INMO Delivering for Members Incremental Credit and Premium Pay Restored See Page 8-9 CONTENTS 3

€5.75 Vol 24 No 9 November 2016

Latest course information from Journal of the Irish Nurses and the INMO PDC Midwives Organisation page 33

World of Irish Nursing & Midwifery

INMO calls for immediate action on pay page 10

Need to accommodate staff following injury page 15

Report from EFN general assembly in Madrid page 26

Optimal cord clamping – research award winner page 50 INMO delivering for members Incremental credit and premium pay restored see page 8-9 CONTENTS 3

News & views 47 Media Watch Ann Keating reviews INMO activities 5 Editorial reported in the news The full restoration of incremental pay for recent graduates and the 48 Quality and safety re-introduction of premium pay for This month Maureen Flynn looks at 6pm-8pm in acute hospitals mark key making data meaningful to drive better gains for the INMO, writes general quality decisions secretary Liam Doran 52 Midwifery matters 7 From the President Deir dre Munro reviews the recently INMO president Martina Harkin-Kelly published key Lancet paper, ‘Beyond too rounds up news from the Executive little, too late and too much too soon’ Council and beyond 57 Focus 8 News B y using a standardised nursing home Premium pay restored for 6-8pm in transfer form, patients can receive more 10 acute hospitals… Full removal of pay person-centred care, writes Jean Barber anomaly marks a key win for graduate members… INMO calling for immediate 60 Update action on pay and nursing/midwifery Round up of healthcare news items shortages… Health allocation inadequate to meet growing demand… Importance of a proactive approach to health and Clinical safety of employees… Progress at the Richmond Building… INMO calls for 43 CPD single-tiered health service… Public This month, our continuing professional holiday payments… Immediate call to education series focuses on head injuries action on Co Louth nurse shortages… Midwifery focus Concerns over failure to address staffing 43 Anne Murray, 2016 CJ Coleman Research deficits at OLOL… Several CUH wards Award Winner, discusses research on serve notice of work to rule action… optimal cord clamping Deepening crisis in care of older person services in mid west… Concerns raised 54 IBD and fatigue over e-rostering project in Letterkenny… Cath y Walsh discusses the underestimation Health and safety concerns at St James’s of fatigue in young people with offsite parking… Parking at new children’s inflammatory bowel disease hospital a serious concern… Cregg House 26 staffing review… Tullamore staffing concerns… CHO 9 staffing shortages Living Plus: Section news, page 25 59 Book review 26 International news Tara Horan reviews The Soft Diet Elizabeth Adams reports on the recent Plus: Monthly crossword competition EFN general assembly in Madrid 67 Finance Features Ivan Ahern advises on choosing a health insurance policy 24 Section focus This month we focus on the Emergency Department Nurses Section Jobs & Training 29 Questions and answers 33 Professional Development Bulletin board for IR queries Eight -page pull-out section from the INMO PDC 30 Organising review INMO organiser Albert Murphy reports 68 Diary on health and safety training for ED reps Listing of meetings and events nationally and internationally 46 Focus Ahead of a new PDC course, Nuala Hannon 69 Recruitment & Training 50 focuses on the common goal of making Latest job and training opportunities in patients’ experiences of cancer easier Ireland and overseas WIN Vol 24 No 9 November 2016 WIN – World of Irish Nursing & Midwifery is distributed by controlled circulation to more than 32,000 members of the INMO. It is published monthly (10 issues a year) and is registered at the GPO as a periodical. Its contents in full are Copyright© of MedMedia Ltd. No articles may be reproduced either in full or in part without the prior, written permission of the publishers. The views expressed in this publication are not necessarily those of the INMO. Annual Subscription: e145 incl. postage paid. Editorial Statement: WIN is produced by professional medical journalists working closely with individual nurses, midwives and officers on behalf of the INMO. Acceptance of an advertisement or article does not imply endorsement by the publishers or the Organisation. EDITORIAL 5 Collective

Irish Nurses and Journal of the Midwives Organisation approach World of Irish Nursing & Midwifery

(ISSN: 2009-4264) Volume 24 Number 9 November 2016 the key WIN, MedMedia Publications, 17 Adelaide Street, In this issue of WIN you will read of posi- Dun Laoghaire, tive developments in relation to incremental Co Dublin. credit for nurse/midwife graduates for the Website: www.medmedia.ie period 2011-2015, and the re-introduction of premium pay for the hours between 6pm and 8pm, payable to members in the acute involve days of action running right sector (see pages 8-9). through the month of November. These positive gains, which put much Currently of 21 representative bodies in needed added salary into our members’ the wider public service, 18 continue to work Acting editor Tara Horan pockets, came about as a direct result within the framework of the Lansdowne Road Email: [email protected] of sustained collective campaigning and Agreement. However, a growing number of Tel: 01 2710205 negotiations over an extended period. the 18 unions, including the INMO, have indi- Sub-editor Sinéad Makk, Anne Savage These two developments are also the latest cated that the speed of pay restoration and Designers Fiona Donohoe, Paula Quigley examples of this Organisation securing, on reduction in working hours must be acceler- Commercial director Leon Ellison an ongoing basis, the reversal of grossly ated as the current timeframe, providing for Email: [email protected] inequitable cuts imposed unilaterally in a €1,000 increase from September 1, 2017, Tel: 01 2710218 recent years by successive governments. with the agreement running to September Publisher Geraldine Meagan These are, of course, only steps on the 2018, is totally unacceptable. road that we must follow, demanding the In this context, the INMO is already in WIN – World of Irish Nursing & Midwifery full reversal of all pay cuts, restoration of ongoing discussions, with these other public is published in conjunction with the all allowances and reduction of work hours, service unions, on the next steps that should Irish Nurses and Midwives Organisation by MedMedia Group, Specialists in Healthcare all of which were part of agreements, be collectively taken by the Public Services Publishing & Design. reluctantly accepted, in recent years. Committee to deliver the best possible out- The Executive Council is aware of the come for all public servants. anger and frustration among members at The key to whatever campaign strategy the slow pace of returning salaries cut, the is finally adopted by the Executive Council burden of additional, unpaid hours and the will be a collective, sustained, approach, excessive and unsafe workloads arising from from all members. Experience has shown, the ongoing staffing crisis, and severe diffi- even as recently as securing the restora- culties with recruitment and retention. That tion of the incremental credit and time and Editor-in-chief: Liam Doran is why the Executive Council, at its meeting one-sixth issues, that collective, strong and INMO editorial board: in October, initiated a nationwide consulta- coherent action by the Organisation deliv- Martina Harkin-Kelly; Mary Leahy; Margaret Frahill; Frances Cullen; Kay Garvey; tion to hear first-hand members’ priorities ers for members in a meaningful way. Mary Gorman; Karen McGowan as we finalise a campaign to address these Pay, hours and staffing are obviously INMO editor: Ann Keating priority issues. all major issues for members at this time. Email: [email protected] At the time of going to press, these Whatever strategy is determined by the INMO editorial assistant: Freda Hughes regional meetings are continuing with much Executive Council will be for the purpose of robust and strong debate as to what should addressing these issues in a manner which INMO photographer: Lisa Moyles be the Organisation’s priorities, subject to a is consistent with the views of members, INMO correspondence to: democratic mandate, in the coming weeks. as indicated by the feedback from these Irish Nurses and Midwives Organisation, Whitworth Building, The Executive Council is scheduled to regional meetings. North Brunswick Street, meet again on November 7-8, 2016 to Members are talking, members are being

Dublin 7. receive feedback from all of these regional listened to and, ultimately, members will WIN Tel: 01 664 0600 meetings, to interpret that feedback and decide what steps this Organisation takes Fax: 01 661 0466 determine what form of campaign will to address these critical issues. A united Vol 24 No 9 November 2016 Email: [email protected] secure the strongest mandate from mem- approach, fully informed by members, will Website: www.inmo.ie bers, in all areas of the health service, deliver and that will be the central objec- across the country. tive of all decisions to be taken by our www.facebook.com/ The situation is also connected to immi- Executive Council. irishnursesandmidwivesorganisation nent industrial action by one teacher union UNITY = STRENGTH and two garda representative bodies, Liam Doran twitter.com/INMO_IRL which, at this time, are scheduled to General Secretary, INMO WIN Vol 24 No 9 November 2016 - - - -

s is the of the hallmark workingINMO Don’t forget to forward your ideas, your ideas, to forward forget Don’t meet Council Executive following The The INMO strives to support and work work and support to INMO strives The on meeting Council The next Executive Get in touch HQ at Tel: 01 6640 600, through the through 600, 6640 01 Tel: at HQ on blog or www.inmo.ie president’s by to: email [email protected] You can contact me at INMO at me contact can You for all members at every opportunity with opportunity every at all members for devel matters pertaining to professional November from 7-8 will feedback receive the sessions and nationwide the recent all from obtained valuable information will members turn in direction the shape of the campaign. advice, and thoughts on how to for plan the Health Summit. paign launched in October. paign launched in to fitness opment, industrial relations, practise campaigns ongoing and our like saw nationwide which campaign national will help secure This sessions. information benefits bright, and is better that future a and midwives. all nurses in 2016 5-6, December on held be will ing INMO HQ. Quote of the month plan carefully” beginning, “Before – Cicero Tullius Marcus Thi continuously you for THE Council met Executive on October the of Septem 3-4 course the Over last. considerable October meetings, ber and time was to discuss given and debate the the you many for exist that anomalies agreed Council The Executive members. the and of pay restoration the pace that we too little and too long and time scale is pay and to accelerate pressure must apply the via conditions cam national improved Report from the from Report Council Executive - -

- - -

www.inmo.ie/President_s_Corner www.inmo.ie/President_s_Corner (see page 8). Martina Harkin-Kelly with (right) Leahy Mary at the protest outside the Dáil to the highlight anomaly pay 2011-2015 for graduates www.inmo.ie made a point of reiterating the need for government commitment to fully to commitment government for need the reiterating of point a made (pages 10-11) our on and website

WIN For For further details on the above and other events see tures, otherwise this would be a lost opportunity to fix the ills in our maternity services. maternity our in ills the fix to opportunity lost a be would this otherwise tures, mence the process of setting the issues of mother and child safety right. When introducing introducing When right. safety child and mother of issues the setting of process the mence I Minister, the struc management strong by Strategy Maternity the underpin and implement,resource THIS annual one-day conference THIS held conference one-day annual in year this Dublin is of collaboration true a mid Harris,Simon Health for Minister south. and north both research and innovations wifery O’Neill, counterpart,Michelle Assembly Northern his with collaboratively working is who the within measures the reiterated and welcomed Harris Mr conference. the addressed that 2016-2026 com will together, better future a Creating Maternity Strategy, National viding evidence-based practice. This allows for critical appraisal and the use of scientific of use the and appraisal critical for allows This practice. evidence-based viding of the to delivery the healthcare of population for evidence they that patients serve. – Dublin Conference Annual Midwifery All Ireland Telephone Triage Triage Nurses Section Telephone Conference open to honoured and in timely this WAS conference opportune and address Limerick. I for complications,preparing midwifery as such areas covered programme conference The supported both It skin. infant and anxiety with injuries,dealing pain,sports chest HIQA, pro by nurse triage telephone the of role keeper’ gate ‘preventative the endorsed and Premium pay restored Premium working nurses/midwives from cut 2%) (over pay premium that confirm to delighted are We under secured agreement the of implementation following restored be will 6-8pm between 2016.January to backdated be will This hospitals. acute in Agreement Road Lansdowne the thewithin that from nurses/midwives to continue will ensure to work payments removed We restored be also will divisions care primary and social The INMO launched the Organisation’s campaign for immediate action on pay and nurs and pay on action immediate for campaign Organisation’s the launched INMO The campaign this on updates See October. in conference press a at shortages ing/midwifery in I AS president, together with the Executive Council, have heard the call from members, members, from call the heard have Council, Executive the with together president, AS I they that have right country, the enough had to across Organisation and the want greatly and restoration pay accelerated secure to needed are strategies whatever initiate with. dealt is this that ensure to working actively are we and levels staffing improved THE pay anomaly for nurses/midwives nurses/midwives for anomaly pay THE one was 2011-2015 from graduated who cruellest the of our to blows graduates. and loudly protest Dáil recent The clearly the to articulated government your As this that was a far. too step president vice first with along president, and heartened were we Leahy, Mary the of travelled who proud members The disquiet their from demonstrate to near protest by participating far and event. the in the gained traction necessary and timely was that in it was the during held run the to up with met Health for Minister the 13 October on that know all will you Budget.now By of deputation a officials INMO and to graduate members the announce roll this of back fight in the win to want we if key out and are won vision and planning Strategic disparity. professions. midwifery and nursing the of survival the ensure to run long the Graduate Dáil protest Dáil protest Graduate

Your priorities priorities Your with the president the with Martina Harkin-Kelly, INMO president INMO Harkin-Kelly, Martina

8 NEWS

Premium pay restored for 6-8pm Worth more than 2% to members in acute hospitals Premium pay cut from nurses/ medical staff, but are now A second and final process respect of progressing this part midwives working between shared with nursing and mid- is required and this is to take of the agreement is scheduled 6-8pm is to be restored fol- wifery staff. The agreement place in the acute hospital set- for November 7, 2016. lowing implementation of the allowed for nursing/mid- ting in the coming weeks. The The Organisation will con- agreement secured under the wifery staffing levels to be verification group has agreed tinue to work to ensure that Lansdowne Road Agreement taken into account in areas that not all sites need to be payments removed from (LRA) in acute hospitals. where this would not allow revisited. However, the follow- nurses and midwives in these The INMO, SIPTU Nursing nursing/midwifery staff to ing hospital groups have been sectors are also restored in line and the IMO have engaged take on these roles. Follow- selected : with the agreement. with the health service ing this a rigorous verification • Ireland East, St Vincent’s Hos- INMO director of industrial employer (the HSE and the process was undertaken and pital, November 18, 10am relations Phil Ní Sheaghdha Department of Health) to had to be met on each • Midlands Hospital Group, Tal- said: “We believe that this pro- implement the agreement acute hospital site. This also laght Hospital, Nov 18, 2pm cess has demonstrated fully on the nursing and medical required site visits and sign off • SAOLTA Group, Galway Univer- that when nurses and midwives interface under the LRA. The from local hospital directors sity Hospital, Nov 28, 10.30am engage with change they do INMO argued that this would of nursing/midwifery as well • Midwest Hospital Group, Lim- so in a manner that promotes allow savings to accrue to as the national verification erick, November 28, 3pm. and enhances patient care and cover the costs associated with group. The national verifi- The HSE is advising these makes financial sense.” restoring the premium pay- cation group, which has a hospital groups of the follow In the context of the out- ment removed from nursing representative of the Depart- on visit, which is a requirement come of the verification and midwifery (and all other ment of Health, the HSE and of the second and final process. process, the independent chair- healthcare workers) under the trade unions (INMO director Non-acute hospital sectors man stated: “Progress achieved Haddington Road Agreement, of industrial relations Phil Ní In respect of sectors outside in firstly agreeing the transfer of and that it should be restored Sheaghdha is the INMO rep), of acute division, the agree- tasks developments, and then to the nursing/midwifery was established and met with ment states that: “The HSE implementing and verifying grades affected. each site in June 2016 and will ensure that the payment the changes through a collab- The INMO did not accept was satisfied that real pro- is applied using the same orative process reflects well on the removal of this premium gress was being made mechanism to the terms and the parties to the agreement... payment which equates to • Phase two, now commencing conditions of members of the It is clear from the delibera- over 2% of salary for staff will involve the HSE social INMO and SIPTU Nursing in tions over recent months and who regularly work shift pat- care division and services out- each sector in which it applied the positive feedback from site terns incorporating the hours side of the acute hospitals prior to the HRA, in line with visits that the transfer of these 6-8pm, and it set about having • Verification is in two phases; this agreement.” tasks can result in earlier inter- it restored using all the proce- the first phase is complete and Having met with the social ventions and consequent earlier dures and processes available. the second is being undertaken care and primary care divisions, discharges. The outcome will be This has paid off – the first over the next six weeks. the INMO believes delivering that substantial financial sav- verification process has been Payment, retrospective to patient services within these ings can be made in addition completed and the payment January 1, 2016 is provided for sectors and reducing the need to increasing the availability of is now confirmed as restored in the agreement. Nurses and to transfer patients to acute inpatient beds, without com- in the acute hospital division midwives in the acute divi- hospitals for treatment, makes promising patient care or and a circular from the HSE has sion will have this payment sense to members working in satisfaction”. issued instructing payment. restored from November 1, these sectors, from a patient Ms Ní Sheaghdha said: “This This process involved 2016 with arrears (10 months) and service perspective. The is another step in restoration of lengthy engagement, chaired payable in January 2017. In cal- INMO has reiterated the pay for INMO members and was independently, after which culating the arrears now due in terms of the agreement which achieved within the terms of the agreement was arrived at the acute division the INMO has requires these two divisions to LRA. In addition this will move between the Department of reminded the HSE that provi- engage with a view to ensuring the role of the nurse/midwife Health, the HSE, the INMO, sion must be made to calculate: those working in these sectors working in all areas of the public SIPTU Nursing and the IMO, in • Retrospection to January 1, can fully apply their education health service to a place where December 2015, which set out 2016 on actual earnings and professional ability. there is a greater input into a three-pronged process: • Effect of retrospection on pre- The INMO will continue to decision making and enhanced • Firstly, the acute hospitals mium pay for annual leave engage in the implementation autonomy in their role. This would introduce the shar- • Effect of retrospection on of the December 2015 agree- will require greater focus by the ing of four tasks identified. pension and lump sum emol- ment in these sectors and keep employer on providing ongoing Vol 24 No 9 November 2016 No 9 November 24 Vol The responsibilities for these uments for those who have members informed during this education, and development of

WIN roles are not removed from retired since January 1, 2016. process. The next meeting in work processes.” WIN Vol 24 No 9 November 2016 NEWS 9 NEWS Recent graduates graduates Recent protest restoration for the Dáil outside pay incremental of O is now contacting all of of contacting all O is now M N our public health service. The The service. health public our I members, graduate our new from to benefit who stand they this to ensure agreement this legitimate, and secure in outstanding, pay increase January”. t represents an important an important represents t I “ Liam Doran, INMO general secretary, rallying rallying secretary, general INMO Doran, Liam the outside on members win to Dáil a key step in the deepening addressing of crisis nurse/midwife staffing public health service the levelsin first step, which must now be must now be which step, first further initiatives, by followed to the deepening address nurse/ to regard with crisis and staffing levels midwife to inability country’s this in these professionals retain - - - n addi I his work on this his this work on O, together with O, together with inister must be wel inister must be M M N I O general secretary Liam Liam secretary O general o M The to Speaking went we as press tarting salary of any nurse/ any of salary tarting N midwife who graduated in the the in who graduated midwife work who is now same period, ing ing issue since his appointment. I said: “ThisDoran agreement the with and who service or overseas, health public the utside up a position in take to wishes the public health service. other unions representing demanding has been nurses, of this the anomaly removal years six since its introduction ago. This positive development of must first a be the of series and to help recruit measures in and midwives nurses retain the public health service. year period since 2011, who who period since 2011, year working currently in the are public health service. tion it will also increase the the will also increase tion it s comed, is long overdue, and we and overdue, long is comed, acknowledge ------inister for Health Health for inister those recruited in in those recruited M O has reached agree O has reached O, means that these O, means that these M

M N N I I his development will development ben his his agreement, secured by by secured agreement, his

e this very regressive measure, measure, regressive very this aduated during this five five aduated during this The removal of this anomaly, of this The anomaly, removal T T mon Harris for the removal removal the for mon Harris h ment with ment which was introduced, unilater was introduced, which involving the withholding of of the withholding involving fourth the for credit incremental of the year undergraduate pro gramme, sees the elimination of in 2011. ally, 2016 in terms of pay. the will dynamic new graduates from increment extra an receive between worth 2017, January depending €1,200 and €1,500 on their current point on the equal treat This provides scale. ated between 2011 and 2015. prior those recruited with ment to 2011 and T affecting the pay anomaly of who gradu nurses/midwives Si efit nurses/midwives, who who efit nurses/midwives, gr Pay increase of graduates to 7,500 recent increase up to €1,500 for up Pay

key win for graduate members win for graduate key Full removal of a removal marks pay anomaly Full secretary deputy general and Dave Hughes, president; vice first secretary; Mary Leahy, Doran, general Liam president; Harkin-Kelly, Martina relations; industrial director of Phil Ní Sheaghdha, (l-r): shortages were nursing/midwifery and pay action on for immediate campaign calling At launch of INMO

WIN Vol 24 No 9 November 2016 Urgent needforaccelerated payrestoration and dangerous for INMO mem unsustainable, unacceptable isstressedsituation that this held aspecialmeeting • • view that tive Council reaffirmed its firm acr ing feedbackmembers from includ situation, of thecurrent nomic situation. improvingcontext ofthe eco of nur shortage and the chronic ment the LansdowneRoad Agree substantial time considering last month at which it spent The INMO pay andnursing/midwiferyshortages INMO callingforimmediate actionon the bers and is in contravention of • 10 NEWS

Curr retain nursing/midwifery staff are inadequate to attract and pay cuts and pension levies, Curr wholl ing levels in clinical areas are requiring services admitted patients/clients safe care number offor the end of their shifts. shifts. end oftheir N cases ar sive pressure and in many unpaid, and are under exces hours, some of which are working excessivelylong F The oss thecountry, the urses and midwives are ollowing a detailed analysis H ent nurse/midwife staff ent paylevels, following S ses andmidwives in the y inadequate to provide E E ’s obligations, as the : xecutive Council e burned out at the E xecutive Council E xecu early ------safety legislation. employer, underhealthand INMO hasnowprioritised issues, theand connected cal • is: the Organisation shortages, regardnursing/midwifery to of the deepeningwith crisis the LansdowneRoad andprevi F pension leviesimposedunder andreversalpay cuts ofthe acceleration of theimmediate following strategies to seek ous agreements. on nur tional hours (unpaid)imposed • •

ex memberswhening they inter able staffing levels in the avail match be curtailedto judgement that servicesmust A and retaining nurses andmid measures aimedatrecruiting adequatel wives insufficientnumbers to demanding specialincentiv service E lev wives in determining staffing nurses/mid judgement of professionalrespect the will, in future, acceptand health employers thatthey from agreement Seeking In response tothesecriti In In addition,inr MPI legislation, and addi dvising and support ercise their professionalercise their els required to provide safe ests of safe patient caresafe ests of ses andmidwives under y staff the health ecognition the e ------commenced ters the INMOhasnow mised and/orunsafe. is thattheycannotcope message ing, from members ing levels are appropriate in vacant posts and ensure staff national andlocal level, to fill numerous agreements, atboth of management to implement abject failurethe contextof when nurses/midwivesas to ment of accept, the professional judge of management refusalby theconstant bated areexacer realities further workloads. These intolerable to unsafe staffinglevels leading unpaid additionalhours and longer with reduced salaries, en tion, respect andsafe working in this campaign forrestora stepsnext and to finalise the meetingsallfrom of these 7-8, 2016, to receive feedback meet again on November was ongoing as we go to press. series of 12 regional meetings, achieve theseobjectives. to A finalise members towith sultation care through safe practice. In relation to these mat relation to these In A The andgrowconsistent, The vironments. ction isalsonecessaryin patient care is compropatient care E the actionsnecessary xecutivewill Council nationwide con to respect, and any ------t vice demands, ie. the national ie. the vice demands, health nurses working in the nurses and41 fewer public July there were 309 fewer staff at theendofconfirms that figures, fromthe crisis is the lateststaff census watch tableopposite). in September them (7,551 admittedpatients staff tocare additional for extra admitted patients require recognisefailing thatthe to managementcontinues with department overcrowding elderly services. and careDrogheda Cork, ofthe local agreements inLimerick, service wifery postsin the health of recent years. This reality recruitmentby embargo the and the damage done system, nurses/midwivesof out ofthe to address the haemorrhage have failedto date, completely recruitment/retention, taken confirms that allattempts at to >39,000in2008). This 2008 (35,000now compared E 4,000 fewer nursing andmid almostbe there continuesto 2015. H erms of bed numbers and ser D Agreement and numerous S Further proof of the growingproof ofthe Further In terms of total staffingIn terms of total E compared to December compared to than thereinwere – see trolley– E H mergency S E , which - - WIN Vol 24 No 9 November 2016 - - 11 NEWS 0 2 n/a 14 16 n/a n/a n/a meet ever growing service service growing ever meet vernment, and immediate immediate and vernment, “The campaign, which will “Thecampaign, which be action on special to measures nurses/mid and retain recruit numbers in sufficient wives to demand. from shaped the feedback by will continue members, until these issues. addressed we have must accept The government their and that nurses/midwives, public servants, have fellow than enough endured more and of now expect early restoration the and other conditions, pay, 2009 between so severely cut said. Mr Doran and 2013,” day, for nurses and midwives. and midwives. nurses for day, definite a want Our members full the for resto timeframe cuts, imposed by of pay ration go 0 57 26 33 49 - - - 8 12 n/a n/a n/a n/a n/a an improving an improving 3 75 n/a n/a n/a n/a n/a n/a servants on the working 7 34 47 35 209 128 278 188 “The Minister for Finance, Finance, for “The Minister INMO general secretary secretary INMO general 2456 254 113 25 96 79 13 44 508 147 302 216 411 n/a mergency continues, every every continues, mergency lection earlier this year, said said lection earlier this year, economy, is now an absolute is now an absolute economy, mid and nurses for priority all we believe, and, wives public pay their who had frontline at least 14%. by reduced in the lead General up to the E the emergency that over. is as over be may emergency The con is the government as far the is the reality cerned, but e Liam Doran said: “The accel Liam Doran in restoration, pay of eration the context of related factors, which are being are which factors, related employers. health by ignored cannot let this continue We longer”. any 24 n/a n/a n/a n/a n/a n/a n/a 55 168 153 102 45 200 210 51 105 33 149 26 36 49 36 98 8 6 0 17 23 10 63 46 164 59 136 152 68 257 333 22 n/a 18 31 116 275 186 146 255 453 380 09 0 9 0 4 “Theof safetyand health INMO president Martina Harkin- Martina INMO president Kelly: compromised is being members our on daily a basis as of direct a result being are which factors workrelated employers” health by ignored 6 2 853222 17 29 39 243 15274 178 157 200 267 169 37019 89 91 150 23043 240 114 262 151 119 84 433 118 45 341 249 117 142 329 180 206 159 156 219 15 180 39 4021 50 47 60 72 80 169 50 113 n/a 7934 56 92 10 64 13 125 123 224 97 107 350 22 38 24 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 6 3 25 n/a n/a n/a n/a Increase between 2007 and 2016: 116% between 2011 and 2016: -2% Increase between 2015 and 2016: -1% Decrease ease 310211262 409 229 366 608 226459 519166 830 176 536 443 329 680 297 500229 446 383 730281 387 389 235 368202 354 280 34107 317 584 275 334 72 661 620 16 71 540 638 437 187 175 644 28 33 485 113 405 567 311 732 63 114 327 90 163 49 529 371 383 337 147 172 200 195 146 25 350 312 45 419 185 304 28 450 145 415 149 326 176 450 57 134 447 130 64 240 441 158 142 118 263 220 206 349 116 302126 323129139 209 331 46 166 380 842 11 72 321 626 16 201 356 214 73 502 642 593 384 271 68 606 279 282 507 59 345 446 51 551 514 91 784 499 138 825 133 189 19 42 178 336 490 53 73 144 35 154 1,547 1,954 2,809 2,718 3,277 2,882 1,753 2,127 2,530 2,638 2,145 2,1773,724 1,540 3,494 1,634 4,443 2,546 5,264 3,727 7,004 4,804 7,686 2,647 4,400 2,803 4,930 3,981 6,511 4,992 7,630 5,406 7,551 Sept 2006 Sept 2007 Sept 2008 Sept 2009 Sept 2010 Sept 2011 Sept 2012 Sept 2012 Sept 2014 Sept 2015 Sept 2016 - - Decr Increase between 2014 and 2016: 16% Increase between 2010 and 2016: 8% Increase between 2006 and 2016: 103% between 2010 and 2016: 8% Increase Increase between 2014 and 2016: 16% Increase between 2009 and 2016: 43% between 2013 and 2016: 53% Increase Increase between 2008 and 2016: 70% between 2012 and 2016: 72% Increase Increase al tot arkin-Kelly said: “The “The said: arkin-Kelly al al estoration and greatly and greatly estoration H tion Commenting on this critical critical on this Commenting exford General Hospital General exford xecutive Council has heard heard has Council xecutive Comparison with total figure only: with total figure Comparison Table 1. INMO trolley and ward watch analysis (September 2006 – September 2016) and ward INMO trolley 1. Table Hospital Beaumont Hospital Beaumont Hospital James’s St Hospital Mayo General Connolly Hospital, Blanchardstown Hospital, Connolly University Hospital Mater Misericordiae Hospital Naas General Hospital Columcille’s St Hospital University Vincent’s St Hospital Tallaght Eastern Hospital University Cork Hospital General Letterkenny Hospital County Louth Cork University Hospital, Mercy Ennis Hospital, Regional Western Mid Bantry General Hospital Bantry General Hospital General Cavan Our Lady of Lourdes Hospital, Drogheda Our Lady of Hospital, Lourdes Hospital Portiuncula University Hospital Galway W Our Lady’s Hospital, Navan Hospital, Our Lady’s University Hospital Kerry University Hospital Limerick University Hospital Waterford Roscommon County Hospital County Roscommon Sligo Regional Hospital Sligo Regional Hospital General Tipperary South St Luke’s Hospital, Kilkenny Hospital, Luke’s St Na Country total Country Midland Regional Hospital, Mullingar Hospital, Midland Regional Tullamore Hospital, Midland Regional Hospital Monaghan General Hospital Nenagh General 0 2 8 4 Midland Regional Hospital, Portlaoise Hospital, Midland Regional improved staffing levels. The The staffing levels. improved being levels, stress intolerable our members, by encountered The health cannot be ignored. is members our of safety and on being compromised a daily work of result direct basis as a E the call from members, right right members, from call the that they the country, across want and enough had have the Organisation to initiate nec are strategies whatever explains why our members are are members our why explains as point breaking beyond now a of the working result unsafe daily. face they environment Mar issue INMO president tina accelerated to secure essary pay r 12 NEWS

Health allocation inadequate World to meet growing demand news Nurses and midwives in action While noting the overall be addressed by a significant around the world increase in health funding for increase in pay levels as soon 2017 announced in the Budget as possible. Argentina • Balestrini Hospital: Abuse last month, the INMO believes INMO general secretary, and labour persecution it will prove wholly inadequate Liam Doran said: “Any increase in dealing with the current and in funding to our under-re- Australia growing demand for services. sourced public health service • Doctors, nurses strike pay deals for 1.5% increases with The increase of €457 million, must be welcomed. However, WA government resulting in a total allocation the allocation proposed will • Nurses strike not ruled out of €14.6 billion, must be com- not enable the health service for future pared with the allocation of in to meet, safely, the ever grow- Canada excess of €16bn to the health Liam Doran, INMO general ing demand. secretary: “The new Public Service • Fewer and fewer full-time service before the economic Pay Commission must create the “The health service still nurses in Rimouski crash. context within which pay restoration has over 4,200 less nursing/ This stark reality confirms can be accelerated and labour market midwifery posts than it had Costa Rica realities acknowledged” • Nurses seeking new that while the increased in 2009. It is against this real- collective agreement funding proposed must be wel- • Theatre ity that the proposal, without comed after several years of • Midwifery special recruitment and reten- France • Vaccination: So that nurses repeated cuts, it will not allow • Community nursing. tion initiatives, to recruit 1,000 are heard the health service to expand In view of these many unan- nurses/midwives in 2017 must and develop existing and new swered questions arising from be measured.” Kenya services across the country. the health allocation, the Mr Doran continued: “It • Medical services in Busia County paralysed following While also welcoming the INMO has sought an immedi- would not appear, from the nurses strike proposal to recruit 1,000 ate meeting with Minister for Budget announcement, that nurses/midwives contained Health Simon Harris to estab- the government is moving to Paraguay • Nurses mobilise outside within the health allocation, lish how these serious issues address the severe structural national parliament the INMO said that after six will be positively addressed. deficits in terms of staffing years with a ban on nurse/mid- Public Service Pay and capacity, which now exist • Nurses continue to fight for their rights wife recruitment leading to a Commission within our public health ser- loss of 5,200 posts, two critical The INMO’s view on the vice. The INMO will continue Phillipines questions must be asked: announced establishment of with its campaign, commenced • Health workers ask Alvarez: • Is the recruitment simply a Public Service Pay Commis- last month, aimed at ensuring Restore P1.5 billion slashed from public hospitals an intent to convert exist- sion is that this Commission staffing levels match service ing agency employment must facilitate, through an activity and no nurse or mid- Portugal which, while correct, will early report, the acceleration wife is left with intolerable • Dozens of nurses protest in front of the Ministry of not increase the overall of pay restoration to nurses workloads and unable to pro- Health number of nurse/midwife and midwives, and other vide safe care. employment in the severely public servants on very average “Against this background we Spain understaffed service? incomes. are seeking an urgent meeting • SATSE urges the Spanish prime minister to • In the absence of special The Organisation stressed with the Minister to discuss end discrimination of measures to recruit and it is not tenable, or sustain- and seek answers to these criti- professional nurses retain nurses and midwives, able, for INMO members cally important issues. • Nurses’ union condemns will the public health service to be expected to wait until “Related to all of this, the continued closure of beds continue to fail to compete September next year for the government must accept that in summer in Hospital de Huelva with private hospitals and UK restoration of €1,000, which the current pace of pay resto- employers who are offering was cut in 2009, and until ration to public servants, on US recruitment incentives? September 2018 for any fur- ordinary incomes, is unreason- • Striking Minnesota nurses It is also disappointing that ther restoration measures. able and must be reviewed. reach tentative agreement there appears to be no provi- The Commission must report The new Public Service Pay • 53 nurses allege labour violations at Twin Cities sion, in the Budget allocation, swiftly and clearly identify Commission must be empow- Community Hospital for the additional nursing/mid- the labour market realities ered to act swiftly on this issue, • After 17-hour negotiating wifery staff already identified with regard to the recruitment and create the context within session, nurses and Allina as being required in a range of and retention of nurses and which pay restoration can be Health reach tentative Vol 24 No 9 November 2016 No 9 November 24 Vol areas including: midwives. It will inevitably accelerated and labour market agreement

WIN • Emergency departments conclude that this can only realities acknowledged.” WIN Vol 24 No 9 November 2016

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E E E E S S S S H H H H N and H a public public a , E to the pay S E H and the S 15 NEWS N suffered and and N suffered H H N had undertaken N had undertaken H of health and safety safety health and of her to to work. return costly for all. for costly ess the P ess sufficient experience to sufficient experience to understanding of the obli of understanding made aware of the efforts made the efforts of aware ses and midwives, that a pro ses and midwives, do so and so she remained do so and so she remained It is in the mutual interest of the mutual interest It is in In another case brought for brought case another In The employment equal The employment Risk assessments and Risk assessments and The equality officer in that The equality officer in that y the the y acts and courts the how estore full pay to the P to full pay estore their employers are making to their employers accommodate their needs. and employ both employers of the huge shortage ees, given nur ity acts are well established established well ity acts are in this country workplace and adherence the in to the principles of the employ to do Acts. Failure ment equality either is instructed the costs of a course, specialist care the P which while out of work. policies and practices develop which would accommodate people Manag with disability. pensation in respect of the pensation in of the respect distr has and given trained should be ers full ward against the the against ward medical reports need to be to be need reports medical employ and seriously taken consulted and ees must be be active to the approach is taken question have interpreted those acts. interpreted have gations imposed on employers gations imposed on employers b to allowed that the case ordered health nurse who, following a a following who, health nurse fit to was towrist return injury, was 2003, duties in May light the by permission refused was salary and her on sick leave five was It pay. to half reduced the months later before revise her sick leave record to to record leave sick her revise whichfrom date earlier the show to she to was return prepared work. In addition, the equality €10,000 com officer ordered r

------E S H did not did not E S nd awarded awarded nd H a E S did not consult E H S insisted that she that she insisted H E ore accommodating accommodating ore S who suffered an injury an suffered who epeated requests from from epeated requests , H E S stopped all engagement engagement stopped all alleged discrimination, the alleged discrimination, the H E work on lighter or modified When the individual com A paramedic employed by by employed paramedic A The In GP spite of medical evi S aised the matter as a griev aised ailed to facilitate the worker the worker facilitate ailed to plained that she was victimised and H the equality Again with her. officer in this case was highly the of critical €18,000. could only return as a full-time as a return only could full paramedic with the ofrange duties, which did she then and further sustained a subsequently The injury. the individual paramedic with to reason do an assessment or duties, until some two years the when June 2014, after later, her union. by was raised matter f occu with a single concerned facilities. pancy close to toilet Despite r the the individual, to accommo effort an make union trade her until her date r was a six-month there ance and delay bef requirements basic fairly the chronic a with individual an of concerned The employee illness. €65,000. was awarded the accident traffic a road during driving an ambulance, while to returned work five months with an instruction later the occupational from health must she that department to return modified duties with or patient handling no manual for six to eight weeks. accommodate her return ably to dence to the employer, the dence to the employer, and diverticular disease disease and diverticular in 2004, work a suitable from was moved with toiletenvironment adjacent where to another area facilities was facilities access to toilet difficult.more - - - - - did E S H since 2001, E S H felt she had no she had no felt , in response, offered offered , in response, E S H yer or the individual’s own or the yer individual’s the finding, the equality finding, equality the the In a medical secretary Similarly, She returned to work She to work returned The After making that com ther staff were moved to to moved were staff ther easonable accommodation and officer that the argued without years 10 for had worked on to take failed They difficulty. of the occu the opinion board tionist. In January 2012, the the January 2012, tionist. In complainant ment age of 60 years. had she where location, work nal r pational the of division health emplo oncologist and GP. the in employed with diagnosed who had been debilitating a bowel condition to regrade her as a recep to regrade and early to retire option but the minimum retire before of the option not explore getting origi to her back the staff nurse other locations but she was was she other locations but one to the only moved a locked that point, both her At ward. GP advised oncologist and her however move, a such against considered. was not this advice April 2010, Under instruction in she was to the moved locked only for she worked unit where an sustaining day before one injury which exacerbated her condition. lymphoedema was October 2010 but in assigned to an even more which unsuitable location, was a heavy geriatric male proper No patients. 20 of ward risk assessment was carried in May out and subsequently, 2011, the occupational health that she department advised to nursing should be assigned no lifting which involved duties injury. of personal or risk of bullying and the pressure the pressure and of bullying to sick under led felt which she stress. work-related and leave of plaint, a number and she o , , ------E S H in this in this , which is a very very which is a , , INMO deputy general secretary, stresses the importance the stresses secretary, deputy general INMO , Dave Hughes of or injury a disability with employees accommodating , such as the , such as E S , between 2013 and , between 2013 and H E to making a complaint complaint to making a

yment, conditions of yment, conditions of S has been forced to pay pay to forced been has H 2009, she suffered diffi suffered she 2009, . The staff nurse had 20 had 20 The staff nurse .

mployers, in law, must not must not in law, mployers, E omotion or regrading and and or regrading omotion The case concerned lym developed nurse The In As all employment law law employment As all E S nd suffered acute and chronic chronic and acute suffered nd easonable accommodation to health difficulties. difficulties. Determined health and work, she returned to com to 2009 in a up worked bled during their working lives.” the versus was a nurse award twice in service and years’ was 2002 in again and 1994 diagnosed with cancer. breast arms both under phoedema a house. munity residential culties with a manager which led her H employees who employees become disa ability and the provision of ability of the and provision r large and substantial employer employer and substantial large such having state, the within an apathetic attitude to the in the employment provisions dis to equality acts in relation to have so often been found in in found often been so to have The equality of the breach law. of in making an award officer, to €85,000 claimant,a summed cognisant am “I stating: by up it of of the an organisation irony the like ees in respect of access to to of access ees in respect emplo ence in to employment, relation pr sets a minimum explicitly expected of employ standard a for it is a serious matter ers, state agency classification of posts. discriminate against employ or experi training employment, out €168,000 as a result of of result out €168,000 as a taken cases different three to due to provide failure its with reasonable employees of accommodation in respect injury sustainedor an disability at work. The A proactive approach to health and safety and to health approach proactive A 2016, skills while continuing their professionalon Members can keep up-to-date this refurbishmentdevelopment. work via the photo gallery on what will become the functionroom (topleft), the meetingroom (bottomleft) and the clinicalskillsroom (right), where INMOmembers will be able to hone their clinical completed early in the new year. Work on the sitebeganinlate July and there will be a formal opening inspring2017, following completion Picturedof refurbishments. are Refurbishment work, which will see the RichmondBuilding transformed into the newINMOEducation and Event Centre, israpidly progressing and isexpected to be Full speed ahead: Full speed ahead: Work continues at Richmond Building

WIN Vol 24 No 9 November 2016 INMO callsforsingle-tiered health service • • INMO taxation. Theprogressive eral to alland teeing equality of treatment that itissingle tiered, guaran two-tiered health system, so transformation ofthecurrent the INMOis sion and opening statement healthcar mittee on the future of Special Oireachtasthe Com meetwas dueto INMO The 16 NEWS

direct, funding of aminimum receive guaranteed public, The 10-15 years would takeservicetiered The tr of apublicholiday providecally for thetransfer public holidaypr ing arrangements in respect of the Christmas Daypublic is totransferservice health the standard practice in the any otherday,Sunday to a 1 WorkingActof Time isation Monday.Organthe While a Day (December26) falls on and St Stephen’sSunday (December 25) falls on a New ments overand the Christmas The Update on public holiday payments over Christmas and New Year period In bothits written submis 997-2015, does not specifi This year Christmas DayyearThis Christmas H health service should Year period2016/2017. points outthat: S ansition to a singlea ansition to E e as we went to press.as wewent to e hasissued the follow funded through gen calling for aradical emium pay falling on ------• health service,which treats health a properly resourced public • •

to ments, ie. employees rostered the purpose of premium pay Tuesday, December 27, for holiday tothe following Sunday premium rate and January 1, will receive the uary 2. transferredMonday,to Jan premium payments will be a Sunday andpublic holiday public holidaypremium rate. December 27 will bepaid the rosteredwork on to Tuesday, premium rate and employees 25 will bepaid the Sunday r during the period of transition during the of 10% of GDP and12-14% autonom vice, shouldbe flattened with for the new publichealthser structure, organisational The frontline managers for expenditure, devolved to including consultants and GPs consultants including be directlyshould employed, All newhealthservicestaff all areas of the healthservice. n ing direct/cross referrals and health professionals, includ nurses/midwives,and other for roles expanded Greatly osteredSunday,work on to The INMObelieves that urse/midwife prescribing in New Year’s Day will fall onfall New Year’swill Day work on Sunday,work on December E y andaccountability, mployees who are - - - -

submission, INMO deputy gen demands beingplaceduponit.” safely andappropriately, the health service unable to meet, is inequitable with the public which currentlysystem, health major transformationa toour the committee to commence INMOis said: “The calling on and actingasapowerful all citizens wellbeing of ing the a powerful social good enhanc not related to ability to pay, is access all citizens equallywith dation for agrowing economy. eral secretary Dave president Martina INMOwith thecommittee, Monday mium rate. receive the publicholidaypre on Monday, January 2, will employeesrostered work to mas andNew Year as follows: forworking over the Christ granted premium payments a ‘5 over 7’roster shouldbe ‘5 over 7’roster Sunday.a which fallon lieu ofthetwo ber 27andMonday January 2in paid dayoffon Decem Tuesday regime will normally receive a Monday to Friday attendance Also commentingonthe Speaking prior In summary staff whowork summary In E mployeesa whowork to Friday roster public holidays holidays public H to meeting a rkin-Kelly www.inmo.ie H ughes foun ------• emplo mium paymentispayable to • • • • 2017. and on Monday, January 2, Tuesday 27, December2016 other than Monday 26and

said: “ the public, formation.for Wecalling are radical investment and trans unfit for purposeandneeds the current systemissimply recognise that politicians to all 2016. plement to was includedin full asasup available atwww.inmo.ie Oir specialmission, tothe place inrecent years.” of healthcare, which has taken privatisation,to the creeping taxation system,andan end through aprogressive general of allhealthservices, funded public holidaypremium Tuesday premium Sunday Sunday premium Sunday holiday premium public holidaypremium Monday Monday No publicholidaypre The INMO’s written sub eachtas Committee iseachtas Committee INMO Information Office INMO yeesworking on days The INMOis calling on , January 1 – Sunday, 1 January , January 2 – public– 2 , January , December 25 –25 December , , December 26 –26 December , , December 27 –27 December , WIN direct provision, in September and - - - - WIN Vol 24 No 9 November 2016

------fur eferred eferred INMO IRO INMO The INMO The INMO throughout throughout Workplace Workplace 19 NEWS early November. November. early – Tony Fitzpatrick, Tony – ation decisions ation decisions The INMO r etrospection appli etrospection In brief… appointments will appointments will eral more meetings are meetings are more eral om the INMO, manage om recently wrote to wrote man recently County agement at Louth Hospital highlighting grave concerns at its fail concerns at its grave to ure implement three arbitr John Doherty issued by 2016 in Louth in March, Follow Hospital. County ing sustained pressure fr ment has confirmed that the John the be made as per Doherty deci arbitration 17/2013) (Circular sions with r cation 2013. to October, matters concerning concerning matters Meath Disability Services, including redeployment/ ros of staff, reassignment social and residents’ ters fund to the have which proposals ing been amended and a ther meeting is due to take place in Meath Disability Ser Commission. Relations These talks ongoing are with management issu vices: Louth C arbitration: equate staffing in several equate staffing in several departments gical 2 and maternity. Sev as possible. tiously The INMO has met with with The INMO has met management at Cavan in recent Hospital General weeks to outline grave inad concerns regarding the hospital, including the emergency theatre, department, AMAU, sur the INMO outstanding and for is trying to obtain dates these to meet as expedi Inadequate staffing at Inadequate staffing at Cavan General Hospital: • • ounty Hospital • ------this, not only in Louthin only not this, home help, only for their home for only help, and Italy to fill deficits and deficits fill to Italy Our members in Co Louth Co in members Our entral to entral all of this is the “The INMO demands that “The INMO demands that C ofessionals. oth in Louth and across the the across and Louth in oth een established and which is is which and established een – Tony Fitzpatrick, INMO IRO INMO Fitzpatrick, Tony – everting to a work-to-rule at at work-to-rule to a everting also call for a comprehensive for a comprehensive also call of the review manage layered which has ment bureaucracy b ofadding quality the to nothing care and the frontline ability of said to need,” to respond staff Fitzpatrick, INMO indus Tony trial officer. relations HSE’s ongoing attempt to estab HSE’s lish management structures, b which cumbersome, are country, involve don’t and bureaucratic mana operational, in any nurses The INMO is actively gerial role. opposing of favour in but nationwide, flattened management struc frontline that empower tures pr of nursing/public directors be immediately health nursing allowed to fill frontline all nurs this vacant at that are ing posts time. obtain recommendation to be rejected rejected be to recommendation This has level. at administration frustration in severe resulted on the part of nurses and their the with patients, and interferes clinical judgement of the regis tered nurse. tered bers are actively considering considering actively are bers r the hospital if clear answers are are clear answers the hospital if not obtained from management October on 25.WRC at the at the hospital. However, due due at the hospital. However, of opening the to surge bed is redeployment there capacity, grave causing which is of staff where the wards for difficulties Mem from. taken the staff are Spain - - - - -

Co Louth is Louth is Co ecruitment is ongo is ecruitment The situation in The ability of the to nurses as advertised the provision of of as the provision advertised : Fitzpatrick, INMO IRO Tony “The empowerment of directors beto beds for allow will nursing of winter months” the critical for reopened ing assessments for patients to patients for ing assessments further compounded due to further compounded due to PHN of amount significant a time community and RGNs’ being taken up with complet priate for nurses to meet with with meet to nurses for priate their patients/clients. to beds, and those in beds, who those in beds, to beds, and finished the are acute phase of cannot their care, be discharged to down or community step facilities. adequate care provide is then that fact the by compromised for some of the health centres which they work dilapidated,are IT the required inadequate, lack not appro and are infrastructure two clinical nurse facilitators to two clinical facilitators nurse ori the induction and assist in of entation the to new recruits service. R ment reached. Management Management reached. ment h ing from the Philippines, India, India, the Philippines, from ing as per the staffing algorithm the staffing algorithm as per in process WRC the in agreed The INMO July/August, 2016. suspended industrial action the immediate for to allow the of implementation agree ------to approve to approve ectors of ectors nurs action at the failure action failure at the ganisation outlined ganisation outlined resulting bed closures resulting bed closures

olleys in the emergency olleys in the emergency first review of the WRC WRC of the first review

eement reached between between eement reached The Or Heading into the busy winter the busy Heading into The Organisation Organisation The has criti Currently, there are 12 vacant 12 are there Currently, anagement posts in the region,the in posts anagement he of management to close beds the INMO and management at at management and INMO the Hospital, Lourdes of Our Lady took Octo on place Drogheda of concern failure grave at the staffing to address management the throughout deficits hospi staffing deficits at OLOL, Drogheda OLOL, deficits at staffing T Grave concerns over failure to address concerns over failure Grave 25. ber, expressed The INMO also tal. its dissatisf are creating a knock-on effect effect creating a are knock-on other for hospitals within the patients for particularly county, Hospi of Lourdes Our Lady in tal, Drogheda, whereby those those tal, whereby Drogheda, on tr access get cannot department cised the current cised the current system, which stipulates that dir layers eight through go must ing of management filling of one the nursing post, that it is inevitably highlighting and care patient compromising is unacceptable. with left are patients months, cover adequate nursing out and the

according to the according INMO. nurse shortages in Co Louth in Co shortages nurse to sanction refusal THE HSE’s nurse staff vacant of filling the hospitals has Louth Co posts in of closure 18 resulted the in beds between care long-term two hospitals. posts between Drogheda nursing transitional Cottage Hospital’s Plunkett’s Oliver St unit and care the of HSE failure The Hospital. to fill these vacancies represents a to the continu contrast stark Immediate call to action on to action call Immediate to create fill and ing drive general m agr WIN Vol 24 No 9 November 2016

------INMO IRO INMO 21 NEWS y, members in in members y, Midwifery Strategy, Strategy, Midwifery Mary Rose Carroll, Carroll, Rose Mary – stress to their already to their stress already This will allow INMO allow INMO will This WRC in November to to in November WRC the Workplace Relations Relations the Workplace The parties agreed to recon to agreed The parties Subsequentl Members in CUH have not not CUH have in Members vene under the auspices of vene under the auspices of the Commission. Commission. the of review implementation agreements. the GB radiotherapy ward, the GB ward, radiotherapy suspended their industrial action when agreement a following was reached conciliation lengthy hear auspices the held under ing of safety and their ability to pro their ability and safety vide care. safe highly stressed working life. It It working life. stressed highly to impact the potential also has on their work/life bal negatively of With the development ance. the National Galway the from the outcomes case and the appointment of now of midwifery, directors might be the time toappropriate pause further out of any rolling the of until a review this project date to pilot has out carried been system ise-rostering the to see if as intended.” delivering concerned that this is an addi that concerned tional matter that will add add will that tional matter further taken this course of action of course this action taken been they have feel but lightly left with no option to but with difficult environment is having is having environment difficult on their a detrimental effect health and wellbeing. support clerical and from draw duties. members to prioritise and to prioritise and members on direct patient care. focus This action was due to com 1, 2016. on November mence ------

weeks, issues of weeks, issues of department in the department the in The deci members’ for nursing and mid nursing for was based on manage was based on October 5 in relation October 5 in relation on 2016 and their expert 2016 and their expert recent ostering pilot project at Let ostering pilot project

ork University ork University Hospital com Maura Hickey, INMO IRO INMO IRO Hickey, Maura hree existing WRC WRC hree existing agree Action Action is to due being taken o Donegal. Staff are seeking seeking Staff are o Donegal. to ongoing inadequate and ongoing inadequate and to on staffing levels nurse unsafe the ward. sion to commence industrial action of May 2015 and May/ ments June their clinical knowledge and patient to relation in concerns Action in oncology/radiotherapy in Action INMO members the oncol in at ward ogy/radiotherapy C to rule industrial work menced action ment’s failure to implement to failure implement ment’s t Mary Rose Carroll, INMO IRO:Carroll, Mary Rose “ unsafeongoing inadequateand staffing levelsand additional beds without on wards any commensurate in staffing increase levels” n concern new year, however midwives midwives however year, new concerned that very issues are staff in by that had been raised hospital the of side general the not been addressed. have very are said: “Midwives Concerns raised over e-rostering e-rostering over raised Concerns Letterkenny in project I with an arisen staff have wifery e-r University Hospital, terkenny C these issues addressed. to have It is to planned the e-ros role tering out to the project maternity ------ety ety els and additional els and additional s believe working in this working in s believe Ward, a general surgical surgical a general Ward,

addressed to our addressed mem INMO, on behalf of its of its on behalf INMO, e. While e. some locations – Mary Fogarty, INMO IRO INMO Fogarty, Mary – A further secret ballot has ballot has further secret A taken This action is being The health and saf embers, has served notice notice served has embers, embers voted overwhelm voted embers he esidents. Several CUH wards serve wards CUH Several ofnotice action rule work to are keeping beds vacant on an on an vacant beds keeping are formal ad hoc basis, a more The is necessary. approach requested formally has INMO management union/ regional a care of all meeting in respect in facilities older the of person contingency to put CHO 3 area to safe in place arrangements guard both our members and and our members both guard r Members have advised the the advised have Members that the Organisation scarcity a nega is having of nurses tive impact on the quality of tive impact on the quality of car ingly in favour of industrial of industrial favour in ingly action. of INMO members in Cork Cork in INMO members of Hospital is being University on compromised daily a basis due to the intolerable work on these conditions ing wards. Member beds being placed on wards, wards, on beds being placed without commensurate any staffing levels. in increase Despite ongoing engagement with manage the INMO by ward and the medical ward. ward. the medical and ward been on the undertaken neu where unit rology/stroke m ongoing issues in rela to due and inadequate to unsafe tion staffing lev not these issues have ment, been satisfaction. bers’ T of its intention to commence form the industrial action in of a work to on three rule, wards University Hos in Cork pital (CUH) – the orthopaedic/ plastic m ------Following recent recent Following In brief… at this centre until at this centre until WRC continues to continues WRC assist act and retain nurses. nurses. retain and act INMO has received a sig INMO has received nder the Medical/Surgical the nder Medical/Surgical eached agreement mean agreement eached Clare, Limerick and North North Limerick and Clare, Taskforce planning review. planning review. Taskforce in commenced The review May 2016. St Columcille’s Hospital, Hospital, Columcille’s St Loughlinstown: INMO Unit members in St Joseph’s of at an advanced stage are concluding the pilot exer cise to assess staffing levels to assess staffing levels cise u the parties in recovering the parties in recovering payments retrospective were due since increments in 2009. frozen St Aidan’s ID Centre, ID Centre, Aidan’s St Gorey: St at industrial action Gorey, Centre, Aidan’s now have INMO members been placed on the correct pre recognising increment, vious nursing experience. experience. vious nursing The INMO members have have INMO members ford: r will further beds that no ing open been additional staff have Greater security recruited. of cover for contracts around has also been secured leave with the assistance of the conciliation WRC services. Abbeygale Unit, Wex While the INMO has had the INMO has had While om nurses in almost all com all in almost om nurses – Philip McAnenly, INMO IRO INMO McAnenly, Philip – he • • • Deepening crisis in care of older care in crisis Deepening west mid in services people nificant number of complaints fr munity nursing units/hospitals units/hospitals munity nursing in Tipperary regarding the low the low regarding Tipperary number of to nurses patients due to the inability of the HSE nursing and retain to attract staff extensive local engagement in individual locations and of the despite the efforts HSE impos it is proving to recruit, T sible for these locations to these locations to for sible attr 22 NEWS

Parking at new children’s hospital Health and safety concerns a serious concern The INMO has raised concerns at St James’s offsite parking about the insufficient provision for staff parking in the plans for The INMO notified the Work- safety legislation, with particu- additional parking facilities off- the National Children’s Hospital place Relations Commission lar attention to shift workers, site, together with the shuttle (NCH). Building has commenced (WRC) of a dispute with with regards to parking and the bus service, however, she was on the St James’s Hospital campus, St James’s Hospital over its general movement of employ- extremely disappointed that however, the INMO has concerns closure of almost 500 onsite ees. This assessment will the health and safety report that the plans do not take suffi- parking spaces without consul- include consultation with the was yet to be completed. cient consideration of the parking tation with staff. INMO and health and safety “We believe that this is a requirements of shift workers and As well as concerns about representatives. very important report as its key safety. The new hospital proposes the lack of consultation, the The INMO sought extension function is to carry out a risk to reduce the carbon footprint, by INMO is concerned about of opening and closing times at assessment under the health minimising the number of staff parking spaces on site, assuming the increasing exposure of offsite carparks and the provi- and safety legislation, with that staff will use public transport its members to health and sion of a shuttle bus. Additional particular attention to shift or cycle to work. safety risks. Although, some security was also agreed as the workers,” said Ms Treacy. INMO IROs Joe Hoolan and additional parking was made area in and around St James’s The INMO also produced Clare Treacy, together with INMO available in offsite carparks, Hospital has a high crime rate. figures at the WRC confirming rep Linda Phelan (Crumlin) met these were not suitable for At a report-back meeting to that 42% of INMO members with representatives of the NCH shift workers due to early clos- the WRC on October 24 man- working in St James’s Hospi- Group. Ms Treacy said: “A high ing times and safety concerns. agement reported progress tal live outside Co Dublin. It percentage of nurses live outside At an initial meeting with the including the extended carpark is clear that these employees of Co Dublin and the vast majority WRC the INMO sought several opening hours, a shuttle bus have no alternative but to drive are shift workers. It is extremely assurances, in particular, rec- service and additional security. to work and it is important that short-sighted to assume that staff can avail of public transport when ognition that shift workers are The risk assessment has yet to they are facilitated to do so they are travelling such distances. exposed to health and safety be completed. A further review safely. The lack of parking will simply risks due to the early start of meeting at the WRC is sched- The INMO noted that a sig- become a recruitment and reten- shift and late finishing times. uled for November 29. nificant number of nurses have tion issue for the new hospital. We The employer agreed to INMO IRO Clare Treacy resigned from St James’s Hos- have asked for this to remain on conduct an immediate risk acknowledged progress had pital citing the parking issue as the agenda as an ongoing issue.” assessment under health and been made in relation to a key reason. Cregg House Concern at Tullamore CHO 9 staffing staffing review staffing levels shortages Nursing staff at Cregg House Concerns have been raised management. Recent corre- The INMO met with man- HSE, Co Sligo are waiting with management over spondence from management agement in CHO 9 regarding patiently for the outcome of reduced staffing levels within confirms that business cases staffing shortages at all levels a staffing review which was to a number of units at the Mid- have been submitted for addi- of nursing within the com- be conducted over a 10-week lands Regional Hospital, tional staff, and in the case of munity. The INMO advised period. Tullamore. the renal unit the hospital is management that the cur- The nurses deferred indus- After meeting with INMO seeking a bespoke recruitment rent workload is intolerable trial action in the form of a representatives and groups of campaign. However, the reality for members and patient care work to rule until this report staff to hear their concerns, is that staff are working short is being compromised due issues. INMO IRO Clare Treacy said: in nearly every area and this is to unsafe staffing levels. The INMO IRO Maura Hickey “Nurses and midwives are having an impact on individual INMO advised management said: “Currently staff are very working under terrible condi- nurses. that failure to fill vacant PHN demoralised with the low staff- tions with staffing at below Ms Treacy says the process is and CRGN posts, and maintain ing levels and cannot see light acceptable levels in some simply too slow and our mem- the agreed nurse management at the end of the tunnel”. areas. Nursing midwifery bers cannot continue to work structure in the community, As we went to press, a fur- staff are reporting stress as under such circumstances. Fur- will leave INMO members ther meeting was scheduled a direct result of working in ther meetings are scheduled to with no option but to ballot for to take place on October 25, circumstances of increasing take place with members. industrial action. Management at which it was expected that acuity and diminishing staffing The INMO continues to seek advised it would revert by the INMO would be informed levels.” permanent contracts for grad- October 27 on all issues raised. Vol 24 No 9 November 2016 No 9 November 24 Vol when the staffing review report A number of claims uate nurses at this workplace – Lorraine Monaghan,

WIN will issue. have been forwarded to and nationwide. INMO IRO 24 Section FOCUS

Spotlight on Section Officers ED Nurses Section Chairperson Vice chairperson THE first ED Section meeting got underway at INMO HQ on September 20, with discussions, debates and planning sessions for the section. Weighing heavily on the agenda was the continued overcrowding, understaff- ing and educational needs of the staff. The Section heard mirrored stories from different EDs around the country. Problems and difficulties were discussed and shared. A reassurance of continued lobbying for Bernadette Stenson Noreen Leahy a safer environment for both the staff and patients was at the [email protected] [email protected] forefront of everyone’s agenda. The roll-out of the CNM1s and CNM2s (for admitted patients) and ADON for patient flow is well underway nationwide. Education Officer Secretary One of the areas highlighted was the vast variances in education across EDs. The differences varied from no facilitator, to intermittent cover, to full facilitator cover. Study leave and the its prioritisation needs urgent addressing in order to maintain safe standards. A review of staff nurse orientation/introduction to ED programmes will be discussed at the next meeting in December. A network for linking EDs to communicate concerns, ideas and solutions was suggested and will be reviewed. It is hoped to have an Emma Murphy Mary Dunne educational component to the meetings going forward. emma.marie.murphy1 marydelaneydunne The next meeting of the Section will be held at 11.30am in INMO HQ @gmail.com @gmail.com on Wednesday, December 7.

Affiliation Form for INMO Section Membership

Name: Tick ONE relevant Section you wish to affiliate with

INMO membership No: Assistant Directors of Nurse/Midwife Education Home Address: Nursing/Midwifery/ Public Health Nursing/ Occupational Health Night Superintendents Operating Department Care of the Older Person Orthopaedic Clinical Placement Tel (work): Co-ordinators PHN Tel (home/mobile): CNM/CMM Radiology Nurses CNS/CMS Email: Research Nurses/Midwives Community RGN Nurses Place of employment: Retired Nurses/Midwives Dir ectors of Nursing/ Job title: Midwifery/Public Health RNID Nursing School Nurses Second section option (to obtain information Emergency Nurses Student Allocation Liaison only): GP Practice Nurses Officers Network Inter national Nurses Student Section Midwives Forward completed form to: National Children’s Nurses Telephone Triage Nurses Mary Cradden, membership services officer, National Rehabilitation Third Level Student Health INMO, Whitworth Building, North Brunswick St, Dublin 7 Nurses Nurses Section News 25

Telephone triage nurses/midwives network at annual section conference

At the 12th annual Telephone Triage (TT) Section conference were (l-r): Carmel Michelle Russell (centre), independent nurse consultant, who Murphy, TT Section chairperson; Hazel James, TT Section education officer; Martina presented on preparing for HIQA inspections, with Carmel Mary Guerin Lavin, Harkin-Kelly, INMO president; Breege Clarke, TT Section vice chairperson and Claire Murphy (left), section chairperson and Claire McMahon, TT Southdoc, a prize draw McMahon, TT Section secretary Section secretary winner

Over 65 nurses and midwives, which was well received by Michelle Russell, independent Each year, the conference from across all out-of-hours all in attendance. This address nurse consultant. proves to be an excellent doctor services, gathered for was followed by an update on Chest pain, arrhythmias networking opportunity for the 12th annual Telephone midwifery complications that and dealing with anxiety were nurses and midwives working Triage Nurses Section con- present over the phone, which among other topics covered in the area of telephone triage. ference which took place on was given by midwife adviser and the afternoon sessions The Telephone Triage Section September 29 in Limerick. Aparna Shukla. included infant skin and sports will hold its AGM in the INMO INMO president Martina Delegates also heard injuries. Attendees also took in Dublin on January 18, and Harkin-Kelly gave the open- presentations on preparing part in a raffle at the end of the encourages any members affil- ing address at the conference, for HIQA inspections from conference. iated to the section to attend.

CNM/CMM Section: RNID conference to focus on empowerment Upcoming meeting Ack pa ed agenda is planned these emerging structures, John Lonergan, author and for the RNID Section confer- which will be addressed by Liz former governor of Mountjoy The Clinical Nurse/Midwife ence, which is set to take place Roche, area director, Nursing and Prison will give a motivational Managers Section will meet on November 22 in the Crowne Midwifery Planning and Devel- presentation on nurturing hap- on Saturday, November 12 Plaza Hotel, Santry, Dublin. opment, Dublin Mid Leinster. piness and contentment. to discuss a range of topics INMO president, Martina Mary McCarron, professor The afternoon session will including leadership and Harkin-Kelly will give the open- of ageing and intellectual dis- comprise a series of short crisis management. ing address followed by Siobhan ability in TCD, will speak on sessions by RNIDs in the com- The meeting will take O’Halloran, chief nursing officer future-proofing the undergradu- munity and some service users. place in INMO HQ from in the Department of Health, ate programme for the changing Delegates will also have the 10am and finish at approxi- who will then address the con- models of service delivery. opportunity to hear an over- mately 1pm. ference theme of ‘Empowering Brian O’Donnell, chief exec- view on the Assisted Decision Members who wish to the RNID’, focusing on delivering utive of the Federation of Making Bill, 2013. attend the CNM/CMM Sec- on their potential. Voluntary Bodies, will talk about Special rates for students tion meeting are asked to Among other topics to be cov- manpower planning – realising are available and all bookings confirm their attendance by ered are the community health the potential of the RNID and can be made by contacting contacting Helen O’Connell organisations and realising the the challenge for employers. the INMO or by logging onto at Tel: 01 6640616 or email: potential of the RNID within Following a panel discussion, www.inmoprofessional.ie [email protected]

All Ireland Annual Midwifery Conference 2016: Pictured at this joint INMO/RCM NI conference were (l-r): Liam Doran, INMO general secretary; Mary Higgins, vice chair, WIN Midwives Section; Máire Devine, senator; Martina Harkin- Kelly, INMO president; Simon Harris, Minister for Health; Vol 24 Breedagh Hughes, director of RCM Northern Ireland; Susan Kent, deputy chief of nursing officer, Department of Health; N

John Skewes, director of policy, employment relations and o 9 communications, RCM UK; Mary Cadell, regional officer, N

RCM Northern Ireland; Deirdre Daly, conference planning ovember 2016 committee; and Colm O’Boyle, conference planning committee. See WIN December/January for a detailed report on this conference 26 INTERNATIONAL NEWS

2014-2020, which sets the priorities for the strategic direction • Directive 2013/55/EU and the Dele- gated Act – the revision of the Directive Influencing 2005/36/EC on Mutual Recognition of Professional Qualifications (amended by Directive 2013/55/EU), published in the Official Journal on December 28, 2013, European with the requirement to be transposed into national law by EU Member States by January 18, 2016. Article 31 of the Directive allows for the development of nursing policies the Delegated Act, which will provide detail of the competencies required for Elizabeth Adams focuses on international general nursing • EFN Workforce Matrix 3+1, which nursing and midwifery initiatives and provides guiding definitions and qualifications for specialist nurse and advanced activities of interest to INMO members practice nurse roles across Europe INMO president Martina Harkin-Kelly states have to implement. It is therefore • Recruitment and retention – the current recently attended the European Fed- imperative that the EFN, in representing drive for extensive recruitment of nurses eration of Nurses Associations (EFN) 35 EU countries’ national nursing associa- within the EU and the significant issues general assembly, proactively representing tions, is strengthened and empowered to with retention, particularly in countries members on their key priorities to strate- influence the EU political agenda, particu- such as Ireland, was discussed in detail gically influence the European agenda on larly in the current economic climate. • WHO Global Workforce Strategy – the a number of issues, including: workforce, European Federation of Nurses new strategy was discussed and the impli- professional practice, policy, research, edu- Associations general assembly cations for the profession in relation to the cation and industrial relations. Prof Máximo A González Jurado, pres- EU Commission Action Plan were explored European Federation of Nurses ident of the Spanish General Nursing • Antimicrobial resistance (AMR) – strat- Associations Council, hosted the 104th EFN general egies to combat AMR and proposals for Established in 1971, EFN represents assembly from October 20-21, 2016 in concrete recommendations in relation more than three million nurses across 35 Madrid. With more than 70 representatives to the role of nurses in combating AMR European countries repre- meeting, there were a number of impor- were discussed. An EFN Position Paper sented by national nursing tant strategic agenda items discussed and Policy Statement has been developed associations. EFN is the including the: and agreed independent voice of the • EFN Strategic and Operational Lobby Plan • Value of health systems – increasing nursing profession at Euro- pean level. It is an important international EFN Executive Committee for 2016-2018, (front row, l-r): organisation representing nurses and nurs- Roswitha Koch, Swiss Nurses ing concerns across Europe. Association, Switzerland; Elizabeth As a member of the EFN since its incep- Adams, vice president, Irish Nursing and Midwives Organisation, Ireland; tion, the INMO is central to a number of Marianne Sipila, president, Finnish significant projects and policy develop- Nurses Association, Finland; Milka Vasileva, treasurer, Bulgarian ments. Issues concerning health, patient Association of Health Professionals care, mobility of health professionals, in Nursing, Bulgaria; and (back row, education, technology and health funding l-r): Paul De Raeve, EFN general secretary; Janet Davies, Royal continue to be central to the EU debate College of Nursing, UK; and Sineva Vol 24 No 9 November 2016 No 9 November 24 Vol and the culmination of these debates Ribeiro Vardforbundet, Sweden

WIN result in legislation which all member INTERNATIONAL NEWS 27

unmet healthcare needs, within a context of budgetary constraints, create a International congress need for the nursing profession to clearly formulate an understanding and definition International Council of ‘value-driven health systems’. This was of Nurses Congress discussed against a performance-meas- 2017 urement system, leading to cuts and The International expectations of doing more with less. Council of Nurses EFN Professional Committee (ICN) 2017 Congress The EFN Professional Committee, on will be held in Barce- which I am chair, met on October 20 as lona, Spain, from May part of the general assembly. The revision 27 to June 1, 2017. of the Directive 2005/36/EC on Mutual The ICN has worked Pictured at the recent EFN general assembly Recognition of Professional Qualifications in Madrid, Spain: Martina Harkin-Kelly, INMO in partnership with Prof (amended by Directive 2013/55/EU), pub- president (second row) and Elizabeth Adams, INMO González Jurado and his team to deliver lished in the Official Journal on December director of professional development and newly one of the largest dynamic and innova- elected EFN vice president, with Prof Maximo 28, 2013, with the requirement to be trans- Gonzalez Jurado, president, Spanish Nursing Council tive congresses for nursing globally. The posed into national law by the EU Member (front row, left) and representatives from national theme is ‘Nurses at the forefront: trans- States by January 18, 2016 was discussed nursing associations forming care’. in detail. However, many member states European Nursing Research Foundation Details of the scientific programme have not yet transposed the Directive into Prof González Jurado, founding director and themes can be accessed at national legislation, and are far from trans- of the European Nursing Research Founda- www.icncongress.com. The plenary lating Article 31 into the nursing curricula. tion (ENRF) and president of the General sessions will be dedicated to exploring The European Commission will make Nursing Council, provided an update to the the theme, with particular focus on an assessment of the new/amended EFN general assembly on the Foundation. the Sustainable Development Goals, national legislations and will plan infringe- The ENRF was officially established as human resources for health, universal ment procedures, if necessary. It is within a legal structure under Belgian law and health coverage and safe staffing. this context that the EFN is planning to as a non-profit organisation in May 2013. Featured main sessions will offer the measure the (non) compliance with the With its own constitution, the objective of most recent expertise on patient-centred Directive based on an online questionnaire the ENRF is to analyse and compile what healthcare, evolving scopes of practice, with a set of legal/professional questions. already exists in terms of nursing research climate change, infectious and non-com- Equally important is the development of in the EU member states in order to convert municable diseases, mental health, a Delegated Act to update Annexe V of the existing data into evidence-based advocacy migration, human rights, patient safety, Directive, detailing the current core curricu- for the EU policy-making process. policy, technology, leadership, education lum and the new content. It is essential that Initially and for a period of three years, and history. Themes for abstract submis- all nursing schools and universities interpret the ENRF will receive financial support sions (concurrent sessions, symposia and the competencies listed in Article 31 in the from the EFN, however, the goal is to posters) will address these issues plus same way. The eight competencies are: be self-sustainable and source funding developments in healthcare systems, • Independently diagnose, plan, organise through various research bids, such as the health promotion, nursing workforce, and implement care European Horizon 2020 programme and disasters and regulation. • Cooperate with other players from the funding partners. The Congress will also be the venue health sector Prof Jurado stated that the aims of the for ICN network meetings. The dead- • Empower patients towards a healthy life- Foundation are to: “Contribute to improv- line for early registration is February style and self care ing healthcare quality and safety” and “the 17, 2017. Registration is now open on • Independently initiate measures to save promotion and development of nursing www.icncongress.com lives through research for Europe”. • Independently advise, instruct and support In December, the governing body of the general assembly and to follow-up on the • Ensure the quality of nursing care Foundation will meet in Madrid, at the general assembly decisions. • Communicate comprehensively and headquarters of the General Nursing Coun- This year, I was honoured to be elected, cooperate with members of other profes- cil, to develop the three-year strategic plan by 35 European member countries, as sions in the health sector (2017-2020) that will be presented for vice president of the EFN Executive Com-

• Analyse the quality of care. approval at the next EFN general assembly. mittee. Two members of the Executive WIN The EFN has developed a competency EFN Executive Committee elections Committee were elected for a two year framework in order to provide a common The EFN Executive Committee is con- term 2016-2018: Janet Davies, Royal Col- Vol 24 No 9 November 2016 understanding from the national nursing stituted by seven members: the president, lege of Nursing (UK), and Veronica Di Cara, association’s perspective. The EFN, in the vice president, treasurer and four delegates Czech Nurses Association (Czech Repub- framework, defines competence as the elected by the EFN members’ national lic), and for a one-year term 2016-2017, “intersection between knowledge, skills, nurses’ associations. They meet at least Sineva Ribeiro Vardforbundet, (Sweden) attitudes and values, as well as the mobi- twice a year (in between each general was elected. lisation of specific components in order to assembly) to discuss key issues for the Elizabeth Adams is INMO director of professional transfer them to a certain context”. EFN, to prepare recommendations for the development Questions & Answers 29

Bulletin Board With INMO director of industrial QA relations Phil Ní Sheaghdha

personal development plan. Query from member At the most recent meeting on this matter on October 11, the unions raised a number of outstanding concerns/questions that I understand from my manager that there are currently require attention, prior to roll-out of the performance achieve- talks ongoing to introduce a performance achievement ment process. These concerns include: model for the HSE. Is the INMO involved in this, and if so, is there any further information on this topic? • The model proposed will apply only to HSE staff and will not extend to voluntary hospitals or section 38 organisations. The unions believe this will affect implementation and we have Reply sought further input from the HSE on this matter • The unions have sought clear direction to employers on the Yes, the public service agreement required performance intended and agreed purpose of the performance achievement achievement measures to be introduced. The INMO and all other model, to ensure that it will in no way interfere with or be used as health service unions have engaged with the HSE to develop a a means to discipline or sanction employees. mechanism which would allow staff have a supportive appraisal Three further meetings are scheduled for November and further of their performance. Following lengthy negotiations, the unions communication will be issued to members. In the meantime, are now satisfied that the performance achievement model has there is currently no agreed performance review system in the correct emphasis on support and development to be of use place in the health service for nursing or other grades, and to HSE staff. The unions’ main concern was that if performance until such time as the steering committee set up to oversee the appraisal/achievements was incorrectly applied and if managers roll-out and evaluates same, is satisfied that the agreement carrying them out had not been trained correctly, performance brokered between the employer and the trade unions is being achievement could be negatively perceived by staff and would not adhered to, it will not commence. help to develop and support staff in their work. It is agreed that a steering group consisting of employer and Therefore, the unions concentrated on ensuring that prior to any union reps for health service workers would be established roll-out, performance achievement training would be provided to and meet regularly to monitor the roll-out of performance all managers who would then be expected to meet with staff they achievement across the health service, and the operation of manage annually to discuss staff objectives, supports they would performance achievement over the first 12 months, with a view require in reaching those objectives and work together towards a to ensuring it is being rolled out in the manner intended.

a positive and professional image observant of health and from member safety concerns, particularly infection control. The draft policy Query sets out requirements cognisant of individuals who may have Can you please advise if there is a dress code or uniform sensitivities or allergies. Likewise, cultural and religious require- policy in the HSE. I am increasingly confused in respect ments are considered and stipulate they comply with infection of a variety of uniforms that exist and also dress codes control and health and safety policies. Non-uniformed staff are for non-uniformed staff. I am not aware of a uniform also covered in this policy, as part of the dress code. The overall policy and require information on the subject. intent would be to ensure staff are easily identified particular to their grade and level of responsibility. WIN The trade unions are currently considering this draft policy and

Reply are due to meet with the HSE with a view to amending/improv- Vol 24 As part of the ongoing consultation, the staff panel of trade ing it. The aim is to have it endorsed at the next National Joint unions engages with the HSE to discuss all policies and pro- Council meeting on November 7. Following this if the policy is N o 9 cedures prior to implementation. This is one such policy that agreed, it will then be communicated within the HSE, made has been forwarded for consultation and comment by the end N available on the HSE website and would be included as part ovember 2016 of October. As we went to press, the INMO Executive Council of the corporate and local induction policy, and would be was in the process of reviewing the draft policy. reviewed as required. Further information will follow when the The draft policy has been developed with a view to creating policy has been fully reviewed. 30 Organising Review ED reps updated XXon health and safety issues

INMO organiser Albert Murphy focuses on ED rep health and safety and the advanced nurse rep courses

THE second emergency department health and safety rep course was held at INMO HQ in September and proved a great success. The course was attended by over 20 representatives from EDs from acute hospitals across the country. This follows on from the first course which was held in May 2016. INMO deputy general secretary Dave Hughes gave ED reps an overview of the Pictured at the second health and safety training course for emergency department representatives at INMO HQ recent ED Agreement from a health and in September were (back, l-r): Arthur Doran, Barry Hussey, Padraig Heffernan, Kellie Walsh, Finbarr O’Mahony, safety perspective. He spoke of the need Eric Lawsin, Sarah Watkins, Liam Conway and (front, l-r): Carmel Hardy, Siobhan Rochford, Liz McManus, Sarah for the INMO safety representatives, the Sheehan, Sinéad Joyce and Jackie Egan importance of health and safety registration and also on the additional measures The INMO will be forming a network of which have been taken in the recent ED ED health and safety representatives and it Agreement. is expected that a dedicated second news- Marian Geoghegan, senior training letter will issue to these reps. officer from the Financial Services Union, Good luck to all our new ED health gave a lecture on the role of the safety rep- and safety representatives in our acute resentative. She stressed to participants hospitals. Pictured at the second ED health and safety training that the registration confers a number of Advanced nurse rep course course were back row (l-r): Michelle Stoke, Claire important legal rights to safety represent- The INMO is running an advanced nurse Hoobin, Ellen Looby and Helen Crehan, front row (l-r) Emer Ward, Brid Jordan-Murphy, Michelle Stubbs atives without the responsibilities falling rep training course on November 10-11 at personally on the rep. It is clear under leg- HQ. This will build on the basic rep train- [email protected] to reserve a place islation that the major duty of care rests ing course which has been running over on the course. with the employer to ensure that all work- the past number of years. Any current Basic nurse rep training places are safe and healthy for employees reps, particularly those who have been A basic rep training course for the regardless of their occupation. on training courses in the past two years southeast was held in Kilkenny on Octo- Fergus Whelan of the Irish Congress of under the revised format, are encour- ber 5-6, which was attended by seven Trade Unions focused on risk identification aged to apply to attend the course. All representatives. in EDs and presented a case study based on interested reps are asked to contact Mar- Albert Murphy is INMO industrial relations officer/organiser; a redacted health and safety assessment. tina Dunne at Tel: 01 664 0624 or email: Email: [email protected]

messageImportant from

Is your INMO membership up to date? the INMO In difficult times the INMO will be your only partner and representative.

If you are not a fully paid up member, you cannot avail of the Organisation’s services and support in such critical areas as: Safe practice, fitness to practise referrals, pay and conditions of employment, other workplace issues and continued professional development. Please advise the INMO directly if you have changed employer or work location Contact the membership office with any updates through the main INMO switchboard at Tel: 01 6640600 or email: [email protected] WIN Vol 24 No 9 November 2016 - 1 2 3 4 1 2 3 4 5 1 2 3 4 5 6 1 2 3 4 1 2 3 4 5 1 2 3 4 5 6 Score Score 43 CPD on any non-bony part of the the of part non-bony on any child is not yet independently mobile independently yet child is not n children you you the consider should children n pos I recreational vehicles or vehicles collision bicycle recreational (crawling, cruising, walking) or ears) face (including eyes The The bruise is

Diving accidents. • • of non-accidental injury if: sibility • Incomprehensible sounds Incomprehensible words Inappropriate and disorientated Confused Orientated and converses normally to painful stimuli Extension in response to painful stimuli in response Abnormal flexion to painful stimuli in response or withdrawal Flexion painful stimuli Localizes Obeys simple commands Inconsolable or agitated Inconsistently consolable or moaning interactions but is consolable or inappropriate Cries, follows objects and interacts Smiles and orients to sounds, to painful stimuli Extension in response to painful stimuli in response Abnormal flexion to painful stimuli in response or withdrawal Flexion painful stimuli Localizes Obeys simple commands Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes in response Opens eyes spontaneously to pain in response open Eyes to voice in response open Eyes spontaneously open Eyes Table 1: Glasgow Coma Scale for adults and verbal children 1: Glasgow Coma Table ccidents involving motorised motorised ccidents involving Table 2: Glasgow Coma Scale for children unable to verbalise Scale for children 2: Glasgow Coma Table igh-speed collisions, eithervehicle motor ollover ollover motor from accidents or ejection alls from from alls a height of than one greater R a motor vehicle F metre or five or five metre stairs H as a occupant vehicle or cyclist pedestrian, A Best verbal response no sound Makes Best motor response to pain no movement in response Makes Best verbal response No vocal response Best motor response to pain no movement in response Makes BehaviourBest eye response Response No eye opening Best eye response Does not open eyes Behaviour Response

• • likely to cause serious head injury: to likely • • - - - - - reland reland I f possible f possible I

1 1 The The majority 3 People who have dementia, dementia, who have People 1,3

2 The majority of people with a with a of people The majority Most head injuries are caused caused injuries are Most head 3 1 t also explains the concepts of t explains the concepts of also focus on head injuries head on focus Gerry Morrow I

. Catherine Lewis, Nina Thirlway Nina Catherine Lewis, series, elopment e likely to have a serious head injury. a serious head injury. to have e likely owever, trauma trauma is the cause leading owever, ead injury is defined as any trauma to to trauma defined as any ead injury is

t is important to note that people who who that people to note t is important The majority of people who attend who attend of people The majority I H The assessment of a person with a head with a head of a person The assessment H cale score. When assessing a person who who person a assessing When score. cale n the latest update in this continuing professional professional continuing this in update latest the n emergency departments with head injury injury head with departments emergency approx although injury, minor a have will for example, may have different levels of of levels different example, may have for functioning to those cognitive pre-injury without dementia. with present of consciousness, loss amne minor head injury will recover without spe will recover minor head injury of death in people under the age of 45 of 45 the age death in people under of and years, up to of these deaths 50% are injury. head a of result a as of deaths from head injury are in people in people head injury are from deaths of or severely with a moderately who present consciousness impaired level. by falls, sports-related incidents and and incidents sports-related falls, by motor vehicle collisions. Approximately occur in 10,000 new head injuries each year. The following circumstances are more more are circumstances following The S injury consists of taking a history and an taking a history and an of consists injury examination, including a Glasgow Coma should ask how and you has a head injury occurred. the head injury when or alcohol recent about ask should you medica anticoagulant current intake, drug Assessment tion, pre-injury level of consciousness and consciousness and of level tion, pre-injury functioning. the head other than superficial injuries to the face. ‘red flags’ ‘red and potential complications of head injuries. clinical update on head injuries on head injuries clinical update This exami includes initial assessment and nation of people presenting with head with head of people presenting nation injury imately imately 20% of these will be admitted to hospital. sia, vomiting, headache or neck pain are or neck pain are vomiting, headache sia, mor cific or specialist intervention. cific

head injury head Management of Management and I dev 44 CPD

• The injury is to both sides of the face or head of 4 for eye response, 5 for verbal response, recover good cognitive function within • The bruises are at variance to the explana- and 5 for motor response should be three months of the injury.3 tion given by the parents or carers recorded as E4, V5, M5 and the total score Factors which may increase the risk of • Retinal haemorrhages or injury to the of 14/15 given. a poor prognosis following mild traumatic eye (in the absence of major confirmed People with dementia, chronic neurolog- brain injury include female sex, age over 40 accidental trauma or a known medical ical disorders or learning difficulties may years, persistent physical illness and/or a explanation) should also be considered a have a pre-injury baseline GCS score of pre-existing neurological condition, previ- ‘red flag’ for non-accidental injury.5 <15, which should be taken into account ous head injuries, co-morbid mental health Examination during clinical assessment. problems, such as anxiety and depression, Examine the person to assess their level The Glasgow Coma Scale score can be and a lack of social support.4 of consciousness, using the Glasgow Coma translated into severity of the head injury: Information and self-care advice Score (see Tables 1 and 2). Look for signs • Mild – score of 13-15 When discharging someone from hospi- of breathing difficulties or shock such as • Moderate – score of 9-12 tal who has had a head injury, you should increased heart rate, low blood pressure or • Severe – score of 8 or less. provide them with appropriate written reduced capillary refill time. Complications ‘safety-netting’ information about their Examine the patient for signs of visible There are multiple possible physical, head injury. This should include advice on: trauma to the scalp, skull, head and neck. thinking (cognitive) and psychological • Seeking medical advice if they have any Check pupil size and that pupils are react- complications following head injury, which ongoing or worsening symptoms, such as ing normally to light. Look for any problems may have an impact on a person’s ability vomiting or headaches with vision or speech disturbance, under- to function and return to normal activities. • Taking appropriate pain relief if neces- standing speech, reading or writing. Up to half of all adult inpatients with a sary, such as paracetamol or ibuprofen as If the person has been standing check head injury experience long-term psycho- appropriate for any problems with balance or walking. logical and/or physical disability.3 • Ensuring a gradual return to normal Ask about and test for any numbness in the Complications of head injury include activities. upper or lower limbs. Test reflexes and look concussion, which is a disturbance in the The Scottish Intercollegiate Guidelines for any loss of muscle power. If appropri- function of the brain caused by a direct Network provides several advice leaflets ate, assess the person’s neck for tenderness or indirect force to the head. It typically including advice for the person taking a and movement ability. Safe examination of results in the rapid onset of short-lived patient home, advice for a patient allowed the neck should only be performed if the impairment, which resolves spontaneously. home after a head injury and advice for person was not involved in a high-energy Post-concussion syndrome can also carers of children who have sustained injury, is comfortable in a sitting position, occur and may include multiple physical a head injury. All these leaflets can be has been walking at any time since the symptoms such as headache, dizziness, accessed at www.sign.ac.uk injury, has no tenderness along the spine, nausea, balance and co-ordination prob- Headway (Ireland) – Brain Injury Ser- or describes a problem with delayed onset lems, changes in appetite, sleep, vision, vices and Support (www.headway.ie) is a neck pain. and hearing, and cognitive and behavioural charity that supports people affected by a Signs of very serious injury include: symptoms such as fatigue, anxiety, depres- head injury. It runs a telephone helpline, • Clear fluid (possible cerebrospinal fluid) sion, irritability, problems with memory, 1890 200278, a network of support groups leaking from the ear(s) or nose concentration and decision-making. and offers rehabilitation programmes, • Bruising around the eyes (with no associ- Additional complications may include carer support, community outreach and ated damage around the eyes) problems with walking (gait), mobility, respite care.

• Bleeding from one or both ears muscle weakness, seizures, communica- Dr Catherine Lewis is a clinical author at Clarity • Blood behind the ear drum tion, swallowing, depression and anxiety, Informatics, Nina Thirlway is an information analyst at • New deafness in one or both ears and signs of post-traumatic stress disorder. Clarity Informatics and Dr Gerry Morrow is editor and medical director at Clarity Informatics • Bruising behind one or both ears.1 Some people experience cognitive Clarity Informatics is contracted by the National Institute Glasgow Coma Scale impairment which may include problems for Health and Care Excellence (NICE) to provide clinical The Glasgow Coma Scale (GCS)3 is used with memory, attention and concentra- content for the Clinical Knowledge Summaries service available through the Clarity Informatics Prodigy internationally in clinical practice to assess tion, planning, problem-solving, language, website at: prodigy.clarity.co.uk the depth and duration of impaired con- and perception. People who have had a References sciousness and coma. head injury may display challenging or 1. National Institute for Health and Care Excellence. Head It is used to assess the level of con- disinhibited behaviour, which can include injury: assessment and early management [CG176]. Published 2014. Available from: https://www.nice.org.uk/ sciousness in all people who have received inappropriate vocalisation or sexualised guidance/cg176/resources [Accessed September 28, 2016] a head injury (including people who appear behaviour. Delayed presentation of intrac- 2. Headway. The silent epidemic of acquired brain injury. Published 2010. Available from: http://www.headway.ie/ intoxicated). People are scored on three ranial complications is rare after mild information/silentepidemic.html [Accessed September different aspects of behavioural response: traumatic brain injury, and usually occurs 28, 2016] 3. SIGN. Early management of patients with a head eye opening, verbal and motor responses. within 24 hours of the injury.4 injury. Published 2009. Available from: http://www.sign. ac.uk/guidelines/fulltext/110/index.html [Accessed Each area of assessment is evaluated inde- Prognosis September 28, 2016] pendently of the other and graded, with Most people who have persistent symp- 4. SIGN. Brain injury rehabilitation in adults. Published 2013. Available from: http://www.sign.ac.uk/guidelines/ the lowest possible score being 3 (deep toms of mild traumatic brain injury recover fulltext/130/index.html [Accessed September 28, 2016] coma or death) and the highest being 15 within two to three months of the injury4 5. National Institute for Health and Care Excellence.

Vol 24 No 9 November 2016 No 9 November 24 Vol When to suspect child maltreatment [CG89]. Published (fully awake). and most people with post-traumatic 2009. Available from: https://www.nice.org.uk/guidance/ CG89 [Accessed September 28, 2016] WIN For example, a person with a best score amnesia of less than 24 hours duration CPD 45

There may be more than one correct answer to the multiple choice questions listed here. The correct answers (given below in the inverted text) are those deemed most appropriate by the CPD Quiz authors in the context of this CPD article.

1. Which type of accidents are more C) New deafness B) Age under 40 years likely to cause a serious head D) Vomiting C) Female sex injury? D) Male Sex A) Fall from a height less than one 3. Which Glasgow Coma Scale Score metre indicates a severe head injury? After reading this article you may wish B) Low speed motor vehicle collision A) 8 or less to reflect on what you have learned, C) Rollover motor accidents B) 13-15 how this might be applied to your own D) Diving accidents C) 9-12 work and to make a note of this in your 4. Which factors may increase a poor portfolio. 2. Signs of serious head injury include: prognosis following mild traumatic A) Clear fluid leaking from ears brain injury? B) Bruising behind ears A) Age over 40 years

For further information and resources: www.clarity.co.uk Answers: Question 1 = C, D Question 2 = A,B,C,D Question 3 = A Question 4 = A, C A, = 4 Question A = 3 Question A,B,C,D = 2 Question D C, = 1 Question Answers: 46 Focus Common goals of cancer care I had an opportunity recently to meet a Ahead of a new series of oncology research scientist who was fascinated to hear some real patient stories. By keeping programmes coming to the INMO PDC, up to date myself scientifically, I can relay Nuala Hannon outlines the common goal of to patients new exciting developments in treatments providing hope and optimism making patients’ cancer experience easier at a difficult time for them. By delivering nurse education sessions on the many Having set up a training business in Dublin and returned to St James’s in 2006 targeted therapy drugs and areas of rapid oncology in 2014, I have had the pleasure as a chemotherapy CNS, where I worked development, I hope I have helped nurses of working with many different people for eight years. to learn about these drugs in a practical involved in cancer care. It is easy to see Then an idea came. At this stage I was way. that everyone from frontline clinicians, deeply involved in cancer care like so I mentioned the huge impact of a cancer community professionals, scientists, many other nurses, and was attending diagnosis on an individual and their fami- researchers, pharmaceutical personnel, conferences and meetings nationally and lies and I’ve no doubt we have all helped insurers and more all have one common abroad. I could see how many disciplines someone with cancer outside of our hos- goal: to make the cancer experience for were involved in planning, delivering and pitals as a family member, a friend or a patients better, easier, smoother and advancing cancer treatments and care but neighbour. We understand that patients kinder. It is very motivating to see this in inter-professional opportunities to meet need psychological support as well as help such a challenging and often sad specialty. and share all this knowledge were scarce. with childcare, household chores, lifts to My oncology career started in the 1990s Service demands on clinicians has resulted hospital appointments and many other on a respiratory ward in St James’s Hos- in a big reduction of attendances at con- practicalities. pital, Dublin. At that time, respiratory ferences etc. Nurses now just don’t get Research and projections tell us that physicians looked after patients with lung the same opportunities to collaborate with cancer rates are rising globally. Bear- cancer and this is where my education in other disciplines due to service needs. ing this in mind, how will we continue to oncology began, learning about chemo- My oncology training business collates meet the needs of patients, both clinically therapy, radiotherapy and the huge impact all this knowledge and, combined with my by delivering treatments and socially by of a cancer diagnosis on a family. own clinical experience, can inform and supporting them through their illness? I I also worked as an oncology nurse update everyone from frontline clinicians certainly don’t have all the answers but adviser for a pharmaceutical company, a and community professionals to scientists I am encouraged by our common goal, role which brought me to most of the hos- and researchers. that is, to make the experience easier and pitals around Ireland and experience how, My vision is that by bringing the infor- kinder. as a nation, we care for our loved ones mation together everyone working in Ní neart go cur le chéile. There is no with cancer. Hooked by this experience, oncology will know what is going on out- strength without unity.

I decided to do a postgraduate degree in side their direct area and that this will Nuala Hannon worked as a clinical nurse specialist for seven oncology in St Luke’s Radiation Centre, impact services for the better. years and then set up Hannon Oncology Education in 2014

Introduction to Oncology Programmes These programmes are intended to give nurses and midwives the knowledge needed to care for cancer patients. An overview of cancer care in Ireland will be provided and key topics discussed. The programmes also provide an opportunity to develop communication skills around cancer discussions with patients.

From Symptom to Specialist Solid Tumours and Treatments Fee per day: Monday, February 27, 2017 Tuesday, February 28, 2017 €90.00 The following topics will be covered: The following topics will be covered: INMO members • Introduction to oncology – what is cancer? • Breast, prostate, colorectal & lung cancer overview €145.00 • Carcinogenesis • Treatment choices non-members • Patient pathway • Side-effects of treatments Vol 24 No 9 November 2016 No 9 November 24 Vol • Staging and grading • Management of side-effects

WIN • Preparing a patient for treatment • Oncological emergencies

For more information on each of these programmes log on to www.inmoprofessional.ie or call 01 6640641 or 01 6640618 MEDIA WATCH 47

Staff shortages at crisis level A call for action on staffing and pay levels, and bed closures in Co Louth hospitals were among some stories to hit the headlines this month. Ann Keating reports

The Evening Echo (October 7) covered the payment of more than €1,000 would take ago and has been INMO’s recent press conference under a effect from January 1, 2017, and that about extended until headline INMO calls for action on pay, 4,000 nurses would benefit. The Irish December 31. staffing levels. “The Irish Nurses and Mid- Nurses and Midwives Organisation said the “Health Minister Simon Harris wives Organisation has called for immediate initiative could be worth up to €1,500 and secured funding to hire 1,000 full-time action on pay and staffing shortages, arguing that up to 7,500 could benefit. The move nurses in the Budget… However, the Irish that current staff levels in some hospitals are effectively reverses a previous government Nurses and Midwives Organisation has violating health and safety legislation. decision that such an incremental credit since questioned whether the headline “Following a meeting of the union’s arrangement should only apply to nurses figure will actually make much difference Executive Council, the union has revved up who graduated in 2016, and not to those on the wards given that there is a huge reli- calls for an immediate reversal of the pay who finished their degrees in the years ance on agency staff at the moment.” cuts and pension levies imposed under the between 2011 and 2015.” Bed closures in Louth public sector Financial Emergency Meas- Bed capacity Nurse shortage crisis deepens says ures in the Public Interest legislation. Harris to review bed capacity amid the INMO was a story carried in the Dun- “The nurses are also hitting out at the nursing deficit was a headline in the Irish dalk Democrat (October 11). “According to additional unpaid hours required under Examiner (October 25). “The Minister for the INMO there are currently nine beds in the Lansdowne Road and previous agree- Health has said his department is to order Drogheda Cottage Hospital Transitional ments. They are calling for special incentive a review of bed capacity in hospitals to try Care Unit and nine newly refurbished beds measures aimed at recruiting and retaining to bring the number of working nurses to in St Oliver Plunkett’s Hospital, Dundalk nurses and midwives in sufficient numbers ‘adequate levels’ after nurses last week closed due to the refusal of the HSE to to adequately staff the health service. called for bed closures at University Hospi- sanction the filling of vacant staff nurse “The INMO has committed to a nation- tal Limerick, claiming there are not enough posts… The current reality is that directors wide consultation with members to finalise of them. Responding to nurses’ calls for bed of nursing have to await eight layers of actions necessary to achieve these objec- closures at UHL, Simon Harris said: ‘We’re management to approve the filling of one tives, which will be followed by a nationwide going to address this by carrying out a bed nursing post. ballot seeking a mandate to commence capacity review, where we are going to look “In the meantime, patients are left with- action if bed numbers/services are not at all of our bed stock right throughout our out adequate nursing cover and now beds reduced in line with available staffing levels.” hospitals, and indeed throughout our com- have been closed in Louth as we head into “INMO president, Martina Harkin-Kelly, munity primary healthcare settings’.” the busy winter months. The bed closures said that the Organisation has heard the Recruitment in Louth are having a direct impact on call from members, right across the coun- The Herald (October 15) reported €10k patients in Our Lady of Lourdes Hospital, try, that they have had enough and want packages and higher pay on offer to lure Drogheda.” the organisation to initiate whatever strat- nurses abroad. “Irish nurses will be lured Cork University Hospital (CUH) egies are necessary to secure accelerated abroad with tempting packages, just days Industrial action, in the form of a work pay restoration and greatly improved staff- after budget measures to hire more nursing to rule, in the oncology/radiotherapy ward ing levels.” staff for Irish hospitals were announced. at CUH was reported in the Evening Echo

Incremental credit restored “The different packages cover areas of (October 5). IRO Mary Rose Carroll said: “The WIN The Irish Times (October 14) reported expense such as travel costs, shipping of fur- union has engaged with hospital manage- Recently graduated nurses to receive niture, estate agents’ fees as well as funded ment on an ongoing basis since December, Vol 24 No 9 November 2016 €1,000 pay boost. “Nurses who graduated education courses… The Beacon Hospital but concerns have not been adequately between 2011 and 2015 are to receive a in Dublin has a term-time work policy for addressed… There has been absolutely no pay boost of more than €1,000 after the staff which allows employees take up to 13 agreement reached and no firm offer put on government agreed to restore incremen- weeks off per year to spend time with their the table… the work to rule will continue tal credit for the 36 weeks they spent on families. The Mater Private Hospital also until agreement can be reached.” placement in hospitals as students. Min- said it was actively recruiting nursing staff. Ann Keating is INMO media relations officer ister for Health, Simon Harris said the A bonus scheme was launched 12 months Email: [email protected] 48 QUALITY & SAFETY

A column by uality Maureen Flynn O&Safety Making data meaningful to drive better quality decisions

This month we focus on the use of data to measure and report on nursing contri- Figure 1. Donabedian framework butions to patient outcomes. Healthcare organisations are becoming more aware Structure Process Outcome of the importance of providing a culture of Physical and Focus on the care Effect of healthcare patient safety and quality, resulting in the organisational delivered to patients on the status drive to increase transparency and demon- characteristics where (eg. services or of patients and strate systems that monitor and measure healthcare occurs treatments) populations quality care.1,2,3 Performance measurement has become an integral part of modern ‘red flags’ mirror the safety clues referred to structure, processes and outcome informa- healthcare systems. Internationally as ‘care left undone events’. tion, empowers CNMs to make decisions healthcare organisations have adapted The quality care metrics report contains and changes to improve nursing practices Donabedian’s classical framework to assess standardised data covering the follow- at ward level. This is achieved by making quality of care. ing processes: medication storage and data visible and discussing actionable plans What is the Donabedian framework? custody, medication administration, doc- monthly with ward team members. The The Donabedian framework has three umentation, nursing assessment (pressure key to success when generating data is categories of information: structure (work ulcer assessment, falls, restraint, patient to make it meaningful and visible at ward environment), process (how care is deliv- observations, nursing care plan, discharge level. Staff engagement in monitoring ered and implemented) and outcome planning, nursing evaluation, environment, quality facilitates ownership of results and (effects of care on the patient). By meas- and provision of information). celebration of improvements. uring and understanding the relationships To be easily accessible and meaningful for Opportunity to get involved between these categories of information clinical nurse managers (CNMs) and teams, At your next ward, team, department or a fuller picture of the quality of care pro- clinical dashboards are currently being devel- directorate meeting you might like to talk vided can be obtained.4 Each category is oped within the medical division to display about how you measure the quality of care influenced by the previous, making the the information from different sources. The provided? What information sources do you components interdependent (see Figure 1). nurse management team is working closely have readily available; do you have data How is the framework used? with staff to review how the data is displayed related to structure, process and outcomes? Many organisations struggle to turn data and interpreted at ward level. Dashboards How could you bring this data together to into an actionable plan to improve quality, provide frontline staff with a quick visual of give you a fuller picture of the quality of becoming data rich and information poor.5 data relating to their unit making it more your care? Could you display this informa- To overcome this, the medical division at meaningful and easier to interpret. This pro- tion together on a clinical dashboard? Letterkenny University Hospital (LUH) has motes engagement and motivates staff to To learn more about the experience at brought together information generated improve practices. LUH contact Sinead Fisher, CNM3, med- from the electronic rostering system and Benefits ical division at: [email protected]. To the quality care metrics reports to make By linking quality care metrics and find out more about nursing and midwifery data more meaningful for ward managers, electronic rostering data, service manag- quality care metrics contact Anne Gallen, staff and patients, using data from the fol- ers are supported to build business cases director, nursing midwifery planning and lowing sources: to improve nursing services and improve development unit, at: [email protected] • S tructure – ‘Health Roster’ (staffing nursing practice. This holistic approach or follow the link to the ONMSD webpage required versus actual on roster) to monitoring and measuring quality care at: www.hse.ie • Process – quality care metrics report gives managers the tools to measure, con- Maureen Flynn is the director of nursing and midwifery, • Outcome – patient experience, ‘red flags’ tribute to and develop quality profiles that ONMSD, lead governance and staff engagement for quality HSE Quality Improvement Division (safety clues – care left undone events) support service developments. This data Acknowledgement and clinical incidents. can empower managers by demonstrating With thanks to Sinead Fisher, CNM3 medical division, This approach shows how each category the value of the nurses’ role in quality care LUH, and Michelle Donnelly, eRostering project manager, is influenced by the previous, eg. how staff- and also inform decision making when pri- Saolta University Healthcare Group, for sharing their experience and assistance in preparing this column ing levels influence the processes and the oritising areas for improvement. References on request (Quote: Quality & Safety 2016 processes influence patient outcomes. The Understanding the links between (Nov): 24(9): 48)

Vol 24 No 9 November 2016 No 9 November 24 Vol About the HSE Quality Improvement Division (QID): the division led by Dr. Philip Crowley was established in January 2015. The mission of the QID team is to provide leadership by working with patients, families

WIN and all who work in the health system to innovate and improve quality and safety of care by championing, educating, partnering and demonstrating quality improvement. Our vision is working in partnership to Quality Improvement Division create safe quality care. 50 MIDWIFERY FOCUS

Optimal cord clamping – key role of the midwife Anne Murray, 2016 CJ Coleman Research Award winner, discusses the findings from her research paper on optimal cord clamping and the importance of trusting midwives to provide the highest quality of care

As midwives who have worked for many Active management of labour which Transition of the newborn from intra- years caring for pregnant and birthing includes immediate cord clamping (ICC) uterine to extrauterine life is one of the mothers and newborn babies will know, was supported by the NICE Guidelines most powerful dynamic interludes in the miracle of childbirth never ceases to 2007 and Cochrane Report 2008. This has the life cycle. The transition from total amaze. However, within the Irish obstet- dominated maternity care to the extent dependence on the mother for every ric-led model, we have lost sight of that that women are instructed rather than life-sustaining requirement, from oxygen miracle. Mothers and babies are being provided with choice. to nutrition, to adapting to total inde- overlooked, while more emphasis is placed Active management of labour has its pendence, necessitates remarkable on buildings, staff, financial resources, place, and access to it has undoubtedly physiological changes from mother and patient turnover and work practices that saved many lives and reduced maternal baby. are considered suitable to the institution. morbidity, even in developed societies For each individual newborn infant, this We are losing sight of providing quality where postpartum haemorrhage remains transition may take minutes, hours or individualised care, with choice and dignity a major contributor to maternal morbidity days. Once the baby is born, the transition for our families. and mortality. Nevertheless, it has brought begins and should continue uninterrupted Midwifery care has been prejudiced by much interference and technology which as the umbilical cord continues to pulsate decades of obstetric influence and child- may not always prove to be in the best allowing the blood from the umbilical birth has become part of the medicalised interest of the mother and baby. vessels to flow to the baby for the first framework that midwives have been forced The timing of clamping and cutting the few minutes. This is called placental to work within. Care has evolved from umbilical cord has been one of the prac- transfusion. accepting a normal process to accepting tices in maternity care, developed because Blood volume of the neonate varies interference in childbirth as the norm. At of appropriateness, history, custom and depending on cord clamping practices.1 present, midwives have difficulty assert- practice. Despite the fact that this has Newborns subjected to ICC have around ing their professionalism and working as been challenged and discussed for centu- 70ml less blood volume per kilogram, autonomous practitioners within this med- ries, only recently has it been the focus of compared to newborns following optimal ical structure. the rigours of science and research. Imme- cord clamping, who have an increase of Labour management and interventions diate cord clamping has been seen as a 30-40%. This means that they have up to Birth is a physiological event in a healthy flawless action at birth. However, it can 90ml per kg2,3 more, amounting to an extra mother and baby and, while intervention is also be seen as interference in the natural 270ml of blood for a 3kg baby. Vol 24 No 9 November 2016 No 9 November 24 Vol appropriate in risk situations, it is not nec- physiology of the transition at birth that Optimal cord clamping

WIN essary for all women. deprives the newborn of vital blood. Several studies have indicated that MIDWIFERY FOCUS 51

newborns who are subjected to ICC have as standard care? This may be due to a anaemia in infancy compared to newborns number of reasons. who are not subjected to the intervention Initiating change of ICC. Iron-deficient anaemia in early Firstly, initiating change is challenging childhood is associated with developmen- and requires all staff working in maternity tal abnormalities.4 units to become involved. Care for birthing Many studies have shown that optimal mothers encompasses many disciplines cord clamping improves blood pressure from obstetricians, midwives, nurses and in the first hours after birth. Studies show paediatricians to neonatologists. These that newborns require less blood transfu- specialists all have differing views about sions and volume expanders. The increased management of the umbilical cord at birth. blood volume following optimal cord The building of trust and the use of clamping provides newborns with a larger excellent communication skills within all amount of haematopoietic stem cells, disciplines is vital. To facilitate transforma- which have huge potential for healing and tion, a change agent is required to organise repairing. the venture and monitor progress. Edu- Optimal cord clamping allows newborns cation about current evidence on optimal a natural stem cell transfusion. Red blood cord clamping must be provided to all the cells are increased by up to 60% following stakeholders. a delay of clamping for three minutes.5,6 Resuscitation This is of major importance as red blood Secondly, the problem of resuscitation cells play an essential role in the trans- arises. Most midwives who practise mid- Figure 1. A LifeSTART resuscitation trolley is used on site port of oxygen. Evidence substantiates wifery in the home environment would at Portiuncula Hospital, Galway to provide a stable, warmed platform for recusitation of the newborn that extra blood is necessary for the newly resuscitate newborns at the perineum with baby at the bedside. It ensures optimal ventilation with established pulmonary circulation.3,7,8 the cord intact. They know that resuscitating the cord intact, which is better for the newborn as the The author conducted research at Por- while the cord is still pulsating provides con- pulsating cord provides continued placental respiration tiuncula Hospital, Ballinasloe, Co Galway, tinued placental respiration for the newborn. through each standard. As midwives, if we which explored the effects of delayed cord Traditionally, resuscitation in the hospi- adhere to these standards we will provide clamping (DCC) on oxygen saturation tal setting at the bedside is not the norm. better collaboration, education and choice levels (SpO2) and heart rate in the first Resuscitaires are usually positioned away for our mothers during childbirth. 10 minutes of life. The research concluded from the parents; believing it protects par- Mothers will become informed about that SpO2 levels in the first 10 minutes of ents from the trauma of resuscitation at optimal timing of cord clamping and the life are enhanced with DCC. birth. Parental choice should be our first importance of the establishment of res- The research found fewer incidences of consideration. Birth and death are poign- piration prior to cord clamping. This will low heart rates in the early minutes after ant and personal life events and patients empower mothers and thus enable them birth, in addition, to establishing that and families should have as much auton- to make informed decisions regarding their newborns with nuchal cords don’t have omy as possible concerning these. care and interventions in labour and child- low one minute Apgar scores when DCC Denying parents the right to see their birth. Childbirth would be returned to its is the practice. Previous research found vulnerable loved newborns in the moments rightful owners and autonomy of the moth- low one minute Apgar scores in newborns before death, contravenes the principal of ers and midwifery would be rediscovered. with nuchal cords when subjected to autonomy. Bedside resuscitation in close Anne Murray is a clinical midwife specialist at Portiuncula ICC. It is for these reasons that a body of proximity to parents would make for better Hospital, Ballinasloe, Co Galway. This article is based on evidence widely endorses the benefits of communication and reassurance, in seeing her research paper, Neonatal pulse oxygen saturation levels (Sp02) and heart rates for the first 10 minutes of life optimal cord clamping regarding anaemia, that everything that could be done was done. following delayed umbilical cord clamping, which won the blood volume, the smooth transition to Most resuscitations have excellent INMO CJ Coleman Research Award 2016 extrauterine life and improved overall outcomes and parents feel privileged to References outcome for the newborn. have witnessed the care, love and kind- 1. Yao A, Moinian M, Lind J. Distribution of blood between infant and placenta after birth. Lancet 1969 2 (7626); Midwifery care ness shown to their precious newborns by 871-873 Midwives aspire to provide the most health professionals. 2. Levy T, Blickstein I. Timing of cord clamping revisited’ Journal of Perinatal Medicine 2006; 34: 293-297 excellent care supported by high-quality Equipment is now available to provide 3. Farrar D, Airey R, Law GR et al. Measuring placental evidence for mothers and babies to ensure optimal ventilation with the cord intact at transfusion for term births: weighing babies with cord intact. BJOG 2011;118: 70-75 that families have the best possible out- the bedside. On site at Portiuncula Hos- 4. Yager JY, Hartfield DS. Neurologic manifestations of WIN comes. Decisions made by midwives while pital, a bedside resuscitation trolley by iron deficiency in childhood’. Pediatr Neurol 2002; 27:

85-92 Vol 24 No 9 November 2016 supporting and caring for women at this LifeSTART is used. 5. Yao AC, Lind J. Placental transfusion. Springfield (IL), time are extremely important and influence The WHO recommends resuscitation 1982 6. Philip AG, Saigal S. When should we clamp the a variety of childbirth outcomes. Optimal with the cord intact if possible. This resus- umbilical cord?’ NeoReviews 2004; 5:142-153 cord clamping is one such judgment. citaire allows optimal care by allowing 7. Airey G, Begley CM, Gyte ML et al. Timing of Umbilical Cord Clamping: Midwives views and Practice. Br J Most midwives know that optimal resuscitation with the cord intact. Midwifery 2008; 16: 236-390 cord clamping is the ideal care during the The practice standards of the NMBI are 8. McDonald C, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal & neonatal third stage of labour, yet it must be asked part of a midwife’s code of professional outcomes. Cochrane Database Syst. Rev 2, 2008 why is it not being universally adopted ethics. Similar principles and values run CD004074 WIN Vol 24 No 9 November 2016 Pathway to respectful care 52 MIDWIFERY MATTERS Midwifery Series published in September.Midwiferypublished Series papers about maternal health in TheLancet full paperb lication for maternity care globally. The Recommended only indications; for clinical as: care, categorising them antenatal, intrapartum, and postnatal clinical practice guidelines for routine review ofevidence-basedsystematic respectful, evidence-based care all. for supporting urgent implementation of to quality and equitable maternal health, This paperhighlightsaglobalapproach manycoexisting countries. occurrencesin yet social and health inequities facilitate low-income andmiddle-income ones, • tinuum of maternalhealthcare: in thecon reportsituations twoextreme authorsnet/publication/308149742) . The w mended as vital reading for maternity w respectfuldence-based, maternitycare much, a pathwaytoo soon: towards evi Beyond soon much, too and too late Lancet paper,little, too too Beyond Deirdre Munro reviews the recently publishedmonumental to spect andabuse. TMTS isusually attributed health costs ventions cause harm as well as increasing and the authors report that TMTS inter •

help late tountil too unavailable held or standards, orcareevidence-based with care with “inadequateresources, below T when applied routinelyapplied oroverused”.when when usedappropriately, butharmful of dence-based interventions, as well asuse includes “unnecessaryuse of non-evi of normalpregnancy andbirth.Italso routine over-medicalisationdescribes the T mortality andmorbidity” problem associated with highmaternal orldwide orkers globally (seewww.researchgate. This isan extremely importantpub This monumentalpaperpresents a Births in facilities are on the increase, oo little, (TLTL),too late which describes oo much, (TMTS), whichtoo soon high-income countries and high-income countries TLTL to interventions that can be life saving ”. TLTL is described asan“underlying too little, too late and toolatelittle, too too 1 is the secondinaseries of six y Miller et alishighly recom with the added influx ofdisre added with the Recommended; ------

countries ent prevalence data from middle-income and tects, andpromotes humanrights. delivered inamanner that respects, pro and right time, be offeredat the needs to be guided by the rightamount of care and respectful care. Maternity care must high-quality, evidence-based,equitable safeguardwomen toensureall need to Healthcare providers andhealthsystems increasing TMTS.and indicating TLTL with the specific minimise focuswith the to TMTS during antenatal and early vention, treatment early detection shift towards improved screening for pre local disease burden, localprioritiesanda always possible. Guidelines need to reflect reducing maternal deaths. Respectful care is optimise healthstatusand quality as well as paper suggestabroader focus isneeded to mortality,authorsmaternal ofthis the global • • eventable maternalmorbidityandmortal- • • of timely evidence-basedcare application inequitable are dueto in outcomes wealth, ageandmigrant status. Often disparities ities insocio-demographic variables, including, countries, occurs everywhereare there dispar TL adherence to evidence-based guidelines adherence toevidence-based reflect weak regulatory capacity as well aslittle ful practices, especially in the private sector, childbirth. Increasing rates of potentially harm- particularly asmore women use facilities for countries, israpidly increasing everywhere, TMTS, historicall Although man and TMTS could helphealthcare providers to avoid TLTL guidelinesadherencecare, toevidence-based Although pr postnatal care sation of normalantenatal,intrapartum, and much, too soon(TMTS)–ie. over-medicali- resourcesand too– orevidence-basedcare late (TLTL)– ie.inadequateaccess to services, little, too as too access toqualitycare, defined absence oftimelywith the associated is ity Pr Key messages from theLancetMidwiferySeries(Sept2016) TL, historically associated TL, with low-income Not recommended. The authors pres for specific clinical practices, ogress isbeingmade to reduce y structural factors affect quality care. Guidelines are needed y associated with high-income - - - - S0140-6736(16)31472-6 worldwide. The Lancet 15); 2016(Sept doi: 10.1016/ towards evidence-based, care maternity respectful little, too late andtoo much, too soon: apathway 1. S, Miller Abalos E, Chamillard Metal. Beyond too Reference Twitter @DeirdreMunro Section and isfounder of Global Village Midwives. Deirdre Munro isEducation Officer of theINMOMidwives and implementsafe maternity care. steps to co-design concise, comprehensible bad). We or (good need clear, and experiences a direct effecthas onoutcomes babies; this implementing as the caregivergood as nityis careonly r guidelines forevidence-based mented’ ‘imple through beyondand TMTS TLTL facilities and systems can create a path costs andinequities. can actually cause avoidable harm,increase care. TMTS maynotimprove outcomes, and outine maternalhealthcare. Guidelines are only that –guides.Mater Individuals, professional associations, • • • • A partum andpostnatal care isurgently needed evidence-based care for routine antenatal,intra- and sustainedimplementation of respectful, Caesar rates logistical and cultural –affect caesarean section existing guidelines,multiple factors – economic, clear, clinical guidelinesandlittleadherence to the increase and variable rates to ashortage of countries. Although researchers partly attribute come countries and rising in most low-income Caesarean section rates are highest in middle-in- in privatepractice andhigher wealth quintiles. between and within countries, andhigherrates of both TLTL and TMTS – with disparate rates maternal healthcare indicator, andan example Q on direction of recommendationson direction of strengths of recommendation, andagreement line developers, usingsimilarlanguage, developed that reflect consensus among guide- input andrigorous implementationscience adherence to guidelines need multi-sectorial Str uality clinical practice guidelines need to be global approach that supports effective ategies for enhanced implementationand ean sectionisaglobally recognised care for mothers andnewborn 1 - - 54 FOCUS

Inflammatory bowel disease – focus on chronic fatigue The nature of IBD being typically a young person’s disease may lead to an underestimation of fatigue in a young cohort, writes Cathy Walsh

Inflammatory bowel disease (IBD) is of chronic conditions2 and has a major functional disability.9 It is easy to adminis- a chronic condition that affects approxi- impact on quality of life and the ability ter and can be completed quickly. mately 20,000 people in Ireland. It is the to function.6 It is a problem for patients The ‘fatigue severity scale’ is used to umbrella term for ulcerative colitis and because of the duration and its impact on measure fatigue in a variety of medical and Crohn’s disease. quality of life. Fatigue, which is a common neurological conditions. It consists of nine IBD is a chronic, relapsing and unpre- concern for IBD patients, is managed inad- questions, using a seven-point scale, rang- dictable condition that typically affects equately in Ireland.1,6 ing from ‘strongly disagree’ to ‘strongly an age group of 15 to 35-year-olds. It is a The very nature of IBD being typically agree’. The scores are totalled from each condition with periods of being very well to a younger person’s condition, may lead question – a lower score indicates less periods of repeated flare-ups. There is no to an underestimation of fatigue in this fatigue in everyday life; a high score (mean cure and treatment varies from person to cohort. > 4.0) indicates severe fatigue. person. Treatments have improved consid- Objectives Methodology and results erably for patients diagnosed with IBD over While studying fatigue and IBD, three A questionnaire was developed that the past 10 years but chronic conditions objectives were identified: included age, diagnosis, remission or and the related symptoms can be difficult • To assess fatigue in patients diagnosed relapse status, and whether the patient to come to terms with. with IBD related to relapse or remission was asked about fatigue as a symptom Chronic fatigue status by a healthcare professional. The fatigue Fatigue is a problem associated with • To assess symptom reporting of fatigue severity scale was included with the ques- chronic conditions1,2,3 and may be underes- by healthcare professionals tionnaire for completion. All questionnaires timated in young people with IBD. Farrell • To raise awareness and provide a patient were anonymous. and Savage highlight that the symptoms information leaflet. A total of 52 questionnaires were com- are a complex phenomenon that have Fatigue severity scale pleted by patients who attended the IBD adverse effects on an individual’s life.4 Fatigue is subjective and difficult to outpatient department over a four-week There is a lack of clarity on the termi- measure. Until recently, fatigue has not period. Criteria included patients who had nology used in relation to IBD and fatigue2 been measured routinely in many con- a diagnosis of IBD for one year or more. The and multiple definitions of fatigue exist.2,5 ditions. Various measures of fatigue are age range was 19-68 (mean age of 42). A Put simply, fatigue is also called exhaus- available7 but are not specific to IBD at the total of 24 males (46%) and 28 females tion, tiredness or lethargy and a feeling of time of this study. (53%) completed the questionnaire. lack of energy and motivation that can be The ‘fatigue severity scale’ (see Figure 1) In the diagnosis question, 18 (34%) had physical or mental or both. Many features designed by Krupp8 in 1989 was chosen as ulcerative colitis and 48 (66%) had Crohn’s of chronic conditions contribute to fatigue, the scale of choice. It is a reliable and val- disease. Of those who completed the ques- including muscle weakness, pain, anxiety idated score designed to assess disabling tionnaire, 73% considered their condition Vol 24 No 9 November 2016 No 9 November 24 Vol and disturbed sleep.6 fatigue in all individuals and to look at the to be in relapse and 27% considered their

WIN Chronic fatigue is a common symptom connection between fatigue intensity and condition to be in remission. FOCUS 55

Figure 1. Fatigue severity scale Figure 2. Fatigue severity During the past week I have found that: Disagree Agree

1. My motivation is lower when I am fatigued 1 2 3 4 5 6 7

2. Exercise brings on my fatigue 1 2 3 4 5 6 7

3. I am easily fatigued 1 2 3 4 5 6 7

4. Fatigue interferes with my physical suffering 1 2 3 4 5 6 7 5. Fatigue causes frequent problems for me 1 2 3 4 5 6 7 6. My fatigue prevents sustained physical functioning 1 2 3 4 5 6 7 7. Fatigue interferes with carrying out certain duties or 1 2 3 4 5 6 7 responsibilities Mean > 4.0 8. Fatigue is among my three most disabling symptoms 1 2 3 4 5 6 7 9. Fatigue interferes with my work, family, or social life 1 2 3 4 5 6 7 Mean < 4.0

Total score: No fatigue FSS mean score = total score for nine items divided by nine Mean score: Source: Krupp LB, et al. Aron Neurol. 1989; 46: 1121-1123; 1989, American Medical Association A mean score of > 4.0 indicates severe fatigue F atigue severity was measured using the perspective is recommended as best prac- fatigue severity scale. Only 7% reported no tice.11 Healthcare professionals need to fatigue, with 19% reporting a mean score consider fatigue as a symptom during Since then, Crohn’s and Colitis UK have of < 4.0, which indicates that they suffer assessment and give appropriate advice. completed an extensive four-year study from fatigue. Severe fatigue (mean > 4.0) Providing relevant written information on on fatigue and developed a fatigue assess- was reported by 74% of the respondents the management and treatment of fatigue ment score specifically for IBD patients.10 (see Figure 2). would be considered appropriate for The study has advised that all patients A review of fatigue in relation to relapse/ patients to understand the condition. with IBD should be screened for fatigue. remission status revealed that patients in Fatigue in IBD patient leaflet Cathy Walsh is a colorectal clinical nurse specialist at relapse had a higher mean score than those I was asked in 2013 by the Irish Society Letterkenny University Hospital, Co Donegal in remission. A total of 69% had a mean of Crohn’s and Colitis to write an article score of > 4.0, indicating severe fatigue for the quarterly magazine on a subject of References 1. Czuber-Doochan W, Ream E, Norton C. Review during relapse. choice. Fatigue was the immediate choice article: description and management of fatigue in Symptom reporting of fatigue revealed as I had noted the significant effects and inflammatory bowel disease. Aliment Pharmacol 2013; that 38% were asked by a healthcare pro- impact of fatigue on patients with IBD. Ther :37; 505-516 2. Jorgensen R. Chronic fatigue: an evolutionary concept fessional about fatigue as a symptom and The feedback on the article, which analysis. J Advanced Nursing 2008; 63(2), 199-207 62% were not asked. This is in keeping with acknowledged fatigue as a factor in IBD, 3. Wilson BS, Lonnfors S, Vermeire S. The true impact of findings by Czuber-Dochan,1 who found was extremely positive from patients and IBD. A European Crohn’s and Colitis patient Life Impact survey 2010-2011. http//efcca-solutions, net/media/ that patients who reported symptoms of healthcare professionals. jointhefight/Impact report.pdf fatigue were not taken seriously by health- A review of the literature relating to 4. Farrell D, Savage E. Symptom burden: A forgotten care professionals and fatigue was not information on IBD and fatigue was una- area of measurement in inflammatory bowel disease. International J Nursing Practice 2012; 18: 497-500 addressed during consultations. vailable for patients at this time. 5. Czuber-Doochan W, Dibley LB, Terry H, Ream E, Norton Discussion I developed the fatigue in IBD patient C. The experience of fatigue in people with inflammatory Fatigue has been identified as a problem information leaflet in 2014. It is currently bowel disease: an exploratory study. J Advanced Nursing 2012; 69(9), 1987-1999 for patients diagnosed with IBD. distributed to all gastrointestinal units in 6. Connolly D, O Toole L, Redmond P, Smith SM. Managing Patients who are in relapse are more Ireland by Tillotts Pharma, which produces fatigue in patients with chronic conditions in primary fatigued than those in remission, which IBD information booklets for patients. care. Family Practice 2013; 30:123-124 7. Neuberger G. Measures of fatigue. Arthritis & is in keeping with the findings of Czu- Conclusion Rheumatism 2003; 49(58): 175-183 10 ber-Doochan. The findings indicated that Fatigue is a neglected component of IBD 8. Krupp LB, Coyle PK, Doscher C, Miller A, Cross AH, WIN fatigue is not only related to relapse but is and is a real symptom for patients during Jandorf L. Halper J, Johnson B, Morgante L, Grimson

R. Fatigue therapy in multiple sclerosis: Results of a Vol 24 No 9 November 2016 ongoing for patients in remission. relapse and remission. IBD is pre-dom- double blind, randomised, parallel trial of amantadine, Symptom reporting is inadequate from inantly a young person’s condition and pemoline, and placebo. Neurology 1995:45:1956-61 healthcare professionals. Czuber-Doo- dealing with chronic fatigue as well as a 9. Valko P. Validation of the Fatigue Severity Scale in a 1 Swiss Cohort. Sleep 2008; Nov 1: 31(11): 1601-1607 chan highlighted that participants struggle chronic condition can have major implica- 10. Czuber-Doochan W. Norton C, Bredin F, Forbes A, to describe fatigue and that it is a poorly tions on quality of life. Nathan I, Berliner S, Darvell M, Gay M, Terry H. Assessing understood symptom that is frequently The fatigue and IBD patient information fatigue in patients with inflammatory bowel disease. Gastrointestinal Nursing 2014; (12) 8; 13-21 overlooked by healthcare professionals. booklet provides information for patients 11.McColl E. Best practice in symptom assessment: A Symptom assessment from the patient’s on fatigue and how to manage it. review. Gut 2004; 53:iv49-iv54 FOCUS 57

Standardising the nursing home transfer form By using a standardised nursing home transfer form, patients can receive more person-centred care, writes Jean Barber

There is no single standardised nursing • Safeguards with home transfer letter available nationally regards to transfer in Ireland. Some nursing homes send very and mobility issues detailed letters, others photocopy the can be addressed patients care plan and unfortunately, a sooner few nursing homes send transfer letters • Information on the with very little information in them. level of mobility Hospital staff then often have to spend that the patient unnecessary time contacting nursing has gives the staff homes for pertinent baseline information a baseline to which and many medical and nursing decisions they can aim once are based on this information. the acute phase of The objective of a standardised let- the illness is over ter is to ensure that the information that • The Waterlow nursing homes send with their patients score will deter- on transfer to an acute hospital is rele- mine if a pressure vant for the patients’ nursing and medical relieving mattress assessments. It also helps in formulating is required and if a the nursing care plan and ensures that referral to the tis- each patient receives a person-centred sue viability nurse approach to care. is warranted Content of transfer letter • The functional The one-page document illustrated con- level (Barthel) sists of personal and medical information, score indicates plus basic baseline information. Personal how independent information is given in the first section. the patient was and is a helpful Outcome The ‘medical information’ section contains guide for rehabilitation By using a standardised transfer letter a line asking nurses to state the reason the • Diet modification information can prevent the patient can receive a more person- patient is being sent to hospital. Included aspiration pneumonia. This information centred approach to care. A grant in this section is a reminder to send the will also trigger a referral to the speech has been given by the Irish Hospice patient’s medication list and any previous and language therapist Foundation to expand the use of this medical history. There is also a section • The patient’s weight and MUST score can standardised nursing home to acute which requests information on whether prompt an earlier referral to the dietitian hospital transfer letter. the patient has any specific palliative care • Previous continence history can prevent A copy of the transfer letter or end-of-life needs or has a DNR order in the inappropriate use of incontinence is available on the homepage of WIN place. products St Michael’s Hospital website

Why information on the following is • If a urinary catheter is in situ, information www.stmichaels.ie under ‘referral Vol 24 No 9 November 2016 important on the type, size and the date that it is information’. It is also available on the • Infection risk, eg. MRSA: If present, the due to be changed is provided and noted ‘medicine for the elderly’ section of the hospital can instigate timely precaution- • Cognitive assessment information provides St Vincent’s University Hospital website ary measures early, eg. use of a single a baseline when differentiating between www.stvincents.ie room dementia, delirium and delirium superim- EpiCare also has a copy on its website.

• Falls prevention strategies can be imple- posed on dementia. The patient’s normal Jean Barber, CNS palliative care/CNS gerontology, mented earlier communication level is also noted. St Michael’s Hospital, Dun Laoghaire, Co Dublin REVIEW 59 A caring cuisine Problems with chewing or swallowing home as well as for caterers in hospitals because of disability, dental problems or and care homes. It aims to improve the illness are widespread. Inspired by caring quality of life for anyone who has problems for her husband who had such a difficulty, with chewing and swallowing. Rita Greer developed recipes for people on As well as providing the recipes for soft exclusion diets and has designed a ‘new versions of old favourites and classic dishes cuisine’ specifically for adults to provide a – from lasagne to a roast dinner – the book balanced and stimulating diet. includes chapters on nutrition, a balanced In the introduction, Ms Greer recounts diet and healthy eating advice. It includes a how necessity was the mother of inven- useful list of cooking equipment and tech- tion. When caring for her husband who niques for food preparation, pointing out was unable to chew and who spent many that soft options cuisine is concerned with years in hospitals and nursing homes, she fine chopping rather than just liquidising said she felt she had been thrown in at the and blending. As well as chapters with rec- deep end. Unable to find a suitable cook- ipes broken up into the various meal types, book and knowing how the standard ‘soft there is what describes itself as an ‘over- diet’ had failed him, she said she had no the-top’ chapter on treats and celebration choice but to face the serious nature of the food, aimed at balancing the moderation problem and set about experimenting and bread and cakes, cereals, cheese, fish and of the rest of the book. Recipes in this trying to understand the implications of meat, poultry and eggs, while offering chapter include ‘spaghettini al salmone’ – a such a regime. enough variety to stimulate the appetite. rather special starter with smoked salmon Her book aims to avoid ‘baby-food’ The author stresses that balance is just and cream. creeping on to the menu, which can dis- as important as for an ordinary diet, or The Soft Diet, a practical and easy to appoint and depress the adult patient even more so, and this cannot be achieved follow book, aims to make food and cook- and often fail to provide adequate nour- by using just a few convenience foods. ing a pleasure again for anyone who has ishment. The Soft Diet offers ideas and a Rita Greer has decades of practical expe- had to adjust to a soft diet and their carers. variety of recipes for anyone who is on a rience, not only as a health writer, but also – Tara Horan

soft diet. It is based on providing proper in the food industry, which makes The Soft The Soft Diet. Rita Greer. Souvenir Press. nutrition, with vegetables and fruit, salads, Diet useful for those caring for someone at ISBN: 9780285643529. £9.99 ! Crossword Competition

1 2 3 4 5 6 7 Across Down Solutions to October crossword: 1. Part of a fish - the dorsal, perhaps (3) 1. As energetic as cowboys after a 3 & 25a. Where senior army officers buy hackneyed campfire meal? (4,2,5) Across: 8 9 stamps? (7,4,6) 2. Put someone’s name forward (8) 1. Brute force 6. Hard 10. Chair 8 & 9. Auburn plectrum broken during 3. Take hold of; understand (5) 11. Influenza 12. Foreleg spinal tap (6,8) 4. Non-stop train or bus (7) 15. Toxin 17. Ouzo 18. Lung 10 11 12 10. Confess, admit (3,2) 5. With which to tie up your shoes (5) 19. Nests 21. Praises 23. Cadre 11. Wetland (5) 6. Pertaining to the eye (6) 24. Fiji 25. Rent 26. Bluff 13 14 13. Melody (5) 7. Golf peg (3) 28. Help out 33. Attempted 15. This summit should let the First Lady 12. T he Epoch of the Broken Stolen 34. Space 35. Dire 36. Thermostat take it easy (7) Piece (11) Down 15 16 17 16. Pasta dish found in the middle of a 13. Craftsman in stone (5) 1. Back 2. Unadorned 3. Eyrie 18 Sinatra violin concerto (7) 14. Collision (5) 20. Cardinal direction (5) 17. Orange is required - so arrange it (8) 4. Ovine 5. Cuff 7. Annex 19 20 21. Holy person (5) 18. Did earn a change, being utterly 8 & 32d. Diagnostic test 9. Buttons 23. Cheer to support come Cabra exhausted (7) 13. Lear 14. Goliath 21 22 23 volunteers (5) 19. How I’d wail for the Hindu Festival 16. Blackboard 20. Stimulant 24. A string’s tangled up in astrological of Lights (6) 21. Perfume 22. Evil 27. Utter categorisation (4,4) 22. Flavour (5) 29. Eider 30. Pesto 31. Itch 24 25 25. See 3 across 23. Vampire slayer played by Sarah 26. Some lions and Ms Adamson - they’re Michelle Gellar (5) the most special! (5,3,3) 24. Something given to pacify The winner of the 26 27 27. Female sheep (3) someone (3) October crossword is: Mary Roche Name: The prize will go to the first all correct entry opened. Fermoy Address: Closing date: Monday, November 21, 2016 Post your entry to: Crossword Competition, WIN, MedMedia Publications, Co Cork 17 Adelaide Street, Dun Laoghaire, Co Dublin 60 UPDATE

A leap forward for cardiac services Helen Connaughton has become the first clinical nurse specialist in Ireland in the area of inherited cardiac conditions. Ms Con- naughton’s success marks an important milestone for cardiology and nursing services, both nationally and in Tallaght Hospital. As the first Irish clinical nurse specialist in inherited cardiac conditions, Ms Con- naughton is now a national leader in this area and demonstrates the investment and advancements that have taken place in cardiac services at Tallaght Hospital. Ms Connaughton was a clinical nurse manager in the cardiac risk in the young Pictured in Tallaght Hospital at the announcement of Helen Connaughton becoming the first clinical nurse (CRY) unit for eight years. The CRY unit specialist in Ireland in the area of inherited cardiac conditions were (l-r): Deirdre Ward, consultant cardiologist; Helen Connaughton, clinical nurse specialist in inherited cardiac conditions; Hilary Daly, director of nursing, aims to provide comprehensive specialist Tallaght Hospital; and Berneen Laycock, assistant director of nursing, all Tallaght Hospital evaluation of those diagnosed with or at risk from inherited cardiac conditions, Ms Connaughton’s post was initially Ms Connaughton said. including families who have lost someone funded by the Patches Trust and for the Hilary Daly, director of nursing at Tal- to sudden cardiac death. past five years she has been funded by the laght Hospital, added: “Tallaght Hospital The unit was developed as a collabora- charity Cardiac Risk in the Young, which has a strong ethos of ‘people caring for tion between Tallaght Hospital, St James’s fund much of the activity at the CRY unit. people’ and Helen achieving this profes- Hospital, St Vincent’s University Hospital “It is a great honour to achieve this sional accreditation enables us to put this and Trinity College Dublin and is located success and to be part of this great leap ethos into place all the more clearly, in at Tallaght Hospital. forward for cardiac services in Ireland,” the area of cardiac services.”

® *In the 52-week trials, SPIOLTO administered once daily in the morning provided clear improvement in lung function within 5 minutes after the first dose compared to tiotropium 5 μg (mean increase in FEV1 of 0.137 L for SPIOLTO® vs. 0.058 L for tiotropium 5 μg [p<0.0001]).3 †SPIOLTO® resulted in statistically significant improvements in SGRQ total scores and responder rates vs. both monotherapies (p<0.05) after 24 weeks. Response defined as a ≥4 change in SGRQ score. Pooled analysis of the pivotal phase III TONADO™ 1 and 2 studies.3 ‡As measured by the Mahler Transitional Dyspnoea Index (TDI) focal score at 24 weeks. Pooled analysis of the pivotal phase III TONADO 1 and 2 replicate studies.3 An increase in Mahler TDI score indicates an improvement in breathlessness.2 Mahler TDI focal score increased by 1.983 units with SPIOLTO® compared to baseline, 1.627 units with Spiriva® compared to baseline and 0.356 units with SPIOLTO® compared to Spiriva® (22% improvement vs Spiriva®; p<0.05).3 References: 1. SPIOLTO® Respimat® Summary of Product Characteristics. 2. Beeh K-M et al. Pulm Pharmacol Ther 2015;32:53–59. 3. Buhl R et al. Eur Resp J 2015;45:969–979. 4. Boehringer Ingelheim. Data on file TOL15 02(c). 5. Spiriva® Respimat® Summary of Product Characteristics. 6. Spiriva® HandiHaler® Summary of Product Characteristics. 7. Dalby R, Spallek M, Voshaar T. Int J Pharm 2004;283:1–9. 8. Pitcairn G et al. J Aerosol Med 2005;18:264–272. 9. Hochrainer D et al. J Aerosol Med 2005;18:273–282. SPIOLTO® RESPIMAT® (tiotropium/olodaterol) Inhalation solution containing 2.5 microgram tiotropium (as bromide monohydrate) and 2.5 microgram olodaterol effects of Spiolto Respimat. Concomitant treatment with xanthine derivatives, steroids, or non- (as hydrochloride) per puff. Action: Inhalation solution containing a long-acting muscarinic receptor antagonist, potassium sparing diuretics may potentiate any hypokalaemic effect of adrenergic agonists.

tiotropium, and a long-acting beta2-adrenergic agonist, olodaterol. Indication: Maintenance bronchodilator Beta-adrenergic blockers may weaken or antagonise the effect of olodaterol. Cardioselective beta-blockers could treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dose and be considered, although they should be administered with caution. MAO inhibitors, tricyclic antidepressants Administration: Adults only aged 18 years or over: 5 microgram tiotropium and 5 microgram of olodaterol or other drugs known to prolong the QTc interval may potentiate the action of Spiolto Respimat on the given as two puffs from the Respimat inhaler once daily, at the same time of the day. Contraindications: cardiovascular system. Fertility, pregnancy and lactation: There is a very limited amount of data from the Hypersensitivity to tiotropium or olodaterol or any of the excipients; benzalkonium chloride, disodium edetate, use of tiotropium in pregnant women. For olodaterol no clinical data on exposed pregnancies are available. As

purified water, 1M hydrochloric acid (for pH adjustment); atropine or its derivatives e.g. ipratropium or oxitropium. a precautionary measure, avoid the use of Spiolto Respimat during pregnancy. Like other beta2-adrenergic Warnings and Precautions: Not for use in asthma or for the treatment of acute episodes of bronchospasm, agonists, olodaterol may inhibit labour due to a relaxant effect on uterine smooth muscle. It is not known i.e. as rescue therapy. Inhaled medicines may cause inhalation-induced paradoxical bronchospasm. Caution whether tiotropium and/or olodaterol pass into human breast milk. A decision on whether to continue/discontinue in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder-neck obstruction. Patients should be breast-feeding or to continue/discontinue therapy with Spiolto Respimat should be made taking into account cautioned to avoid getting the spray into their eyes. They should be advised that this may result in precipitation the benefit of breast-feeding to the child and the benefit of therapy for the woman. Clinical data on fertility or worsening of narrow-angle glaucoma, eye pain or discomfort, temporary blurring of vision, visual halos are not available for tiotropium or olodaterol or the combination of both components. Effects on ability to or coloured images in association with red eyes from conjunctival congestion and corneal oedema. Should drive and use machines: No studies have been performed. The occurrence of dizziness or blurred vision any combination of these eye symptoms develop, patients should stop using Spiolto Respimat and consult a may influence the ability to drive and use machinery. Undesirable effects: Common (≥1/100 to <1/10): specialist immediately. In patients with moderate to severe renal impairment (creatinine clearance ≤50ml/min) Dry mouth. Uncommon (≥1/1,000 to <1/100): Dizziness, insomnia, headache, atrial fibrillation, palpitations, use only if the expected benefit outweighs the potential risk. Caution in patients with a history of myocardial tachycardia, hypertension, cough, constipation. Serious undesirable effects include anaphylactic reaction and infarction during the previous year, unstable or life-threatening cardiac arrhythmia, hospitalised for heart failure consistent with anticholinergic effects: glaucoma, constipation, intestinal obstruction including ileus paralytic during the previous year or with a diagnosis of paroxysmal tachycardia (>100 beats per minute) as these and urinary retention. An increase in anticholinergic effects may occur with increasing age. The occurrence patients were excluded from the clinical trials. In some patients, like other beta-adrenergic agonists, olodaterol of undesirable effects related to beta-adrenergic agonist class should be taken into consideration such as, may produce a clinically significant cardiovascular effect as measured by increases in pulse rate, blood pressure arrhythmia, myocardial ischaemia, angina pectoris, hypotension, tremor, nervousness, muscle spasms, fatigue, and/or symptoms. Caution in patients with: cardiovascular disorders, especially ischaemic heart disease, malaise, hypokalaemia, hyperglycaemia and metabolic acidosis. Prescribers should consult the Summary of severe cardiac decompensation, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, hypertension, Product Characteristics for further information on side effects. Pack sizes: Single pack: 1 Respimat inhaler and aneurysm; convulsive disorders or thyrotoxicosis; known or suspected prolongation of the QT interval and 1 cartridge providing 60 puffs (30 medicinal doses). Legal category: POM. MA numbers: PA 775/9/1.

(e.g. QT >0.44 s); patients unusually responsive to sympathomimetic amines; in some patients beta2-agonists Marketing Authorisation Holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, may produce significant hypokalaemia; increases in plasma glucose after inhalation of high doses. Caution Germany. Prescribers should consult the Summary of Product Characteristics for full prescribing information. in planned operations with halogenated hydrocarbon anaesthetics due to increased susceptibility of adverse Additional information is available on request from Boehringer Ingelheim Ireland Ltd, The Hyde Building, The

cardiac effects. Should not be used in conjunction with any other long-acting beta2-adrenergic agonists. Park, Carrickmines, Dublin 18. Prepared in June 2015. Immediate hypersensitivity reactions may occur after administration. Should not be used more frequently than once daily. Interactions: Although no formal in vivo drug interaction studies have been performed, Adverse events should be reported to the Health Products Regulatory Authority inhaled Spiolto Respimat has been used concomitantly with other COPD medicinal products, including at www.hpra.ie or by email to [email protected]. short-acting sympathomimetic bronchodilators and inhaled corticosteroids without clinical evidence Adverse events should also be reported to Boehringer Ingelheim Drug Safety on 01 291 3960 or by email to of drug interactions. The co-administration of the component tiotropium with other anticholinergic [email protected] containing drugs has not been studied and therefore is not recommended. Concomitant administration of other adrenergic agents (alone or as part of combination therapy) may potentiate the undesirable Date of preparation: March 2016 IRE/SPRES-161038a

9147 SPIOLTO World of Irish Nursing Ad 210x297 AW_IRE.indd 2 29/02/2016 16:20 62 UPDATE

Pivotal role of the PAU model of care THE inaugural pre-admission unit (PAU) conference, entitled ‘Operation excellence – sharing solutions’, saw 168 delegates, representing 41 hospitals throughout Ire- land, gather in the Clarion Hotel, Sligo to demonstrate the interest and enthusiasm among nursing, anaesthetic, surgical and allied healthcare professionals regarding the pre-admission process. Dr Colm Henry, national clinical

advisor and group lead for the acute hos- Pictured at the inaugural PAU conference were (l-r): Marion Ryder, interim director of nursing; Mr Justin Lane, pitals, outlined the pivotal role of PAUs orthopaedic consultant; Rosaleen White, HIPE; Teresa Donnelly, CNM2 theatre, Therese Gallagher, UNO/SM; in ensuring service efficiency, patient Charlotte Hannon, clinical facilitator, nurse practice development unit; Alison Smith, TPot co-ordinator; and Noreen Casey, allocations liaison officer, nurse practice development unit, all from Sligo University Hospital safety and positive patient experiences within the elective surgical and ortho- the PAU model of care, the forthcoming the importance of resilience for healthcare paedic services. nurse education curriculum for PAUs, and professionals and the relevance of com- Among other topics discussed at the the challenges of informed consent prior to mencing the discharge planning process at conference were the work encompassing admission. Medication safety in the PAU, the PAU were also covered.

Vaccinating against seasonal influenza Support needed for Pictured at the launch of the Community Health Organisation (CHO) Area1 Flu mistreated nurses Vaccine Campaign, which was launched by RTÉ’s northern editor, Tommie Gorman, NEW research has revealed that nurses on October 10 were (l-r): Mags Moran, need more help dealing with disrespectful community infection prevention control nurse manager, Donegal; Clodagh Keville, behaviour from colleagues if patient care is community infection prevention control to be maintained. nurse manager, Sligo/Leitrim; and Martina The study, which was led by Dr Roberta Harkin-Kelly, INMO president. The launch, which took place in An Clochar, Health Fida from the University of East Anglia, Campus, Ballyshannon, aims to raise argues that in order to retain high-quality awareness of the importance of at-risk nurses it is important to understand what people getting vaccinated against seasonal influenza and was attended by HSE staff and factors might protect them from the neg- representatives from various agencies. The ative effects of workplace mistreatment. at-risk category includes healthcare workers; everyone aged 65 and over; anyone over six This new study, conducted with Dr months old with a long-term illness; pregnant Heather Laschinger from the University women; and nursing home residents of Western Ontario, Canada, investigated whether individuals’ beliefs about their ability to deal with workplace-specific HSE launches breastfeeding resources stressful events can protect nurses from In conjunction with National These new resources provide invalua- these negative effects. It is part of a wider Breastfeeding Week, which took place in ble information, support and friendships research project on nursing work environ- October, the HSE launched a number of for families, and the HSE aims for the ments led by Dr Laschinger. new resources, all of which are available new supports to reach more families and Published in the journal Health Care at www.breastfeeding.ie improve access to user-friendly breast- Management Review, the results show Among the resources launched are: feeding help and information. that self-efficacy does have a protective • Ask our expert – email a question to a In Ireland, 57% of mothers are breast- role. The more nurses believed in their lactation consultant via the HSE ‘ask our feeding their babies on discharge from capability to cope with stressful inter- expert’ service or through webchat maternity hospital, however in the first personal situations at work, the less they • A new HSE breastfeeding Facebook page, few days and weeks at home, may expe- perceived incivility from co-workers and which provides a support community, rience challenges which often prompt supervisors. with information and tips from the ‘ask them to stop breastfeeding sooner than Nurses with higher levels of self-efficacy our expert’ lactation consultants they planned. It is important for families also experienced less emotional exhaus- • New Irish breastfeeding videos, which to be aware that there is breastfeeding tion and cynicism a year after they were provide guidance for mothers on topics support out there from the maternity first surveyed and reported fewer mental such as positioning and attaching baby, services, public health nurses and volun- health issues. However, self-efficacy was Vol 24 No 9 November 2016 No 9 November 24 Vol expressing milk and what to expect in tary breastfeeding organisations in the not significantly related to later intentions

WIN the early days. community. to leave the job. UPDATE 65

Supporting nurses and midwives to monitor and improve quality of care The HSE Office of Nursing and Midwifery – University College Dublin, University of A national quality Services Director (ONMSD) has com- Limerick and the National University of care metrics working menced research to identify specific and Ireland, Galway. group will review relevant nursing and midwifery quality The participation of nurses and mid- the Delphi findings care metrics for acute hospital care, midwives in the research is vital to its success to prioritise the wifery, children’s, community and public and expressions of interest to partici- metrics and indica- health nursing, as well as mental health pate in the study and have a say in the tors and this will be and intellectual disability nursing. development of nursing and midwifery reissued to nurses A key priority is supporting nurses and sensitive indicators are being sought. and midwives to midwives to measure, monitor and Nurses and midwives will be invited to obtain feedback improve the quality of nursing and mid- advise the researchers on what they feel and consensus. wifery care. are the important aspects of care delivery, The research The purpose of the study is to develop a contributing to a quality and safe care team is aiming to suite of nursing and midwifery quality care experience for patients, clients, families encourage nurses and midwives of metrics and their indicators, which can and carers. all grades across all fields and disciplines be used to measure the quality of nursing A systematic review will be carried out to engage in the study. Details of the sub- and midwifery clinical care processes. by the research team to ensure all metrics mission process will be provided shortly. The study, co-ordinated through the and indicators have a strong evidence base. Further information on the research Nursing and Midwifery Planning and Questionnaires will be issued to nurses and study is available from the NMPDU or by Development Units (NMPDU), is aca- midwives as part of a ‘Delphi’ process to contacting national lead, Anne Gallen at demically supported by three universities identify relevant metrics and indicators. email: [email protected]

Raising money for premature babies I rish Premature Babies, a national charity set up to support the families of pre-term babies and to support the work of neonatal intensive care units, has launched a 2017 calendar last month to raise money for 10 hospital grade breast pumps, which cost approximately €22,000. The charity delivers frontline services to families and supports the work of the neonatal intensive care units around Pictured (L-R) at the recent Irish Association of Directors of Nursing and Midwifery annual conference Ireland by buying and providing vital were: Martina Harkin-Kelly, INMO president; Thomas Kearns, executive director, Faculty of Nursing and Midwifery, RCSI; and Suzanne Dempsey, director of nursing, Children’s University Hospital, Dublin and group director of equipment towards the care of pre-term nursing, Children’s Hospital Group. The conference, the theme of which was ‘Coming back to what we know – babies. a future of care and complexity’, was held on October 6- 7 in the Radisson Blu Hotel, Athlone Since 2009, the charity has implemented a parent-friendly breastfeeding programme and bought 11 hospital grade 40 years of orthopaedic nursing education pumps and currently rents them to new Over 100 guests gathered on October 20 Board of Ireland) when it commenced. mothers of pre-term babies. for an official reception in the Lady Martin Over the 40-year period from 1976 to

The charity has fundraised and donated Auditorium in Cappagh National Ortho- 2016, 62 programmes were held, with WIN 15 hospital grade pumps to some of the paedic Hospital, as the nursing department a total of 479 nurses completing the neonatal units around Ireland. Currently, celebrated 40 years in orthopaedic nursing programmes. Vol 24 No 9 November 2016 it does not have enough pumps to meet education. Some 234 nurses graduated with a the demands of new pre-term mothers Official records of education date certificate in orthopaedic nursing, 124 and it is hoped that the calendar launch from 1976, with the Cappagh National with a diploma in orthopaedic nursing, will raise enough funding to buy 10 more Orthopaedic Hospital’s orthopaedic nurse 78 graduated with a higher diploma in hospital grade pumps and meet demands. education programme, which was the nursing studies (orthopaedic nursing) The calendars can be purchased for €10 at only certificate programme recognised by and 43 graduated with a postgraduate www.irishprematurebabies.com An Bord Altranais (Nursing and Midwifery diploma in orthopaedic nursing. € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € €

€ € € € € € € € € € €FINANCE€ 67 € € € € € € € € € € € € € € € € € € € € € € € € € M € NEY € € € € € Choosing€ € € €a health€ € € € € € € € € € € € € € insurance€ € € €policy€ € € € € € € € € € € € € € € € € € € € € € € € € € € MATTERS Ivan Ahern advises on getting the right € € € € € health€ cover€ at the right€ price € € € € € € € € € €

APPROXIMATELY 2.12 million people in Ire- Child discounts land now have health insurance. While the Most insurers will offer discounts or spe- public healthcare system offers fantastic cial terms at various times of the year on treatment once a patient is in the system, child prices so it is important to always ask getting access can be a challenge. about possible discounts. Recent figures show that 430,573 Policy excess people are on waiting lists to be seen for Taking on a policy excess is one of the the first time through the public system.1 best ways of reducing health insurance These are patients who have been costs. Price reductions of at least 10% may referred after an initial consultation with be possible by accepting a small excess for their GP. In addition, there are 77,800 private hospitals. patients waiting to have their procedure Private rooms carried out as an inpatient/day case pro- A private room in a private hospital is cedure. Waiting times will vary depending never guaranteed. Unless a private room is on whether a patient is classed as routine a necessity for you, consider dropping this or urgent. benefit for similar cover to make big savings. Currently, there are more than 18,000 Corporate plans people waiting over 18 months for their Corporate plans tend to be the most initial hospital appointment and, while competitively priced plans on the market every effort is being made to improve and are worth considering before you these numbers, it is not going to happen such as a GP, physiotherapist or dentist renew your cover. They normally cover overnight as the public system is currently visits – check the cover for each benefit public and private hospitals and usually struggling to meet demand. and how many visits are covered on your include some level of day-to-day cover for If you have health insurance cover or are plan. your routine medical costs. considering taking cover out, before look- Managing the cost of health insurance Expert advice ing at price, it is essential that you have Outlined below are some tips and fac- Health insurance is complex but it’s the right health insurance. Decide what tors to consider in managing the cost of also arguably one of the most important is important to you and make out a list of health insurance: insurance plans to have. Don’t cut corners questions to ask about your cover. Age with your cover – seek expert advice from a Tips for choosing the right cover Lifetime community rating applies qualified adviser to ensure that your plan is • Make sure you choose a health insurance a loading to those taking out cover for the best value cover that meets your exact plan with some access to private hospi- the first time after the age of 34, which requirements. tals. Plans with cover in public hospitals increases the cost of your premium. This Shop around only do not always guarantee fast access loading is 2% per year for every year, Think of your health insurance cover like to treatment eg. a 35-year-old will pay an extra 2%, a you would think of your car or home insur- • Check the inpatient/day case excess on 40-year-old an extra 12% etc. This loading ance. Do your homework each year prior to your plan. This is the amount you pay remains for the lifetime of the policy. your renewal to get the best deal possible and can vary substantially, depending on Split your cover and if you’re satisfied that it meets your

whether this amount is calculated per You can have every family member on requirements, then switch. WIN

admission or per night the one policy but all on different levels of Ivan Ahern is a director of Cornmarket Group Financial • Check that you have full cover for day cover, which could help you save money. Services Ltd Vol 24 No 9 November 2016

case treatment such as chemotherapy, Young adult discounts Cornmarket compare all health plans in the market so radiotherapy and colonoscopies in private Many insurance companies offer dis- that you choose the plan that suits you. Call Cornmarket hospitals counts on health insurance for young at Tel: 01 470 8098. Cornmarket Group Financial Services Ltd is regulated by the Central Bank of Ireland. Cornmarket • En sure you have cover for major cardiac adults. You could be paying a full adult is part of the Great-West Lifeco group of companies, one of procedures in the Blackrock Clinic, Mater price for an 18-year-old dependent when the world’s leading life assurance organisations

Private and Beacon hospitals as much as a 50% discount could be Reference • C onsider cover for day-to-day benefits available. 1. National Treatment Purchase Fund 2016 68 DIARY

Wednesday 18 November Telephone Triage Section AGM. 11am. INMO HQ. Contact jean. Library Opening Hours Sunday 6 [email protected] or Tel: 01 6640648 Retired Nurses and Midwives for further details Section four-night autumn break November to Galway Bay Hotel. Full details Saturday 21 Monday-Thursday: For further information on the library available from www.inmo.ie or Tel: ODN Section meeting and AGM. 8.30am-5pm and its services, please contact: 01 6640616 Cavan General Hospital. 11.30am. Contact [email protected] or Friday: Tel: 01-6640-625/614 Wednesday 9 8.30am-4.30pm Tel: 01 6640648 for further details Fax: 01-01 661 0466 Research Nurses Section meeting. Email: [email protected] Venue to be confirmed.Contact Saturday 21 [email protected] or Tel: School Nurses Section meeting and 01 6640648 for further details AGM. INMO HQ. 10.30am. Con- tact [email protected] or Tel: Saturday 12 01 6640648 for further details CNM/CMM Section meeting. INMO Membership Fees 2016 10am. INMO HQ. Contact jean. February [email protected] or Tel: 01 6640648 A Registered nurse €299 for further details Friday 3 (Including temporary nurses in prolonged Tuesday 22 Nurse/Midwife Education Section employment) RNID Section conference. Crowne AGM and meeting. INMO HQ. Plaza Hotel Santry, Dublin. Log 11.30am. Contact jean.carroll@ B Short-time/Relief €228 onto www.inmoprofessional.ie to inmo.ie or Tel: 01 6640648 for This fee applies only to nurses who provide very book your place or contact jean. further details short term relief duties (ie. holiday or sick duty [email protected] or Tel: 01 6640616 Saturday 4 for further details relief) Midwives Section AGM and Tuesday 29th meeting. Cork University Mater- C Private nursing homes €228 Please note change of date nity Hospital. 2pm. Contact jean. D Affiliate members €116 National Children’s Nurses Section [email protected] or Tel: 01 6640648 meeting. INMO HQ. 11am. Con- for further details Working (employed in universities & IT tact [email protected] or Tel: institutes) 01 6640648 for further details Training and education E Associate members €75 Not working December v One-day ear irrigation training programmes with Category 1 F Retired associate members €25 Tuesday 6 NMBI approval and four CEUs G Student nurse members No Fee Care of the Older Person – What will be held on November 17, Matters to me IHF. INMO HQ 2016 in the Education and 10am. Cost €45 members/€100 Conference Centre, Royal non-members. Maximum capacity Victoria Eye and Ear Hospital, of 16 people so please ensure you Adelaide Road, Dublin 2. For book early. Log onto www.inmo- further details contact Sabrina professional.ie or contact jean. Kelly, nurse tutor at Tel: 01 [email protected] or Tel: 01 6640616 6644652 or email: sabrina. for further details [email protected]

Wednesday 7 v The Irish Stoma Care and Emergency Department Section Colorectal Nurses Association meeting. 11.30am. INMO HQ. Con- study day will take place on tact [email protected] or Tel: 01 Friday, March 24, 2017 at the 6640648 for further details Mater Misericordiae University Hospital, Dublin. The title of January the study day will be ‘colorectal innovations: a fusion of clinical Wednesday 11 excellence. The study day Care of Older Person Section AGM. programme will be issued INMO HQ. 11am. Contact jean. in the coming months. For [email protected] or Tel: 01 6640648 further information email@ for further details [email protected]

• Annual leave Know your rights and entitlements • Sick leave • Maternity leave The INMO Information Office offers same-day responses to all questions • Parental leave • Pregnancy-related Contact Information Officers Catherine Hopkins and Karen McCann at sick leave Tel: 01 664 0610/19 • Pay and pensions • Flexible working Email: [email protected], [email protected] • Public holidays Mon to Thur 8.30am-5pm; Fri 8.30am-4.30pm • Career breaks • Injury at work • Agency workers • Incremental credit