Last year's threatened nurses' strike now seems like a distant memory. However, the forthcoming publication of the report of the Commission on Nursing is set to bring the nurses and their grievances back into the limelight.
But whatever ambivalence may exist among the public towards other sectors threatening industrial action, the support enjoyed by nurses is a powerful weapon for the profession in any battle for better pay and conditions.
At the recent Irish Nurses Organisation annual conference in Wexford the determination of the nurses to fight their cause was reiterated when the INO general secretary, Mr P.J. Madden, told delegates, to loud cheers, that there was "substantial unfinished business".
The Commission on Nursing was set up in April last year as part of the Labour Court recommendation which settled the nurses' dispute and avoided a national strike. It was part of an £87 million package, including increased pay, which nurses accepted in a ballot completed near the end of February 1997.
The role of the commission was to examine and report on nurses' role in the health service, promotional opportunities and related difficulties, necessary structural and work change, the requirements placed on nurses, education and training and grading.
At the time, the Government gave an unconditional commitment to implement the findings of the commission.
Last year there was strong feeling among many nurses that if they had gone out on strike they would have won all their demands. But they were told that the commission would address the shortcomings in their settlement. The prominent issues here were early retirement, the poor career structures in nursing, and allowances for special qualifications.
During its consultation process the commission met 3,000 nurses around the country. The forthcoming report has nearly 200 recommendations and the vast majority of these are expected to be warmly welcomed by the profession. They deal with a number of issues which have been outstanding for many years.
But it is what is not recommended that is likely to cause difficulties.
The commission report does not specifically deal with industrial relations issues - they are not within the terms of reference - but rather, recommends that they be returned to the Labour Court as soon as possible. It was this issue which almost caused a split among the unions in the final stretch as the commission worked to complete the report.
In its interim report, published in October last year, the commission identified early retirement as a key grievance among nurses. The report stated that nurses believe an inequity existed between the years of service for those working as psychiatric nurses (who can retire at 55) and the years required by other disciplines within the nursing profession. But this has not been dealt with by the Nursing Commission. Instead it comes under the terms of reference of the Commission on Public Service Pensions.
Grievances were also identified over nurses having to "act up" over long periods because of slowness in filling promotional posts. Strong feeling also surrounds the lack of financial reward for nurses when they acquire additional qualifications related to their job.
In contrast teachers receive substantial allowances for postgraduate degrees. Lower annual leave entitlements are another source of contention.
It is understood that the Psychiatric Nurses Association (PNA) was particularly unhappy in recent weeks that the terms of reference of the commission were not deemed broad enough to deal with outstanding industrial relations issues and particularly long service increments.
When these issues return to the Labour Court the unions hope the backing of the commission will carry sufficient weight for the issue to be sorted out to their satisfaction.
In other areas the Nursing Commission Report recommends the restructuring of the profession, redefining management roles. New gradings will be introduced for ward sister, and the junior ward sister post seen as a promotion opportunity.
Ward sister would also have overall management responsibility in intensive care units, accident and emergency and coronary care units in large acute hospitals.
The report recommends that the Director of Nursing no longer have hands-on management responsibility, but deal with overall direction of the hospital and budgetary policy.
In the earlier settlement, following the threatened strike action, other grades received substantial increases in pay, but there were much lower increases for middle-management grades. At the time of the ballot, ward sisters and management grades seemed willing to vote for the proposals on the basis that the erosion of pay differentials between them and staff nurses would be given a priority by the commission.
It recommends the establishment of a new four-year degree programme, which would include one year working in a hospital as a student nurse.
As part of the new structures recommended nurses will be encouraged to follow a "clinical career pathway" where they will become more specialised, operating with a degree of autonomy, operating for example as a specialised breast cancer nurse, or running a breast cancer clinic. Linked to these changes substantial amendments to the 1985 Nurses Act are being sought by the commission. The proposed new Nursing Council would give the necessary support for these changes.
Other recommendations include the establishment of an occupational health service, and independent counselling for nurses under stress.
Bullying was identified as a major problem during the consultation process and the commission hopes that the changes proposed to overhaul the profession, giving nurses a sense of empowerment, will counter much of this problem.
The commission had a total of 15 members, including representatives from the Department of Health and the unions - INO, SIPTU, PNA and IMPACT.
As part of its work a group travelled to Australia to examine nursing practices in that country.