Patience runs out as the angels of mercy go for the jugular

IT WILL be a brave man who attempts to stop the nurses stampede towards their first national strike

IT WILL be a brave man who attempts to stop the nurses stampede towards their first national strike. I say "man" advisedly because the general secretary and deputy general secretary of the Irish Nurses' Organisation (INO) are both men; so is the chief management negotiator and, of course, so is the Minister for Health, Mr Noonan.

What we are witnessing in the INO is not so much an industrial dispute as a social revolution. For decades nurses have been the most acquiescent of public sector workers. The INO only affiliated to the Irish Congress of Trade Unions in recent years and its presidents were almost invariably matrons, in other words members of nurse management.

But that was in the days when most qualified nurses could be expected to emigrate or marry. Either way, they left the profession after, fulfilling their "vocation" for a number of youthful years; years when £1 issues like long term career structures, pay scales and early retirement seemed unimportant.

Today, a third of staff nurses have put in over 15 years service, over half have at least nine years service and all 26,000 know that, short of winning the Lotto, they will still be working the wards at 65. That prospect has concentrated minds.

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There have also been changes in the nature of the job. A far higher degree of medical knowledge and technical expertise is needed than ever before. The existing "on the job" apprenticeship by student nurses is being converted into a three year, college based national diploma course. Most new entrants are expected to take the fourth year extension to convert that diploma into a degree.

Existing nurses have also acquired additional qualifications. The maximum bonus they can acquire for those qualifications is £600 a year.

Unlike many other workers, nurses have no national agreements on overtime. They may receive shift premiums worth around £3,000, if they work unsocial hours, but extra time worked can only be reclaimed as time off in lieu. Amid all the glittering new medical technology nurses still find themselves tied to outdated and highly questionable work practices.

In many hospitals, for instance, nurses have to work a seven night, 12 hour shift roster. Patients have an unfortunate habit of dying in the early hours of the morning. In such cases nurses on night shift often stay on an extra hour or two to comfort, the family, knowing that they must be back on duty at 8 p.m. that night for the next 12 hours.

There were signs of discontent including a mild rash of local strikes during the past two years over staffing levels, working conditions and facilities for patients. But, as recently as the negotiation of the Programme for Competitiveness and Work, nurses voted to accept relatively modest pay increases and a chance to negotiate a further 3 per cent in a productivity oriented, restructuring deal.

What the nurses are now seeking is a total reappraisal of their role within the health services and recognition from society in general that their role is as important, in its way, as that of doctors or dentists. Many nurses feel that it is, at least in part, because the overwhelming majority of them are women that they have never been granted more than a fraction of the status of the senior, male dominated, health professions.

Unfortunately, national wage agreements are poor vehicles for carrying out revolutions. Agreements are more akin to wagon trains. If one wagon tries to pull out of its allotted place the wagon masters - in this case the Government and the other social partners - will whip it back into line. The alternative is a stampede.

Ask any trade union leader and (they are nearly all men) will tell you: that the nurses have done exceptionally well out of the PCW. The £50 million package rejected by the INO has a real price tag nearer 6 per cent than the notional 3 per cent limit set in the PCW.

It was so good that two of the smaller nursing unions, SIPTU and the Psychiatric Nurses' Association, voted to accept it. The PNA comprises psychiatric nurses and about half of SIPTU's membership are also in this category.

Traditionally, this group has been the most militant within the nursing profession. It won marginally better pay and working conditions, not to mention early retirement at 55, many years ago through that militancy. Psychiatric nurses know a good deal when they see it.

But the nurses streaming into the INO are young and, what they lack in experience, they make up for in a new round assertiveness and Consciousness of their own worth. If the PCW cannot provide an adequate framework for their demand they believe that framework needs to be changed.

FOUR thousand of them have joined the organisation during the present confrontation over pay, pushing the INO membership to over 20,000 for the first time. The wider implications of challenging the PCW do not appear to have occurred to them or, if they have, have not deterred them.

Negotiating a new national agreement is proving difficult. Not least because private sector workers are increasingly irate at what they see as a "free for all" in the public sector under the guise of restructuring deals, while they are clamped tightly, to the official pay parameters of the PCW.

Many of them will have far more sympathy for the nurses' case than, for instance, for teachers or low paid: civil servants. But how far that sympathy will extend, if meeting the nurses demands means fewer tax cuts in the Budget, is another question.

Maybe there is a magic solution to the nurses' problem out there. One certainty is the INO leadership health managers and Mr Noonan, will be searching frantically for it over the next few weeks. In the meantime it is easy to sympathise with the INO general secretary's plea to members at Tuesday's mass meeting. "We can't do the impossible", he told them. "My name is P. J. Madden, not Jesus Christ."