There is increasing unrest and discontent among members of the nursing profession and this has been highlighted through the recent national delegate conferences of the nursing unions.

A leading SIPTU official recently declared that nurses were "on the verge of war".

Since the establishment of nursing on a statutory basis in 1919, health service managers have enjoyed a nursing profession which has been accommodating and loyal. The popularity of nursing as a career and the vocational nature of nursing have provided for a stable influence that has formed the backbone of the health services.

It is ironic that the stable, reliable and traditionally non-militant attribute of nursing served to be its greatest disadvantage in terms of progressing its agenda of development. A number of reports on nursing beginning in the 1970s have recommended change. However the majority of the key recommendations were never implemented.

The latest report of the Commission on Nursing aims to be comprehensive in dealing with the outstanding issues and upgrading the nursing profession in terms of professional career pathways, education, and remuneration. It is significant to note that the Commission on Nursing report was prepared on the basis of a recommendation from the Labour Court which recognised that there had been extensive changes in the requirements placed on nurses both in training and in the delivery of services.

It was during the health cutbacks of the late 1980s that nurses came to the realisation that they were not indispensable and many nurses who had been employed on a long-term temporary basis suddenly found themselves unemployed. It was during this period that the seeds of the current crises were sown.

Since the mid-1980s nurses have had to respond to many changes in healthcare policy and direction, most often without adequate educational preparation. Nurses, as the front line professionals, have been challenged by patients and relatives whose expectations have never been greater and are often unrealistic given available resources.

There is also a trend of increased violence and aggression towards nurses, which continues to rise at an alarming rate. In such a healthcare climate the strengths and weaknesses of nursing as a profession have been highlighted and the lack of investment in nursing as a maturing profession has become clear. The extensive range of recommendations contained in the Commission on Nursing report serves to highlight the scale of change required in relation to professional developments, education and career pathways.

The lack of sufficient numbers of nurses to staff hospitals is another feature of the current situation and Ireland is now actively recruiting nurses from overseas to staff hospitals. The luxury of excessive numbers of nurses being available to employers in the past encouraged nurse employment patterns of large numbers of long-term temporary nurses who lacked the rights and entitlements of permanent staff.

There never has been a national strategic approach to manpower planning in nursing, the lack of which is evidenced in certain key trends in manpower statistics recently published by An Bord Altranais. The figures highlight trends which should have given sufficient warning of a shortage of nurses, and provided the necessary impetus to commence positive public relations exercises and recruitment campaigns long before now.

The statistics from An Bord Altranais showed that between 1993 and 1998 there was approximately a 10 per cent reduction in the number of students accepted for nurse training. Meanwhile, during the same years, there was almost a 16 per cent increase in nurses going abroad. The declining numbers in Irish nursing have not been helped by the fact that in recent years much of the reporting on nursing in the press has been rather negative in highlighting situations of either violence towards nurses or cases of litigation against nurses and health service agencies.

In terms of nursing developments, we are now beginning to examine and introduce developments which should have begun 10 year ago, as was the case in other jurisdictions such as the UK. An Bord Altranais is only now commencing a review of the Scope of Nursing Practice - long after the role and responsibility of nurses have changed.

Research developments are central to the nursing profession's future. However, Ireland, unlike many other EU member-states, does not have a national nursing research strategy. Nurses form the largest number of employees in the health services sector and on average the nursing budget amounts to 40-45 per cent of the hospital budget. Nursing is only one of five health professions regulated through a statutory body. Such privilege and power however, is not reflected in the level of nursing involvement in policy formulation or leadership of the health services.

In recent years university-based nurse education has progressed rapidly and from the year 2002 nurse training will be a four year university-based degree programme. Such advanced educational preparation for nurses is likely to extend the role of the nurse into many new and independent roles, which traditionally may have been the preserve of medical doctors. It is not inconceivable that some nurses, given the appropriate training, may perform minor surgical procedures.

Based on the recommendations of the Commission on Nursing, nurses as independent practitioners with prescribing powers and advanced clinical skills are likely to be a feature of future health services. The extension of the nurse's role into such areas will require a radical redefinition of nursing, including a restatement of competence in nursing legislation. Such extension of roles will be very appealing in economic terms, not least because it may be cheaper for a nurse to perform the procedure than a doctor.

In support of national and international trends in healthcare, the long-term view of the nursing profession and its potential role in health services must be central to discussions on pay and conditions. Nursing's ability to provide quality care is beyond question. Therefore, discussions must focus on nurses as future health service executives and leaders, clinical directors, and independent specialist and advanced practitioners as advocated in the Commission on Nursing report.

Current negotiations must provide for an outcome to ensure a system of pay and conditions which is commensurate with the changing and future demands being placed on nurses. As stated in the Commission Report on Nursing: "The quality of care and public satisfaction with the health services is often related to the quality of nursing service." If we want to maintain the fine reputation of Irish nursing and equally maximise its potential in a context of changing health services we must invest in its future.

Seamus Cowman is Professor of Nursing in the Faculty of Nursing, Royal College of Surgeons in Ireland.