The Irish Nurses' Organisation has accused the Mid-Western Health Board of prevarication after it raised concerns about the methodology of a report on the conditions of an Ennis-based elderly care hospital.
The report on St Joseph's Hospital pointed to staff shortages at the 238-bed hospital, task-driven patient care and overcrowding in three of the seven wards. The board is not accepting any findings until it receives the final report.
It denied the allegation of prevarication and stated the independent report, leaked to local media this week, was a draft which had been referred to the author for clarification.
But Mr Liam Doran, general secretary of the Irish Nurses' Organisation (INO), said it was "a shocking indictment" that the report recommended that 61 more staff should be recruited. The hospital employs 77 nurses and 75 nonnursing staff.
Mr James Conway, a health board assistant chief executive, said one of the clarification points was how the author arrived at a recommendation to employ 34 nurses and 27 hospital attendants. "There were a number of points that staff made that we wanted to query. We have grave concerns about some of the findings," he said.
Hospital conditions were excellent, he said, and £500,000 had been spent on a refurbishment programme and on new equipment. A process of implementing change had already begun with the INO and 10 additional staff members were being recruited.
The report was written by Ms Betty Brady, a former president of the Association of Irish Nurse Managers, after it was commissioned by the board and the INO through the Labour Relations Commission.
Ms Noreen Muldoon, INO industrial relations officer for the mid-west, said a deputation put the nurses' case to the Minister for Health, Mr Martin, on Thursday.
The Clare Champion newspaper and Clare FM radio station called for an independent inquiry after they publicised details of the report's findings.
The report says the hospital has a lack of administration back-up, outmoded systems, and staff shortages at all grades. There is a need to create "a new culture of togetherness" among staff and management.
It notes a high degree of commitment among staff but widespread frustration at the lack of patient care. "There is no time to address the anxieties, worries or concerns of patients or to assess the reasons for changes in behaviour or mood swings," it states.
The alleviation of a repetitive daily routine would reduce incidents of conflict among patients. The current "impossibility" of providing them with social activities and the increase in patient dependency has resulted in "the deterioration in the quality of individual and connective time nurses can spend with patients on non-clinical aspects of care".
The report says hospital attendants are not being properly utilised because of their multiplicity of duties. Their actual level of patient care is "very small". As a result, ward sisters are "bolstering front-line care" to the detriment of management or development roles. Temporary nurses are frequently assigned to different units, where they can cause distress because of their unfamiliarity to patients.
Temporary staff are also concerned about working more than 39 hours a week and being asked to work when the number of hours worked on previous days was not taken into account. The report recommends that rostering be discontinued.
Not all beds had screens, it notes. There was a lack of infection control policies and a need for an emergency button, particularly at night when fewer staff were on duty.
It further notes that the catering officer did not liaise with the ward sister, the nutrition status of patients was not being assessed and there was no dietetic service other than by phone to Limerick's Mid-Western Regional Hospital.
The report also claims there is no menu choice for lunch. This was denied by the board's general manager for Co Clare, Mr Seamus McNulty. He said there was a general issue surrounding care and whether patients should be given as much independence as possible. "We believe if you are practising very good elderly care interventions that you will want to make sure patients maintain their independence for as long as possible."