The nursing and midwifery shortages in Dublin city are worrying, not just for potential users of the health service there but also for the slowly but steadily diminishing number of Irish nurses working in the capital's hospitals.

There are over 1,200 nursing vacancies in Dublin. Because approximately 90 per cent of all nursing vacancies in the State arise in the capital it is clear the retention and recruitment of nurses is primarily a Dublin problem.

There are approximately 60,000 nurses in Ireland who pay an annual retention fee to retain their registration. Only half of these are actually employed in the health service. Yet the number of nursing vacancies in our capital city has continued to rise to a very worrying level despite the State having two registered nurses for every nursing position.

Most people's understanding of how nursing is organised is gleaned from TV programmes like ER. In the programme, Nurse Carol Hathaway is the talented head nurse of a permanent team of professional and highly-skilled nurses. It is easy to understand the impact it would have, if instead of her usual team of 10 nurses she had to cope with a permanent reduction to seven as a result of recruitment difficulties.

Her situation would be significantly worse again if of that seven, only three were on permanent contract to the Emergency Room. Two others have been recruited from abroad, are very skilled in ER nursing and have been oriented in her department. However, because English isn't their first language she is concerned that in a crisis with instructions being shouted or muttered, perhaps using local terminology, the potential for an instruction being misunderstood is high.

Much of the immediate response to nurse shortages in Dublin has involved recruitment drives abroad. We also have a consistent increase in the number of Irish nurses who are opting to work through agencies on a casual basis, rather than take a hospital contract. Nurse managers rely on these nurses and midwives to help with acute shortages in critical areas, now a permanent feature of hospital life in Dublin.

I am gravely concerned that the quality of the nursing service in Dublin will deteriorate significantly if the majority of the staff in any particular ward or department is not on permanent contract to the hospital.

A quality nursing service requires continuity and the development over time of specialist skills by a core group of nurses committed to the long-term development of the nursing service. Expert knowledge of a specialty alone without familiarity with the place where the specialty is practised is sub-optimal.

A quality nursing service also requires that the majority of the team shares a common first language so that communication between patients and staff is enhanced. Continuity and long-term commitment are needed most particularly in hospitals with regional and national specialties, which applies to the major hospitals in Dublin. Without them, standards of excellence which require skilled, cohesive nursing teams will be seriously compromised.

The recruitment and retention problems faced by Dublin hospitals are not insurmountable. There are many potential solutions which could be explored. Capital cities having a problem with recruitment and retention of nurses is not unique to Dublin.

Prof Linda Aiken of the University of Pennsylvania, speaking at a Masterclass for senior nurse managers in Dublin recently, confirmed that American city-centre hospitals have always paid their nurses premium rates. A London weighting allowance of between £3,000 and £4,000 per annum is paid by the major London hospitals as an important part of their nurse recruitment and retention strategies.

At the beginning of the last century Dublin hospitals had difficulty recruiting nurses. The response at that time was to build nurses' homes providing subsidised accommodation close to the hospital. This was to enable nurses to get to and from work easily, an important factor for an occupational group whose shift patterns cover 24 hours a day 365 days a year.

Accommodation in nurses' homes would clearly not attract the modern Irish nurse. However, like many successful new companies in Dublin, hospitals could rent properties in their local area. These could be made available to nurses taking up hospital contracts. This would save them from having to do battle with the expensive Dublin rental property market.

Some computer and financial companies provide their staff with transport to and from work. This is another strategy the Eastern Regional Health Authority could explore as a priority.

Most acute hospitals depend on their core permanent staff to work extra shifts. This commitment by their permanent staff could be recognised in the form of an allowance or bonus payment. Such an allowance would be acceptable to nurses and would be a further inducement to younger nurses to commit to hospital contracts.

If the current situation is allowed to continue the consequences will be grave indeed. It is likely to lead to further losses of our Irish nurses, who other countries still recognise as among the best in the world.

Our health service requires a critical core of permanent contracted nursing staff who have the long-term welfare of the service as one of their goals. This group must be recognised and rewarded for their commitment in the past and for their loyalty in staying with the service in the present, despite many opportunities to defect.

Irish nurses are well educated, computer literate, can tolerate high stress levels, are adaptable, flexible, and are excellent communicators. These are skills that are needed badly in nursing. They also attract much higher levels of remuneration outside the health service.

ULTIMATELY, it is small comfort for Dubliners to know that Ireland has the best nurses in the world, if we don't ensure that large numbers of them are enabled to remain working in permanent contracted positions in the health service here.

The situation is far from hopeless. Research has consistently shown that nurses enjoy nursing. If I were 18 again, I would still choose to be a nurse.

Nurses get high levels of intrinsic satisfaction from nurse-patient interaction, be it sitting with the profoundly depressed, helping the severely handicapped, being part of an emergency response team in an acute setting, sharing the joy of a young couple at the birth of their first child or holding the hand of a dying elderly person in long-term care whom we've grown to love.

All of us will need nursing at some time in our lives. It is to be hoped that Irish nurses will be there for us when our particular need for them arises. What is needed now is the collective will to create imaginative ways to recruit, retain and attract Irish nurses back to their profession.

Maeve Dwyer is Matron of the National Maternity Hospital, Hollis Street, Dublin