Fresh ideas badly needed to solve nursing shortage - as patients suffer
Cancelled operations, rolling theatre closures and scores of beds lying idle are some of the hidden effects of the shortage of nurses in our hospitals.
Outside of hospital, too, many community areas are without enough public health nurses and this impacts on the amount of home visits which many vulnerable people receive in their homes.
It's also leading to burnout for many staff nurses who must carry the responsibility for patient care. It explains the emphatic result of 90pc in a ballot for industrial action to force health authorities to tackle the shortage.
The problems are being felt across all wards but a lack of specialist nurses in critical care, surgery and also in emergency departments is creating serious service blockages.
Surgeons can find their theatre lists are cancelled in the morning because nurses have been redeployed to cover the emergency departments or wards.
HSE chiefs hope to deck the halls with holly at its Dublin headquarters from December 28-30 when 'walk-in' interviews are offered to emigrant nurses who will presumably be full of the joys of a Christmas at home with the family and may be swayed to take up a job here.
But it all seems ill-planned, last-minute and cheap, and so is unlikely to tempt many nurses who now have a good lifestyle, having been lured to the UK and Australia with generous incentive packages, more favourable personal taxation regimes and less-crowded hospitals.
There is also competition from our own private hospitals, which have offered cash incentives of up to €6,000.
Despite the plea of Health Minister Simon Harris to come home, some nurses who are interested in jobs are also finding there are mixed messages.
They may be offered just three-month contracts and in the case of Taoiseach Enda Kenny's local hospital, Mayo General, there is a refusal to fund senior posts.
While hospital managers have made a business case to fill senior posts, the funding has not been sanctioned by the HSE.
The Irish Nurses and Midwives Organisation, which is threatening industrial action, beginning with a work-to-rule in early February and escalating to work-stoppages if some progress is not made, estimates that there are some 3,500 fewer nurses now than in 2008. In the meantime, the population has been growing and ageing.
We will never get back to those 2008 figures and it would also not make good sense in terms of skill mix.
Nursing unions must accept more restructuring of posts to include the hiring of healthcare assistants to take over more non-nursing duties.
Beaumont Hospital is also piloting the use of physician associates who are widely used in other countries. They are trained to perform roles like taking medical histories and support doctors in their diagnosis under supervision.
Stephen McLarnon, who has run nurse recruitment fairs here this year with representatives from top hospitals from abroad, said there will be no overnight fix.
He said the working conditions need to improve but, to do this, hospitals need to recruit more nurses.
"It's a Catch 22. If you come back to the system now, it is under-resourced and you will be over-worked," he said.
"Packages will be a sweetener, the reality is that they want working conditions that are normal."
Irish nurses working in the UK are a top target at the three-day recruitment drive over Christmas.
They are offered €1,500 relocation expenses, a paid- for registration fee and salary of between €27,483 and €43,800, depending on experience.
The relocation incentive package only applies to nurses in the UK and has not been extended to Irish nurses in other countries.
New graduates are also being told they will get a full-time job if they want one, according to the HSE.
The problem facing hospitals and the wider service is not just about recruitment but also retention.
The anecdotal evidence is that of the 90 or so nurses who came back to work here under the HSE incentive drive in recent years, around half have since left.
The INMO proposal to hold round table talks with the appointment of a mediator is worth a try because the HSE ideas file on how to reduce the crisis is pretty bare at this stage.
There is a desperate need for some fresh thinking that gets past the union rhetoric and the sluggish response by the HSE and, importantly, the Department of Health, which seems bereft of ideas on very many areas of policy these days.
Patients cannot be allowed to suffer any more through industrial action but that is what it risks coming to unless there is a new urgency.