cost by the Minister for Health that A&E overcrowding was a Ann Moriarty her life, patient advocate Rebecca O’Malley national emergency.” stressed yesterday…It was highlighted in one unpublished HSE report that “nurses had voiced their concerns with doctors in August 2007 when Ms Moriarty was discharged Mullingar Regional Hospital from the hospital’s accident and emergency department. The proposed opening of Phase 2B, a 108 bed development The report recommended that junior medical staff must at Mullingar Regional Hospital made front page news on respect nursing staff and consider their contributions to the Westmeath Examiner (18 October) – Staff concern the decision making process.” Liam Doran said the INO over progress on Phase 2B. According to IRO Derek Reilly “had always held the view that the professional opinion “Despite a recent assurance from Health Minister, Mary of an experienced nurse should always form part of the Harney and construction having been completed for 11 overall decision.” years, the 108- bed wing Phase 2B of Mullingar Regional It was announced that an independent review of services Hospital is unlikely to be in use in the near future.” Mr at Ennis General hospital would be carried out by the Reilly said “there had been no communication with INO Health Information and Quality Authority (HIQA). The or any unions in relation to the move.”

6. Pressandmedia.indd 77 30/03/2009 13:02:14 Monaghan Hospital Sheila O’Connor and Caitriona Molloy from the advocacy group Patient Focus, collected it on her behalf…In the We read in the Irish Times (24 October) – 130 staff to speech, delivered by Patient Focus, the midwife said move from Monaghan hospital. “Up to 130 staff at she took her actions because of the women and their Monaghan General Hospital will have to be re-deployed families who were affected by Dr Neary. She thanked the when all acute services at the hospital are transferred colleagues who supported her, particularly Patsy Doyle to Cavan General Hospital in the new year, the Health of the Irish Nurses Organisation and Jim Reilly of the Service Executive has confirmed…The changes mean Health Services Executive. The midwife has remained acute inpatient services will no longer be provided anonymous since making her revelations. She has said in Monaghan. However, the hospital will continue to she doesn’t wish any personal acclaim for her actions, provide day medical and day surgical services and step- she did it for the sake of the women involved.” down beds. The treatment room at the hospital will be converted to a 12-hour, seven-day minor injuries unit.” Viv Graine of the Irish Tatler said “An award to an anonymous person is unusual but such a courageous IRO, Tony Fitzpatrick said “it was regrettable the acute stand, on an issue with such a profound effect on so medical services were closing. He said millions had been many women’s lives, deserved to be honoured.” spent in the recent past refurbishing the two medical wards and now they are going to be closed or used for Portiuncula Hospital, Ballinasloe another purpose.” The Athlone Voice (18 November) ran a front page story Portlaoise Hospital on a dispute at Portiuncula Hospital, Ballinasloe where two senior nursing staff were suspended – Nurses show Page 1 of the Leinster Express (29 October) gave space of force for two colleagues in Portiuncula dispute. to the news that the new A&E Department at Portlaoise “Hundreds of nurses at Portiuncula Hospital are to stage e Hospital is set to open - 6m A&E to open. According to a major lunchtime protest today and have also threatened IRO, Derek Reilly “the unit will get an extra night nurse, a strike action in a show of force for two colleagues receptionist and a triage nurse. However, he said, 90 per whom they believe had been wrongfully suspended by cent of the facility would open, and the INO had got the hospital management…The INO claim the two nurses minimum extra resources.” were effectively disciplined for raising grievances.” He went on “We really need an additional nine nurses… Regina Durcan, IRO, said “nursing staff believed that fair to open it fully…There may be some areas of the facility procedures had not been followed in the case of their closed off but, overall, what the patients will get will be two colleagues, whom they want reinstated.” far superior to what they had before.” She went on “It’s about ensuring that fair procedures are afforded to the two nurses. Our fear is that if this CUMH can happen to senior nurse managers, it can happen to anyone.” The Irish Examiner (30 October) carried a story on the increase in the number of births at Cork University Deputy General Secretary, Dave Hughes was quoted Maternity Hospital – Maternity hospital to exceed in the Galway Advertiser (20 November) under the annual capacity by 2,000 births. IRO Patsy Doyle said heading – INO protest outside Portiuncula over alleged “This hospital was built for 7,000 births, what we will see ‘wrongful suspension’ of two senior nurse managers. this year will be close to 9,000, and that’s expected to He said “INO members at the hospital are taking action rise even further next year.” She went on “We have 376 in pursuit of a full investigation as to how lodging a midwifery posts at CUMH, based on 7,000 deliveries. The grievance was allowed to become a disciplinary action staff are worked off their feet trying to keep the service against those who lodged it.” running.” HSE Spending for 2009 Whistleblower Midwife Honoured Liam Doran, responded in the Herald AM (18 December) The Drogheda Independent (19 November) reported to an announcement by the HSE that they wanted to hack on an award presented to an anonymous midwife, a e400m from health service spending in 2009 on top of member of the INO, who blew the whistle on obstetrician e530m savings under the heading – Cowen to consult Michael Neary – Midwife who blew whistle on Neary on health cuts. He said “In the pending discussions with honoured by award – Accolade recognises courage of Government we will propose alternative ways of saving midwife’s actions. “The anonymous heroine has been significant monies in order to allow and ensure essential awarded one of the accolades of the year in the Irish frontline services continue to be delivered.” Tatler Magazine Awards. She was presented with a special recognition award for her courage in highlighting Neary’s practices. The doctor was eventually struck off Above is only a small snapshot of the huge media by the medical council in what has become one of the coverage afforded to the INO in the past year. Officials most infamous episodes in recent Irish medical history. and activists also did frequent interviews on national The midwife did not collect the award in person, instead and local radio and also on TV during the year.

6. Pressandmedia.indd 78 30/03/2009 13:02:27 Affiliations

The INO is affiliated to the following bodies: • ICTU Disability Committee Cora McGrath, Noreen Muldoon National • ICTU Global Solidarity Committee – Mary McCarthy • Irish Congress of Trade Unions • ICTU Retired Workers Committee – Peg Nealon • Economic and Social Research Institute • Irish Society for Quality in Healthcare Other Bodies/Committees • Mental Health Association of Ireland • Inclusion Ireland (formerly National Association for Mentally National Handicapped – NAMHI) • National Council for the Professional Development of • National Women’s Council of Ireland Nursing and Midwifery • Institute of Public Administration • European Working Time Directive – NIG Medical Phil Ní Sheaghdha • Irish Association for Industrial Relations • European Working Time Directive – Nursing and Midwifery • Irish Labour Society Expert Group – Liam Doran, David Hughes, Annette • Health Informatics Society of Ireland Kennedy, Phil Ni Sheaghdha, Jo Tully, Teresa Hayes • Industrial Relations Research Trust (IRRT). • Health Forum Steering Committee – Liam Doran The Organisation also sponsors the Open University • HSE Nursing and Midwifery Staffing Levels Steering Programme at the National College of Ireland, and contributes Committee – Sheila Dickson, Annette Kennedy to the Economic and Social Research Fund Raising Campaign. • HSE Resource and Implementation Group on Nurse Prescribing – Liam Doran, Annette Kennedy International • HSE National Working Group - Venepuncture and IV • International Council of Nurses (ICN) Cannulation for Nurses and Midwives – Annette Kennedy • Nursing and Midwifery Forum of the World Health • HSE Advisory Committee for Implementation of Nurse Organisation (WHO) Prescribing for Ionising Radiation – Annette Kennedy • European Federation of Nurses Associations (EFN) • Nursing and Midwifery Education Review Committee – • European Midwives Association Annette Kennedy • European Student Nurses Group • An Bord Altranais – Continued Competence Assessment of • The Midwives Section of the INO is affiliated to the Registered Nurse Prescribers Project – Annette Kennedy International Confederation of Midwives (ICM) • Department of Health and Children Sexual Assault • The Operating Department Nurses Section is affiliated to the Treatment Services Review Committee – Annette Kennedy European Operating Room Nurses Association (EORNA) • National Women’s Council – Clare Treacy (Board of • The Occupational Health Nurses Section is affiliated to the Directors), Sheila Dickson, Bernie Smyth Federation of Occupational Health Nurses in the European • Inclusion Ireland (formerly National Association for the Union (FOHNEU) Mentally Handicapped of Ireland – NAMHI) • European Healthcare Management Association Marie Gilligan • Workgroup of European Nurse Researchers (WENR) • Irish Deaf Society – Clare Treacy • American Nurses Credentialing Centre (ANCC) International • National Anti-Poverty Strategy (NAPS) – Clare Treacy Advisory Council • ETUC (European Trade Union Confederation) – Youth Committee – Edward Mathews (Chair)

INO Representation on Irish Congress of International Trade Unions and Other Bodies • ICN Council of National Representatives • ICTU Executive Council – Liam Doran, Clare Treacy Sheila Dickson, Annette Kennedy • ICTU Public Services Committee • ICN Credentialing Forum – Sheila Dickson, Annette Kennedy Sheila Dickson, Liam Doran, Dave Hughes, Patsy Doyle, • ICN Remuneration Network – David Hughes Phil Ni Sheaghdha, Philip McAnenly, Mary Fogarty, Tony • European Federation of Nurses Associations (EFN) Fitzpatrick, Michael Dineen, Edward Mathews, Liz Curran. Annette Kennedy (President 2005-2007) • ICTU Equality Network – Clare Treacy • European Midwives Association • ICTU Third World Committee – Liam Doran Deirdre Daly (President 2005-2009) • ICTU Youth Committee – Edward Mathews (Chair) • European Forum of National Nursing and Midwifery • ICTU Health and Safety Committee – Catherine Samuels Associations and WHO – Madeline Spiers (chair) • ICTU Representatives on the following Bodies/Committees • American Nurses Credentialing Centre Advisory Body – The Women’s Health Council – Clare Treacy Annette Kennedy (Executive member) Maynooth NUI – Governing Authority Member – • International Centre on Nurse Migration Strategic Advisory Annette Kennedy Group – Annette Kennedy • ICTU Women’s Committee • Workgroup of European Nurse Associations – Sheila Dickson, Clare Treacy (Chairperson) Jacqueline Burke

6. Pressandmedia.indd 79 30/03/2009 13:02:46 For The Record Benevolent Fund each month. The journal is produced in a full colour A4 format and is posted to members’ preferred addresses. The Finance and General Purposes Committee, and/or the It continues to go from strength to strength and the President and General Secretary, continued to authorise feedback from the membership remains very positive. payments from the INO Benevolent Fund to members, The journal welcomes ideas and suggestions for articles and retired members, who find themselves in difficult and the editorial team at MedMedia is available to discuss situations. The Benevolent Fund is primarily funded these in detail with members. by income generated from the Organisation’s affinity partnerships with different commercial companies. In Circulars/Newsletters return for access to our membership, for the purposes of offering services at competitive rates, these companies In addition to WIN, regular circulars/newsletters to make payments to the Benevolent Fund arising from the branch officers, section officers, nurse representatives generated income. and hospital committee representatives were issued from the General Secretary and the officials to ensure that In 2008 contributions were, in this context, received from members were fully briefed on issues as they developed, the following: during the year. • Friends First Finance Direct (preferential loans) – e 13,337.52 Government Departments/Other Bodies • MBNA (affinity credit card) – e13,597.35 • HMCA (health insurance) – e24,655.29. We would like to formally thank the Minister for Health and Children, the Ministers of State, and the officials of Educational Loan Fund the Department of Health and Children, for the courtesy shown to us during a very challenging year of negotiations The Organisation continues to offer interest-free loans, in and discussions. We would also like to thank the Health accordance with the regulations of the fund, to members Service Executive, and the Health Service Executive – in 2008. The Organisation believes that this investment is Employers Agency, for numerous engagements during of major significance in the ongoing development of the the year, and we look forward to working constructively nursing and midwifery professions. with them in the years ahead. Our thanks is also due to officers of An Bord Altranais, the National Council for Irish Nurses Rest Association the Professional Development of Nursing and Midwifery and the Irish Congress of Trade Unions. We also wish to Two members, from each of the following, are represented express our appreciation to the officers of the Labour on the committee of the Irish Nurses Rest Association: Court, Labour Relations Commission and the Irish • Irish Nurses Organisation Business and Employers Confederation (IBEC). • Irish Guild of Catholic Nurses • Irish Association of Nurse Managers Finally we also wish to thank the many other government • Director of Public Health Nurses Association. departments and bodies, with whom we met during the last year, including the Department of Justice, Teresa Hayes (Executive Council) and Mary Cotter, the Department of Enterprise and Employment, the represent the INO.The Association is open for applications Employment Equality Agency and Health and Safety from nurses/ midwives in need of convalescence or a Authority. holiday, for a limited period, who are unable to defray all the expenses they may incur, or for the provision of Press and Media grants to defray other expenses incurred in the purchase of a wheelchair or other necessary medical aid. The Organisation continues to maintain a high media profile to promote the Organisation’s policies and activities Publications in the media. We would like to place on record our sincere gratitude for the media coverage in the last year. The World of Irish Nursing and Midwifery (WIN) Honorary Officers The World of Irish Nursing and Midwifery (WIN), the official journal of the INO which is published monthly It gives us great pleasure to place on record our deep and mailed to over 40,000 members every month, aims appreciation to all our honorary officers and nurse to cover a wide range of issues of interest to Irish nurses representatives for their talent, time and commitment, and midwives. This includes industrial relations news and and without whose excellent work the INO could not ongoing developments within the INO, general nursing/ develop. To those currently in office and to those who midwifery news, profiles, international news, features have now resigned we are most grateful. A list of current about innovation in nursing/midwifery, clinical articles, officers can be found in Appendices I and II. education and research. INO Staff The journal also has an expanding classifieds section with nursing recruitment advertising and a comprehensive We wish to express appreciation for the very hard work and diary of events. Forthcoming courses organised by commitment of all of our staff, in our head and regional the Professional Development Centre are featured offices, during the year. It is greatly appreciated.

6. Pressandmedia.indd 80 30/03/2009 13:03:07 Appendices Section 7

7. INOARep08Appendix.indd 1 30/03/2009 14:27:59 7. INOARep08Appendix.indd 2 30/03/2009 14:28:18 Appendix I: Branch officers – Currently in Office

BRANCH CHAIRPERSON VICE-CHAIRPERSON SECRETARY TREASURER ATHLONE Joan Scanlon Teresa Guinan Patricia Hayes Mary Nooney St Hilda’s M’Cap Services Athlone District Hospital Loughloe House Athlone District Hospital Grace Park Athlone, Athlone, Athlone, Athlone, Co Westmeath Co Westmeath Co Westmeath Co Westmeath ATHY/ Marian Walsh, Olive Ennis-Farrell, Anne Ball Eileen Lawrence BALTINGLASS St Vincent’s Hospital, St Vincent’s Hospital, St Vincent’s Hospital Baltinglass District Hospital Athy, Co Kildare Athy, Co Kildare Athy, Co Kildare Baltinglass, Co Wicklow BALLINA Ita Timlin Evelyn Doherty Kathleen Sheehan St Augustine’s Welfare Belmullet District Hospital St Augustine’s Welfare Home, Ballina, Belmullet, Home, Ballina, Co Mayo Co Mayo Co Mayo BALLlNASLOE Ethel Leonard Bernadette Griffin Mary Barrett Mary Fallon Portiuncula Hospital Portiuncula Hospital St Brendan’s Home Portiuncula Hospital Ballinasloe, Co Galway Ballinasloe, Co Galway Loughrea, Co Galway Ballinasloe, Co Galway BALLYSHANNON Valerie McGonigle Bríd Curristin Marie Hunter Angela Rochfort Sheil Hospital Donegal Town Community Sheil Hospital Sheil Hospital Ballyshannon, Co Donegal Hospital, Donegal Town Ballyshannon, Co Donegal Ballyshannon, Co Donegal BANTRY Anne Crowley Margaret Cronin Collette Walsh Murphy Castletownebere District Bantry General Hospital Bantry General Hospital Hospital, Castletownbere Bantry, Co Cork Bantry, Co Cork Co Cork CARLOW Mary Burke Aine Kearney Majella McDonald, CAREDOC, St Dympna’s Carlow District Hospital CAREDOC, St Dympna’s Hospital, Athy Road, Carlow Hospital, Athy Road, Carlow Town Carlow Town CARNDONAGH Maria McLaughlin Rita Doherty Geraldine Diver Margaret Mary Gilmore Carndonagh Community Glenmarkee Carndonagh Community Carndonagh Community Hospital, Carndonagh Carndonagh Hospital, Carndonagh Hospital, Carndonagh Co Donegal Co Donegal Co Donegal Co Donegal CASHEL Mary Fanning Claire Gleeson Josephine Tobin (HSE – Sth East) Our Lady’s Hospital Our Lady’s Hospital Our Lady’s Hospital Cashel, Co Tipperary Cashel, Co Tipperary Cashel, Co Tipperary CASTLEBAR Maureen Hanlon, Margot Lydon Jacinta Flynn Patricia Barrett-O’Boyle Mayo General Hospital, St Fonnan’s Nursing Unit Gurteen, Ballyhaunis Monroe, Knockdoe, Castlebar, Co Mayo Achill Island, Co Mayo Co Mayo Claregalway, Co Galway CAVAN Louise Clarke Mary Kelly Colette McGivney Mary C Reilly Cavan General Hospital, Cavan General Hospital Cavan General Hospital Virginia Health Care Centre Cavan Cavan Cavan Virginia, Co Cavan CLARE Concepta Ni Laighllis Teresa McGann Margaret Hackett Breda Hannon Straid Bindon, Inis, Ennis General Hospital, Derry, Barefield, Ennis General Hospital, Co an Chlair Ennis, Co Clare Ennis, Co Clare Ennis, Co Clare CLONAKILTY/ Colette O’Sullivan Mary Wycherley Margaret Pat Murphy SKIBBEREEN Palm Cottage, Carhue, Mount Carmel Hospital, Skibbereen District Timoleague, Co Cork Clonakilty, Co Cork Hospital, Skibbereen, Co Cork CLONMEL David Clarke Karina Nugent Marie Corry (HSE – Sth East) South Tipperary South Tipperary South Tipperary General Hospital General Hospital General Hospital Clonmel, Co Tipperary Clonmel, Co Tipperary Clonmel, Co Tipperary CORK HSE Jean O’Connell Maura Lombard Lorraine O’Connor Adrienne Murphy Cork University Hospital ‘Fraoch’, Knock Cork University Hospital Cork University Maternity Wilton, Cork Rochestown, Cork Wilton, Cork Hospital, Wilton, Cork CORK Mary O’Callaghan Laurence McCarthy Eilish Corcoran Katherine Moylan Voluntary/Private Brothers of Charity Brothers of Charity South Infirmary/Victoria St Joseph’s Hospital Lota Lota Hospital, Old Blackrock Rd Mount Desert, Lee Road Co Cork Co Cork Cork Cork

7. INOARep08Appendix.indd 83 30/03/2009 14:29:30 BRANCH CHAIRPERSON VICE-CHAIRPERSON SECRETARY TREASURER DROGHEDA Brenda Tiernan Geraldine Horgan Andrea McCabe Our Lady of Lourdes Our Lady of Lourdes Our Lady of Lourdes Hospital, Drogheda, Hospital, Drogheda, Hospital, Drogheda, Co Louth Co Louth Co Louth DUBLIN EAST Jennifer Bollard Annette O’Higgins Noreen McSweeney Kathleen Griffin COAST ‘Wine Tavern’, St Columcille’s Hospital, St Columcille’s Hospital, St Columcille’s Hospital, Stratford-on-Slaney, Loughlinstown, Loughlinstown, Loughlinstown, Co Wicklow Co Dublin Co Dublin Co Dublin DUBLIN Patricia McCartney Ann Marie O’Reilly Alicya Grudzien Josephine Ryan NORTHERN St Vincent’s Centre, St Michael’s House, 90 Seagrove Drive, St Joseph’s Centre, Navan Road, Dublin 7 Ballymun Road, Dublin 11 Finglass, Dublin 11 Clonsilla, Dublin 15 DUBLIN SOUTH Norman Jones Eileen O’Farrell Teresa Hayes WEST St James’s Hospital, 57 The Park, Kingswood Adelaide & Meath Hospital, James’s Street, Dublin 8 Heights, Tallaght, Dublin 24 Tallaght, Dublin 24 DUNDALK Geraldine McCabe Colette Vize Amanda McNulty Anne E Gilligan Louth County Hospital Louth County Hospital Louth County Hospital Louth County Hospital Dublin Road Dublin Road Dublin Road Dublin Road Dundalk, Co Louth Dundalk, Co Louth Dundalk, Co Louth Dundalk, Co Louth GALWAY Ann Martin Maureen Lydon Mary Connor Mary Esther Walsh Galway University College St Francis Nursing Unit Galway University College Bon Secours Private Hospital, Newcastle Road Newcastle Hospital, Newcastle Road Hospital, Renmore Galway Co Galway Galway Galway KlLDARE/NAAS Margaret Armstrong Teresa Dixon Caroline Kennedy Sr Ellen Tobin Naas General Hospital Naas General Hospital, Naas General Hospital, Naas General Hospital, Naas, Co Kildare Naas, Co Kildare Naas, Co Kildare Naas, Co Kildare KILKENNY Olive Cullen Frances Power Margaret Murphy St Patrick’s Centre, Kilcreene Orthopaedic Kilcreene Orthopaedic Kells Road, Kilkenny Hospital, Kilcreene, Hospital, Kilcreene, Co Kilkenny Co Kilkenny KILLARNEY Shelia Dickson Noreen Corcorcan Nora Deirdre Buckley St Columbanus Home Caherciveen District Killarney Community Hosp. Killarney Hospital, Caherciveen Killarney Co Kerry Co Kerry Co Kerry LAOlS Tony Arthur Mary Flynn Bernadette Parsons Cora McGrath Midland Regional Hospital Midland Regional Hospital Midland Regional Hospital Midland Regional Hospital Portlaoise, Co Laois Portlaoise, Co Laois Portlaoise, Co Laois Portlaoise, Co Laois LElTRIM Marian Quinn Concepta Quinn Evelyn Mulkerrins Josephine O’Bradaigh Arus Carolan Nursing Unit, St Patrick’s Hospital, Arus Carolan Nursing Unit, Arus Carolan Nursing Unit, Mohill, Co Leitrim Carrick-on-Shannon, Mohill, Co Leitrim Mohill, Co Leitrim Co Leitrim LETTERKENNY Teresa Cassidy Mary Howley Marian Skelly Nuala Richardson Letterkenny General Chapel Road 2 Fields Court, Letterkenny General Hospital, Letterkenny, Dungloe, Co Donegal Kilmacrennan, Co Donegal Hospital, Letterkenny, Co Donegal Co Donegal LIMERICK Thomas Ryan Eileen Mullane Thomas Murphy St Vincent’s Centre St Ita’s Hospital St John’s Hospital Lisnagry, Co Limerick Newcastlewest, St John’s Square, Limerick Co Limerick LONGFORD Kelly Neville Elizabeth Heaslip Marie McGivney Trean St Joseph’s Hospital Cloonagh Mohill, Co Leitrim Longford Dring, Co Longford MALLOW Mary Roche Breda Duane Noirin Brennan Lower Gurrane Heatherside Hospital ‘Heathercourt’, Bearforest, Fermoy, Co Cork Buttevant, Co Cork Mallow, Co Cork MEATH Margaret O’Reilly Anne Tully Sinead Dillon Angela Maguire Our Lady’s Hospital Our Lady’s Hospital Our Lady’s Hospital Our Lady’s Hospital Navan, Co Meath Navan, Co Meath Navan, Co Meath Navan, Co Meath

7. INOARep08Appendix.indd 84 30/03/2009 14:30:24 BRANCH CHAIRPERSON VICE-CHAIRPERSON SECRETARY TREASURER MONAGHAN Linda McAree Michelle Corley Margaret McMahon Patricia Toal Monaghan General Monaghan General Monaghan General St Mary’s Hospital Hospital, Hospital Hospital, Castleblaney, Monaghan Monaghan Monaghan Co Monaghan MULLINGAR Ann Quinn Catherine Tormey Ann Farrell St Mary’s Hospital Mullingar General Hospital St Mary’s Hospital Mullingar, Co Westmeath Mullingar, Co Westmeath Mullingar, Co Westmeath OFFALY Bernadette Nally Mary Keane Geraldine Talty Brigid Grogan Tullamore General Hospital Tullamore General Hospital Tullamore General Hospital, Tullamore General Hospital Tullamore, Co Offaly Tullamore, Co Offaly Tullamore, Co Offaly Tullamore, Co Offaly ROSCOMMON Mary Freeman Marie Gunning Ursula Morgan Catherine Gallagher Roscommon County Roscommon County Roscommon County Roscommon County Hospital, Roscommon Hospital, Roscommon Hospital, Roscommon Hospital, Roscommon SLIGO Catherine Judge Delia McDevitt Breda McHugh Mary Walsh Sligo General Hospital Sligo General Hospital St John’s Hospital Sligo General Hospital The Mall, Sligo The Mall, Sligo Ballytivnan, Sligo The Mall, Sligo TIPPERARY Mary Nevin Maura Byrne Mary B Tierney Patricia Ryan NORTH Nenagh General Hospital Nenagh General Hospital, ‘Lanespark House’ Nenagh General Hospital (HSE – MidWest) Nenagh, Co Tipperary Nenagh, Co Tipperary Ballynonty, Thurles Nenagh, Co Tipperary Co Tipperary TRALEE Eileen Carmody Grainne Hyde Fiona Dundon Johanna Dillane The Old Bridge, Laharn Kerry General Hospital Kerry General Hospital Bon Secours Hospital Listowel Road, Tralee Tralee, Co Kerry Tralee, Co Kerry Tralee, Co Kerry Co Kerry WATERFORD Claire Mahon Marie Aylward Mary McCormack- Waterford Regional Waterford Regional Sandison Hospital, Ardkeen, Hospital, Ardkeen, Waterford Regional Waterford Waterford Hospital, Ardkeen, Waterford WEXFORD Hanna Nolan Mary Mooney Mary Kehoe Wexford General Hospital Wexford General Hospital Wexford General Hospital Wexford Wexford Wexford WICKLOW Marion Byrne Nancy Grennan Wicklow Town District Wicklow Town District Hospital, Wicklow Hospital, Wicklow

7. INOARep08Appendix.indd 85 30/03/2009 14:30:37 Appendix II – Section Officers – Currently in Office

SECTION CHAIRPERSON VICE-CHAIRPERSON SECRETARY ASSISTANT DIRECTORS Anna Winters Helen Buckley Marie Hoey OF NURSING SECTION Millbrook House, Cashel Naas General Hospital Connolly Hospital Mohill, Co Leitrim Co Kildare Blanchardstown, Dublin 15 CLINICAL NURSE Annette Morgan Mary Gallagher Mary Haywood-Jones, MANAGER SECTION Royal Victoria Eye and Ear Letterkenny General Hospital Beaumont Hospital, Hospital Co Donegal Dublin 9 Dublin 2 CLINICAL NURSE Geraldine Hogan Jacinta Mulhere Margaret Sullivan SPECIALIST SECTION Naas General Hospital Peamount Hospital Limerick Regional Hospital Naas, Co Kildare Newcastle, Co Dublin Dooradoyle, Limerick CLINICAL PLACEMENT Catherine Conlon Mary Fergus SECTION Tullamore General Hospital Mayo General Hospital Tullamore, Co Offaly Castlebar, Co Mayo Community Nurses Sarah McKiernan Marie Lucey-O’Connor SECTION (RGNs) 161 Hillside 99 Watson Drive Greystones, Co Wicklow Killiney, Co Dublin DIRECTORS OF NURSING Imelda Browne Evelyn Barry Breda Hayes SECTION Cherry Orchard Hospital Baltinglass District Hospital St Mary’s Hospital Dublin 10 Baltinglass, Co Wicklow Phoenix Park, Dublin 20 EMERGENCY NURSES SECTION Sile O’Sullivan Patrick Gallagher (formerly A&E Section) Naas General Hospital Beaumont Hospital Naas, Co Kildare Beaumont Rd, Dublin 9 GP PRACTICE NURSE Ursula Molloy SECTION Breenagh, Letterkenny, Co Donegal INTELLECTUAL Catherine Doyle Patricia Boylan Josephine Ryan DISABILITY SECTION St Vincent’s Centre Cheeverstown House St Joseph’s Centre Lisnagry, Co Limerick Templeogue, Dublin 12 Clonsilla, Dublin 15 MIDWIVES SECTION Sally Millar Colm O’Boyle Hollymount Trinity College Peterswell, Co Galway Dublin 2 National Care of Older Breda McHugh Claire Fardy Ann Marie Eighan Person SECTION St John’s Hospital, St Columbas Hospital St Mary’s Hospital Ballytivnan, Thomastown, Mulllingar, Sligo Co Kilkenny Co Westmeath National Interventional Maureen Woodnutt Joan Clifford Radiology SECTION St James’s Hospital Adelaide & Meath Hospital James’s Street, Dublin 8 Tallaght, Dublin 24 NURSE MIDWIFERY Margaret Carroll Gervaise Maher EDUCATION SECTION Trinity College, Stirling Mews Dublin 2 Clonee, Co Meath OCCUPATIONAL HEALTH Una Feeney Patricia English Lucy Tierney SECTION 9 Woodlands, Cappagh Haulbowline Naval Base St James’s Hospital Kinsale, Co Cork Haulbowline, Co Cork James’s Street, Dublin 8 Operating Department Sandra Morton Kate Nagle Caroline O’Connor Nurses SECTION Cappagh Hospital, Connolly Hospital Department of Nursing & Finglas, Blanchardstown, Midwifery, University College Dublin 11 Dublin 15 Cork, Cork ORTHOPAEDIC SECTION Rosemary Masterson Charlotte Hannon Mary Kilker-O’Sullivan Cappagh Orthopaedic Hospital Sligo General Hospital St Mary’s Orthopaedic Hospital Finglas, The Mall, Gurranebraher, Dublin 11 Sligo Cork OVERSEAS NURSES Emmanuel Etcheri Judith Tabuena SECTION St Loman’s Psychiatric Unit St. Vincent’s Centre Adelaide & Meath Hospital Lisnagry Tallaght, Dublin 24 Co Limerick

7. INOARep08Appendix.indd 86 30/03/2009 14:30:56 SECTION CHAIRPERSON VICE-CHAIRPERSON SECRETARY PHN SECTION Eileen O’Farrell Ann O’Neill 57 The Park, Kingswood Heights, 23 Rosewood Grove Tallaght, Dublin 24 Balgaddy, Dublin 22 REHABILITATION NURSES Eileen Crowley Mary Carrie Fanchea McCourt SECTION St Ita’s Hospital Currabeg National Rehabilitation Hospital Newcastlewest, Co Limerick Ardee, Co Louth Rochestown Avenue Dun Laoghaire, Co Dublin RETIRED ASSOCIATE Teresa Phil O’Mahoney Catherine Marnane Mary M Nicell SECTION 138 Hillcrest Park, 27 Templeogue Wood, 43 Meadowbrook Avenue, Ballygall Road East, Templeogue, Baldoyle, Dublin 11 Dublin 6W Dublin 13 SCHOOL NURSES SECTION Julie McTernan 80 College Park Newbridge, Co Kildare STUDENT SECTION David Wallace Trinity College Dublin 2 SURGICAL/MEDICAL Aideen Cassidy Noreen Flannelly-Kinsella Aine Davern DAY CARE SECTION Adelaide & Meath Hospital Our Lady’s Hospital Beaumont Hospital Tallaght, Dublin 24 Navan, Co Meath Beaumont Road, Dublin 9 TELEPHONE TRIAGE Mary Burke Liz Murphy NURSES SECTION CAREDOC, CAREDOC, St. Dympna’s Hospital, St. Dympna’s Hospital, Athy Road, Carlow Athy Road, Carlow

7. INOARep08Appendix.indd 87 30/03/2009 14:31:10 Appendix III: INO Secretariat – 2008

General Secretary: Liam Doran MA BA RGN RMHN Deputy General Secretary: Dave Hughes MA (Industrial Relations) Director of Professional Development: Annette Kennedy MSc BNS Director of Organisation & Social Policy: Clare Treacy RGN RPN Dip IR Dip EO Director of Industrial Relations: Phil Ní Sheaghdha MA RGN Dip IR & TU Studies

Industrial Relations Staff HSE Eastern Region – Dublin City Hospitals: Albert Murphy HSE South West Area and other Dublin health agencies: Joe Hoolan HDip A&E RGN (Resigned Dec 2008) Lorraine Monaghan, Dip Emp Law, BA IR & RM January 2009 (Locum) HSE East Coast Area and other Dublin health agencies: Philip McAnenly BA (Pers Mgt & IR) RGN RPN HSE Northern Area and other Dublin health agencies: Edward Mathews RNMH HSE Midland Region and some Dublin health agencies: Derek Reilly RGN HSE Mid-West Region: Mary Fogarty Dip Communications, RGN HSE North East Region: Tony Fitzpatrick HDip A&E, RGN HSE North West Region: Noel Treanor BA (Hons) RGN, Maura Hickey RGN RM Dip Health Service Management (Sept 2007 – June 2008) HSE Southern Region: Michael Dineen RPN, Patsy Doyle BSS RPN HSE South East Region: Liz Curran RPN HSE Western Region: Noreen Muldoon RGN (Part Time), Regina Durcan RN, RM (Part Time, Appointed June 2008) Media Relations Officer: Ann Keating Information & Research Executive (IR): Colette Mullin BL Dip Emp Law, BA IR & PM Information Officers: Catherine Hopkins Dip Mgt & Emp Rel, Dip IT, JEB Lorraine Monaghan Dip Emp Law, BA IR & PM

Administration Administration Manager: Dorothy Mullarkey Dip Management & IR (Retired Sept 2008) Secretary to Executive Council/ADC Co-Ordinator: Oona Sugrue (Contract) Office Manager: Claire Cluxton Assistant Office Manager/Assistant Media Relations Officer: Jacinta Moyles Personal Assistant to General Secretary: Michaela Ruane Dip HRM, JEB Dip IT Personal Assistant to Deputy General Secretary: Martina Dunne Personal Assistant to Director of Industrial Relations: Mary Cradden Personal Assistant to Director of Social Policy: Noeleen Smith

7. INOARep08Appendix.indd 88 30/03/2009 14:31:26 Admin Support Staff: (HQ) Edel Bose, Phyllis Foody, Ann O’Brien Tina Sweeney (Appointed April 2008) Admin Support Staff (Cork): Rosemary O’Sullivan Admin Support Staff (Galway): Margaret O’Donoghue, Lisa Curran (Part-time) Admin Support Staff (Limerick): Karen Liston Accounts Manager: Una O’Brien MIATI Accounts Manager Designate: Angela Clarke MIATI Accounts Assistants: Dolores Byrne, Sinead Loy, Kylie Matterson, Clare Morahan (Temporary) Membership Services Officer: Kevin Downey Membership Assistant: Una McEvitt Telephonist/Receptionist: Marion Behan

Professional Development Centre Education and Promotion Officer: Kathy Foy-Newman RSCN Dip IR, Dip PR (Retired July 2008) Researchers – Commission on the 35 Hour Week: Petrina Donnelly (April-Dec 2008) Fionuala McCusker (April-Dec 2008) Course Co-ordinator: Marian Godley Assistant Course Co-ordinator: Linda Doyle Research/Personal Assistant to Director Cathriona Lacey of Professional Development: Admin Support Staff: Helen O’Connell

Section Development Section Development Officer: Mary Power MA RGN RM (Branch Restructuring Project – Since Sept 2007) Assistant Section Development Officer: Jean Carroll BA Psychology Dip BS (Acting Section Development Officer – Since Sept 2007) Admin Support Staff: Geraldine McNamee

Library Librarian: Muriel Haire Dip LIS Assistant Librarian: Niamh Adams MA BA HDip LIS Library Assistant : Rhona Ledwidge Aileen Rohan Dip LIS

Maintenance/Housekeeping Maintenance Officer: Stuart Mc Neill Cleaner/Housekeeper: Edita Stasitiena Jurate Jakubonyte (part-time)

7. INOARep08Appendix.indd 89 30/03/2009 14:31:40 Appendix IV – Organisational/Grading Chart

General Secretary – Director of HR

PA – Grade 5 Membership Officer – Grade 6 Accs Manager – Grade 7 Membership Asst – Grade 4 Accs Assistants x 3 – Grade 4

Maintenance x 1 – Craftsman Grade

Secretary to Executive Council/ Media Relations Officer – ADC Co-ordinator – Grade 6 Grade 7

Deputy GS – Director of IR – Director of Director of Programme Mgr Programme Mgr Organisation and Professional Social Policy – Development – Programme Mgr Programme Mgr

Office Manager – Grade 7 IROs x 12 – PA x 1 – Grade 5 Assistant Office Mgr – Grade 5 General Mgr PA x 1 – Grade 5 PA x 1 – Grade 5 Receptionist x 1 – Grade 4 Admin Staff x 9 (Incl Part Time) – Grade 4

PA/Research Assistant – Grade 5 Admin Assistant – Grade 4 Section Development/Branch Development – General Mgr Asst Section Development – Grade 5 Professional Policy Officer – Vacant Course Co-ordinator – Grade 5 Asst Course Co-ordinator – Grade 4 Information Exec – Housekeeping General Mgr x 2 – Cleaners Info Officers x 2 – Grade (1 Full Grade 5 time/1 Part Time) Librarian – Grade 7 Asst Librarians x 2 – Grade 5 Library Assistant x 1 – Grade 4 (Part Time)

7. INOARep08Appendix.indd 90 30/03/2009 14:37:09 Appendix V: Salary scales applicable from Sept 1, 2008

Payment of 2.5% Towards 2016 Increase with effect from September 1, 2008

Incremental point 1 2 3 4 5 6 7 8 9 10 Student Nurse (Degree students 25,500 12 month rostered placement) Student Nurse Mental Handicap 25,500 (Degree students 12 month rostered placement) Staff Nurse (including Registered Midwife, 31,875 33,470 35,069 36,666 38,256 39,630 41,008 42,380 43,753 45,102 Registered Sick Children’s Nurse, Registered 46,541 Mental Handicap Nurse) Long service increment after three years on maximum of scale Senior Staff Nurse/Midwife 48,870 Dual Qualified Nurse 36,055 38,445 39,721 40,702 41,783 43,223 44,625 46,689 (registered in any two of the five disciplines) Long service increment after three years on maximum of scale 48,130 Senior Dual Qualified Nurse 50,537 Clinical Nurse/Midwife Manager 1 45,987 46,864 48,102 49,360 50,599 51,846 53,236 54,531 Clinical Nurse/Midwife Manager 2/ 50,096 50,958 51,685 52,875 54,188 55,478 56,768 58,220 59,570 Clinical Nurse/Midwife Specialist (plus allowance of £843 pa payable on a red-circled basis to theatre/night sisters who were in posts on November 5, 1999) Clinical Instructor 52,353 53,230 53,880 55,086 56,302 57,613 58,932 60,249 61,564 Clinical Nurse/Midwife Manager 3 57,931 59,114 62,107 63,284 64,467 65,666 Nurse Tutor 59,296 60,127 60,955 61,787 62,617 63,450 64,276 65,110 65,942 66,772 Principal Nurse Tutor 62,280 63,490 64,596 68,050 69,258 70,395 71,816 73,721 Student Public Health Nurse 33,248 Public Health Nurse 48,765 49,604 50,321 51,451 52,750 54,009 55,277 56,702 58,028 (plus allowance of £1,686 pa payable on a red-circled basis to staff who were in posts on November 5, 1999) Asst Dir of Public Health Nursing 57,934 61,221 62,572 63,816 65,074 66,794 Director of Public Health Nursing 77,198 79,538 81,886 84,232 86,577 88,924 (plus performance related pay) Advanced Nurse Practitioner 58,509 59,678 60,807 64,271 65,362 66,629 67,813 68,990 73,725 Assistant Director of Nursing 58,509 59,678 60,807 64,271 65,362 66,629 67,813 68,990 73,725 (Band 1 hospitals) Assistant Director of Nursing 55,469 56,691 57,934 61,221 62,572 63,816 65,074 66,794 (Non Band 1 hospitals) Area Director 83,837 86,426 88,988 91,186 93,636 96,136 98,600 Nursing & Midwifery Planning & Development Director 76,134 78,265 80,613 83,193 86,021 88,925 Nursing & Midwifery Planning & Development Director of Nursing/Matron Band 1 78,451 80,632 82,817 84,994 87,174 89,361 91,539 (plus performance related pay) Director of Nursing/Matron Band 2 73,823 75,901 77,985 80,060 82,148 84,229 86,311 Director of Nursing/Matron Band 2A 73,232 74,539 75,849 77,154 78,465 79,769 81,078 Director of Nursing/Matron Band 3 68,003 69,526 71,052 72,579 74,100 75,633 77,154 Director of Nursing/Matron Band 4 63,416 65,393 67,362 69,340 71,320 73,291 75,258 Director of Nursing/Matron Band 5 59,204 60,526 61,847 63,166 64,485 65,812 67,134 Director of Centre of Nurse Education 68,357 70,546 72,734 74,924 77,112 79,301 81,489 83,770

7. INOARep08Appendix.indd 91 30/03/2009 14:38:08 ??Location and Qualification Allowances applicable from September 1, 2008 Eligibility Nurses eligible for payment of location/qualification allowances are Staff Nurses, Senior Staff Nurses, CNMs 1 & 2 (incl. Theatre Sisters). A nurse may benefit from either a qualification allowance or a location allowance when eligible – the higher of the two – when working on qualifying duties. Pro-rata arrangements apply to job-sharing and part-time staff.

Grade Nature of allowance Registered General Nurses Employed on duties in the following locations: €1,956 Accident & Emergency Depts, Theatre/OR, Intensive Care Units, Renal Units, Cancer/Oncology Units, Geriatric Units/Long-stay Hospital or Units in County Homes Registered Nurses Employed on duties in the following locations: €1,956 Units for Severe and Profoundly Handicapped in Mental Handicap Services, Acute Admission Units in Mental Health Services, Secure Units in Mental Health Services, dedicated Care of the Elderly (excluding Day Care Centres) and Alzheimers Units in Mental Health Services and the Intellectual Disability Sector* (including Psycho-geriatric Wards, Elderly Mentally Infirm Units, Psychiatry of Later Life Services). (*Allowance effective from 1 January, 2004.) Registered Nurses a) Employed on duties in specialist areas appropriate to the €2,938 following qualifications where they hold the relevant qualifications: With effect from 1 March, 2002 payment of the specialist qualification • Accident & Emergency Nursing Course allowance is extended to all specialist • Anaesthetic Nursing Course courses confirmed as Category II by • Behaviour Modification Course An Bord Altranais • Behavioural Therapy Course • Burns Nursing Course • Child & Adolescent Psychiatric Nursing Course • Coronary Care Course • Diabetic Nursing Course • Ear, Nose & Throat Nursing Course • Forensic Psychiatric Nursing Course • Gerontological Nursing Course • Higher Diploma in Midwifery • Higher Diploma in Paediatrics • Infection Control Nursing Course • Intensive Care Nursing Course (incl. Paediatric Intensive Care & Special and Intensive Care of New Born) • Neurological/Neurosurgical Nursing Course • Operating Theatre Nursing Course (incl. Paediatric Op. Theatre) • Ophthalmic Nursing Course • Orthopaedic Nursing Course • Higher Diploma in Cardiovascular Nursing/Diabetes Nursing/ Oncological Nursing/Palliative Care Nursing/Accident & Emergency Nursing • Rehabilitation Nursing Course • Renal Nursing Course • Stoma Care Nursing Course Registered General Nurses b) Holding recognised post-registration qualifications in midwifery €2,938 or sick children’s nursing and employed on duties appropriate to their qualification All Public Health Nurses & Receive Qualification Allowance of €2,938 Assistant Directors of Public Health Nursing

Dual Qualified Scale:Applies to nurses in possession of two of the five registered nursing qualifications or in training for the second qualification on October 1, 1996. In the case of midwifery and sick children’s nursing, the dual qualified scale is effective from August 1, 1998. A staff nurse can only receive either a dual qualified scale or an allowance, whichever is the greater. The exceptions to this are: a) Nurses who were paid on the dual qualified scale on October 1, 1996 and in receipt of a location allowance at August 1, 1998 or eligible for a new location/qualification allowance from March 31, 1999. In such cases the value of the location/qualification allowance is e1,468 which they receive in addition to their dual qualified scale; b) With effect from November 26, 2003, nurses who are paid on the dual qualified scale and who then move to an area that attracts a location/qualification allowance will continue to be paid on the dual qualified scale and will also receive the abated value of the location/ qualification allowance of e1,468. Payment of the allowance will cease if the nurse moves out of the qualifying area.

7. INOARep08Appendix.indd 92 30/03/2009 14:38:38 Other allowances applicable from September 1, 2008

Grade Nature of allowance Relevant nursing staff Nurse management sub-structures – special allowance for weekends/public holidays €3,132 Psychiatric nurses Community allowance €5,223 Nurses assigned to occupational therapy (qualified) €3,929 Nurses assigned to occupational therapy (unqualified) €1,791 Public health nurses Island inducement allowance €1,859 Public health nurses Fixed payment €29.62 weekend work First call on Saturday and first call on Sunday €39.32 Each subsequent call on Saturday and Sunday €19.69 Payment in lieu of time off for emergency work €29.59 Theatre nurses who participate On-call with standby each day: in the on-call/standby emergency Monday to Friday €44.57 services Saturday €57.24 Sunday and public holidays €77.38 All of these figures based on a 12-hour period (pro-rata to apply after hours) Call out rate – Monday-Sunday: a) Fee per operation per 2 hours (17.00-22.00 hours) €44.57 b) (i) Operation lasting > 2 hours and up to 3 hours (17.00-22.00) €66.84 (ii) Operation lasting > 4 hours and up to 5 hours €111.40 c) Fee per operation per hour (after 22.00 hours) €44.57 On-call without standby: €89.13 i) Fee per operation call-in without standby ii) Overruns from roster at normal overtime rates (no time back in lieu) On-call over weekend: In situations where no rostered duty is available over the weekend, the following will apply on a pro-rata basis (ie. appropriate rate divided by 12, then multiplied by number of hours available). No time back in lieu will apply Nurse co-ordinator allowance: A shift allowance of e19.04 will be paid to a staff nurse who undertakes the role of formalising the reporting and accountability relationship with the theatre superintendent. The allowance only applies to a nurse who fulfils specified duties when called in (DoHC circular refers) Midwives providing domiciliary Fee per service €131.00 care under the maternity and Reduction where antenatal visit is after 36th week of pregnancy €8.16 infant care scheme Patient removed to hospital before onset of labour and not accompanied by midwife €48.61 Patient removed to hospital before onset of labour and accompanied by midwife €64.90 Patient removed to hospital after onset of labour and not accompanied by midwife €81.33 Patient removed to hospital after onset of labour and accompanied by midwife €97.30 Abortions and miscarriages €64.89

Specialist Co-ordinator €4,546 Allowance

7. INOARep08Appendix.indd 93 30/03/2009 14:38:53 ??Appendix VI: INO Private Nurses Fees – (Emergency & General Nurses Section Effective 1 July, 2008-30 June, 2009)

Mon-Fri Mon-Fri Saturday Saturday Sunday Sunday 24, 25 & 31 Dec Day Night Day Night Day Night Day & Night

Up to 4 Hrs e113 e134 e172 e225

5 Hrs e121 e144 e187 e267

6 Hrs e137 e164 e215 e309

7 Hrs e159 e184 e244 e349

8 Hrs e175 e192 e203 e215 e272 e281 e391

9 Hrs e184 e204 e214 e229 e285 e298 e430

10 Hrs e207 e229 e239 e257 e313 e337 e471

11 Hrs e229 e253 e262 e286 e340 e375 e513

12 Hrs e251 e281 e288 e315 e369 e413 e555

13 Hrs e276 e308 e313 e344 e397 e449 e596

Specialist areas: eg. ICU/CCU/A&E/Haemodialysis/Midwifery/Theatre Allowance 15%

• Nurses are advised to ensure that a Doctor is in attendance on cases in Private Homes to which they are called. • Responsibility for payment of fees: The person (employing authority or individual) who engages the nurse is responsible for the payment of his/her fees within one calendar month. • Shift payments outlined are inclusive of statutory rest periods as per the Organisation of Working Time Act (1997).

Twilight Shift 8pm-12 Midnight Escort Rates On-Call Fees

Mon - Fri e160 1st Hour e70 Mon - Fri e80

Saturday e185 2nd - 8th Hour e16 Saturday e87

Sunday e227 After 8 Hours e23 Sunday e96

• If called during a period of Theatre On-call/Sleep Over the full night duty rate (not the on-call allowance) should be paid from the time the on-call period started. • Private Industry Fee e35 per hour daytime. Shifts commencing AFTER 6pm should attract an additional 25%. • Patients insured under voluntary health insurance are covered up to a certain figure for the services of a special nurse in the home. • Nurses must send receipts to patients immediately on receipt of fees.

7. INOARep08Appendix.indd 94 30/03/2009 14:39:08 Appendix VII: Subsistence Rates

Subsistence (Normal) Rates:

Class A (salary above E50,535 per annum)

Night Allowance 140.44

Day Allowance 10 hours or more 41.55

Day Allowance 5 hours but less than 10 16.95

Class B (salary E50,534 and below)

Night Allowance 132.18

Day Allowance 10 hours or more 41.55

Day Allowance 5 hours but less than 10 16.95

Mileage Rates

Official Mileage in a Calendar year up to 4,000 4,001 & over

cent cent

Engine capacity up to 1,200cc 86.05 44.42

Engine capacity 1,201cc to 1,500cc 102.58 51.33

Engine capacity 1,501cc and over 129.88 61.07

Kilometre Rates

Official Kilometres in a Calendar year up to 6,347Km 6,347Km & over

cent cent

Engine capacity up to 1,200cc 53.48 27.61

Engine capacity 1,201cc to 1,500cc 63.75 31.90

Engine capacity 1,501cc and over 80.72 37.96

7. INOARep08Appendix.indd 95 30/03/2009 14:39:33 ??Notes

7. INOARep08Appendix.indd 96 30/03/2009 14:39:46 Annual Report 2008

Irish Nurses Organisation Cumann na nAltraí Gaelacha

INO annual report cover 5MM SPINE 2008.indd 1 30/03/2009 15:46:14