Media coverage of the impending industrial action by Irish nurses has been extensive. But, with the exception of Medb Ruane's article last week, this coverage has failed to explain the circumstances that have brought this caring and formerly largely compliant workforce to the brink of strike.
A good illustration of nurses' altruism is the fact that during the health cutbacks of the mid-1980s senior midwives in the National Maternity Hospital offered to forgo part of their salaries to limit staff reductions and thus maintain a high standard of care. What has happened in the intervening years to have driven these same midwives to withdraw all but essential services to mothers and babies next Tuesday?
To answer this question we need to go back to 1985. Between 1985 and 1988 the number of hospital beds was cut by over 20 per cent. The average length of stay in hospital, which was 9.7 days in 1980, had fallen to 7.8 days by 1996. Thursday's Irish Times reported that our population is the highest since the foundation of the State. Our birth rate is at its highest for almost 20 years. More people living here unfortunately means more sick people, and happily more babies being born.
But where are the extra hospital wards to cope with this demographic success story? In Dublin at present, far from having extra wards, most of our acute hospitals have wards and operating theatres closed. This is principally because we have been unable to recruit and retain adequate numbers of nurses and midwives.
The need to reduce our national debt and cope with a worrying recession in the mid-1980s was understood by most nurses. Health service reductions were particularly harsh, however, despite being remarkable from a fiscal rectitude perspective.
But nurses continue to bear the brunt of public dissatisfaction and at times understandable outrage when the service cannot respond to demand. What makes the situation even worse for nurses is that the promised increase in community services never substantially materialised.
Increasing expectations from a more affluent, educated and litigious Irish public have added to the pressure on nurses, who see their future as continuing to be the apologists for the gap between people's demands and what can be achieved within budget. What is frustrating nurses further is that they live in a country with the trappings of wealth apparent everywhere except in hospitals.
Nurses, who in the mid-1980s could afford to rent or buy houses in the Dublin suburbs, can no longer do so. Of equal importance to nurses is that their patients' lot is also not improving. They can see no future other than to continue to be at the receiving end of often angry questioning.
Nurses are incredibly resilient. But they are human and can be expected to cope with a demanding work environment only if there is a prospect of things improving.
A simple analogy of the impact on nurses of the health cuts in the 1980s is a school classroom with 30 pupils and 30 desks. Suddenly and inexplicably 20 per cent of the desks are permanently removed. At the same time the teacher is asked to take additional pupils. She is also told that she will have to teach a considerably more complex curriculum, which she must learn and prepare in her own time and at her own expense. All the while she must soothe and placate successive groups of parents whose children frequently have no desks. Would we be surprised if this resulted in an exodus of teachers from the profession?
This is just what is happening in nursing in Dublin. Recruitment in recent years has reached crisis level. A nursing strike will make the situation even worse. There is ample evidence that strikes by other occupational groups have acted as catalysts for disaffected staff to resign. The current anger of nurses stems from the fact that the Labour Court recommendations, while going some way to address pay disparities between nurses and their paramedical colleagues, did not adequately address the complexity of an increasingly specialist and diverse workforce.
My hospital has seen an increase of 25 per cent in births between 1994 and 1998. Have we extra in-patient beds? No. Making matters worse or adding to the problem, one ward has remained closed because of a shortage of midwives. Wards which remain open are often overcrowded because of extra beds. In such situations, patients will express their understandable dissatisfaction. Unfortunately, they express it to the midwives who care for them.
Achieving a quality health service for the 21st century depends on Ireland, and Dublin in particular, managing to recruit and retain sufficient numbers of highly motivated and skilled nurses. In a strong employment market, the value Irish society places on nurses must be underwritten in financial terms. Otherwise, the haemorrhage out of my profession in Dublin will worsen.
These are some reasons nurses have made their agonising choice to limit service to patients from next Tuesday.