€5.75 Vol 25 No 10 December 2017 / January 2018

Latest INMO CPD education Journal of the Irish Nurses and programme Midwives Organisation Page 33

World of Irish Nursing & Midwifery

Farewell editorial from Liam Doran page 4

Pay Commission gets down to work page 9

New network for nurse/midwife leaders page 25

New Pink Power campaign page 27

Clear aims 2018: Let’s make it ours CONTENTS 3

News & views 29 Comhlámh Ruth Powell explains how Comhlámh 4 Editorial assists those thinking about volunteering In his final editorial, Liam Doran, INMO their skills either at home or abroad general secretary, reflects on the Organisation’s journey during his two- 31 Questions and answers decade tenure Bulletin board for IR queries

8 News 51 Executive Council focus Overcrowding at record level in 2017... A series profiling three members of the INMO submission to Pay Commission... INMO Executive each month ESRI report presents major challenge... 2018 Executive Council elections – call 52 Quality and safety This month Maureen Flynn looks at for leaders... Actions agreed at WRC 4 Measurement for Improvement ED review... HSE issues clarification on Trust in Care and Safeguarding policies... Midwifery Transfer of tasks progressing well... 55 Paula Barry examines the strengths, Resolution close on PHN contracts of weaknesses, opportunities and threats employment... Governance of home relating to the midwife’s role in the Irish helps under focus... Review of medication health service management in ID sector... India main source of new recruits... Success for 63 Update community midwives’ subsistence Round up of healthcare news items claim...Temporary reassignment of IROs... Work to rule likely at St Finbarr’s... Staffing issues in Bandon and Fermoy... Clinical Tallaght ED remains ‘intolerable’... 43 CPD Plus: Section news, page 21 Rebecca Elliot, Nina Thirlway and Gerry Morrow focus on pre-conception advice 7 From the President for women who are planning a pregnancy INMO president Martina Harkin-Kelly rounds up news from the Executive Council and beyond Living 22 International news 59 Book review Elizabeth Adams introduces the Nursing Tara Horan reviews I Found My Tribe by Now! campaign which aims to release Ruth Fitzmaurice the potential of nurses to deliver Plus: Monthly crossword competition universal health coverage 61 Finance 49 Students & new graduates Ivan Ahern explains how to find out if Liam Conway updates readers on news you are due a tax refund in 2018 for students and new graduates Jobs & Training Features 33 Professional Development Eight-page pull-out section from the 25 Leadership INMO PDC The Nursing and Midwifery Leadership Network was set up to foster collaboration 66 Diary and innovation among leaders nationally Listing of meetings and events nationally and internationally 27 Pink Power The INMO has relaunched its successful 67 Recruitment & Training Pink and Blue Power cancer screening Latest job and training opportunities in campaigns Ireland and overseas 27 WIN Vol 25 No 10 December 2017/January 2018

WIN – World of Irish Nursing & Midwifery is distributed by controlled circulation to more than 35,000 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. Irish Nurses and Thank you – it has been a privilege Midwives Organisation

World of Irish Nursing & Midwifery As you will show that, in July 2008, the working may know, week of every nurse and midwife in Ire- (ISSN: 2009-4264) I am retir- land was reduced to 37.5. This was the first Volume 25 Number 10 December 2017/ January 2018 ing at the reduction in the working week of a single WIN, end of this occupation for over 40 years. This cam- MedMedia Publications, month, paign was remarkable in that the reduction 17 Adelaide Street, so this is was achieved without any loss of pay to Dun Laoghaire, my last any member of the Organisation. Co Dublin. editorial This campaign was fought against the Website: www.medmedia.ie for WIN and in that context I would like to background of increasing levels of hospi- reflect, for a few moments, on the growth tal overcrowding. In response to this the and development of this great Organisation Organisation had initiated our daily Trolley since I started, as its first student officer, in Watch – the measurement of the number June 1983 when the Organisation had just of admitted patients without an inpatient Editor Alison Moore over 9,000 members. Between 1983 and bed. Trolley Watch has now become syn- Email: [email protected] 1998, when I became general secretary, I onymous with the INMO, and is accepted Tel: 01 2710216 worked as student officer, industrial rela- as the most potent measure of the levels Production & news editor Tara Horan tions officer, head of industrial relations and of overcrowding being endured, by patients Sub-editor Fodhla McCarthy deputy general secretary. Over that 15 years and staff, on a daily basis. I worked with three general secretaries, Ena However, I now turn to the dark, and Designers Fiona Donohoe, Paula Quigley Meehan, John Pepper and PJ Madden (now dismal, five years spanning 2009 to 2013. Commercial director Leon Ellison Fr Madden) and wish to thank them, most During this five-year period I had, as general Email: [email protected] sincerely, for the help, support and guid- secretary, to recommend members should Tel: 01 2710218 ance they gave me in those early years. accept cuts in pay and working conditions Publisher Geraldine Meagan I became general secretary in Septem- (including a return to the 39-hour week) WIN – World of Irish Nursing & Midwifery ber 1998, following a threatened national because the alternative – government is published in conjunction with the dispute, in 1996, with the Commission on imposed cuts – would be worse. However, Irish Nurses and Midwives Organisation by Nursing about to report and the Organ- I want to state that this Organisation’s MedMedia Group, Specialists in Healthcare isation having grown to over 20,000 refusal to accept cuts in Sunday/public hol- Publishing & Design. members. In October 1999 we com- iday and night duty premium, as suggested menced a nine-day national strike which, in the first Haddington Road proposals, still like many of you, I remember very vividly. I represents one of the proudest days of my am resolute in my conviction that the out- tenure of general secretary. come of that dispute, in terms of pay, new It must be understood that if the INMO career opportunities, the development of had not led that campaign of rejection of Editor-in-chief: Liam Doran the honours degree programme and the those proposals, nurses/midwives, and all INMO editorial board: acceptance of our involvement in all mat- other public servants who work 24/7, would Martina Harkin-Kelly; Mary Leahy; ters of concern to nurses and midwives, have suffered permanent cuts in premium Margaret Frahill; Frances Cullen; Kay Garvey; confirms those nine days were a watershed pay. This was avoided because of our cam- Mary Gorman; Karen McGowan in the development of this Organisation. paign which resulted in 14 of the 19 public INMO editor: Ann Keating In 2007/2008 the INMO was again sector trade unions rejecting the proposals Email: [email protected] involved in a nationwide dispute, as we – many of them against the recommenda- INMO editorial assistant: Freda Hughes sought a reduced working week in line with tions of their executives. The INMO, during INMO photographer: Lisa Moyles other allied health professionals. History that dark period, led from the front and this INMO correspondence to: is something of which I am very Irish Nurses and Midwives Organisation, proud. Whitworth Building, Since 1998 I have had the North Brunswick Street, honour of working with seven Dublin 7. Tel: 01 664 0600 presidents: Ann Cody; Clare Fax: 01 661 0466 Spillane RIP; Ann Martin; Made- Email: [email protected] line Spiers; Sheila Dickson; Claire Website: www.inmo.ie Mahon; and, currently, Martina Harkin-Kelly. All great people, who have given time, determi- www.facebook.com/ irishnursesandmidwivesorganisation nation and leadership to this Organisation. I wish to thank them for being so supportive of twitter.com/INMO_IRL me at all times. I have served Editorial 5 Thank you – it has been a privilege

10 Executive Councils working with excel- and the range of industrial, lent people who gave up their time to lead, professional and educational and at times make difficult decisions, in the services we provide. interests of the entire membership. I now want to say a It has also been my privilege to know very sincere thank you to hundreds of branch/section officers and everyone who has worked local representatives over these years, with me in the Organisa- who I respect, and appreciate, more than tion. I have had brilliant, I can ever say in words. Our union can only thoughtful, determined and thrive, serve and grow through the work committed people at my of local activists. These officers and local side at all times. The current representatives have been the backbone of team is simply the best and this Organisation and I shall never forget we have met the challenges, their diligence, commitment, loyalty and and the dark days, surviving steadfastness to do everything possible to only because we leaned on help members with their workplace issues each other. On the way there and difficulties. They are the reason we were some laughs mixed now have over 40,000 members. with a steely determination I have, during my time, dealt with seven to do the best we could for Ministers for Health, five secretary gen- every member that we were erals in the Department of Health and so proud to represent. Please observed the transition from health boards rest assured we will go from to the HSE’s Integrated Service Areas, to strength to strength under Hospital Groups and community health Phil and this great team. organisations (bureaucracies +++). Finally, may I say, to Throughout my time we have sought each and every member, to ensure that nursing and midwifery is how proud I am to have resourced, and managed, by senior nurses/ worked for you as general midwives with autonomy and authority. secretary for almost 20 As I leave I realise more work needs to be years. When you are in the done to achieve this goal, and I know we care of nurses and mid- will keep trying. wives, you are in the hands In 2002 the Organisation bought our cur- of dedicated, efficient and rent headquarters, The Whitworth Building, competent professionals and in 2013 we bought the neighbouring and I am honoured to have Richmond Building which will open shortly been your representative. as our Education and Event Centre. I am Thank you – it has been a very proud that we now own these facilities privilege. which, together with our regional offices, are Liam Doran testimony to the growth of the Organisation General Secretary, INMO Farewell Liam, but not goodbye We started out together in 98, We were labelled a lethal cocktail.

From the front you led, no challenge or foe was WIN too great, With leadership, courage and vision you delivered without fail. Vol 25 No 10 December 2017/January 2018 In good times and bad you gave INMO members all you had, The trade union leader of your generation, our parting now leaves me sad. Bon voyage Liam, this is your time, spend it with Patricia and your family. You have made your mark, Enjoy retirement, but never lose your spark. – Dave Hughes Having worked with Liam for 19 years, these past number of weeks have been both sad and incredibly informative. By that I mean the achievements, the single-minded attention to detail and unabashed promotion of nursing and Opposite page (top): Liam Doran’s first editorial photo from 1998; (bottom): Liam midwifery, in any forum regardless of the audience, never ever gets switched off. pictured at the successful campaign to reduce working hours in 2007; This page He leaves behind a strong team with this focus ingrained and I hope, as I progress (top to bottom): Liam pictured recently in his office in INMO HQ; The student into the post of general secretary, to maintain and grow this momentum so that protest in 2012 marching down O’Connell St in Dublin; the 1999 strike campaign the professions of nursing and midwifery can prosper. – Phil Ní Sheaghdha marching down O’Connell Street; The thousands of nurses who came out to protest in November 1999; and (left) Liam with Dave Hughes at the 2017 ADC Your priorities with the president

Martina Harkin-Kelly, INMO president

Merry Christmas Merry Christmas to all of you and may the new year ring in with good cheer and a brighter Quote of the month future for you, our nursing and midwifery members from myself and the National Executive. “The secret of change is to focus all of It’s like Ground Hog Day (again!) as the trolley crisis continues. Not once did our employer your energy, not on fighting the old, manage to achieve the daily target of 236 set by the Minister last winter. Limerick soars in but on building the new” numbers from week to week with 61 recorded on October 23 and even Navan recording 33 - Socrates on the same day – with the overall October figure coming in at 8,093! When annualised for 2017, there is an increase of 8% on the first 10 months of 2016 at 82,459. This occurred in the same week that the HSE warned of the next big superbug CRE and the awaited arrival of the flu H1N3 strain from Australia. Yet, our employer has once again stooped to arguing about Report from the whether a cubicle space be counted as a bed. My response to that is simple – NEWSFLASH – Executive Council THE ED IS NOT A WARD! We also rode out hurricane Ophelia and storm Brian. Despite many of you heading into work and leaving your loved ones and many of you being told to stay Recent Executive Council meetings were at home in the interest of safety, our employer decided to deduct pay resulting in the INMO dominated by finalising the content and having to get this decision overturned. Our employer, it seems, like our bankers, has no moral details of our evidence-based submission compass - the mentality is grab a buck at any cost. The INMO has sought engagement to the Public Service Pay Commission. The with the HSE on developing a national understanding regarding a ‘Status Red’ storm alert. letter received on October 25 confirmed Have a wonderful, peaceful and enjoyable Christmas with your Family, loved ones and and set out that the commission will carry friends – le gach dea ghuí i gcomhair na nollag agus na h-ath bhliana. out its work in two modules. Module 1 will report on the priority areas of nursing and Farewell but not goodbye to Liam Doran midwifery, consultants and non-consultant This month’s journal presents Liam’s last WIN editorial. Liam deserves to be saluted. He hospital doctors by end of second quarter has been at the centre of the INMO for more than three decades – and his like will never of 2018. It was the Executive’s view that, be encountered again. For the two decades Liam has been general secretary, he has nav- given that all possible initiatives have been igated the INMO through many difficulties. As he has said himself, he was ‘wet around exhausted, the government must now look the ears’, when he was faced with the 1999 strike after only a year in position. Liam gal- in the direction of pay and hours to ensure vanised the INMO and succeeded in earning better conditions for nursing and midwifery that there is a strong nursing and midwifery in Ireland. I only got to know Liam over the past five years and particularly over the past workforce to meet future needs. As I always year working alongside him as president. I could not have asked for a better mentor, a say, as sure as there is sand in the Sahara master of timing, planning, brinkmanship and delivery. He possesses an innate ability to others will also present evidence of where read the political landscape and we all know that a week is a long time in politics. Family we stand from their perspective. This is game life is everything to Liam, his wife Patricia and his two children Adam and Aoife, are a on and we will play it to the nth degree to source of immense pride. This Organisation was also his family and the dedication he set the record straight. During this executive has demonstrated is truly remarkable. A gent whose many deeds and acts of kindness to meeting series, the Department of Public members who found themselves in need of support echoed the familial role of care and Expenditure and Reform also published the compassion. The statesman image and style – the suits, crisp shirts and cuff links that Public Service Pay and Pensions Bill (2017), articulated the tone of meaning to do business. All that is left to say is that, he will be which gives effect to the Public Service missed; know this Liam, be proud of the Organisation’s achievements under your leader- Stability Agreement (2018/20). This Bill ship. On behalf of the members and the Executive Council I want to wish you very good clearly signals the government’s intention in health and happiness and that you will enjoy a well-deserved retirement – comhairdeas relation to those not signed up to the agree- leat. Go raibh mile maith agat, agus go n-éirí an bóthar leat. ment. Executive also welcomed the news that the PNA have accepted the PSSA. NMBI meeting on professional competency The Executive Council was due to meet on I led a four-strong delegation of the INMO to meet with Mary Griffin, NMBI CEO, and December 11 and 12, 2017 with the first meet- Bernie Carpenter, NMBI project lead of the Professional Competency Scheme. The meet- ing of the new year on January 15 and 16, 2018. ing stemmed from the fact that the INMO had raised concerns re the initial consultation with registrants, on the Professional Competency Scheme’s, process, timeline, notifica- tion and selected venues. While this engagement and consultation process is welcome,

we strenuously emphasised that any NMBI scheme must not come as an additional Get in touch burden to the nurse/midwife. The model must be user-friendly and allow the nurse/mid- You can contact me at INMO wife to be facilitated by their employer in maintaining competence. HQ at Tel: 01 6640 600, through the president’s blog on www.inmo.ie or by For further details on the above and other events see www.inmo.ie/President_s_Corner email to: [email protected] 8 NEWS Overcrowding at record level in 2017 INMO welcomes 7% reduction in November 2017 figures

The number of admitted 6,212 admitted patients on these wards are already short • University Hospital Galway patients (91,147) on trolleys trolleys in EDs and 2,476 staffed resulting in essential – 539 or overcrowded wards con- admitted patients on trolleys/ patient care being delayed • Letterkenny General Hospital tinued at record levels in the extra beds on inpatient wards. or left undone (missed care). – 502. first 11 months of this year, This totalled 8,688 admitted Overcrowded wards are also The ED Taskforce was due to according to the latest INMO patients without a proper inpa- contrary to best practice and meet as we went to press at trolley/ward watch figures. tient bed in November 2017. increase the risk of cross infec- which the INMO would again This is a 6% increase on the The INMO stated that tion between patients. be seeking confirmation that first 11 month of 2016 and a placing extra patients on The hospitals with the high- all hospitals are resourced to: 95% increase on the first 11 understaffed inpatient wards est number of patients on • Open all available beds months of 2007. is not an appropriate or trolleys, in November were: • Introduce incentivised recruit- However, the figures for effective response to the con- • University Hospital Limerick ment/retention packages the month of November (see tinuing overcrowding crisis. – 878 to ensure additional nursing below) show a 7% reduc- Overcrowding wards simply • University Hospital Cork – 651 staff are employed to deal tion compared to November compromises the care of all • University Hospital Waterford with this continuing demand 2016. Broken down this saw patients on that ward, as – 624 • Ensure senior clinical decision

Table 1. INMO trolley and ward watch analysis (November 2006 – 2017) Hospital Nov Nov Nov Nov Nov Nov Nov Nov Nov Nov Nov Nov 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Beaumont Hospital 513 602 725 814 676 710 421 661 729 586 383 269 Connolly Hospital, Blanchardstown 237 219 260 231 423 292 276 425 514 443 261 266 Mater Misericordiae University Hospital 359 504 537 440 354 375 252 266 450 464 404 397 Naas General Hospital 280 144 239 366 387 192 160 104 315 108 256 257 St Colmcille’s Hospital 38 91 246 216 237 172 167 42 n/a n/a n/a n/a St James’s Hospital 55 87 351 201 121 112 89 62 231 178 309 153 St Vincent’s University Hospital 369 581 570 495 593 546 322 63 250 464 379 213 Tallaght Hospital 329 326 570 463 607 181 135 245 375 459 293 451 Eastern total 2,180 2,554 3,498 3,226 3,398 2,580 1,822 1,868 2,864 2,702 2,285 2,006 Bantry General Hospital n/a n/a n/a n/a n/a n/a n/a n/a 15 0 47 121 Cavan General Hospital 203 154 144 254 330 369 170 79 32 172 13 56 Cork University Hospital 188 478 480 383 635 479 339 361 329 424 648 651 Letterkenny General Hospital 308 6 25 25 26 81 68 209 47 184 481 502 Louth County Hospital 33 0 1 5 n/a n/a n/a n/a n/a n/a n/a n/a Mayo University Hospital 289 129 94 100 113 37 108 18 198 108 213 259 Mercy University Hospital, Cork 107 97 123 79 198 168 217 308 236 141 424 237 Mid Western Regional Hospital, Ennis 109 51 32 4 76 1 47 0 n/a 10 1 13 Midland Regional Hospital, Mullingar 16 4 26 36 160 388 196 175 245 305 444 449 Midland Regional Hospital, Portlaoise 42 45 25 21 75 261 13 73 94 251 258 173 Midland Regional Hospital, Tullamore 3 1 29 0 117 190 77 65 272 248 399 290 Monaghan General Hospital 12 23 17 n/a n/a n/a n/a n/a n/a n/a n/a n/a Nenagh General Hospital n/a n/a n/a n/a n/a n/a n/a n/a n/a 4 1 2 Our Lady of Lourdes Hospital, Drogheda 348 276 414 56 350 709 533 248 584 578 607 386 Our Lady’s Hospital, Navan 105 65 118 47 9 116 108 53 45 101 59 108 Portiuncula Hospital 8 11 14 125 52 132 109 21 121 56 144 79 Roscommon County Hospital 80 117 76 52 87 n/a n/a n/a n/a n/a n/a n/a Sligo University Hospital 30 72 59 100 111 164 274 32 223 204 107 198 South Tipperary General Hospital 60 157 3 53 3 121 188 251 153 193 680 400 St Luke’s Hospital, Kilkenny n/a n/a n/a n/a 50 109 67 86 96 339 360 398 University Hospital Galway 115 292 369 323 416 846 330 411 536 480 594 539 University Hospital Kerry 42 21 52 38 71 45 57 36 128 92 208 263 University Hospital Limerick 239 169 245 300 331 393 347 399 556 542 789 878 University Hospital Waterford n/a n/a 43 35 141 112 160 234 153 251 412 624 Wexford General Hospital 154 23 63 161 250 207 139 39 197 22 132 56 Country total 2,491 2,191 2,452 2,197 3,601 4,928 3,547 3,098 4,260 4,705 7,021 6,682 NATIONAL Total 4,671 4,745 5,950 5,423 6,999 7,508 5,369 4,966 7,124 7,407 9,306 8,688 Comparison with total figure only: Increase between 2016 and 2017: –7% Increase between 2012 and 2017: 62% Increase between 2008 and 2017: 46% Vol 25 No 10 December 2017/January 2018 Vol Increase between 2015 and 2017: 17% Increase between 2011 and 2017: 16% Increase between 2007 and 2017: 83% Increase between 2014 and 2017: 22% Increase between 2010 and 2017: 24% Increase between 2006 and 2017: 86%

WIN Increase between 2013 and 2017: 75% Increase between 2009 and 2017: 60% NEWS 9

makers are available from 8am- leading to no waiting lists for to November 2016. The reduc- most disturbing and suggests 10pm over seven day cycle. same. tion, in the numbers on trolleys hospital management are In addition, the INMO INMO general secretary in emergency departments is increasingly repeating the mis- will be pressing to ensure all Liam Doran said: “The latest particularly welcome. takes of the past. Overcrowding available resources are pro- figures confirm a welcome 7% “However, the significant wards has never solved the vided for community beds/ reduction in the number of increase in additional patients problem of hospital overcrowd- home care packages and com- admitted patients, without a on inpatient wards, on trol- ing, and this will only be done munity nursing requirements bed in November, compared leys or additional beds, is through additional acute beds.” INMO submission to Pay Commission Nursing and midwifery the public health service than highlighted the reduction in grades are among the first joined it workforce figures in recent grades being examined by the • The net increase in staff years, stating that in 2017 the Public Service Pay Commission nurses was 302 WTE, as the nursing and midwifery work- (PSPC), which under the Public recruitment of 2,573 staff force remains 3,500 less than Service Stability Agreement is nurses was negated by the it was in December 2007 when charged with examining issues fact that 2,271 left the work- there was a lower activity in of recruitment and retention place over the same period. the Irish health service. throughout the public service. The INMO cited interna- The need to future-proof our Following the PSPC’s request tional evidence demonstrating health service in response to for submissions from employ- the issues that staff shortages demographic changes as set ers and trade unions, the INMO pose for nurses and midwives out in the recent ESRI report, made a robust evidence based who work in this type of a were included in the sub- written submission by the health service, including mission. This highlighted the November 29, 2017 deadline. burnout, increasing instances projected need to expand the INMO general secretary designate Phil This highlighted all the fac- of injury and violence, and acute hospital services by 33% Ní Sheaghdha with the INMO submission tors affecting recruitment and increasing resignations. and older persons’ services by to the Public Service Pay Commission retention of nurses and mid- The submission presented 54% based on the increasing Recruitment and Retention wives, and stressed that all evidence that inferior pay and aging population. Agreement of February 2017 nursing/midwifery grades are scales in Ireland are a major These expansion initiatives (which included delegated having difficulties with both factor affecting the retention will require additional nursing/ authority to directors of nurs- recruitment and retention. of nurses/midwives in the Irish midwifery staff. To recruit and ing and midwifery to recruit), The INMO pointed out that health service. Nursing/mid- retain at a level that allows the has been requested by the Ireland is the least compet- wifery pay scales are 15%-20% overall nursing and midwifery PSPC to attend before it and itive country from a parity lower than allied health pro- population to grow requires set out the implementation of pay perspective based on fessionals, who have the same new measures. The submission progress of that agreement. the earning power of nurses/ level of qualifications and a included evidence of the failure The INMO has asked to midwives, across the Eng- shorter working week. This is in of all recent non-pay measures make oral submissions and lish-speaking countries of the contrast to international stand- to deliver this outcome. presentations to the Pay Com- US, Canada, Australia and ards where the pay of allied The INMO reminded the mission. Additionally, the the UK. These countries are health professionals is on a par Pay Commission that nurs- Organisation requested the now the chief destinations for with that of nurses/midwives. ing and midwifery are female opportunity to provide expert Irish nurses and midwives. In The INMO emphasised the dominated professions (91%) testimony to support the evi- addition, these countries are negative outcome for patients, that have, since 2007, endured dence in its written submission. offering superior packages of nursing/midwifery shortages chronic shortages. Low pay is The process has now started. in recruitment campaigns in and increased skill mix. It cited also evident when comparisons The Commission is now exam- WIN other countries that Ireland is all relevant literature, including are demonstrated to other pro- ining all evidence presented seeking to recruit from, making the RN4Cast study of 12 Euro- fessions. The INMO said the to it. The INMO submission is Vol 25 No 10 December 2017/January 2018 them more attractive to pro- pean countries, which recorded need to break the cycle of low evidence based and leaves no spective international nurse/ the consequences of missed pay for Irish nurses/midwives doubt that the chronic short- midwife recruits. care as increased mortality and has been ignored for too long. age of nurses and midwives The shortage of nursing in poorer outcomes for patients, The evidence supports the fact will not be addressed until the Ireland is well documented. when nursing/midwifery that recruitment and retention issue of pay is addressed. The INMO reiterated the issues ratios drop below safe levels. of these grades are directly The Pay Commission’s find- surrounding the difficulty with Evidence of unsafe hospital affected by uncompetitive pay ings/recommendations for recruitment, and highlighted activity was also presented, and poor working conditions. nursing and midwifery are the fact that the 2016 annual referencing continuing over- Next steps expected in June 2018. figures illustrate that: crowding in EDs and wards. Sean McHugh, the chair – Phil Ní Sheaghdha, INMO • 250 more nurse managers left The INMO submission also of the Nursing/Midwifery general secretary designate WIN Vol 25 No 10 December 2017/January 2018 - from: https://doi. from: The full ESRI report report ESRI full The can be downloaded org/10.26504/rs67 11 NEWS “The INMO is calling for for calling “The INMO is “This report tells us what is what is tells us “This report All eligible members are are members eligible All needs a The INMO always immediate discussions, of of discussions, immediate parties, arising all interested the with from report view to a the obvious actions agreeing and steps now required.” sary to implement this report into all must be integrated decisions. health policy future implications arising from this implications this from arising the as have, we that so report, a proposes, report Slaintecare development 10-year plan for our health service. to going the over happen next we must now decade, and come must We act upon it. deliver to together all actions we necessary to ensure address existing shortcomings and expand the service to meet this future This demand. will the that actions require neces adopted at annual delegate delegate adopted at annual conference. forward to come encouraged the strengthen and, therefore, within democratic structures the Organisation. Now Council. Executive strong to chance your is become a our all shape help and leader futures. ------xecutive Council is is Council Executive The INMO general secretary secretary INMO general graph and biographical data data and biographical graph if form nomination your with to run. intending are you ing, evidence-based and well report, which con researched challenges firms the dramatic the health service facing the coming decade over and will not meet We beyond. country by challenge as a this growing on year, year simply, incre an in service health our mental This fashion. report collec immediate, an requires and sustained response, tive the political system from which society, and across the resource must address ning and capital to investment and sustain a deliver develop, expanded significantly health service capable of the meeting demand identified. in increase Sheaghdha, designate, Phil Ní said: “This is a most sober you work etc. Such details work etc. you Such details help to really the election make member, every for come alive photo your so please submit multi-year manpower plan multi-year central to all INMO activities activities INMO all to central of affairs the manages as it the Organisation, while also to implement policies seeking ------SRI report, can only ESRI can only report, The government, and all all and The government, These will allow the Organ Together with their applica Together terms of educating sufficient of numbers nurses/midwives, and ensuring that we retain this adequate for numbers expanding health service ing services and home care/ ing services and home This must services. help home funded, as and for, be planned it is labour intensive. ing from our aging population from ing invest be met by only can ment in the complete range including of services required, long-stay and intermediate beds, public health nurs care Older person services – the the services – Older person demand in increase significant services aris older person for An election manifesto. A photograph A minimum of 2,000 acute acute 2,000 of minimum A in the growth to meet beds to demand – it is necessary that note the in decade past has activity hospital acute to 20%, up by increased in a 94% resulted has which increase the in of number admitted patients on trolleys. in activity further increase A indicated as 33%, to up of in the a significant and be met by immediate expansion of our acute bed capacity

political parties, must now now must parties, political and analysing from on move strategising about this chal • to isation of inform members who you what your are, issues/ where elected, if are priorities tion form all candidates must candidates must all form tion submit: • lenge, and commit, in terms funding, and of multi-year in relation to what is required what is required to in relation are member eligible an be to the notice. included in • • - - - - Sláintecare Sláintecare

5pm on Wednesday, 5pm Wednesday, on

xecutive Council for for Council Executive

Completed nomination nomination Completed SRI report also sup The ESRI report The report identifies the the identifies The report The that stark declaration 25% increase in the nursing/ in 25% increase over workforce midwifery which will years, the five next investment radical a require both in in nursing/midwifery

. All details 2018. All details 7, February election process to the The election to the process INMO to May the period May 2018 2020 is set to commence early out in as set year, the new in on page 10. the special notice to must be submitted forms secretary the INMO general (the officer) on or returning before 2018 Executive Council elections – call for leaders elections Council 2018 Executive ports the INMO’s demand in its the INMO’s ports submission, pre-budget recent the following: for • try in the coming decade. vices (up 54%), now requires vices (up 54%), now requires and all parties the government, in the fund, Dáil, to commit to the in suggested as report, report, a major expansion of can it that so service the health the serve people of this coun need for for a need major expansion, of the Irish healthcare of all areas that system, to ensure health can services the meet now known demands that face will it in the coming years. will health services for demand areas in such pivotal increase (up services hospital acute as ser older person 33%) and nomic and Social Research Research Social nomic and Institute (ESRI), details which the huge challenges facing from the health service arising the significant demographic changes that will occur in this the country over next 12 years to 2030. INMO welcomed the The INMO welcomed the the Eco from report recent

10-year funded development plan now an absolute priority development plan now funded 10-year ESRI report presents major challenge major presents report ESRI 12 IR News

Actions agreed at WRC ED review

At the WRC review of the patients. Management indi- Group wide executive forum/ the recommendations of the Emergency Department Agree- cated that 50% of the 124 hospital level meetings independent security report of ment last month, the INMO posts had been filled. However, The INMO outlined that a 2016. The INMO highlighted expressed its grave dissatis- there is significant difficulty key component of the WRC concerns that some depart- faction with the worsening in recruitment maintaining agreement of January 11, 2016 ments still do not have a overcrowding in particular hos- pace with the number of leav- is the requirement for the 24-hour security presence and pitals and the failure of the HSE ers. The HSE confirmed that convening of group wide exec- do not have restricted access. to implement all elements of it hoped to have all staff in utive forums and hospital level The HSE is to address these the agreement. place by the end of January forums. The membership of deficits immediately. The meeting was chaired by 2018. Further work is ongo- these groups is clearly set out Winter plan John Kelly of the WRC. INMO ing, involving Prof Jonathan and should involve the group The winter ED plan was due representatives at the most Drennan, on reassessing the CEO (forum chair) and the to be signed off by the Minis- recent meeting on Novem- staffing requirements for group director of nursing. ter for Health at time of the ber 13, 2017 included general admitted patients based on the Management accepted that meeting. The HSE undertook secretary designate Phil Ní numbers of patients involved. this is a key component of the to provide details of the plan Sheaghdha, acting director of ADON patient flow agreement and agreed to stress to include additional surge industrial relations Tony Fitz- Management outlined that the need for these regional and capacity, measures to be imple- patrick, IRO Philip McAnenly the agreed assistant director local forums to meet on a reg- mented to the worst affected and two INMO reps Emma of nursing patient-flow posi- ular basis involving the CEOs hospitals and the detail of the Marie Murphy and Mary Del- tions had been filled. However, and group DONs. The INMO ongoing supports to improv- aney Dunne. it was agreed that the HSE emphasised the need for the ers. The HSE outlined that, for Actions were agreed under a would request an audit report group wide executive forum example, additional bed capac- number of headings as follows. from directors of nursing and to meet regularly but also that ity would be provided including Enhanced clinical role those appointed as patient- the forum needs to be efficient 30 beds to Galway, 17 to Lim- Wording on the enhanced flow ADONs to establish if to deliver best results. erick and 15 to Waterford. In clinical role is to be agreed individuals are in post and are CNM2 shift leaders and addition, the details of home between the INMO and the acting in accordance with the CNM1 posts support care measures as part DOH within two weeks and be job description that was agreed Management agreed that all of the winter initiative would submitted to the DOH Nurse nationally. CNM2 shift leaders and CNM1 be forwarded to the INMO Policy Division. This will be This audit should capture positions should be filled. The once approved by the Minis- linked with the CNS develop- any additional roles that the HSE confirmed that these are ter. It was agreed that no beds ment pathway. ADON for patient flow is funded posts and therefore any should open unless safe staffing Triage escalation undertaking, including people vacancy that arises should be is agreed and in place. This was an action from management and day to day filled. It was noted that all the Bed closure reports the WRC ED review of June operational management initial CNM1 posts have been The HSE agreed to share 16, 2017. The acute hospitals within EDs. advertised and filled. However, the weekly data on acute and division was to link in with The parties re-emphasised vacancies may have arisen non acute bed closures in the the emergency medicine pro- that there is a clear job descrip- since appointments were system, as requested by the gramme and revert within two tion for the patient-flow made. However, these should INMO. Management advised weeks to the INMO. ADON and management will be immediately backfilled. that 150-170 acute beds are Staffing for admitted patients ensure that all services follow Security report closed each week due to staff- The HSE outlined difficul- that job description. The HSE The HSE confirmed that it ing and infection control issues. ties with recruiting the 124 was to revert within two weeks would produce a report regard- – Tony Fitzpatrick, acting posts earmarked for admitted with regards to this. ing the implementation of director of industrial relations ED staffing taskforce phase II – underpinned by three pillars The INMO continues to are that patient care needs and that positive patient and In parallel with this work, a engage with the Department are different; nurse staffing staff outcomes are important pre-pilot test will be conducted of Health and the HSE on the number, profile and mix are indicators of the safety and in one emergency department roll out of phase II of the ED key to ensuring high quality quality of nursing care to assess and validate whether staffing taskforce. Work is care to patients; the organ- • A PESTLE exercise to use the TRENDCARE or progressing well on an over- isational environment in • An overarching unit to board BEST tool when the pilot rolls all draft framework for this which patients receive care governance framework. out in three sites in 2018. The research, which will be under- and staff deliver care has The next meeting is due to site chosen for the pre-pilot

Vol 25 No 10 December 2017/January 2018 Vol pinned by three pillars: an impact on the ability to take place in Hawkins House test is Our Lady of Lourdes • Four care assumptions which deliver safe, effective care; on December 19, 2017. Hospital, Drogheda. W IN 14 IR NEWS HSE issues clarification on Trust in Care and Safeguarding policies

Following clarification of several issues raised by the Synopsis of guidance on linkages of Trust in Care and Safeguarding policies INMO, members are advised they may now participate with Context The outcome may be a decision for a • Without prejudice to the Trust in Care • Concerns of abuse or neglect can formal investigation under the Trust process, a Safeguarding preliminary training on the Safeguarding of arise from a number of sources and in Care policy. If the findings of the screening notification may be Vulnerable Adults policy. How- the initial identity of the person of investigation uphold the complaint/ submitted to the Safeguarding team. ever, note that the Trust in Care concern may not be clear allegation, the employee will be This screening only considers if there policy remains the only policy • The Trust in Care policy is the HR subject to the disciplinary process are reasonable grounds for concern in place to investigate and/or policy and should be invoked if a staff Safeguarding policy to justify taking protective steps in review any allegations against member is deemed to be a ‘person • This is the framework to protect relation to the service user staff members. of concern’ who may have a case service users from any potential risk Information sharing and liaison The amended Safeguarding to answer. It is the agreed national of abuse or neglect • Any information shared or notified to policy arose out of a WRC con- HR policy for managing concerns or • The protective procedure is that the the Safeguarding team should relate ciliation on October 23, 2017, allegations of abuse in which a staff service manager and/or designated to the service user’s information only subsequent correspondence member may be implicated officer ensures that immediate and not identify a person of concern. • The purpose of the Safeguarding standard safety steps are taken Such a submission is for notification from the HSE and the ongoing policy is to determine if there are • They should gather preliminary purposes and the safeguarding team work of the Review Develop- reasonable grounds for concern information but this should not be has no role or oversight on the Trust ment Group (RDG) charged to justify putting a protection plan an investigation of a staff member or in Care process with revising the Safeguarding in place for a service user. The a specific allegation • The Safeguarding preliminary of Vulnerable Adults Policy paramount priority is the safety and • Where the service manager is also screening therefore may need to be document of 2014. welfare of the service user – there the designated officer, responsibility limited in certain details about the Several outstanding issues should never be undue delay in for liaising with the Safeguarding allegation, recording only that there after the WRC agreement of undertaking protective measures team should be delegated to are follow up investigations ongoing July 12, 2017 have now been Policy and procedure framework another appropriate manager, • If further information is needed or addressed, including those listed and information linkage while the service manager retains reasonable grounds for concern under the following headings. Trust in Care policy responsibility for managing the exist, then a protection plan for the • This provides for preliminary screening employee in accordance with Trust service user with a Safeguarding Definition of institutional/ of a specific complaint/allegation in Care. Delegation is intended to co-coordinator is needed organisational abuse against a staff member and, where ensure that the Safeguarding team • At the conclusion of the Trust in The INMO is seeking a clear required, the investigation process is provided with relevant information Care process only information that definition of institutional/ into the complaint/allegation in respect of the service user while is relevant to protection for any organisational abuse to be • The relevant line manager carries upholding the employee’s rights to service user should be notified to the included in the Safeguarding out a preliminary screening process. confidentiality and due process Safeguarding co-ordinator policy. This will be addressed via the RDG on the Safeguard- institution overseeing and eval- management (see Table). This Note the HSE’s clarification ing policy, which is having uating the process. guidance, while overdue, was clearly outlines that in cases ongoing meetings. Trust in Care policy welcomed by the INMO. where the service manager is Practitioner working group It was agreed at concilia- Designated officers also the designated officer, he/ It was agreed that a practi- tion on July 12, 2017 that the The HSE committed to she should delegate respon- tioner working group would be Trust in Care policy remained ensuring the training of addi- sibility for liaising with the established to streamline the the only policy in place to tional designated officers Safeguarding team to another documentation around safe- investigate and/or review any and would at all times ensure appropriate manager. guarding of vulnerable adults. allegations against a staff patient safety and fair proce- Review Development Group The first meeting of this group member. The INMO requested dures for staff. Directors of The RDG on Safeguarding took place on October 23, management to issue a memo- public health nursing are not is continuing its work and last 2017 with a further meeting randum outlining this position. designated officers, as desig- met on November 15, 2017. planned for December 2017. This was received on Novem- nated officers are not required The addendum to the policy Peer to peer abuse ber 6, 2017 in the form of in the community approach. presentation which outlines It was agreed at conciliation guidelines outlining the appro- Management has committed the additional measures con- on October 23, 2017 that the priate information sharing to training of approximately tained in the WRC agreement HSE would forward terms of ref- linkage between the Trust in 100 officers. In relation to the and the guidance sheet issued erence for the pilot proposal to Care and the HSE Safeguard- number of designated officers by the National Safeguard- the INMO within three weeks. ing policies for dissemination per area, the INMO proposed ing Office can be viewed on It is proposed this pilot will to training facilitators, desig- 50 beds per designated officer www.inmo.ie Vol 25 No 10 December 2017/January 2018 Vol take place in CHO 1, 2 and 7, nated officers, safeguarding and management is to revert – Tony Fitzpatrick, acting

W IN with a third party educational teams and other relevant on this. director of industrial relations 16 IR NEWS

Tony Fitzpatrick, INMO interim director of industrial relations, reports on current national IR issues Transfer of tasks progressing well The national implementation hospital managers, direc- verification group (NIVG), tors of nursing and clinical Table: Further provisions of NIVG report which was set up to verify pro- directors. • Clarification on the sharing of tasks gress on the transfer of four The transfer of tasks pro- • Additional implementation initiatives specific tasks from medical cess has progressed through • Recommendations on additional availability and analysis of training to nursing/midwifery staff, a significant collaborative • Inclusion of modules on the agreement in induction processes for NCHDs with the tasks then becoming approach between the Health and nurses shared between the two pro- Service Executive, Department • A new protocol for doctors and nurses to raise concerns in relation to fessions, has completed its of Health, the INMO, SIPTU implementation locally, which can be escalated if unresolved verification process nursing, the IMO and the • Additional visits to locations to provide further impetus in relation to The NIVG reports that signif- acute hospitals. This involved implementation of the agreement icant progress has been made representatives of each organ- • Ongoing reporting arrangements to provide information on on the transfer of each of the isation visiting hospital sites to implementation which can be analysed at hospital and group level, as well as the parties to the agreement tasks identified in the Hadding- ensure that staff and manage- • Continuation of availability of the NIVG to address any concerns, ton Road and Lansdowne Road ment are committed to and if requested Agreements. The fours tasks delivered the required change. are intravenous cannulation, NIVG members are of the view training on two of the tasks, ie. identified are now part of nurs- phlebotomy previously carried that the revised practices have peripheral iv cannulation and ing duties and form part of out by NCHDs only outside of commenced and will become venepuncture, increased year their scope of practice. It had normal hours, IV drug admin- embedded across the system on year from 2015 to 2016 by been anticipated that some istration – first dose, and over time. 66.3% and 38% respectively. teething problems would arise. nurse-led delegated discharge The original agreement The agreement outlined In particular, it is recognised of patients. They were agreed provided for the agreed tasks that these tasks can no longer that relevant staff, both doc- following intense negotiations being undertaken by the staff be the sole responsibility of tors and nurses, must have in late 2015 and the transfer of member who is most appro- any one grade but that nurs- confidence in this process. tasks commenced in 2016. priate to do so at that time and ing/midwifery practice should These issues have been dis- The NIVG reviewed all in that location. A key element expand to incorporate them. cussed and identified by the information provided by the of the implementation relates It was also agreed that the NIVG of which nursing and hospitals and hospital groups to the professional require- transfer should not de-skill medical unions are members. including: ment of training of nurses on medical staff and that they To assist continued progress, • Position in each location the tasks prior to undertaking should maintain some involve- the recently finalised Imple- • Evidence from local meetings them. Based on figures pro- ment in the tasks to ensure mentation and Verification • Written verification reports vided by the HSE, the number that this does not occur. report provides for issues out- signed and/or completed by of nurses who completed The result is that the tasks lined in the Table. Resolution close on PHN contracts of employment The WRC’s assistance has been the allocation of the PHN PHNs who have graduated would be paid at the appro- sought on outstanding issues would be to the CHO area. The and are working as per their priate grade (not at a lower regarding the PHN contract INMO argued that this was too sponsorship agreement, are salary/grade) from the date of of employment. Progress has large an area, would contra- entitled to be paid a PHN appointment.” Also, the spon- been made in regard to attend- vene redeployment distances salary pending the sign off on sorship contract signed by the ance pattern and reporting (45km) and placement needed the national contract. PHN clearly outlines that they relationships, but placement of to be confined to the Commu- This matter was clarified by will be paid at PHN level, once the PHN remains to be agreed. nity Care Area/Local Health a CERS Circular 02/2017, which they are registered as a public A WRC conciliation con- Office, for example, allocated clearly states: “If the nurses health nurse. ference was scheduled for to Meath Community Care concerned are employed as If PHNs are being paid at December 1, 2017 but it was Area, rather than CHO 8. PHNs as per the circular, car- a lower level, they should hoped the issue would be set- A meeting took place with rying out the full role and immediately raise this with tled ahead of this. The INMO is the HSE on November 16, 2017 duties associated with their their director of public health in direct contact with CERS in and it is hoped that this matter substantive PHN posts, it nursing and HR department. If the hope of bringing the issue will be concluded ahead of would normally be deemed they are unable to resolve the Vol 25 No 10 December 2017/January 2018 Vol to conclusion. a WRC due to take place on that they have an implied con- matter locally, they should

W IN The HSE had sought that December 1, 2017. tract of employment and they contact their INMO IRO. WIN Vol 25 No 10 December 2017/January 2018

------HSE HSE EWS 17 IR N HSE again on this issue on HSE outlined that the Note that this review is at at is review this that Note It was the that agreed The directly INMO will write It was agreed that no pro no that was agreed It present looking at HSE intel present Relations Employee porate Services. posal or recommendation or posal recommendation or sub the steering group from implemented would be groups until there further engage is ment consultation and with group. oversight the union lectual disability services. as agreed is whatever However, within practice the appropriate via enforced would be the HSE, with agreements service level the Section 38 organisations. with to meet due The INMO is the Cor the at 2018 20, February ous issues with regards to the ous to the issues with regards The help. home of governance by chaired is being process hoped is it McHugh and Sean conclude its will the group work within three months. for current the on models ment governance and provision the of home help services. to the chair clarifying its issues issued memorandum the with the national August 2014 by in chair of the The directors. group to contact undertook of Health the Department this in involvement its seeking by as requested working group, The next meeting is the INMO. due to take place on December 19, 2017. was anxious to engage with was engage to anxious with vari the the to INMO resolve subgroups various and group commenced their work.have the would forward an forward would date up to on the presentation single assessment tool to the INMO, docu a status while providing ------CA HCA shared shared E S At the the At of meeting Novem The INMO met with the the with The INMO met gation and supervision. Issuesgation and supervision. the arise of level regarding clinical supervision, the var from grades, of iation to home current the help, the and process application help home of segregation coordinators ommendation and the of same by modification non-clinical staff N assessment with rec PHN assessment ligibility criteria, ie. the PHN E by service is still governed criteria eligibility the the in Health Act of while 1970, do not home help services the same eligibility require criteria Lack of IT infrastructure. Lack NMBI issues including dele including NMBI issues Current application processes application processes Current and the induction of home helps and HCAs Agency and private providers is placed continually on the is on the placed continually local risk register



with the with the INMO mem • • • • • bership of the bership steering group. the The HSE has accepted of terms the to amendments to have and acceded reference a four on RNIDs of minimum The steering the steering group. ber 15, Michael Fitzgerald of of ber 15, Michael Fitzgerald and deliverables project bilities, H The governance. of the bership steering group of terms the and reference. number a sought INMO The of amendments to the terms mem the to and reference of • is being delivered by a range range a by delivered is being whose roles caregivers, of the across vary significantly services. HSE to discuss the of the work including its steering group, and responsi aim, scope, roles - - - - - Ns and and Ns H The INMO team of Tony Tony The INMO team of Several Several significant challenges Prioritisation of duties that that duties of Prioritisation Duplication of duties workloads Current Current community nursing ity 1 cases only. At present, At present, ity 1 cases only. not cases are P2, P3 and P4 this matter completed and are currently in currently are place, due to workload issues, staffing and P requires which CRGNs to deal with CRGNs Prior

dward Matthews Matthews Fitzpatrick, Edward the with met Byrne Ailish and HSE on two occasions, most 20, on November recently that The HSE advised 2017. Division, in Care Social the partnership with the Quality Division, estab Improvement lished a Quality Improvement Improvement Quality a lished in December 2014. Programme In 2015, the quality improve ment teams visited 148 for houses/units people with intellectual disability and variation in policies and found duration the in of content and staff for programmes training in the safe of management The services. medication across identified subsequent report that medication management • • encies and of concern matters the from perspective that exist staff nursing community of to the current pro with regards of home help services. vision the process of The second part the working for will group be to examine the implementation of the single assessment tool. the from must be addressed including: INMO perspective • wishes to continue the clear the clear wishes to continue exists that linkage between and home community nursing part Therefore, services. care one of this will process be to tease out the issues, inconsist

------HSE HSE to HSE to Ns and CRGN CRGN and Ns H

outlined that it HSE outlined that it

has established established The HSE has The INMO has long advo The There is currently significant significant currently is There The INMO team, led by by led team, INMO The a steering group to develop a steering to develop group national medication man agement guidelines that will of development the support procedures and policies local on medication management. tects service users and staff. and staff. tects service users develop appropriate guidance guidance appropriate develop medication management for disability services in within there is to ensure a order that pro homogeneous system cated the need for the cated the for need ment and administration of of ment and administration intellectual medications across disability services. Review ofReview sector management in ID medication of For a significant period time, the INMO has outlined its to the concerns grave to the with manage regards nation of public and private of public and private nation providers. board consisting of board mainly variation across community community variation across and provision the on areas care of home help ser governance providers of number The vices. the western with sea vary, while staff, employed directly voluntary in Dublin, it is mainly service. the providing agencies combi a have areas Several cerns with the current cerns with the current system. agement on November 15, 2017. 2017. 15, November on agement of director acting industrial Fitzpatrick and Tony relations P of up made representatives, outlined the the outlined representatives, con serious Organisation’s Governance ofGovernance focus helps under home first of the meeting The group set up to issues on the resolve of home helps governance and the implementation of tool assessment single the took place CSARs to replace the INMO and man between Tony Fitzpatrick, INMO interim director of industrial relations, reports on current national IR issues national current on reports of director INMO interim relations, industrial Fitzpatrick, Tony 18 NEWS

India main source of new recruits INMO joins Malayalee nurses/midwives in celebration

MOST nurses and midwives working with the Irish health service readily understand that many of our acute hospital services and care of the older person facilities in greater urban areas would simply have to close except for the reliance on nurses and mid- wives recruited from outside of Ireland. The number of nurses/ midwives recruited into the country in 2016 and 2017 outstrips the number of new registrants trained in Ireland. Indeed, Ireland’s reliance on nurses/midwives from other countries, in percentage terms outstrips that of most other INMO deputy general secretary Dave Hughes(centre) developed nations. and Indian Ambassador to Ireland Vijay Thankur Singh preform the ceremonial opening at recent World Malayalee In terms of destinations Federation tribute to nurses and midwives working in Ireland where our overseas recruited nurses/midwives arrive from, invited the INMO and Dave participation. The Malayalee Indians who now live through- India consistently tops the list. Hughes, deputy general sec- Federation promotes commu- out Ireland. Recently the World Malay- retary, spoke on behalf of the nity participation as a key for On the night there were alee Federation, through its Organisation and outlined the integration of nurses and speeches from INMO deputy Irish chapter, held a major some statistics which demon- midwives from South India general secretary, Dave public event entitled ‘A Trib- strate the high reliance that into their Irish communities. It Hughes, local TD Ruth Cop- ute to Nurses’ in Phibblestown Ireland has had on inward organises various events and pinger, the Indian Ambassador Community Centre, Clonee, migration of nurses and mid- activities throughout the year, and a musical director who Dublin 15. On the night in wives and, in particular, from including cricket and badmin- conducted a seven piece band question up to 500 nurses, India. ton tournaments, family days playing music from Southern with their families, attended Malayalee Indians are and celebrations to coincide India. the event, which was an Indian those who originate from the with Indian festival occasions. INMO members Tony cultural night. The very spe- southern regions in India, gen- This special tribute for nurses Thomas and 2017 CJ Cole- cial guest of the night was the erally natives of Kerala and and midwives working in Ire- man award winner, Dr Suja Indian Ambassador to Ireland, South India. It is a region of land was a truly inspiring affair Somanadhan were honoured Vijay Thankur Singh. India with a rich culture and and a real eye opener in terms on the night for their academic The federation very kindly a strong sense of community of the settled community of achievements. Success for community midwives’ subsistence claim The INMO successfully rep- and five hours away from their After two conciliation recommended compensation resented 18 WTE community base place of work. The current conferences at the WRC, of €2,500 to the members of midwives employed by the rates are: management agreed to pay the team in back payments. Rotunda Hospital, Dublin at • €14.01 for 5-10 hours subsistence going forward from INMO members who travel the Workplace Relations Com- • €33.61 for over 10 hour. September 2017. in the course of their work and mission and Labour Court in The Rotunda Hospital com- Agreement could not be meet the above criteria should respect of the payment of munity midwife team was not reached on the payment of contact their local IRO if they subsistence. aware that they were entitled retrospection so the INMO are not in receipt of subsist- Under the rules, a staff to claim subsistence pay and referred this aspect of the ence payments. Vol 25 No 10 December 2017/January 2018 Vol member is entitled to claim therefore did not submit claims claim to the Labour Court. – Lorraine Monaghan,

WIN subsistence when over 8km as they occurred. The Labour Court then INMO IRO WIN Vol 25 No 10 December 2017/January 2018 - - - 19 NEWS D was investigated investigated was D E Contact details Contact Office INMO Cork 021 4703000 Tel: Office INMO Cork 021 4703000 Tel: INMO Limerick Office 061 308999 Tel: Office INMO Head 01 6640600 Tel: Office INMO Head 01 6640600 Tel: Office INMO Head 01 6640600 Tel: Office INMO Head 01 6640600 Tel: Os is set out above. Os is set The INMO industrial rela industrial INMO The – Liam Conway, INMO IRO INMO Conway, Liam – Tallaght Tallaght  INMO members at Cork Cork at INMO members Maternity Hos University last month early pital met to discuss ongoing staffing the of areas all concerns in hospital. Difficulties in rapid access access Difficulties in rapid care triage and ambulatory acknowledged and are were to staffing shortfalls due nursing WTE nursing six The approved to specifically posts required admitted patients in for care 2017 have July in ED as agreed to commence yet The hospital remains in ‘black in ‘black The hospital remains on escalation’ a continuous additional basis, including on trolleys inpatient wards. CUMH update CUMH tions team is engaging with management to dis locally the issues resolve and cuss the voiced concerns and by this meeting. at members

• • • in May 2012. HIQA by The temporary reassignments The temporary reassignments of IR - - - - - IRO Mary Power Liam Conway Liz Curran Joe Hoolan Flanagan Dean Noel Treanor Carroll Mary Rose t Finbarr’s at this this at St Finbarr’s – Liam Conway, INMO IRO INMO Conway, Liam – It was confirmed that: However, Management’s Management’s However, The INMO and its members The INMO and its members A shortage remains in the the in A shortage remains the ED staff in nursing

Tallaght ED remains ‘intolerable’ remains ED Tallaght position remains the very polar very the position remains our for the to opposite reality in members time. basis daily on a face ing staff and the of requested presence senior clinical decision makers the ED. within basis on a 24/7 • agement in relation to their agement in to their relation and health and patient safety concerns safety to com prior mencing the work to rule. ongoing The intolerable difficulties staffing and over crowding emergency in the department of Tallaght Hos discussed the pital were by last Management and INMO The INMO detailed the month. serious difficulties that nurs with a work to rule the end at of November. willing to engage are with man delegate conference, at which delegate conference, will be presented. full report a - - - Areas temporarily covered by reassigned IROs by reassigned covered temporarily Areas C last month. month. C last t Finbarr’s are concerned concerned are Finbarr’s t C on November 29, 2017. on November C – Liam Conway, INMO IRO INMO Conway, Liam – S Meanwhile, ongoing concernsMeanwhile, Notice of industrial action action of industrial Notice The INMO and its members The INMO and its members The review will conclude The will conclude review Cork Voluntary/Private Branches, ID Services Cork and Kerry, and Kerry, ID Services Cork Branches, Voluntary/Private Cork Branches Tralee Killarney and and Cork West South Lee, North Lee, CHO 4, HSE South, Cork Branches Mallow North Cork including Tipperary and South Wexford Kilkenny, Carlow, and Clonmel Branches Cashel Kildare, Co Hospice, Cross Harold’s IBTS, Hospital, Tallaght Wicklow Branches and Waterford West and Portlaoise Tullamore, Mullingar, CHO 8 Midlands, Hospital Portiuncula Navan Hospital, and Our Lady’s Branches Area North East Coombe CHO 7, West, Dublin South Areas Care Community Street Temple Hospital, National Maternity Hospital, Hospital James’s St Crumlin Hospital, Hospital, Area Fermoy at Fermoy about staffing levels Hospital were Community WR the at heard the over These concerns were to maintain the failure nurs ing staffing complement of 31 the hospital. Following for WTE between all exchange lengthy a the INMO secured parties, issues the addressing proposal concern and recommended of acceptance of the proposals. bers are working with ongoing ongoing working with are bers and have short staffing levels where the point now reached this cannot continue. commencing has been served, pital, based on the cost of care pital, care of cost the on based model. in WR staffing levels are adequate adequate are staffing levels each ward/unit in the for hos that this does not reflect the that this does not the reflect on the reality ground, mem prior to next year’s annual prior to annual next year’s ------O staff, which O staff, t Finbarr’s Hos St Finbarr’s Bandon Commu Members have pre have Members

Management has taken Management has taken Consequently a number of of a number Consequently In keeping with the motion motion the with keeping In O areas of assignment, until of assignment, until O areas ity. Added to this is the fact this to Added fact the is ity. of new build the majority that ing consists of layout single The room occupancy. matter to due was be the heard by viously balloted for industrial industrial for balloted viously action they as concerns had position about management’s the same staffing of retaining capac bed increased for level at Members nity Hospital continuing are a work to rule over staffing to a new with a move levels building. Staffing issues Bandon and Fermoy and Bandon issues Staffing pital severely short staffed on on short staffed pital severely a daily and ongoing basis with sick term long term and short and maternity leave. leave the overall the that position pital, Cork have balloted for for balloted have Cork pital, industrial due to ongo action concerns, unfilled ing staffing short ongoing posts, CNM to addition in staffing levels cuts to massive agency spend. the hos of This has left areas Work to rule likely at St Finbarr’s St at to rule likely Work Members at Temporary reassignment of IROs reassignment Temporary temporary changes have been been changes have temporary to regard with put in place, IR is services the of review full the completed. vices with the aim of improving members. for these services places, the Organisation is places, the Organisation is how it reviewing currently also ser industrial relations delivers tors, including an upcoming an upcoming including tors, exciting the and retirement to Treacy Clare appointment of the Labour Court. to ADC in relation from work all additional support in ganising areas of responsibility of responsibility ganising areas of its IR some for is due to a fac number of INMO is currently re-or currently The INMO is Section News 21

Section update Midwifery students benefit Care of the Older Person Section Conference from All-Ireland conference The Annual Care of the Older Person (COOP) Section Midwives gathered in saw first hand what amazing conference is scheduled to take Armagh in October to attend work is being done to develop place on March 13, 2018 in the the All Ireland Annual Mid- the strategy. Of particu- Midland Park Hotel (formally wifery Conference. With over lar interest to my class was the Heritage Hotel), Portlaoise 170 midwives in attendance, a the topic of VBAC by Cecily town centre. The day will great atmosphere for learning Begley, which everyone found focus on managing families’ and networking pervaded. We so interesting as we had the expectations as our loved ones were delighted to welcome a opportunity to listen to what reach the end of their lives, large contingency of students midwives in other hospitals Pictured at the All Ireland Annual Midwifery the expansion of the role of who travelled from UCD, for around the country are doing conference in Armagh were (l-r): Speakers the COOP nurse, motivational many of whom it was their to develop the service. Kysia Lynch, Chairperson, AIMS Ireland and Seana Talbot, president, National Childbirth Trust and coaching, governance and first experience of such an As the caesarean section Maternity Services Liaison Committee member fitness to practise, and a session event, and they thoroughly rates are on the rise it is of on pensions. enjoyed it. particular importance to us to Bookings are available at: Here is a brief account from understand what services we www.inmoprofessional.ie Jessica O’Brien, one of the stu- can offer women and empower or you can contact the INMO dents who attended. them in future pregnancies. directly at Tel: 01-6640616. As part of our training to Many other talks and pres- become midwives, we were entations took place during RNID Section invited to the INMO midwifery the day and the conference The RNID Section is set to conference and travelled from was concluded with the poster hold its national confer- UCD to Armagh City Hotel. 35 competition, which saw many ence on March 22, 2018 student midwives (both higher midwives develop new ideas in the Midland Park Hotel diploma and direct entry stu- and studies for the future of Pictured (l-r) were: poster competition winners, Portlaoise. The theme is the dents) attended the conference midwifery. midwives Jackie Mc Brinn; Paula Boyle; and Barbara Strawbridge RNID in Practice – Embrac- in October. The conference was It was brilliant to see the ing Community Living. We enjoyed thoroughly by my areas of midwifery practice are delighted to welcome, class and we all found it to be that midwives want to develop among many other promi- extremely informative for our which will certainly improve nent speakers, Kay Mafuba training. midwifery services in Ireland in from the University of West When we qualify, we will the future. London. There will also be met by the new National Overall, the conference was be sessions on challeng- Maternity Strategy and get- a big success and thoroughly ing behaviour, a piece from ting the opportunity to discuss enjoyed by all of my class who the athlete leadership pro- the development of the strat- attended and we would like to gramme on the results of egy at the conference was thank the INMO for a really Conference attendees examining entries to the research carried out by cli- extremely interesting as we enjoyable day. poster competition ents on how best they wish to be addressed, the RCN NI LD nurse of the year Siobhan Retired Section takes on the Viking city Rogan will share her expe- Storm Brian did not dampen cultural attractions, including of Waterford. We viewed the riences on setting up and the spirits of the 26 members the World’s First Viking Virtual oldest piece of Waterford crystal WIN leading CALMS. Please go to: of the Retired Nurses Section as Reality Adventure Centre, set in (1789) in the 18th century Geor- www.inmoprofessional.ie to they headed to Waterford, the a replica Viking house – not for gian Bishop’s Palace. Vol 25 N o 10 December 2017/January 2018 book your place. oldest City in Ireland, founded the faint-hearted! It was a great trip and we are in the ninth century by Vikings. Reginald’s Tower, named after looking forward to our Spring Reminder to all national Waterford had plenty of the Viking King who founded break already and another sections that your AGM will other notable residents includ- the city contains many treas- chance to catch up with friends be scheduled prior to mid ing TF Meagher who conceived ures including a 12th century and colleagues. Before that we February, in keeping with the Irish Flag, which flew for the gold kite brooch. The Medieval have our Christmas Lunch in the Organisation’s ADC first time in Waterford in 1848, Museum was another very popu- Wynn’s Hotel, on January 18, submission deadlines. and Blessed Edmund Rice who lar attraction for us as it included 2018. We will meet at 12.30 for a Members, please keep an founded the Christian Brothers the Cloth of Gold Vestments, on meal at 1pm. Enquiries to :Ann eye on the website as your in 1802. display behind bulletproof glass, Igoe at: [email protected] or AGM dates are confirmed We visited many of the and the 1373 Great Charter Roll Geraldine at Tel: 0872794701. 22 INTERNATIONAL NEWS

very often undervalued and underutilised. Nurses could have an even more signifi- cant impact in the future – and will be Raising the decisive as to whether UHC is achieved • Developing nursing will have the triple impact of contributing to three of the Sustainable Development Goals – status of improving health, promoting gender equality, and strengthening economies. The report also noted the very large nursing globally shortfall in health workers globally, esti- mated by the WHO as 7.2 million in 2013 and increasing to 12.9 million by 2035, and their maldistribution which means that Elizabeth Adams introduces the Nursing Now! low and middle-income countries have far fewer nurses than high-income countries campaign which aims to release the potential do. of nurses to deliver universal health coverage The report has been so well received that planning is underway to launch a global campaign to strengthen and Nursing Now! is a campaign focused on overview of global health after Global develop nursing. This already has the sup- raising the status and profile of nursing Health Partnerships. port of the WHO and UK ministers from globally and maximise the contribution A Cambridge philosophy graduate, both the Department for International that nursing makes to universal health he worked in community development Development and the Department of coverage (UHC), women’s empowerment and industry before joining the NHS in Health. and economic development. Nursing Now! 1986. He has worked in mental health as Nursing organisations nationally and – a three-year global campaign and pro- well as acute services and from 1993 to globally are providing support and discus- gramme of the Burdett Trust for Nursing 1997 was chief executive of the Oxford sions are in hand with the Commonwealth – will launch in the New Year. Radcliffe Hospital NHS Trust, one of the Secretariat, the World Bank and other Lord Nigel Crisp who will chair the new UK’s leading academic medical centres. organisations. global Nursing Now! board (the member- Further information available at: https:// Under the leadership of Lord Crisp, ship of which is set to be announced in the nigelcrisp.com/ the Nursing near future), is an independent crossbench Background Now! global member of the House of Lords where he This Nursing Now! campaign is based on campaign co-chairs the All-Party Parliamentary the report The Triple Impact of Nursing – will build Group on Global Health. He was previously how developing nursing will improve health, on nurses’ chief executive of the NHS and perma- promote gender equality and support eco- unique posi- nent secretary of the UK’s Department of nomic growth (2016) published by the UK’s tion as the Health – the largest health organisation All-Party Parliamentary Group on Global health pro- in the world with 1.3 million employees – Health (APPG) following its review of nurs- fessionals where he led major reforms between 2000 ing globally. The report concluded that: who are at and 2006. • Universal health coverage will not be the heart Lord Crisp has published extensively achieved without developing nursing of every on global health including, Turning the globally. Nurses are the largest part of health World Upside Down – the search for global the professional health workforce and system, Vol 25 No 10 December 2017/January 2018 Vol health in the 21st Century; Global Health provide an enormous amount of care and provide

WIN Partnerships; and One World Health – an treatment worldwide; however, they are continuity INTERNATIONAL NEWS 23

of care for their patients and are part of their local community. The campaign aims to raise the status and profile of nursing globally so that it can make an even greater contribution to improving health and wellbeing. The Campaign will be launched in early 2018, and will position nursing more cen- tral to health policy and ensure that nurses can use their skills, education and training to their full capacity. The campaign will seek to: • Influence policy and decision makers by demonstrating what nurses can achieve and advocating for specific objectives and goals • Create a grassroots movement among the global nursing workforce to gener- ate energy, boost morale and encourage recruitment. Foundation for future long-lasting Pictured at the recent fourth Global Forum on Human Resources for Health in Dublin were (l-r): Dr Catherine change Hannaway, global health consultant; Lord Nigel Crisp, independent crossbench member of the House of Lords Change will take a generation or more, and co-chair of the All-Party Parliamentary Group on Global Health; and Elizabeth Adams, director of professional however, a step-change and lasting development, INMO improvements can be made in three years. The campaign will work with the WHO, I had a very welcome opportunity to The Nursing Now! campaign’s objectives UN Women and other bodies to ensure meet with Lord Crisp at the Fourth Global are to: that its activities are linked with the global Forum on Human Resources for Health in • Promote the influence of nursing and health workforce strategy and the five-year Dublin – see photo above. develop nurse leadership – ensure that Action Plan of the Commission on Health Further information there are more nurses in senior leadership Employment and Economic Growth, in Background information on how roles where they can influence policy and addition to other global strategies. this campaign has evolved is available provide more opportunities for develop- Nursing Now! Global Board at: www.appg-globalhealth.org.uk/ ment. This will be supported by a suite Janet Davies, CEO and general secretary, home/4556655530 and on Twitter Page: of development programmes for nurses Royal College of Nursing, UK, supported my www.twitter.com/nursingnow_ You can at all levels and a flagship global senior nomination to the Board to represent the also follow the #NursingNow hashtag. leadership programme European Region. The nomination commit- Newsletter • Provide evidence of the beneficial tee have now met with Lord Crisp, chair of You can subscribe to the Nursing Now! impact of nurses – disseminate evidence the campaign Board, and Alan Gibbs, chair newsletter and register for updates at: and seek more investment on research of the global Burdett Trust for Nursing. The http://bit.ly/globalhealth_newsletter

into the impact of nursing on health, announcement of the appointments to the Elizabeth Adams is INMO director of professional women’s empowerment and economic Board is anticipated in January 2017. development growth. This will be supported by a land- mark study on the economic impact of nursing – covering the impact of job European leadership in action creation and greater workforce partici- pation by women as well as the positive benefits of the improved health of the workforce

Brussels meeting: WIN • Support nursing as a route for women’s The new president of the European empowerment – showing how nursing Vol 25 No 10 December 2017/January 2018 Federation of Nurses affects the status and economic power Associations(EFN), of women. This will involve working with Elizabeth Adams met with Dr Paul De other global institutions to improve the Raeve, EFN general life of women at work secretary with a • Demonstrate the effect of ‘Nursing in all renewed focus and vision to strategically Policies’ – working with a small number of strengthen nursing exemplar countries or states to show how across Europe developing nursing and engaging nurses in policy making can improve health - and developing better ways of sharing good practice. Focus 25 Leading the way The Nursing and Midwifery Leadership Network was set up to foster collaboration and innovation among leaders nationally

The reason for establishing the Nurs- ing and Midwifery Leadership Network (NMLN) was a desire to bring nursing and midwifery leaders together to draw on their collective experiences and expertise. Leaders across all nursing and midwifery organisations gathered for a series of con- versations to explore key questions about the future of our professions and the envi- ronment within which we provide care. The Network is convened by the Irish Association of Directors of Nursing and Midwifery (IADNAM) and the partner organisations include The Chief Nurse’s Office at the Department of Health, Office of the HSE’s Nursing and Midwifery Ser- Members of the Nursing and Midwifery Leadership Network pictured at Richmond Barracks in June 2017 at the launch of NMLN Publication ‘ The Power of Conversation’ were (l-r): Prof Josephine Hegarty, School of Nursing and Midwifery, vices Directorate (ONMSD), the INMO, UCC; Mary Brosnan, director of midwifery and nursing, National Maternity Hospital; Mary Griffin, CEO, NMBI; Thomas RCSI, NMBI and the heads and deans of the Kearns, CEO, Faculty of Nursing, RCSI; Anne Marie Ryan, deputy chief nurse, Department of Health; Suzanne Dempsey, various faculties of nursing and midwifery, honorary president, IADNAM; Avilene Casey, director of nursing, , ONMSD; Prof Martin Mc Namara, UCD Health Sciences Centre; Georgina Bassett, leadership and innovation advisor, National Leadership and Innovation Centre, HSE; including UCC and, in particular, UCD. and Mary Wynne, director, ONMSD These leaders were keen to not only sup- port colleagues working in very challenging For example, the debates about the midwives and other health professionals environments but also to ensure the pro- impact of the traditional hierarchical as well members of the public from across fessions of nursing and midwifery thrive structures in nursing and midwifery, or a wide range of disciplines and across the and are at the forefront of crafting new interprofessional rivalries around patient entire country. We are extremely grateful models for health and social care systems care are important in the context of iden- for this support to maintain the momen- in the years ahead. tifying impediments and improving the tum over the past three years. Future uncertainties overall patient experience. We are thoroughly indebted to our What will this future look like? What Our ‘Big Group Conversations’ and all colleagues in the corporate community direction will ‘the systems’ in wellbeing, the associated work allow us to explore who created the environment for our ‘Big health and illness take? How should we new ways of considering the future roles of Group Conversations’ and motivated us structure our professions so that we have nursing and midwifery as key components to maintain the impetus to complete this greater impact and sustain our professional in enabling people to ‘live well’ at all stages first phase of our deliberations. It has been credibility and standing within health and of life. a very exciting and energising process and our contribution to our communities? How This approach is not always popular we look forward to expanding our net- do we build capacity to work in partner- in our profession which often assumes a works as we involve nurses and midwives ship with our colleagues in our respective rather narrow view of ‘tangible output’ from all areas of practice. Our conversa- workplaces and with people who require and ‘action’. We are proud that through- tions will continue to challenge our current WIN our care and clinical expertise? Are we pre- out the project we are reflecting a true thinking about key aspects of the future of pared to use our voice(s) as leaders and thought-leadership model and a commit- health care in Ireland. Vol 25 No 10 December 2017/January 2018 take up an advocacy role when required? ment to positivity and change-making with Join us These were just some of the future uncer- a collective appreciative inquiry approach. If you would like to join us in our next tainties on which we deliberated. The series of conversations on the themes phase of our work, please get in touch with Debate outlined above are described in the recent any of the members of the Network or The process we engaged in was extremely publication The Power of Conversation: tweet us using #NMLNetwork. dynamic and challenging at times. We were Nursing and Midwifery Leadership in Action. If you would like to read The Power determined to incorporate the totality of Collaboration and support of Conversation: Nursing and Midwifery the themes that mattered to us, while also Such an enormous and challenging pro- Leadership in Action, you can find it on: accepting that we held disparate views that ject would not have been possible without www.IADNAM.ie had the power to both unite and challenge the successful and meaningful engage- Mary Brosnan and Paul Gallagher, IADNAM; Mary Wynne, the very core of what we believe. ment with advocacy groups, nurses and ONMSD; and Elizabeth Adams, INMO Focus 27 INMO playing its part in fight against cancer The INMO has relaunched its successful Pink and Blue Power cancer screening campaigns The INMO has relaunched a free breast health assessment initiative, under the banner of ‘Pink Power’ for members of its Income Protection Scheme. The aim of the initiative – which is being introduced in Pictured at the recent re-launch of the Pink and Blue Power cancer screening initiative were (l-r): Clodagh partnership with Cornmarket – is to make Ruddy, client services manager, Cornmarket; Ivan Ahern, director, Cornmarket; Martina Harkin-Kelly, INMO president; a breast assessment available to all INMO Liam Doran, INMO general secretary; and Tara Cassidy, salary protection account manager, Cornmarket Income Protection Scheme members. Scheme. The launch date is January 2018. Through this powerful initiative the Costs are covered under members’ income Screening invitations INMO can promote breast health aware- protection policies. Female members Month Invites to members working in ness, the importance of regular checking under the age of 50 and male members and help save lives. aged between 40 and 65 will be invited to January 2018 Dublin Pink Power attend on an area by area basis. (See Table May 2018 Leinster (excluding Dublin) Some INMO members will remember for details) July 2018 Munster this programme from five years ago. Fol- Speaking on the campaign, INMO pres- January 2019 Connacht and Ulster lowing a high level of breast cancer claims ident Martina Harkin-Kelly said: “At the in the INMO Income Protection Scheme, moment, there is no official national pros- assessment, mammogram, ultrasound and the INMO originally pioneered this tate or breast assessment service available biopsy, if needed”. service back in 2012 together with in Ireland for these age groups so when How the service works Cornmarket, the administrators of you are invited, we strongly encourage The initial GP assessment only takes 15 the Scheme. you to attend. BreastCheck, the national minutes. It can be booked easily online Irish Life proudly sponsored breast cancer screening programme is where you can also view the locations and the programme and more than 3,100 only available for females over age 50. times available. Thanks to the kind sup- members availed of a breast screen- But sadly, cancer knows no bounds. Some port of directors of nursing and midwifery, ing or prostate check with 282 26% of women diagnosed with breast assessments will be made available in many mammograms and 211 ultrasounds cancer in Ireland are under age 50 so we hospitals nationwide, as well as select GP performed. Three members were diag- were keen to make this service available to clinics. The service is provided by private GP nosed with breast cancer. Thankfully, this age group. It is a unique opportunity service providers Full Health Medical. their outlook was positive due to for members to get a comprehensive GP Booking is as easy as 1, 2, 3… early intervention through the service. WIN More women get Breast Cancer than any other cancer Vol 25 No 10 December 2017/January 2018 • Breast Cancer is the most common cancer in women in Ireland • 2,800 new cases of breast cancer diag- nosed each year • Survival rates are increasing thanks to assessment/screening initiatives – educa- tion and early intervention are key. Invitations Once again, Pink and Blue Power is being made available nationwide to 7,765 eligible members of the INMO Income Protection Focus 29 Mobilising for justice Ruth Powell explains how Comhlámh can assist nurses and midwives who are thinking about volunteering their skills either at home or abroad

Comhlámh is a member and supporter organisation open to anyone interested in social justice, human rights and global development issues. The group was set up in 1975 by Irish development workers, who defined the organisation’s principle objective as, “to enable persons who have rendered services overseas in developing countries upon their return to Ireland to bring to bear their own particular expe- rience in order to further international development co-operation.” The Irish Nurses and Midwives Organisa- tion (INMO) became an official supporter of Comhlámh earlier this year, and we were delighted that INMO came to the launch of the network in February 2017. Comhlámh is the Irish association of volunteers and development workers and, while we do Pictured at the Irish Aid Volunteer fair in October were (l-r): Áine Lynch, Volunteering in Humanitarian Aid, project officer Comhlámh; Kathleen Cass, Comhlámh chairperson; Mark Cumming, Comhlámh head; Ciaran Cannon, Minister not recruit and send nurses and midwives of State at the Department of Foreign Affairs and Trade; and Jean-Christophe Crespe, director, La Guilde on placements overseas, we provide a wide range of diverse supports and services for telephone or face-to-face in informal breakdown the costings for you. people thinking about volunteering in the meetings at our office on Parliament Street We state that we educate, support, so-called global south. in Dublin. nurture, innovate and activate our mem- Firstly, Comhlámh recommends that any We can help nurses and midwives find bers. So to that end, we hosts a number nurses or midwives, who are thinking about appropriate placements. We can help you of events throughout the year, such as volunteering overseas, should only travel decide when to go, where to go and what the First Wednesday Debates (every first with a volunteer sending agency that has to do when you get there. And while you Wednesday of the month) training work- signed-up to the Comhlámh Code of Good are overseas, we can assist you with your shops and social events. We are very proud Practice. This code ensures responsible PRSI or PSPS contributions so that when to work with six very active membership and responsive practices for the volunteer you return to Ireland your payments have groups so if volunteering overseas isn’t for health worker, the sending agency, the been met. you right now, you could join one of these host community and project. Nurses and midwives are needed for groups and get involved that way. Some 44 organisations have signed up short-term or long-term placements, in We were delighted to launch our ‘Sup- to the Code and many of them have long- many areas of the world for all types of porter Network’ in 2017, for organisations and short-term placements for nurses and projects and programmes. Typically, a that do not send volunteers overseas, midwives. short-term placement is from two to four but adhere to the principles and values We offer information for people looking weeks and for this you would be expected embedded in our code of good practice. It WIN for volunteering placements. In addition to to raise funds to financially support the is a great endorsement that the INMO offi- our Comhlámh social media presence, we project. However, most agencies will give cially became a supporter in 2017. Vol 25 No 10 December 2017/January 2018 also have a dedicated social media plat- you a fundraising kit so that you would Why not phone Comhlámh today, for form called #VolOps, where we summarise not need to ask family or friends for spon- that face-to-face meeting about all your the vacant placement information every sorship, but rather organise one or two volunteering options? Or you can contact week. We also have a free, online, pre-de- fundraising events before travelling. In us to find out more about our active mem- cision course entitled ‘Where do I start?’ to longer-term placements – for six months bership groups, events, activities and our help nurses and midwives to think about to two years – the nurse or midwife would social occasions. We would love to hear their first steps. be paid a small stipend from the organi- from you. You can contact Comhlámh by We present information about volun- sation and other expenses such as flights email: [email protected] or by phone at teering at many outreach events, such as and accommodation, would be covered. Tel: 01 478 3490. at volunteering fairs or other conferences, Each organisation has different packages, Ruth Powell is an information and support services project and we answer questions online, on the and each organisation should be able to officer at Comhlámh Questions & Answers 31

Bulletin Board With INMO director of industrial Q A relations Phil Ní Sheaghdha

• The pilot initiative will be limited to a maximum of 250 in each Query from member of the two years of the pilot phase I have read about the pre-retirement initiative as part • Nurses and midwives who opt for the scheme must retire upon of the Recruitment and Retention Agreement in March completion of the job-sharing period and not later than attain- 2017. Could you let me know more details on this and if I ing age 65 need to complete a special application form? • Nurses/midwives in full time (1.0 WTE) permanent positions aged 55 or over may apply to work on a 0.5 WTE job-sharing basis for a maximum of five years prior to retirement. Super- Reply annuation benefits will then be calculated based on actual As a retention measure, the INMO sought and secured a pilot service plus a maximum of two and a half years in respect of pre-retirement initiative for nurses and midwives. This will oper- the pre-retirement job-sharing period, subject to over-all max- ate as follows: imum of 40 years’ service • The scheme will be operated strictly on pilot basis for two • If a nurse/ midwife who has opted for the pre-retirement initiative years, following which an evaluation will be conducted to were to apply to return to full-time employment, then the service establish the effectiveness of the intervention as a retention given would be counted as actual service without addition. mechanism. With the benefit of this evaluation, a decision will Circular 014/2017 was issued June 20, 2017 and gave effect to the be taken on the continuation of the initiative above with a start date of July 1, 2017. Please visit www.inmo.ie • Eligibility will be confined to nurses and midwives aged 55 and over to view the circular. There is no special form that you need to who have 20 years’ public service or more whole-time service and complete, just place your request in writing and forward to your do not have enhanced superannuation benefits. Nurses and mid- director of nursing. You should always seek acknowledgement wives up to clinical nurse/midwife manager 2 (or equivalent) and of receipt. Should you have any queries regarding this, please basic grade public health nurses will be eligible for the scheme contact the INMO Information Office at Tel: 01 6640610/19.

Query from member Reply I advised my employer of my pregnancy a few weeks ago. Yes, you have the right to time off work without loss of pay to I requested time off to attend a medical appointment attend antenatal and postnatal appointments. This time off and this request was put in writing to my employer. My includes the time required to travel to and from the appoint- employer has advised that I am not entitled to time off ment. You must notify your employer in writing of the date and to attend this medical appointment, that I must take time of the medical appointment as soon as is practicable and this time out of my annual leave. It happens that this in any event not later than two weeks before the date of the appointment falls on a day that I am required to work. appointment and proof must be produced if requested. Should I believed that I have an entitlement to paid time off to you have any further queries regarding this please contact the attend this medical appointment. Can you please clarify? INMO information office at Tel: 01 6640610/19.

• 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 WIN Vol 25 No 10 December 2017/January 2018

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1 Rebecca Elliot, Nina Thirlway and Thirlway Elliot, Nina Rebecca rganization as “providing “providing as rganization O

nterpregnancy interval (the time from from time interval (the Interpregnancy Pre-conception care is important is important care Pre-conception he potential impact of maternal age of maternal age The potential impact f the woman has had a previous mis woman has had a previous the If n the the In clinical latest from update advice pregnancy a planning are who women for Pre-conception Pre-conception Informatics, advice pre-conception on focus Gerry Morrow delivery of one child to conception of the to conception of the of one child delivery discussed. next) should also be that an interpreg to suggest evidence improve the long- and short-term health health and short-term the long- improve outcomes of women and their children. con health around woman’s because a n addition, it allows women to to women In addition, it allows nancy. potential risks and make of any be aware decisions their informed about pregnancy. factors modifiable risk potentially Many are outcomes pregnancy influence that conception. before present ception and in early pregnancy impacts impacts pregnancy early ception and in on their lifelong health that of their and and mental It allows physical children. to be conditions and social needs health to preg and managed prior addressed that care is often prenatal too given late to change the outcome of the pregnancy. Timing of pregnancy outcomes should be and birth fertility on an have years 35 over Women discussed. increased of risk chromosomal miscarriage, abnormalities complications obstetric and women. to younger compared care care Pre-conception is defined the by Health World carriage, it is fact important to discuss the there that is definite no to time’ ‘right start trying to conceive again. factors of number a by influenced be will nancy interval of 18-59 months is safer in in of 18-59 months is safer nancy interval terms of perinatal outcomes but the deci woman’s the into account take sion should example for a individual circumstances, be may interval interpregnancy shorter older women concerned for appropriate fertility. decline in about age-related biomedical, behavioural and social health health and social biomedical, behavioural to occurs pregnancy interventions before and and modify behaviours health improve influences”. environmental 44 CPD

reduced fertility, first-trimester miscar- would be considered to be a higher risk disease and those who are in close contact riage, preterm birth, low birth weight and to the pregnancy). Some medications are with people with hepatitis B.9 gastroschisis. not considered to be safe in pregnancy Mental health problems Smoking/alcohol intake/illicit drug use and may potentially adversely affect the Discuss with the woman how preg- Advise all women planning pregnancy foetus. There may be a need to switch to nancy and childbirth could affect her who smoke to stop smoking. Women who a safer alternative medication before con- mental health problem – for example risk wish to stop smoking should be referred ception. Some medications will need to be of relapse of an existing mental health to a smoking-cessation service. Advise stopped if they require a washout period condition – and how her mental health women who may become pregnant to ini- before conception. Ideally, the smallest problem and/or its treatment might affect tially try to stop smoking without using number of medications at the lowest dose her or her baby, before and after birth. nicotine replacement therapy (NRT). possible should be used when trying to The risks of not treating her condition and Consider offering NRT to women who are conceive. Advise women planning preg- the importance of controlling symptoms planning a pregnancy and who have tried nancy not to take any over-the-counter before conception should be explored.10 and failed to stop smoking without using medicines without consulting a pharma- Consider referring women with a current NRT. Bupropion or varenicline should not cist to ensure that these products are safe or past severe mental health problem, such be prescribed to women who may become to take if she were to become pregnant. as severe depressive disorders, bipolar dis- pregnant.5 Advise women planning pregnancy not to order and psychosis, to secondary care for Advise women planning pregnancy (or take any herbal remedies.8 pre-conception counselling. Ideally refer to who are at any stage of pregnancy) to Cervical screening a specialist perinatal mental health service avoid drinking alcohol. Specialist referral Advise all women planning pregnancy if available. Advise the woman to continue should be offered if a woman is unable to who are due a cervical smear test to have using effective contraception until a full reduce her drinking with support in pri- the test as soon as possible, before becom- assessment by the psychiatrist has taken mary care.7 ing pregnant. place. Advise the woman not to stop taking Advise women planning pregnancy Immunisations her medication unless otherwise directed who use illicit drugs to stop using drugs Determine if a woman planning preg- by the psychiatrist.10

(including so-called ‘legal highs’), if they nancy is protected against rubella (for Dr Rebecca Elliot is clinical author at Clarity Informatics, are able to do so. Women planning preg- example documentation of having received Nina Thirlway is style editor at Clarity Informatics nancy who use illicit drugs and are unable two doses of rubella-containing vaccine or and Dr Gerry Morrow is editor and medical director at Clarity Informatics. Clarity Informatics is contracted by to stop with support in primary care should a positive antibody test for rubella). Offer the National Institute for Health and Care Excellence be referred to a specialist service. Women measles, mumps, and rubella (MMR) vac- (NICE) to provide clinical content for the Clinical using illicit drugs who may become preg- cine to seronegative women planning a Knowledge Summaries service available through the Clarity Informatics Prodigy website at: https://prodigy- 9 nant before illicit drug use has stopped pregnancy. knowledge.clarity.co.uk/ should be offered contraceptive advice. Determine if a woman planning preg- References (full reference list available from the Prodigy Women injecting illicit drugs should be nancy has immunity to varicella (if there Pre-conception advice and management topic. https:// offered testing for hepatitis B, hepatitis C, is a definite history of chickenpox or prodigy-knowledge.clarity.co.uk/) 5 1. WHO. Preconception care to reduce maternal and and HIV. herpes zoster, she can be considered to be childhood mortality and morbidity 2012; Available Hazardous substances or radiation protected). from: http://www.who.int/maternal_child_adolescent/ documents/concensus_preconception_care/en/ Advise women planning pregnancy to If there is no definite history of chicken- [Accessed Oct 31, 2017] be aware of the potential for exposure pox or shingles, and the woman is eligible 2. Callegari LS, Ma EW, Schwarz EB. Preconception care and reproductive planning in primary care. Medical to toxic substances in their home, work- for the vaccine (for example healthcare Clinics of North America 2015; 99(3):663-682 place and surrounding environment, and workers who come into direct contact 3. RCOG. Patient information committee Information for you: Early miscarriage. Patient information leaflets. 2016; to avoid them if possible. It is possible with patients; laboratory staff where Available from: https://www.rcog.org.uk/en/patients/ for chemical exposure to occur through exposure to varicella virus is an occupa- patient-leaflets/early-miscarriage/ [Accessed Oct 31, 2017] breathing, eating or drinking, or skin tional risk; and healthy, susceptible close 4. NICE. Fertility problems: assessment and treatment. absorption. Advise a woman who is plan- household contacts of immunocompro- Available from: https://www.nice.org.uk/guidance/cg156 [Accessed Oct 31, 2017] ning pregnancy and is concerned about mised patients), offer serological testing. 5. NIHR. Dissemination Centre. Better beginnings: work exposure to hazardous substances, Also offer vaccination if the woman does improving health for pregnancy. 2017; Available from: http://www.dc.nihr.ac.uk/themed-reviews/Better- infections or radiation to discuss her inten- not have evidence of varicella zoster beginnings-web-interactive.pdf [Accessed Oct 31, 2017] tion of becoming pregnant to her employer antibody.9 6. NICE Weight management before, during and after pregnancy: quick reference guide. 2010; Available from: if possible. It may be possible at some Note that the varicella and rubella https://www.nice.org.uk/guidance/PH27 [Accessed Oct work places to have a discussion with an vaccines should not be given to immuno- 31, 2017] 7. Chief Medical Officer Low risk drinking guidelines. occupational medicine specialist, if this is compromised or pregnant women, and 2016; Available from: https://www.gov.uk/government/ available.8 women who are not pregnant should avoid publications/alcohol-consumption-advice-on-low-risk- drinking [Accessed Oct 31, 2017] Prescription and OTC medication and pregnancy until one month after adminis- 8. AAFP. Preconception care. Position paper. 2015; herbal remedies tration of the last dose.9 Available from: http://www.aafp.org/about/policies/all/ preconception-care.html [Accessed Oct 31, 2017] If the woman is taking prescribed medi- Women planning pregnancy should be 9. PHE (2016) Immunisation against infectious disease cation, discuss any changes that may need vaccinated against hepatitis B if they are (the ‘Green Book’). Available from: https://www.gov. uk/government/collections/immunisation-against- to be made, taking into account that it is at high risk of contracting the disease. infectious-disease-the-green-book [Accessed Oct 31, 2017] important to continue certain drugs (for People at risk include intravenous drug 10. NICE. Antenatal and postnatal mental health: clinical

Vol 25 No 10 December 2017/January 2018 Vol management and service guidance. 2014; Available example if stopping the drug would cause users, those who change sexual partners from: https://www.nice.org.uk/guidance/cg192 Accessed

WIN a worsening of the underlying disease that frequently, those with chronic renal or liver Oct 31, 2017] 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. There is evidence to suggest that an 3. Women who are obese (BMI of 30 kg/ 5. Women planning pregnancy should be interpregnancy interval of how long is m2 or more) should take: vaccinated against hepatitis B if they: safer in terms of perinatal outcomes: A) 5mg folic acid daily before conception A) Are intravenous drug users A) Five to nine months and during the first-trimester B) Have chronic renal or liver B) Eighteen to 59 months B) 400 micrograms folic acid daily and disease C) Eight to 19 months until the twelfth week of pregnancy C) Are in close contact with people D) One to five months C) 5mg folic acid daily throughout with hepatitis B pregnancy D) Change sexual partners frequently 2. Of 100 couples (where the woman is D) 400 micrograms folic acid daily aged under 40 years) having regular throughout pregnancy sexual intercourse without contra- ception how many will conceive 4. Women who wish to stop smoking within one year? prior to pregnancy should be: After reading this article you may wish A) 50 A) Referred to a smoking cessation service to reflect on what you have learned, B) 60 B) Prescribed bupropion or varenicline how this might be applied to your own C) 70 C) Encouraged to try to stop without work and to make a note of this in your D) 80 using NRT in the first instance portfolio.

For further information and resources: www.clarity.co.uk Answers: Question 1: B Question 2: D Question 3: A Question 4: A, C Question 5: A, B, C, D C, B, A, 5: Question C A, 4: Question A 3: Question D 2: Question B 1: Question Answers: Organising Review 47 Advice for AGM season

INMO organiser Albert Murphy focuses on the preparation involved in the lead up to branch AGMs

AS THE weeks count down to Christmas nominate a health and safety rep who will members may be getting excited at the report on the health and safety issues of prospect of the annual general meetings concern to the branch. which will start in January 2018. The follow- ADC delegates ing is some advice in relation to organising The annual delegate conference takes effective annual general meetings. place in May of each year. This conference Preparing for annual general meetings is the supreme democratic forum of the The AGM for each branch is required union where policy is debated and decided under the rules of the organisation. These upon. In this context branches are asked to meetings are perhaps the most important forward a number of motions for debate at meetings of the year for the branch and it the conference. is crucial that as many members as possible The motions fall into a number of catego- attend. Vibrant branches are an important ries namely educational, industrial relations part in the democracy of every trade union, and professional. New UHG rep: Sean Shaughnessy (left), new INMO rep for UHG, is pictured at INMO HQ with Albert Murphy particularly the INMO. A motion to conference is simply a state- The purpose of the branch meeting is to ment requesting that an action is taken by appoint the officers of the branch for the the union or a policy objective is set by the INMO members of the GroupScheme are coming year. The branch committee is com- union for implementation. eligible to huge discounts from companies prised of the following: University Hospital Galway gets new including Expedia, Click&Go, Skechers, Hal- • The branch secretary arranges meetings, representative fords, ASOS, M&S, Benefit Cosmetics, Argos implements decisions, represents branch The INMO is delighted to announce that and most recently Peter Mark. For informa- issues to head office and provides monthly Sean Shaughnessy has been appointed as tion on how to register and save check the reports to the branch committee the released representative for University GroupScheme on the INMO website. • The branch chairperson presides at branch Hospital Galway. The Organisation wishes Rep training meetings and annual general meetings Sean every success in this important role for The Basic Rep Training course was held in ensuring that the meetings are conducted advocating on behalf of Members in Univer- October at the Slieve Russell Hotel, Cavan. properly sity Hospital Galway. The participants of the course reported that • The branch committee members assist and Group scheme they learned new skills and gained confi- participate in the implementation of policy. Congratulations to the five winners dence at the training course. Noel Treanor At your AGM you will be asked to elect of the GroupScheme competition. Each is the IRO covering Cavan and he also an incoming committee which will consist winner received a €100 gift voucher card attended the course. He stated that “it was of the aforementioned officers. In addition, for registering or clicking onto the INMO a great opportunity to meet the local reps some branches will appoint a student rep- GroupScheme. The winners were Deirdre in the area, and in particular, in relation to resentative and an equality representative O’ Keeffe, Yvonne Landers, Jean Mc Phillips Cavan General Hospital”. who will act as a contact person for equal- and Sarah Buggy. The fifth winner chose to Albert Murphy is INMO industrial relations officer/organiser; ity related matters. Some branches will also remain anonymous. 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 25 No 10 December 2017/January 2018

- - - - - Shape the conditions of today, to better Shape the conditions of today, For fourth year students, why not get not get why students, year fourth For It contact Just to easy is get involved. Pictured (l-r) at the ENSA AGM in Brussels were: Gabriel were: in Brussels the ENSA AGM Pictured (l-r) at ENSA president, Max Zilezinski, (France); ENSA treasurer Boyreau, (Ireland); Conway Liam (Norway), Werner Kristin (Germany); (Switzerland) Pinto and Stefanie your tomorrow. your rience, free training training there and free is rience, the also INMO. the to side social and networking the of future the are as a member, You, of Irish healthcare. future the INMO and officer graduate and new student is INMO Conway Liam 01 6640628 Tel: Email: [email protected]; Survey 2017 and this delegation also met also met delegation this 2017 and Survey in ADC the Simon Harris at with Minister and a review for The students lobbied May. travel/accommoda of the current increase students supernumerary for tion allowance students more The placement. clinical on need rep We the better. that get involved country. the from all over resentatives Free Forums? Youth the INMO in involved training course two-day a involving rep is Accommodation, travel provided. You for. provided are meals expenses and experience in repre can gain invaluable colleagues and your senting yourself in the workplace. about information you send will I and me The Student can Section how you join us. regu communicate Forums Youth and campaigns. issues and current about larly will you the INMO in By getting involved expe valuable gain be informed, always ------NSA NSA E the future the 49 FOCUS GRADUATE & NEW STUDENT NSA for 2017-2018. At At 2017-2018. for ENSA INMO student and new graduate officer, officer, graduate new and student INMO , reports from the AGM of the of AGM the from , Liam Conway reports The Student Section was recently The Student Section was recently Members of the Section will Members be the given I was delighted to be elected as the I was delighted to be elected as the We want you to want you get in the Stu involved We manent contracts for all new graduates all new graduates for contracts manent Section attended The of 2016 and 2017. the for launch of the the conference press Internship Midwifery and Nursing INMO ing, which will stand out on your CV. Other ing, which will CV. stand out on your benefits of the with becoming involved Student Section of the INMO include the and mid nurses Irish to represent chance years In previous AGM. the ENSA at wives nurses Irish represented students have Istanbul and Barcelona. Copenhagen, in two of can also avail student reps Active courses run development free professional Development Professional the INMO’s in the year. throughout Centre per for fighting and organising in involved dents from first to fourth year year eligible to fourth are first dents from Section. this in to become involved delegate to be nominated as a opportunity for voice will be a You ADC. the to attend and at national the students both locally The Section has the through INMO. level shape to INMO the within autonomy full Student decision making. campaigns and can members also train free avail of rep graduate education graduate was also discussed. of president vice not why class rep a are you Section. If dent the INMO in area class and your represent class rep not a are you Section. If Student an is this then involved get to want but All stu to opportunity your ideal say. have the conference, delegates voted for for voted delegates conference, the versus to country 12 versus from – examined was private healthcare versus Public country. of a nurse role The debated. were systems post and CPD and debated was or midwife to apply to join the Global Association of to of Association to apply Global the join This (GASNN). Nurses Student and Novice and voice student’s strengthen only will empowerment on the global stage. Getting involved ------Students shaping shaping Students uropean Nursing Students Association in Brussels Association Students Nursing European uropean Com European uropean uropean E uropean Counterparts. INMO stu INMO Counterparts. European Within this forum, we explored how we explored how forum, Within this The next day, delegates from all over from all over delegates The next day, age as many students as possible to get to get students as possible age as many in the Section involved and to avail of our The topic of shift two-day course. free rep eight hours – worked patterns and hours dent members can have their say and be their say and be can have dent members decision making both at local in involved the INMO through level and national encour to continue We Student Section. ship-style directly with the ship-style directly hospital and combined a of method apprenticeship initially and the opportunity to complete varies funding Education the BSc after. current with Ireland’s country, each from the most in ranked fees category. expensive This was also in recently seen the Commission’s The report. UK has the highest tuition costs out of all the countries, with second. Ireland empower students. In relation can we to this topic, the INMO has advanced structures in to of place compared many our ent education systems and pathways into into education systems and pathways ent example, in For and midwifery. nursing three methods of entry, there are Germany 8, apprentice BSc Level third-level direct urope met to discuss current student Europe current met to discuss student Europe. and across issues both nationally differ the to discuss It very was interesting mission on the first day of the day of the first meeting to mission on the and per on innovative an update receive system sonalised medicine and healthcare policies. uropean Nursing Students Associ Students Nursing The European took place in Brussels AGM ation (ENSA) I was delighted to October. in represent at the student members the INMO and the at met We event. this WIN Vol 25 No 10 December 2017/January 2018 ------Ar 51 Focus My professional qualifications qualifications My professional There continues to be a national to be a national continues There I travel to Lourdes every year with with year every to Lourdes travel I Provision of career development of Provision career development ANP/ CNM/CMS and opportunities at AMP level further attempt is there no Ensuring fee. retention NMBI the increase to Lobbying for safe staffing safe for and a Lobbying safe clinical areas in all environment working sion levy and USC sion levy and bution to the economic recovery is economic the is to bution recovery acknowledged the pen of the removal for Agitating midwives to ensure that our contri our that ensure to midwives • • • • • • adult in HDip RSCN, RGN, include Children’s in HDip nursing, emergency emergency nursing, BSc in nurse management/leadership/healthcare and I’m organisation planning and in masters a for studying currently advanced practice. priately skilled nursing staff working inworking staff skilled nursing priately hospital/unit nation children’s every departments.including emergency ally, of RCNs of retention crisis in respect and hospitals larger the within both on Executive units. My role regional advo continually to allows me Council cate on behalf of colleagues my in that many learned I have this regard. resolu immediate have do not issues we processes are there tions, however great often require which follow can we must unite as Ultimately, patience. group supportive mutually collective a – changes future see to are we if daoine. na a mhaireann a chéile scáth must never lose sight of the reality that reality the of sight lose never must for care quality to in order safe provide enough appro must have we children, the Waterford and Dioceses Lismore Waterford the nurse pilgrimage chief been have and the for past which six years I enjoy. tion to the health of the population to be articulated and reaffirmed. needs tive Council, fining it both challenging both it fining Council, tive it feel As a PHN I and informative. voices strong we have is imperative care as primary Council at Executive speed and at breathtaking transforms the the of role PHN contribu our and days I was class rep and assisted my and assisted my class rep was days I of issues. on a number students fellow Waterford in rep union been have I the for five community past care of secretary currently and am years Branch. I have Waterford the INMO time on the my enjoyed Execu really - - - - - I have been a local INMO represent I have I worked as a community RGN in in community RGN as a worked I the of member been an active I have In 2001 I commenced a postgradu In 2001 I Being a passionate advocate for the the Being for a passionate advocate professions nursing/midwifery and to recruit initiatives Introducing and midwives nurses retain Agitating for a pay rise for nurses and nurses for a pay rise for Agitating ities at local and national level. I was was I level. national and local at ities the ED on in local meetings involved concerns nursing progressing Forum and Group East Hospital the Ireland at 1 andwith phase involved currently am on 2 of the Staffing Group Expert and staffing safer ensure to the ED Skill Mix in a and environments working safer levels, when registration nurse’s for protection I circumstances. working in high risk am following: committed to the 100% • • • cation at a clinical level and enjoy enjoy and clinical level cation at a participating in which will initiatives for safety of care and quality improve sick children. years of a number for UHG in ative term represent second is my this and on the nursing national ing children’s of I am a member Council. Executive of Associations Nursing the Paediatric This on is Europe behalf of the INMO. nursing in children’s for time an exciting Ireland as we the await the of building we hospital, however children’s new with the INMO for 18 years both as the both as years 18 for the INMO with I the hospital INMO rep. and ED rep with INMO activ involved am actively providing ongoing ongoing education staff providing and of PEWS implementation supporting completed I this busy hospital. within a diploma postgraduate in clinical I am keenly education, NUIG in 2016. edu nurse in paediatric interested ate diploma which in theatre nursing the in worked I 2003. in completed I theatre department in Waterford the ENT and in Hospital Regional orthopaedic theatres. two years for Wexford and Waterford commencing my PHN training before as a employed been I have in 2007. for community care PHN Waterford in years. the past nine student In my years. 18 over for INMO Graduating in 1997 with a higher with a higher in 1997 Graduating at remained I midwifery in diploma for years Holles further a three Street on the postnatal ward and then in the department.theatre - - - - - Galway Grainne Walsh Walsh Grainne

Catherine Sheridan Catherine On my return to Ireland I com I to Ireland return On my RGN, RCN, University Hospital Hospital University RCN, RGN, Bernadette Stenson Bernadette ANP candidate, AssessmentRapid RGN, RM, PHN, Waterford CCA Waterford PHN, RM, RGN,

Unit, Vincent’s St Unit, University Hospital menced my midwifery training in in training midwifery menced my the National Maternity Hospital. ing experience experience ing and experienced have conditions deteriorating the first-hand and for nurses working environment been involved I have frontline. the on I am currently an ANP candidate in candidate in ANP an currently I am SVUH, assessment unit in the rapid the CNM2 in was previously I where hospital-wide nurs years 18 I have ED. nator for Galway University University Hospitals, Galway nator for I trained as an RGN in St James’s Hos James’s St in RGN an as trained I in RCN as an pital and subsequently Hospital, Har Children’s the National most spent Dublin. I have Street, court the in working as an RCN career of my Unit, University Hospital Children’s Paediatric the currently am I Galway. System (PEWS) Warning co-ordi Early I began my nurse training in 1990 on on in 1990 training nurse I began my diploma in 2000 higher the Project This in 1993. and graduated nursing working on two years followed by was the Luton and at ward a busy surgical England.Luton, Hospital, Dunstable

Introducing Executive Council members Council Executive Introducing 52 QUALITY & SAFETY

A column by Ouality Maureen Flynn &Safety Measurement for Improvement Curriculum

In this month’s column, we invite nurses and their families are included alongside Figure: Seven steps to effective and midwives who may be interested clinical outcomes Measurement for Improvement in learning more about the measure- • Building capability: for extraction and ment aspect of QI to review the recently sharing of information from data to pro- launched ‘Measurement for Improvement vide assurance and support improvement Curriculum’, which is a reference docu- • Adopt measurement as routine: building ment to support consistent Measurement good data collection practices into rou- for Improvement Training in Irish health- tine work and record keeping care (2017) developed by the Quality Uses of the MFI Curriculum Improvement Division, Measurement for The MFI Curriculum can be used as a ref- Improvement (MFI) Team. Measurement erence document for those designing and represents one of the six drivers or key delivering MFI training, and by nurses and elements of the Framework for Improving midwives seeking to assess their level of Quality in our Health Services alongside understanding of MFI. The purpose of the leadership, person and family engagement, Curriculum is threefold: staff engagement, use of improvement • To map out the essential components of methods, and governance (which have MFI training and education in Ireland featured in previous columns). MFI can be •To drive consistent, high quality and com- applied at the frontline of service delivery prehensive MFI training and education in for Improvement should be considered – at PDSA (Plan Do Study Act) cycle or QI Ireland • Have an awareness of the three contexts project level – or at organisational level. • To make MFI training accessible to more of MFI – PDSA, QI projects and Organisa- MFI staff working in the Irish health services tional Level MFI can be defined as the analysis and The MFI Curriculum maps out four step- • Understand how to collect data for MFI: presentation of quantitative and qualitative wise levels of MFI expertise ranging from Following level one training, those inter- data to identify opportunities for improve- level one – which provides a basic appre- ested in obtaining further MFI skills can ment and to demonstrate if a change has ciation of the value of MFI – progressing to sign up to workshops delivered through- resulted in an improvement. Its purpose is level four – which represents a comprehen- out the year. to drive better decision making and support sive knowledge and skill set in MFI. Access the MFI urriculum sustainable improvements in the quality of Seven steps to effective MFI Go to: http://bit.ly/MforI care. The key principles of MFI are: The MFI Curriculum outlines the seven Feedback • Measure only what matters: define a steps to effective MFI and details the tasks, This version of the Curriculum is being limited number of measures that are rele- knowledge areas and skills those engaging tested and refined through delivering MFI vant to your QI project in MFI require at each step - see Figure. training with frontline staff from the Clin- • Being smart in how we measure: use Get involved ical Microsystems and Pressure Ulcer to available data; measure once, use often; The MFI Team’s vision is that everyone Zero Collaborative. We would welcome look at families of measures (eg. looking working in health and social care services your feedback or comments on the Curric- at infection rates, hand hygiene and hos- receives some training in MFI, depending ulum through the following short survey: pital length of stay together provides a on their requirements and the needs of www.surveymonkey.com/r/N83TYWL better understanding of how a hospital is their organisation. To that end, level one Maureen Flynn is the director of nursing ONMSD, lead performing in relation to the prevention training is currently being developed into governance and staff engagement for quality HSE Quality Improvement Division of HCAIs); measure variability; trends an online training module. Nurses and mid- Acknowledgement: Special thanks to Dr Gemma Moore over time; and benchmark with peers wives completing level one training will: and the measurement for improvement team for writing • Transparency: ensure transparency in • Have an understanding of the value of this column. We would like to acknowledge the following for their feedback and suggestions for improving earlier the measuring, sharing and reporting of Measurement for Improvement drafts of the MFI Curriculum; Dr Mary Browne, Dr Philip information • Have information on the basic principles Crowley, Dr John Fitzsimons and Lorraine Murphy (QID, HSE) Caralyn Horne (SCD, HSE), Dr Peter Lachman • Include the patient voice: so that the of Measurement for QI (ISQua) and Lloyd Provost (Associates in Process experiences and perspectives of patients • Understand when and why Measurement Improvement)

Vol 25 No 10 December 2017/January 2018 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. Focus 55

Measuring up: Role of the midwife Paula Barry examines the strengths, weaknesses, opportunities and threats relating to the midwife’s role in the Irish health service

I have been a midwife at the Coombe care/management of women and babies, structure of the midwifery profession or Women and Infants University Hospi- it is a moveable feast. In relation to mid- the systems in which we work. Many mid- tal since 2003. In my various roles across wifery care, there are fantastic advances wives generally move into one particular clinical practice, education, practice devel- throughout the country. Examples include; area or role. An example of these areas are; opment and research, I have seen many implementation of midwife clinics, the clinical, managerial, policy development, changes. The following are my reflections Domino model of care, the development education or research. In comparison, our on the role of the midwife in December of home birth services, and facilitation of medical colleagues have a multidimen- 2017 via a SWOT analysis. water immersion for labour/birth. Initiates sional aspect to their role, including clinical Strengths have developed such as ‘Hopscotch’, wom- practice, academia, research, audit and Great passion and commitment for an-centred caesarean section, facilitation managerial responsibilities. midwifery exists among midwives in Ire- of birth options, (VBAC) clinics, specialist Although, it may not work for all mid- land. For many, it is more than just a job care of women in the HDU setting, birth wives, or all areas of practice, perhaps or a career, it forms identities. Midwives reflections and bereavement services. there should be more flexibility within our are ‘with woman’ before, during and after The publication of the National Maternity role. It might help keep us grounded, but birth, and for this reason are integral to the Strategy (2016) brings with it, great oppor- also allow us see ‘outside the box’, keep health and wellbeing of women and babies, tunity for change. This will be discussed in abreast of best practice and be better families and society as a whole. more detail later in this article. change agents. Unlike the nursing pro- There is a high standard of education Because of the changing face of Ireland, fession, we have been slow to implement for midwives working in Ireland. Similar we care for women from many countries. advanced practice. We need to urgently to our medical, nursing and allied health- This diversity has made us more aware of role out advanced midwife practitioner care colleagues, we have moved from the other cultures, creeds, health needs and (AMP) posts in all areas of midwifery, apprenticeship, to an academic model of wishes. This has expanded our hearts and particularly as the expert/lead carer for training. Hospitals are affiliated with uni- minds and can only be a good thing in healthy women with uncomplicated versities and many midwives are at degree, that it enhances our skills, experience and pregnancies. if not master’s level. Midwives are involved makes us better health care professionals, Most maternity care in Ireland is frag- in research, audit, policy and guideline and human beings in general. mented. This results in many women never development and there is an emphasis Many of our maternity units accom- really getting to know any one midwife. on the provision of evidence-based, high- modate midwifery, medical and nursing They may see several midwives during quality care. students. This is a strength. Students keep their pregnancy and in the postnatal There is great emphasis on continued us on our toes, they challenge practice and period, and have never met the midwife WIN professional development with midwives bring new ideas. Having students creates caring for them during labour/birth. This attending courses, and conferences stronger links between the hospital and can lead to frustration among women as Vol 25 No 10 December 2017/January 2018 in Ireland and abroad. Leadership and the university. Clinical learning and the- service users and among midwives as care management training has also become oretical leaning must go hand in hand for providers. common place. We have strong clinical safe, high quality care provision. Continuity of care is key for safe, satis- governance structures. The NMBI regulates Weaknesses factory care and is recommended by the and guides our practice. As midwives we In my opinion midwifery as a profession, Department of Health.1 Another potential work within our scope of practice, and are when compared to our nursing colleagues, weakness within the system is the use of cognisant of our Midwifery Practice Stand- has been slow to evolve. Our role became blanket policies/guidelines; while essen- ards and Code of Conduct. somewhat eroded over the years and as tial in certain situations, they can make it Maternity care is constantly evolving. a result has lacked real vision. There has difficult to individualise care. This can be With new approaches to screening, diag- been a paucity of strong midwifery leader- particularly evident within units where nosis, advances in pharmacology and the ship at many levels. This may be due to the activity levels are high and challenges exist 56 Focus

with staffing and resources. Often we have is music to many midwives ears. It gives us babies, lack of resources and time to give to adopt a ‘greatest care, for the greatest the opportunity to flourish and be experts women the care they deserve adversely good’ philosophy, but this can leave service in ‘normality’, but also care for women who effects the morale of midwives. users and staff feeling frustrated. develop risk factors/complications. The medicalisation of pregnancy and I have discussed advances in midwifery Midwives are integral to the care of all birth can threaten the role of the midwife. care under ‘strengths’, these initiatives are women and babies. The midwife, within her Scope of Practice sporadic and often depend on geographical Visits from HIQA, although often as per the NMBI,2 is the expert in ‘normal- location. Services such as Domino or home dreaded, can encourage us to take stock, ity’. Often this is lost in an increasingly birth are not available to all women in Ire- review practice and standards and also technological, medicalised environment. land. So, although advancements are being supports us to make improvements. It Some midwives feel relegated to the role made, they are slow and will require great makes us take responsibility for our service of obstetric nurse and express a sense of effort’s to implement nationwide. frustration at not being able to fully utilise Midwifery students, are now part of their role. This can result in some mid- university life. Although, I have placed wives leaving to work in countries where the standard of midwifery education Strengths care is primarily community based and under the ‘strength’ heading, it could Education the option of practising in birthing units come under ‘weaknesses’ also. Yes, Evolution of care Weaknesses or in a home births service is readily midwifery should be at degree Structure of profession available. level, but one could argue that Fragmented care Similar to our nursing and medi- the education programme has cal colleagues, many midwives are become too academic with not Role of the deciding to leave Ireland for over- enough emphasis being placed seas work opportunities. This has on clinical exposure. There is a midwife devastating consequences for Irish theory/practice gap and most maternity units. We lose our own of us would agree the best place Threats home grown midwives, resulting in to learn is in the clinical area, it is Case complexity Opportunities lengthy and costly recruitment cam- Litigation difficult to beat ‘hands on experi- Specialist posts paigns in-order to recruit midwives ence’. A balance of theory and clinical Maternity from abroad. is essential. Strategy Another issue that will directly affect Opportunities the provision of maternity care is the There is change and opportunity afoot. up-coming referendum to repeal the 8th With emphasis on education and the amendment to the Irish constitution in changing role of the midwife, posts such as and value what we do. spring/summer 2018. It will have direct clinical midwife specialist (CMS) and that We are told Ireland is coming out of the consequences on the role of the midwife of the AMP have evolved and will continue recession. This should mean more money in Ireland. There will be midwives on either to evolve into the future. There is great and scope to employ more midwives. The side of the debate and indeed many will sit educational opportunity, with various past few years of financial constraints on the fence. Some may see it as an oppor- options including full/part-time and online and staffing embargoes have negatively tunity for change, a women’s rights issue. courses. This flexibility opens doors for all impacted the health service in general. Others will say ‘what about the rights of grades of staff. Threats the unborn’? Whatever side of the fence Midwives are now part of guideline Care has become complex. Increas- we sit on it will not be easy. It will require development groups, committees and ing numbers of women are attending respectful debate and understanding and working groups. The diversity in our role with various health needs and co-mor- thankfully both are abundant among mid- provides opportunity to be agitators and bidities, which can impact negatively on wives in Ireland. change agents, not just at clinical level, but pregnancy. Rates of obesity and diabetes In summary, using a SWOT analysis at managerial and organisational level also. have increased. Advanced maternal age, framework, I have given a snapshot of my Being part of the multidisciplinary team at increase in IVF conception and other med- thoughts on the role of the midwife in Ire- all levels is essential, exciting and progres- ical conditions can impact on pregnancy land in 2017. Some thoughts fall under one sive in so many ways. It enhances working and the maternity service in general. definite heading, others overlap. relationships, morale, and job satisfaction. Fear of litigation has had a significant Are there challenges ahead? Yes More importantly it enhances care. The effect on care provision. Many midwives Are there exciting times ahead? Yes Twitter hashtag ‘#togetherisbetter’ comes work in fear and practice defensively. This The future will bring both change and to mind and is so true. can leave midwives feeling disempowered opportunity for midwives in Ireland, this is Women (service users) want change, resulting in stress, and can eventually lead for sure.

they want options and various models of to burn out. Paula Barry is research midwife at the Coombe Women & care and this is having a positive impact Centres of excellence, although they Infants Hospital in Dublin

on the role of the midwife. The National offer fantastic learning opportunities References Maternity Strategy supports pathways of through the diversity of women and babies 1. Department of Health (2016) Creating a Better Future care, choice and the overarching frame- and complexity of care, it can however take Together, National Maternity Strategy 2016-2026. Dublin Vol 25 No 10 December 2017/January 2018 Vol work of supporting physiological birth its toll on midwives. Challenges such as 2. Nursing and Midwifery Board of Ireland (2015) Scope of Nursing and Midwifery Practice Framework. Dublin WIN irrespective of a woman’s ‘risk’ status. This high activity levels, throughput of women/ REVIEW 59 Triumph in the face of adversity Although I didn’t know him person- on. In I Found My Tribe, she describes the ally, I felt great sadness when I heard frustrations of sharing their home with a recently that Simon Fitzmaurice had died. team of nurses and carers. I felt great empathy for his wife Ruth and Ruth succinctly describes the “merry their five young children, who I had got to band of the kindest souls mixed with some know through Ruth Fitzmaurice’s moving wonderful freaks” that passed through their memoir I Found My Tribe. home as nurses and carers. There was the Simon was diagnosed with motor neu- nurse who slipped Ruth presents of holy rone disease in 2008 and was given three medals and believed the devil talked to years to live. Ruth describes the MND her in person; a night nurse with a ghoulish in the initial years after the diagnosis as white face who seemed to hide behind hall “like water torture, slowly drip-drip-drip- corners and jump out at her each time she ping. A tiny nerve ending, a small piece of passed; nurses brandishing big jewellery strength, gets stolen every single day.” and natural remedies; the unfortunate carer Simon went into respiratory failure in with spina bifida who could barely walk 2010 and was put on a ventilator during an sent by the agency to help hoist Simon. emergency procedure. Ruth’s memoir gives Fortunately for her (and the profes- us a rare insight into the feelings behind sion) there were many good nurses also, those facts. “The carer-patient bond may bringing their musical voices, mischief and not sound so sexy but it is stronger than laughter. But most came and went, until the urge to eat. By the time Simon landed twins in 2012 and, despite being completely Marian arrived – at last a nurse that Ruth in hospital with pneumonia, we were so paralysed, he continued his film-making didn’t need to run from and whom she silently in tune I could almost read his career. Using iris recognition software, Eye implored would never leave. thoughts. My hands knew where to lift. Gaze, he typed a memoir It’s Not Yet Dark I Found My Tribe is a raw, moving and A mere glance of his eyes could tell me and wrote and directed a feature film My sometimes tragic account of lives lived to where it hurt and how I could help.” Name is Emily in 2014. Last year he adapted the full. It is a book you will want to rec- Simon survived those three months in his memoir into a documentary, which he ommend to your friends and colleagues. ICU and returned home with the ventilator then directed, with it premiering at the Sun- – Tara Horan

and went on to live a further seven years. dance Film Festival 2017. I Found My Tribe by Ruth Fitzmaurice is published by These were fruitful years – he and Ruth had Meanwhile, Ruth and their family carried Vintage (2017), ISBN 9781784741471, RRP E15.99 ! Crossword Competition

Across Down 1 2 3 4 5 6 7 8 1 Pays no attention to good wishes from the 1, 5d, 20d & 30d Carol about having November crossword solution: detective inspector (10) a drunken argument upstairs? 9 Across: 6 Performs a role in the 11 across (4) (4,4,7,2,4) 1 Ire 3 Antechamber 10 11 10 Cuticles (5) 2 A garment for winter sports 8 Double Dutch 9 Chain-saw 11 Mint a poem anew to create a Christmas show (9) equipment, provided by Eddie the 10 Gasps 11 Lough Neagh 12 Tugging (7) Eagle, for example? (3-6) 13 Spawn 15 Tension 12 13 14 15 15 Brown shade associated with old photographs (5) 3 Artist’s stand (5) 17 Mislaid (4) 4 Quivering tree (5) 16 Macroom 21 Navel 16 17 18 Mesmerised, having put paper on the presents, 5 See 1 down 23 Perth 24 Bungling 25 Gerbil 26 Treacherous 18 19 20 by the sound of it! (4) 7 Noise from a bird (5) 19 Equipped with weapons (5) 8 Scarpered (10) 27 ETA 21 22 21 Gift token (7) 9 As identifies Sirius - or Rin Tin Tin? (3,4) Down 23 Composer of La Traviata (5) 13 Informal data? Well, partly informal! (4) 1 Indigestion 2 Emulsion 23 24 24 A home for birds all year round, but for a fairy at 14 Clues go out for sugar (7) 3 Atlas 4 Each-way bet 25 Christmas! (4) 16 Earlier (10) 5 Ariel 6 Bisque 7 Raw 25 Sent around some fishing equipment (4) 20 See 1 down 12 Haemophilia 13 Scold 26 27 28 29 30 26 With perfect timing, where the snooker chalk 21 You might sprinkle it on your chips (7) 17 Operable 18 Stagger 31 32 goes (2,3) 22 Trans-national currency (4) 19 Avenge 22 Lilac 23 Poets 28 Might the poet rig up an occasion of self-praise? (3,4) 27 Man-made waterway (5) 24 Bets 33 34 33 Principality near Rimini (3,6) 29 Not a happy participant in certain 34 Synthetic material (5) Christmas dinners! (5) 35 Major US university (4) 30 Pulsate (5) The winner of the 35 36 36 Zygomatic features of insolence given to Star 31 See 1 down Trek’s Dr McCoy? (10) 32 Burden, responsibility (4) November crossword is: Name: The prize will go to the first correct entry opened. Graham Knight Closing date: Friday, January 19, 2018 Leopardstown Address: Post your entry to: Crossword Competition, WIN, MedMedia Publications, Dublin 17 Adelaide Street, Dun Laoghaire, Co Dublin € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € €FINANCE€ 61 € € € € € € € € € M€ € N€EY€ € € € € € € € € € € € € € € € € € € €P60:€ your€ € ticket€ € € € € € € € € € € € € € to€ a €tax€ refund€ € € € € € € € € € € € € € € €Ivan Ahern€ explains€ how to find€ out if€ you are € € € € € € € € MATTERS due a tax refund in 2018

€ €As we look €forward to the €new year and € € € € € € € € € € € € € € make our resolutions for 2018, pledges to cut costs feature high on many of our lists. Before cutting your spending, why not review your P60 and find out if you could be due a tax refund? Your P60 shows how much you earned in 2017 and, most importantly, how much Nurse/Midwife tax you paid on your income. It is really P602018 1 Jan 2018 Nurse/Midwife P60 important to review your P60 as tax is Tax refund P60 most likely the biggest bill you paid last 20:18 P602018 1 Jan 2018 year. Tax refund 20:18 Here are our top tips to understanding your P60, to help you get on top of your 20:18 taxes this new year. Assess your potential tax refunds If you have not reviewed your tax affairs • Nurses on short term contracts through Get to know your tax credits in a number of years or there are changes an agency – additional tax relief of €80. An example of some of the tax credits in your personal circumstances, such as Claiming this allowance alone could be which you may be entitled to claim for getting married, changing employer or worth €293 per annum (based on a nurse 2017 are listed below: changing working hours, you could find earning €40,000 and claiming tax relief • Single Person: €1,650 that you have additional tax relief, tax at €733) • Married Person Credit: €3,300 credits or allowances – which could mean Check your payslip regularly • PAYE Credit: €1,650 a tax refund. Do you check your payslip regularly? • Lone Parent Credit: €1,650 At Cornmarket, we often find many Nurses and midwives can often discover • Widowed Person Credit (without depend- INMO members don’t claim their enti- they have been on the incorrect point of ent children): €2,190 tlements and their unclaimed tax relief the salary scale or their standard rate cut- • Incapacitated Child Credit: €3,300 accumulate year on year. You can claim off point and tax credits are incorrect. Get • Dependent Relative Credit: €70 back tax refunds for up to four years – familiar with your payslips and make sure • Home Care Credit: €1,100 that’s since 2014. For this reason, many your tax is being calculated correctly. • Age Tax Credit Single: €245, Married: INMO members may be due a substantial Submit your medical & dental expenses €490 amount of money if they haven’t filed a tax This is another area where tax refunds Other tax relief return over the past few years. can accumulate over the years. You can There is also tax relief for college fees, To put this into context, the average tax claim for tax relief at 20% on the following single premium pension contributions, refund is €1,100.1 expenses: nursing home fees and rent, among others. WIN Claim your flat rate expenses • Doctor, GP, consultant or hospital fees Cornmarket’s Tax Return Service can advise

Nurses and midwives are also able • Orthotics or similar treatment referred by you on these and tell you if you are due a Vol 25 No 10 December 2017/January 2018 to claim for flat rate expenses. This is a a practitioner tax refund. Call us at Tel: 01-4086261 to job-related tax relief and is given at your • Drugs or medicines prescribed by a find out how to avail of this service.

marginal rate of tax. Examples include: doctor, dentist or consultant Ivan Ahern is a director of Cornmarket Group Financial • Supply and launder your own uniforms – • Items or treatments prescribed by a Services Ltd. tax relief of €733 doctor, eg. physiotherapy References • Supply your own uniforms but are laun- • Transport by ambulance 1. Cornmarket PAYE Tax Return client statistics, 2016 dered free – tax relief of €638 • Non-routine dental treatments, eg. Cornmarket Group Financial Services Ltd is a member of the Irish Life Group Ltd which is part of the Great-West Lifeco • Launder uniforms that are supplied by crowns/veneers/root canal Group of companies. Cornmarket’s Tax Return Service is not employer – tax relief of €353 • Certain dietary products recommended a regulated financial product. This service is provided by Cornmarket Retail Trading Ltd, a wholly owned subsidiary of • Uniforms supplied and laundered by your by a doctor, eg. for those with coeliac dis- Cornmarket Group Financial Services Ltd Telephone calls employer – tax relief of €258 ease or diabetes. may be recorded for quality control and training purposes UPDATE 63

Harris launches new ANP programme Minister says 700 additional ANP posts will be delivered by 2021

Health Minister Simon Harris recently confirm that funding has been allocated ticularly around services for older person launched a new programme for advanced to backfill on a permanent basis the posts care, chronic disease management and nursing practice (ANP), which he said vacated by the candidate ANPs so these unscheduled care which are the focus of would result in the delivery of 700 ANP are all new posts.” this initiative.” posts by 2021. Minister Harris added: “This initiative The chief nursing officer, Dr Siobhan Speaking at the launch, Mr Harris said: will provide patients with more appro- O’Halloran, in welcoming the com- “This will mean more nurses as senior priate, safe and accessible care across a mencement of the programme thanked decision makers and will drive improve- range of services. I am delighted to be the National Steering Committee, the ments in our health services. This new Minister in this next phase of advanced NMBI, the HSE Nursing and Clini- ANP education model will see 120 ANPs nursing practice that is building and cal Care Programmes, the Education trained to provide care in the areas of growing the future for ANPs in Ireland. Consortium and the nurses who have older person services, management of This type of transformational leader- embraced the initiative. She said “A chronic diseases, including rheumatology ship by Irish nurses developed an initial critical mass of ANPs delivering services and respiratory conditions, and the man- framework for advanced nursing practice in these specific areas will contribute to agement of unscheduled care. here in Ireland that has been referenced reducing presentations to EDs and give “This is a great programme and I am in other countries. Currently, ANPs in patients choice over when and where confident that he introduction of more Ireland play an important role in clinical they receive care.” ANPs across our health services will have practice particularly in EDs and Local The programme will be run by a consor- a very positive impact. It will help ensure Injury Units. The value of these roles is tium of colleges, led by University College that we are providing the right care to the acknowledged and adds to the quality of Cork and including the Schools of Nursing right person in the right location, be that healthcare in Ireland. There are however and Midwifery from Trinity College Dublin, a hospital, a community-based service areas of advanced practice that are under the National University of Ireland Galway or a patient’s home. I would also like to developed within our health services par- and University College Dublin. Oncology nurses TV campaign designed to aid better launch research understanding of dementia competition

The Irish Association of Nurses in Oncol- ogy (IANO), in association with Bayer is delighted to announce the launch of the 2018 IANO President’s Prize. Applicants are asked to submit a research project and one successful winner will be chosen to do a clinical placement in Memorial Sloan Kettering Cancer Centre (MSKCC) for one week. This is the fifth President’s Prize of this kind, the prize will be presented at the IANO annual conference on April 14, 2018. Veronica McInerney, early phase clinical WIN trial manager with the Health Research

Board, who was the 2016 President’s Prize Vol 25 No 10 December 2017/January 2018 winner, recently spoke about her experience: “Winning the President’s Prize was brilliant because it permits such a unique opportunity to visit one of the biggest cancer centres in the world. This award is an excellent Pictured at the launch of the HSE’s Dementia: Understand Together initiative were: Maureen O’Hara who has shared opportunity for the successful candidate to her experience of living with dementia for the campaign, and Simon Harris, Minister for Health. The initiative, work alongside a multidisciplinary oncology Ireland’s first-ever TV, radio and online advertising campaign to raise awareness and understanding of dementia, team within their chosen specialty area, in being undertaken in partnership with the Alzheimer Society of Ireland and Genio, seeks to lift the veil of stigma and isolation around dementia through the real-life stories of people living with the condition. It is estimated that a world-renowned centre of excellence.” there are 55,000 people living with dementia in Ireland and this number is expected to more than double to 113,000 The deadline for submissions is January by 2036. For more information, including details of county-by-county supports and services available, visit www. 31, 2018. understandtogether.ie or Tel: 1800341341 UPDATE 65

Third of women not meeting advised folate levels in early pregnancy

Some 33% of women in Ireland are not approximately 21-28 days after concep- Commenting on the report, meeting WHO recommended blood folate tion).This early closure is why the WHO Dr Cliodhna Foley Nolan, director of levels for the prevention of neural tube recommends all women who may become human health and nutrition for safefood, defects (NTDs) in early pregnancy. This pregnant to take a daily supplement of said: “This report highlights that one- was the key finding of a new report com- 400 micrograms of folic acid prior to third of pregnant women are not being missioned by safefood entitled The folate conception. The supplement should also adequately protected against the risk of status of pregnant women in the Republic be continued until at least the 12th week NTDs. It is concerning that the number of Ireland; the current position. of pregnancy. of babies developing NTDs has increased The report revealed that only one in Three-quarters (76%) of the women in recent years and along with the UK we four women who took folic acid started who did not take folic acid reported that have a higher rate of NTDs than other it at the recommended time, ie. at least it was because they did not expect to get European countries due to our genetic 12 weeks before conception. Almost all pregnant and 35% reported that they did disposition. (98%) of women reported that they not know that they needed to take folic “A high proportion of pregnancies are started taking folic acid after they found acid before becoming pregnant. not formally planned and this research out they were pregnant. However, on The UK and Ireland have had a higher underlines the critical importance of tak- average this was at five and a half weeks rate of NTDs than other European ing daily supplementation of folic acid for into the pregnancy. Folic acid is needed countries and a recent study showed all women who could become pregnant. to support the effective closure of the that incidence rate of NTDs in Ireland has A daily supplement is the way to go as neural tube of the spine and brain, which increased from 0.92 per 1,000 births in a healthy diet alone won’t help women happens very early in pregnancy (at 2009 to 1.17 per 1,000 births in 2011. achieve the WHO levels,” she said.

Global migraine Ireland one of few European countries patient survey not on track to eliminate hepatitis C The Migraine Association of Ireland has Ireland is one of the few countries in There won’t be the same need for drug urged migraine sufferers to take part Europe not on track to eliminate hepatitis treatment. It makes sense, from a health in the first Global Burden of Migraine C by 2030 based on the current policy. and cost point of view, that Ireland sets Patient Survey. Migraine is the third most This was according to Charles Gore, its sights on making this disease a rare common disease worldwide but is often CEO of the World Hepatitis C Alliance, disease, moving with the rest of Europe. overlooked or people underestimate the who was speaking at a recent seminar Dr Jack Lambert, consultant in infec- significant impact that migraine has on to explore how Ireland can match up to tious diseases at The Mater Hospital, the lives of those affected. the global push to make the virus a rare questioned why funding allocated by the The global survey gives migraine disease by 2030 State to the treatment of the virus should sufferers the opportunity to share their Ireland has one of the highest rates of not be spent on drugs only. first-hand experiences of living with the infection among vulnerable groups when The government allocates €30 million disease and the impact it has on their lives compared to other European countries. to the hepatitis C programme, primarily and the lives of those around them. The Over 73% of people who inject drugs for drug purchase. He said that there three topics covered in the survey include: have the virus and 35% of people who are had to be greater transparency in the • How migraine affects your everyday life homeless are infected here. way in which this significant funding is and wellbeing Mr Gore also said that other countries allocated. • Your experience of migraine, from first that are further along the journey to “What my patients need most is care WIN symptoms to diagnosis and treatment elimination had secured deals with drug and outreach in homeless services, drug

• Your experience of migraine medications companies, whereby the pharmaceutical treatment services, in methadone GP Vol 25 No 10 December 2017/January 2018 and treatments. costs were reduced as treatment rates practices. They need peer support and The survey takes around 25 minutes were increased. However, he stressed community response,” he said. “We’re not to complete. The data is entered anony- that treatment of the virus should not be prioritising these and so we are not doing mously and the results when analysed will based on a prescription approach only but the right things to make elimination a be shared with patient advocacy groups, one that focused on diagnosis, outreach, reality.” physicians and medical societies. It may and prevention. Dr Lambert also said that there was a also be published in peer-reviewed jour- “Working proactively to eliminate the discrepancy between accepted notifica- nals, presented at medical congresses and virus will also eliminate much of the cost tion figures for the virus and the reality reported on in the media. associated it,” he said. “People won’t of the situation on the ground, leaving a To take the survey go to: www.migraine. get liver cancer because of the virus, huge gap between treatment numbers ie/worldwide-burden-patient-survey/ they won’t be progressing to cirrhosis. and those actually infected.