The nursing profession, as the State is about to discover to its cost, has changed more than almost every other profession and every other group of State employees, in the past quarter century. The qualifications required of nurses and the demands placed upon them have changed beyond recognition. Above all, the attitudes of nurses, and their perceptions of their place in society, have changed as their work has changed, as their responsibilities have increased and as the knowledge and skills required to do their job have expanded.
Up to two or three decades ago, the profession was still very much in the mode that it had been in since the days of Florence Nightingale. The nurse was perceived, as much by herself as by others, as the suppliant and subordinate hand maiden of the doctor: the member of the health care team who would provide the tender loving care that the doctor - the doer - might be too busy to administer. And, for much of the time, that was almost as much as was expected of her in a relatively low technology general hospital environment.
But, as our Industry and Employment Correspondent points out elsewhere in today's edition, what has happened to nursing in recent decades is nothing short of a social revolution. Indeed, it is more. There has been a technological and administrative revolution as well, in which the duties of the nurse have become as hard edged, as critical for the patients' survival, as many of the actions undertaken by the doctors, without any diminution in the continuing (and emotionally wearing) responsibility to provide the tender loving care also.
These changes, and more, have taken place without any significant alteration in the relativities between nurses' pay and the pay of others in the public service. That is why the national negotiations within the framework of the Programme for Competitiveness and Work were not (in hindsight) the right context in which to negotiate with the nursing unions. It may not be insignificant that the nursing unions, whose members work predominantly in less technological and less medically complex branches of the profession, accepted the recent pay offer while the members of the Irish Nurses Organisation, who are more often to be found working at the sharp end of modern general hospital care, want more - and deserve more - recognition of their changed role and increased responsibilities.
Their pay relativities to teachers, to social workers, to health administrators, should be vastly different to what they now are cast, as they originally were, in the old nursing mould. That is why other unions involved in the PCW negotiations should stand back and allow the nurses to complete the restructuring of their profession by acquiring remuneration more appropriate to the changed work they do and the increased responsibilities they carry. They should offer an undertaking that they will not try to leap frog over whatever benefits the nurses may get because the nurses are, indeed, a special case deserving of separate consideration.