As nurses poured down from Parnell Square in Dublin last Thursday behind the Nursing Alliance banner, electrical contractors were beginning to put up the Christmas lights in O'Connell Street. Not many marchers noticed them in the euphoria of the moment, but things like Christmas, rent and mortgage repayments are beginning to loom larger in nurses' consciousness. That is what's behind the growing pressure on the Nursing Alliance to escalate its action.
Many marchers on Thursday were convinced that the strike would be short. The fact that the unions, particularly the Irish Nurses' Organisation, have maintained heavy pickets is an indication of this.
These may be scaled down over the next few days to allow for the long haul, but so far nurses have been expected either to provide emergency cover inside the hospital or spend at least four hours a day outside the gate. In some cases they are putting in considerably longer hours, and there are cases of part-time nurses putting in more time on picket duty than they would working normally.
Many nurses are also parents and, with the half-term school holiday this week, some are having to pay extra for child-minding while they picket and work the wards for nothing.
On top of that have come lectures from a small but vocal number of senior medical personnel about the nurses' moral and professional obligations to patients. The publicity generated by problems at Our Lady's Hospital for Sick Children in particular has generated enormous anger among nurses.
In fact, as the general secretary of the Irish Hospital Consultants' Association, Mr Finbarr Fitzpatrick, has said, in the majority of hospitals alliance strike committees, management and medical staff have good working relationships. However, he is concerned at the prospect of emergency cover. "It's pared down to the minimum as it is," he said. "I hope they never do it, but if reduced, the risk of something going wrong multiplies enormously."
The general secretary of the Psychiatric Nurses' Association, Mr Des Kavanagh, believes industrial action in the psychiatric services can be escalated to hurt management rather than patients. Unlike the psychiatric services, the only obvious area where general nursing cover could be reduced is in the accident and emergency sector. In larger urban centres, where there is more than one hospital, it might be possible to close some casualty units.
There is an excellent precedent. In 1987 a former Fianna Fail administration left only one Dublin hospital casualty unit on the north side and one on the south side open each day. The minister for health at the time was Rory O'Hanlon, a doctor.
The Nursing Alliance has certainly shown that nurses have the determination and organisational ability to escalate industrial action. What other organisation could assemble up to 10,000 people from all over the State in Parnell Square and leave on time?
Hopefully, the question of escalation will not arise. But that is only possible if the current talks are successful.
Considerable progress is understood to have been made since Thursday on issues ranging from allowances to increasing student intakes, promotional posts and the dispute over reporting-back procedures for directors of nursing. The issue of recognition for long service by staff nurses remains the key to a breakthrough.
It was acceptance by the Nursing Alliance of the problems the Government had with conceding additional long-service increments to staff nurses within the context of social partnership that allowed both sides to enter the process being chaired by Mr Kevin Duffy. However, the unions appear to have understood this meant simply changing the terminology for payments from "long-service increment' to "recognition for long service".
Such a transparent transaction would invite knock-on claims from groups such as paramedics and teachers. What is needed is something similar to the agreements these groups have under which posts of responsibility can be made available to long-service employees who are not promoted.
Creative thinking might prove more effective than greater militancy in terms of resolving this problem.