The Nursing Alliance has agreed that in the event of major accidents, industrial action "should be suspended for as long as would be required to deal with the emergency".
It has also agreed that when people awaiting admission to hospitals are designated emergency cases by a consultant they should be treated as such. However, the alliance reserves the right to review its stance if there is a sharp rise in the volume of emergency admissions.
These are among the main points in the guidance notes being issued by the alliance to strike committees throughout the State. The notes were finalised at a meeting of the alliance yesterday.
However the chief executive of the Health Services Employer Agency, Mr Gerard Barry, said later that his members were "deeply worried" at the failure of the unions to agree on guidelines with management at national level. "The absence of such a plan will place lives at risk," he warned.
The alliance guidelines certainly fall far short of the requirements laid out in the contingency plan proposed to the unions last week by the HSEA. This plan requires "full staffing" in no fewer than 16 sectors it considers "critical care areas".
These range from intensive care units to operating theatres, delivery rooms, transplant units and neuro-surgery units.
The management plan also requires nurses to continue working in many areas of ambulatory care, as well as carrying out non-nursing duties such as the supervision of support staff and ensuring the provision of both clinical and non-clinical supplies to the wards.
The plan further proposes that senior nurse managers should determine staffing levels in many of these areas.
In contrast the alliance is delegating responsibility "for the determination of emergency cover and picket rosters" to local strike committees.
It says that nurse managers should be rostered to provide emergency care like everyone else. Where this is not practicable, nurse managers and other nursing staff without specialist clinical skills should make themselves available for extra picket duty in order to leave other nurses free to provide emergency cover.
The alliance was anxious yesterday to play down any danger of conflict with consultants in determining which patients' require emergency care. The guidance notes make the point that most emergency admissions will be "self-evident".
They suggest that local management should be advised of the requirement for consultant involvement where the condition of a patient "is not self-evidently an emergency". They further provide for consultants to designate emergency cases themselves.
"In the event of the strike committee becoming concerned about the volume of admissions being deemed an emergency then an immediate review of our approach and co-operation should be undertaken. Local lay management must be informed of the concerns being encountered and of the fact that a review of the situation is under way," it states.
Among the duties nurses will no longer perform is intravenous drug administration. This will devolve to doctors. However, such restrictions would not apply in acute emergencies such as cardiac arrests.
In maternity and obstetric units a high level of cover is expected, including metabolic screening, but many routine procedures and administrative routines will be suspended during the strike.
Post-registration students, including pupil midwives, will be on strike, but pre-registration students will not be called out.
For nurses providing emergency cover, the alliance is calling on hospital managements to continue public liability insurance cover and is also seeking free meals, as the nurses will be working for nothing.
Throughout the State, local managers and strike committee representatives will be meeting over the next few days to try to agree on emergency cover on the basis of their very different, and conflicting, guidelines.