The health services are facing a "meltdown" if the current talks at the Labour Court are not successful. The ground has been well prepared by the court's vice-chairman, Mr Kevin Duffy, who drove the employers and unions relentlessly through 38 hours of preliminary "process" talks on Friday and Saturday. There was only one brief eight-hour break for sleep in the middle. It is now the call of the court's chairman, Mr Finbarr Flood.
Everyone is agreed that the key to resolving the dispute is the new senior staff nurse grade, as reported in yesterday's Irish Times. The chairman of the Nursing Alliance, Mr Liam Doran, senior SIPTU official Mr Oliver McDonagh and the general secretary of the Psychiatric Nurses' Association, Mr Des Kavanagh, all identified it as such as they entered yesterday's hearing.
Mr Kavanagh described it as "a major breakthrough. We will never again have a situation where a staff nurse can retire only as a staff nurse."
With 80 per cent of nurses trapped in the staff nurse grade, the possibility of progressing to what is, in effect, a new grade within the health service is potentially very attractive. It is targeted at older nurses who would have trained under the old apprenticeship scheme and who, because of their age or lack of formal qualifications, lack the opportunity to progress into the management grades.
To some extent the proposal recognises the de facto situation in many hospital wards where the most experienced staff nurse normally takes charge if there is no ward sister on duty. Such nurses may also have to assume other duties.
One advantage of the new proposal from the management side is that, unlike the new promotional outlets proposed for staff nurses as clinical nurse managers or clinical nurse specialists, it will not suck experienced personnel out of the wards.
However, while both sides welcome the new grade in principle, the big questions are how many such posts can be created, and how much they will be worth. The nurses are unlikely to vote for a Labour Court recommendation that provides only token numbers. While the court is extremely unlikely to meet the Nursing Alliance claim for 4,000 such posts, it must go a substantial way towards it.
Given that the new grades of clinical nurse specialist and clinical nurse practitioner are expected to yield at least 1,000 promotions over the next 12 to 18 months, anything approaching 3,000 new senior staff nurse positions would provide 4,000 extra promotional outlets in the system. This would meet the alliance claim and, incidentally, almost double the opportunities for staff nurses to progress through the system.
The issue of how much the senior staff nurse should be paid is probably simpler to resolve. It has to be significantly higher than the top of the existing staff nurse grade of £22,000, but it cannot overtake the junior ward sister grade. To do so would spark off a whole new dispute within nursing over pay relativities. The current junior ward sister grade runs from £21,000 to £25,000.
There is also the question of how long nurses should have to wait to be eligible to apply for the new grade. It takes 13 years to reach the top of the staff nurse grade. Precedents suggest that it would take between 16 and 19 years' service.
There are, of course, other important issues to be resolved. It is understood that some of them, such as the future for nurse tutors and reporting back procedures for directors of nursing, are close to a solution.
Substantial progress is also understood to have been made on the issue of allowances. Although these had been expected, when they were announced earlier this year, to provide increases worth over £1,000 a year to about half the State's staff nurses, in many hospitals the figure is nearer to a third. There are proposals now to extend them in the psychiatric and public health service areas as well.
Annual leave is another area that the court must look at. It will have to balance the argument that nurses should receive extra leave days to bring them in line with paramedics against the argument that it could produce knock-on claims from other health workers with a 39-hour week.
Mr Flood will be under tremendous pressure to produce a quick recommendation, but nursing unions, health managers and the Government will also want him to get it right. He has an unenviable task.