The argument that any concession to the nurses would destroy the whole social partnership model may seem plausible. Gardai, prison officers and teachers will, it is argued, press for knock-on claims, leading to a catastrophic increase in public spending and to the unravelling of our recent economic gains.
But the experts who argue thus are missing the point entirely, and ignore the realities of hospital care. If the nurses lose, our State and its economy will face a far greater crisis.
The nurses are a special case, not for any of the sentimental arguments which have been advanced, but for substantive economic reasons. Put simply, we have a profound shortage of nurses.
This is not due to a lack of training places or to a lack of applicants, but rather to the haemorrhage of nurses from the profession. Disparities in pay and working conditions between hospital nursing and other professions are encouraging nurses to vote with their feet.
Ironically, some leave for better-paid jobs in private nursing agencies. Indeed I have attended the going-away parties of resigning nurses only to find them back at work in their old units on the very next day, as more highly-paid employees of nursing agencies!
Cardiac and general surgery, accident and emergency services, intensive care and oncology (cancer) services have been particularly hard hit by the nursing shortage. Oncology nursing provides a telling example.
In January 1999 I worked in five hospital units in south-east Dublin. One of these (a private unit) has now closed due to its inability to find qualified nursing staff. This placed an additional burden on the already-stretched resources of the other public and private units.
Another short-staffed private unit has been advertising unsuccessfully for trained oncology nurses for months. This unit has now been forced to impose a freeze on new patients who, unacceptably, face a wait of up to three months for chemotherapy.
St Vincent's in Dublin is also understaffed, and only the heroic efforts of our small cohort of trained, certified oncology nurses, many of whom are working substantial amounts of unpaid overtime, keep the department functioning. Crash courses in oncology nursing have been organised so that nurses not oncology-certified can take up some of the duties which should ideally be carried out only by fully-trained certified oncology nurses.
The impact of this situation on the running of the service should not be underestimated. Every week we are meeting to decide which of the many patients who need treatment will actually receive it in a reasonable period of time.
Patients are being transferred from one institution to another in accordance with the fluctuating availability of nursing staff. Some are being treated in institutions which are not fully equipped to deal with chemotherapy complications, because the units which are so equipped are already bursting at the seams.
These problems were inadvertently compounded by our public servants. While this crisis was brewing, the Government made £500,000 available to the Eastern Health Board to create 24 cancer nurse co-ordinator positions.
These were essentially administrative jobs, and proved attractive to oncology nurses, who were working long hours in understaffed units. The effect was to remove a cohort of our most experienced staff from the clinical front line just at the time when units were in danger of closing.
I no longer believe that our first priority is to avoid the strike at all costs, desirable as this may be in terms of its potentially horrific short-term implications for patient care. Rather, we must effect the reforms which will make the profession of nursing an attractive career option, and which will enable us to retain priceless nursing expertise within the system.
The issue is a simple one of supply and demand. In the present situation, the supply of nurses is inadequate to meet the demand because remuneration is too low. Correcting this problem will, in the short term, necessitate a dramatic increase in nurses' pay levels.
More fundamental questions remain, however, concerning our health service, questions which underpin the current nursing problems.
Why does such a wealthy state as ours have such a dysfunctional hospital service? It has been argued that the fundamental cause is the system of financing, and the influence of our civil service. The system requires reform; at present we take tax revenues and dole them out to hospitals in preordained amounts, which do not vary with workload. If an institution provides a superior service, and as a result attracts more patients, the budget does not increase. Rather, the hospital is penalised with government fines for overspending.
This system may even encourage hospitals to be inefficient. Waiting lists grow, staffing levels are kept low and in effect the system attempts to discourage its customers from using its product. Meanwhile, an unaccountable Department of Health exercises absolute discretionary power in the allocation of resources.
Fundamental reforms are needed if we are to have a high-quality hospital system. Institutions must be reimbursed according to the service which they provide, perhaps from a not-for-profit publicly-administered insurance system. Our ethically dubious public-private mix would disappear. Our nurses would no longer be "public servants", and their pay could be dictated by simple economic forces.
John Crown is consultant medical oncologist at St Vincent's Hospital, Dublin