World of Irish Nursing & Midwifery May 2019

This is INMO Monthly Magazine for its Nursing & Midwifery Members. No download, no waiting. Open and start reading right away!


40 Quality and safety

News &views  5 Editorial

This month Maureen Flynn discusses the use of ‘good information practices’

Following acceptance of the proposals to end strike action, Phil Ní Sheaghdha, INMO general secretary, pays tribute to members who fought hard for patient safety and staffing in a determined, controlled and collective manner INMO president Martina Harkin-Kelly rounds up news from the Executive Council and beyond 8 News INMO members vote by 62% to accept Labour Court proposals… University Hospital Limerick needs to heed the lessons of Mid Staffordshire… Nursing Now launched in Ireland… Trolley crisis plumbs new depths… Limerick sees 81 on trolleys – highest ever daily count… Parental leave reinstated for member… World news headlines Plus: Opinion by Dave Hughes, page 17 Plus: Section news, page 19

42 Patient Safety

The application of clinical governance to the HSS provision in Ireland is a threat to patient safety, warns Rachel Eustace

44 Focus

Nurses are well positioned to positively affect the health and care of homeless people, writes Jessica Kenny

7 From the president

57 Update

Round up of healthcare news items


Clinical 45 Child health

Hazel A Smith discusses informed consent and assent in clinical research

47 Gastroenterology

The role of a specialist nurse is key in the ongoing care and support of patients with IBD, writes Angela Mullen

49 Diabetes services

39 Students & new graduates

Referral of people with uncomplicated type 2 diabetes to primary care

INMO student and new graduate officer Neal Donohue offers advice to internship students preparing for interviews

51 Dermatology

David Buckley outlines a stepwise approach to managing atopic eczema

Features 20 International

Living 53 Book review


Elizabeth Adams reports from the 109th EFN general assembly in Brussels 21 Celebrating our professions This month marks both International Nurses Day and International Day of the Midwife 23 Centenary focus Mark Loughrey talks to WIN about his new book, A Century of Service , celebrating 100 years of the INMO

Niall Hunter reviews Through the Pages of History by Michael Whelton Plus: Monthly crossword competition

55 Finance

Ivan Ahern discusses how the Single Public Service Pension Scheme could affect your retirement

Jobs & Training 29 Professional Development

24 Legal focus

INMO director of regulation and social policy Edward Mathews advises members on filling out an incident form

Eight-page pull out section from the INMO PDC

26 Questions and answers

58 Diary

Bulletin board for industrial relations queries

Listing of meetings and events nationally and internationally


59 Recruitment & Training

27 Executive Council focus

Latest job and training opportunities in Ireland and overseas

A series profiling three members of the Executive each month

WIN – World of Irish Nursing & Midwifery is distributed by controlled circulation to more than 40,000 members of the INMO. It is published monthly (10 issues a year) and is registered at the GPO as a periodical. Its contents in full are Copyright© of MedMedia Ltd. No articles may be reproduced either in full or in part without the prior, written permission of the publishers. The views expressed in this publication are not necessarily those of the INMO. Annual Subscription: € 155 incl. postage paid. Editorial Statement: WIN is produced by professional medical journalists working closely with individual nurses, midwives and officers on behalf of the INMO. Acceptance of an advertisement or article does not imply endorsement by the publishers or the Organisation.

Cover image by Derek Speirs: ‘Charlie’s Angels’ on ‘The Big March’ in 1980 – as pictured on the cover of ‘A Century of Service: A History of the Irish Nurses and Midwives Organisation 1919-2019’ by Mark Loughrey (see page 23)


Hard won progress for our professions

Journalof the Irish Nurses and Midwives Organisation

World of Irish Nursing & Midwifery

(ISSN: 2009-4264) Volume 27 Number 4 May 2019 WIN, MedMedia Publications, 17 Adelaide Street, Dun Laoghaire, Co Dublin. Website:

At the time of going to print, the count of ballots has just been completed. 62% have voted to accept the proposals. These proposals represent substantial progress for our professions. Tens of thou- sands of nurses and midwives will see their pay increase, with more to come for man- agement grades. More will get allowances which they were not previously eligible for, all allowances will increase, and there will be additional promotional opportunities for nurses and midwives. Crucially, we now have funding for the safe staffing framework – a mechanism that allows us to secure appropriate staff numbers based on patient dependency and skill mix. For the first time ever, we will have a scientific method to determine how many nurses are needed and move away from only providing the staffing that budg- ets allow. We did not gain this progress because we asked for it. We gained this because YOU fought for it. For three days, INMO mem- bers stood proudly on the pickets and in services providing emergency care. We used our collective unity, organ- isational discipline and public support. Through our unity, we brought a reluc- tant government to the negotiating table. Where individually we are often ignored, together we are strong. We will now focus on implementing the proposals fully and ensuring that the employer lives up to their side of the bar- gain. These proposals were hard won – we must ensure they become reality without delay. The INMO will use this progress as a base from which to campaign to further improve conditions for our professions and our patients. Over the past months of this campaign, I’ve attended meetings with members across the country. One thing was clear: our members’ faith in the public sector employers is at an all-time low. There is rightly a deep anger and frus- tration at the conditions in which nurses and midwives are forced to work. There is a large gap between the care we are trained to provide, and what we can actually offer in practice.

These proposals will not resolve all our problems – no single solution ever could. But they will make substantial improve- ments to your working lives and encourage more nurses and midwives to practise in Ireland. I wish to thank the nurses and midwives on our strike committees, our reps and members for their incredible dedication and hard work over the past months. They have worked long hours, in difficult condi- tions, under immense pressure, often on top of their day jobs. The manner in which this strike was conducted demonstrated the very best of nursing and midwifery. Patient safety was protected and your workplace committees ran things with pre- cision and skill. Thanks are also due to our president, elected officers and Executive Council for their tireless work and brave decisions throughout this dispute. I would also like to thank our colleagues in other unions for their solidarity – especially Patricia King in ICTU, who gave us great assistance. We are also grateful to the Labour Court and the Workplace Relations Commission for their considerable efforts to resolve this dispute. We also owe the public a debt of gratitude. We work hard for them when they need us, but when we went on strike, they were with us all the way. From pass- ing beeps to hot drinks, it was clear that the public stood firmly with nurses and midwives. As this dispute concludes, I would encourage everyone to remain fully engaged in our union. As professionals with a common interest, we can only move for- ward together. Striking is the most visible part of union work, but the day-to-day democracy and care for your fellow mem- bers is key to improving our workplaces, livelihoods and conditions for patients.

Editor Alison Moore Email: Tel: 01 2710216 Production & news editor Tara Horan Sub-editor Max Ryan Designers Fiona Donohoe, Paula Quigley

Commercial director Leon Ellison Email: Tel: 01 2710218 Publisher Geraldine Meagan

WIN –World of Irish Nursing &Midwifery is published in conjunction with the Irish Nurses and Midwives Organisation by MedMedia Group , Specialists in Healthcare Publishing & Design.

Editor-in-chief: Phil Ní Sheaghdha INMO editorial board: Martina Harkin-Kelly; Catherine Sheridan; Eilish Fitzgerald, Kathryn Courtney, Ann Fahey INMO editors: Michael Pidgeon ( Freda Hughes ( INMO photographer: Lisa Moyles INMO correspondence to: Irish Nurses and Midwives Organisation, Whitworth Building, North Brunswick Street, Dublin 7.

Tel: 01 664 0600 Fax: 01 661 0466

Email: Website: irishnursesandmidwivesorganisation

Phil Ní Sheaghdha General Secretary, INMO

Your priorities with the president

Martina Harkin-Kelly, INMO president

Centenary planning meetings The INMO’s centenary is a major milestone. We started celebrations with an event for members in Dublin’s Mansion House. Our centenary annual delegate conference in Trim will see further celebrations, including the launch of Mark Loughrey’s excellent INMO history book, A Century of Service , along with the centenary badges being awarded to the hundreds of delegates at the conference. A final plank of celebrations will be announced at the conference. I would encourage all branches and sections to get in involved – it’s not often an organisation has its 100th anniversary. Nursing Now launch Nursing Now is a global campaign to raise the profile and status of nurses. The INMO is the lead organisation of the campaign in Ireland. The campaign aims for recognition of nurses’ contribution to healthcare, gender equality, and wider society. Its aims include greater investment in nursing, more nurses in leadership positions, and increasing nurses’ input and impact on healthcare. Launching the campaign in the old Richmond Hospital in April, I was proud to see international nursing experts speak alongside nurses from Ireland – including student nurse Roisin O’Connell, intellectual disabilities nurse Ailish Byrne, and Shirley Ingram, an ANP in cardiology. The launch event heard from Elizabeth Adams, president of the European Federation of Nurses, Dame Christine Beasley, Nursing Now board member, and Howard Catton, interim CEO of the Interna- tional Council of Nurses. This could not be occurring at a more opportune time for this campaign, as Ireland’s nurses and midwives clearly need to develop a strong voice in our health service and in the coming reforms. EFN General Assembly, Brussels While things have been busy on the home front, the INMO continues to represent members internationally. The European Federation of Nurses (EFN) held its General Assembly in April in Brussels. One of the topics we focused on was the future of the European Nurses Research Foundation, founded in 2016, which is the research arm of the EFN. I represented the INMO on a working group to re-examine its business model and governance. We made recommendations to address previous concerns, which were agreed by the assembly. The EFN also agreed to share information about salary nego- tiations internationally, to improve practice across Europe. The EFN is in the process of nominating two directors, more details of which can be found on their website, with elections taking place on June 17 and 18. The EFN’s presidential elections are scheduled for October 2019 and the sitting president Elizabeth Adams (an INMO member) is eli- gible to run for a further two-year term. At the Brussels meeting, I expressed our thanks to the EFN for its support to striking INMO members in the recent industrial action, and update our international colleagues on the progress made since. Centenary delegate conference At the time of print, we are making the final preparations for our centenary delegate conference. The recent ballot results and strikes will no doubt feature heavily in dis- cussions. It will also be a time to reflect on our wider priorities as a movement, as we celebrate our 100th year. The health service and our workplaces have changed dramati- cally over the past century – and will clearly do so again in the coming one. Sláintecare, in particular, will change the form our health service takes. It is vital that nurses and midwives are at the centre of policy discussions around these changes. But some things do not change; our values remain clear and consistent throughout both centuries. Skilled, dedicated care for our patients is one for all nurses and midwives. Support for colleagues and belief in our collective, unified strength is another for any union member.

Quote of the month “The test of our progress is not whether we addmore to the abundance of those who havemuch; it is whether we provide enough for those who have too little.” - Franklin D Roosevelt

Report from the Executive Council

THE Executive Council met on a number of additional occasions this year on ear- lier dates than scheduled, largely due to the industrial dispute over recruitment and retention. But as they say the show must go on, so the Executive must also deal with the usual day-to-day organi- sational issues. At the time of going to print, we were engaged in the last stages of planning our centenary annual delegate conference (ADC). The Executive deliber- ated over the 34 submitted motions – 17 of which were on industrial affairs. Many of your branches and sections have met to discuss the motions, debate their contents, and select speakers. We will also have elections this year for the Standing Order committee, which is responsible for many of the ADC prepa- rations. All of this preparation took place against the backdrop of balloting across the country, at many hundreds of bal- loting meetings running from April 8 to May 1. This is a longer time frame than usual to allow as many votes as possible.. I would like to thank all the IROs, staff, Exec members and volunteer reps for their work in seeing this democratic exercise through. The next planned Executive Council meeting June 10-11. You can contact me at INMO HQ at Tel: 01 6640 600, through the president’s blog on or by email to: Get in touch

For further details on the above and other events see


INMO members vote by 62% to Result a direct result of the hard fight by nurses and midwives for patient

patient safety and staffing in a determined, controlled and collective manner. We are extremely proud of the safe, patient-focused strike organ- ised by our strike committees. “The government has com- mitted to full implementation of these proposals. We are now seeking an immediate meeting with them to ensure this hap- pens without delay. “I want to thank our pres- ident, officers and Executive Council for their tireless work

to look at pay for those in managerial grades • Increased location and qual- ification allowances and an expansion of allowances to those working in acute sur- gical and medical areas and midwives working in mater- nity services • Extra promotional opportuni- ties for nurses and midwives, including a commitment that 2% of the nursing/midwifery workforce will be advanced practitioners

• Supports for professional development and education. INMO nurses and midwives took strike action for three separate days – January 30, February 5 and 7. Once the final proposals were agreed, voting was held in workplaces across Ireland, run- ning from the April 8 to May 1, with the ballot count taking place in INMO HQ on May 2. INMO general secretary Phil Ní Sheaghdha said: “INMO members fought hard for

INMO members have voted to accept the Labour Court pro- posals offered to resolve their industrial dispute earlier this year. The ballot count returned a result of 62% in favour of the proposals, which include meas- ures such as: • A commitment to safe staff- ing levels, based on patient dependency • A new, higher salary scale for staff nurses and midwives • An independent expert group

Cottage Hospital, Drogheda


Rotunda Hospital

accept Labour Court proposals safety and safe staffing levels

and brave decisions throughout this dispute. I would also like to thank our colleagues in other unions for their solidarity – especially Patricia King in ICTU, who gave us great assistance. We are also grateful to the Labour Court and the Work- place Relations Commission for their considerable efforts to resolve this dispute. Finally, I would like to thank the public who showed Ireland’s nurses and midwives such support during our strike days.”

South InfirmaryVictoria University Hospital


University Hospital Limerick needs to heed the lessons of Mid Staffordshire

lessons from Mid Staffordshire are applied at University Hos- pital Limerick. Florence Nightingale’s guid- ing principles stated that the first job of any healthcare professional is to ensure the patients are safe and well cared for. Limerick nurses are speak- ing out for patients to ensure they are well cared for and insisting the senior managers in the HSE and Department of Health address these concerns. The failure of management to appropriately manage the hos- pital and comply with national agreements makes it an impos- sible environment for nursing staff to ensure that patients are safe and well cared for. Furthermore, it is clear and INMO members have outlined that patients are trying to avoid attending UHL by instead presenting at South Tipperary General Hospital or Galway University Hospital. Practice nurses report that GPs and practice nurses have lengthy debates with patients when they indicate they wish to refer them to the acute facility. There must now be a review of the standards of govern- ance and performance within University Hospital Limerick. When patients and staff are articulating their concerns about the provision of care within this facility, then the political system as well as health service management must pay attention and take appropriate action. If they do not then they have not learned the lessons of Mid Staffordshire and patients’ lives and the health, safety and wellbeing of staff are at risk. The Minister for Heath and the director general of the HSE must take action now to address these matters. – Tony Fitzpatrick, INMO director of industrial relations

The INMO wrote to the Oire- achtas Committee on Health recently to outline grave con- cerns about a combination of issues at University Hospital Limerick. This followed the INMO highlighting concerns about industrial relations problems in the hospital at the National Joint Council in March and also raising the matters at the Health Service Oversight Body last month. The s e p rob l ems cen t re around the failure of hospital management to comply with the Protection of Employees (Information and Consulta- tion) Act 2006 and subsequent health service/trade union agreement around engage- ment and consultation. The hospital management is disre- garding the provisions of this agreement and also the terms of the Public Service Stability Agreement on such matters. The INMO has also high- lighted the significant clinical risk that exists within the hos- pital as a result of severe overcrowding. In recent weeks the number of patients on trol- leys in the hospital reached 81, which is a new record. This overcrowding ensures that the emergency depart- ment is packed full of admitted patients awaiting appropriate inpatient beds. Furthermore, the hospital places additional trolleys on inpatient hospital wards, creating a risk through- out the hospital. The nationally agreed Esca- lation Policy requires that when the Full Capacity Pro- tocol is utilised, ie. trolleys placed on a ward, the hospital must prioritise de-escalation immediately. However, the reality in Limerick is that hos- pital management is now using trolleys on wards as part of its normal bed capacity and the

Lessons from Mid Staffordshire

The Report of the Mid Staf- fordshire NHS Foundation Trust Public Inquiry 1 identified numerous warning signs which could and should have alerted the system to the serious fail- ings in healthcare that took place at the Trust. The report made many recommendations, with the essential aims to: •  Foster a common culture shared by all in the service of putting the patient first •  Develop a set of fundamental standards, easily understood and accepted by patients, the public and healthcare staff, the breach of which should not be tolerated •  P rov i de e v i den c e - ba s ed means of compliance with these fundamental standards which can be understood and adopted by the staff who have to provide the service •  Ensure openness, transpar- ency and candour throughout the system about matters of concern •  Make all those who provide care for patients – individuals and organisations – properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service •  Provide a proper degree of accountability for senior man- agers and leaders to place all with responsibility for protect- ing the interests of patients on a level playing field •  Enhance the recruitment, education, training and sup- port of all key contributors to the provision of healthcare, in particular those in nursing and leadership positions, to integrate the essential shared values of the common culture into everything they do.

Tony Fitzpatrick, INMOdirector of IR: “The practices at UHL are putting patients at risk as well as affecting the health, safety and wellbeing of nurses working there”

hospital has failed to de-es- calate in the past two years. This is putting patients at risk as well as affecting the health, safety and wellbeing of nurses working in those areas. In addition, as part of the Full Capacity Protocol, day service areas and the medi- cal assessment unit are also being used to accommodate admitted patients while, at the same time, expect- ing staff to continue to run operating lists. Again, this is creating significant risks and is not appropriate for the safe provision of care. The clinical director of the hospital astounded mem- bers of the INMO recently when he was reported in the media as stating that there was no clinical risk within the department as a result of this overcrowding. The INMO and its members met with public representatives for the area in Dáil Eireann last month to outline the need for action on Limerick University Hospital. An external industrial relations and clinical review of the hos- pital is needed. It is the clear view of the nursing staff that University Hospital Limerick is Ireland’s Mid Staffordshire waiting to happen, if action is not taken. The INMO is seeking that the


Launching the Nursing Now Ireland campaign in the Richmond Education and Event Centre last month were (l-r): Ailish Byrne, intellectual disabilities nurse with Muiriosa Foundation; Phil Ní Sheaghdha, INMO general secretary; Shirley Ingram, advanced nurse practitioner,Tallaght Hospital; Steve Pitman, INMO head of education and professional development; Elizabeth Adams, president, European Federation of Nurses Associations; Dave Hughes, INMO deputy general secretary; Dame Christine Beasley, trustee of the BurdettTrust for Nursing; Martina Harkin-Kelly, INMO president; Howard Catton, CEO, International Council of Nurses; Edward Mathews, INMO director of professional and regulatory services; and Roisin O’Connell, student nurse atWaterford Institute ofTechnology

Nursing Now launched in Ireland Global campaign calls for greater government investment in nursing

they have a particular role in developing new models of community-based care and supporting local efforts to promote health and prevent disease. The INMO is leading the campaign in Ireland in partner- ship with University College Cork and Dublin City Univer- sity. The patron for Nursing Now Ireland is Sr Stanislaus Kennedy, a visionary who has p i o n e e r e d , c amp a i g n e d , explored and developed a range of inspiring social inno- vations to benefit thousands of people who have experienced exclusion in its many forms. Nursing Now is a three-year global campaign organised in collaboration with the Interna- tional Council of Nurses (ICN) and the World Health Organi- zation (WHO). Nursing Now is run by a campaign board com- prising nurses and non-nurses from 16 countries. The cam- paign is a programme of the Burdett Trust for Nursing, with the Duchess of Cambridge as the international patron. Nursing Now is based on the findings of the WHO’s Triple Impact report, which concluded that as well as improving health globally, empowering nurses would contribute to improved gender equality – as the vast major- ity of nurses are women – and build stronger economies.

Nursing Now, a global cam- paign to improve health by raising the status of nursing, was launched in Ireland last month. The worldwide campaign aims for the recognition of nurses’ contribution to health- care, gender equality, wider society and improved econo- mies. Its aims include: • Greater investment in nursing • More nurses in leadership positions • Increasing nurses’ input and impact on healthcare. The campaign is bringing to policy makers the tangible evidence needed to show that nurses improve health and will make a crucial contribution to realising universal health coverage. The launch of the Nursing Now Ireland campaign took place at the Richmond Educa- tion and Events Centre on April 25, 2019. The audience heard how the health challenges of the 21st century cannot be overcome without strengthen- ing nursing. Speakers outlined how it is time to give nurses more recognition, investment and influence. Nurses are at the heart of most health teams, play- ing a crucial role in health promotion, disease preven- tion and treatment. As the health professionals who are closest to the community,

Pictured above (top): INMO president Martina Harkin-Kelly and director of professional and regulatory services Edward Mathews cut the cake to launch Nursing Now Ireland campaign. (lower pic, l-r): Fiona Hannon, student nurse, UCC; Neal Donohue, INMO student and new graduate officer; Sarah Collins, student nurse, UCC; and Roisin O’Connell, student nurse, WIT

Nu r s i n g Now c a l l s o n governments to invest in imp rov i ng nu rs e s ’ wo r k- ing conditions, training and leadership skills to enhance health, empower women and strengthen local economies. Opening the launch of the campaign in Ireland INMO president Martina Harkin-Kelly said: “Patients and health staff can tell you – nurses are con- sistently undervalued. Nursing

Now aims to change that, demonstrating the incredible work that nurses do worldwide. Not only are we the lynch- pin of health services, nurses are a driving force in ensuring healthy lives and promoting wellbeing around the world.” Welcoming the guests and global speakers to the event, INMO director of professional and regulatory services Edward Mathews said: “Nursing and


Alsoatthelaunchwere(l-r):ChristineMcDermott,ANPneonatology,Rotunda Hospital;KarenBrennan,ANPemergencydepartment,SouthTipperaryGeneral Hospital;and DanielaLehwaldt,assistantprofessorand internationalliaison, SchoolofNursingandHumanSciences,DublinCityUniversity

Ibukan Oyedele, staff nurse, Cherry Orchard Hospital, at the Nursing Now Ireland launch

Howard Catton, CEO, International Council of Nurses

ICN CEO; Elizabeth Adams, president of the European Fed- eration of Nurses Associations (EFN); and Dame Christine Beasley, Nursing Now board member and trustee of the Bur- dett Trust for Nursing. There were also three pres- entations to showcase the work and contribution of nurses from: • Ailish Byrne, senior staff nurse (RNID) with the Muiriosa Foundation, who spoke about the role of nurses in caring

for people with intellectual disabilities • Shirley Ingram, advanced nurse practitioner at Tallaght Hospital, who provided an out- line of her role as a specialist in chest pain and assessment • Roisin O’Connell, student nurse (intern) at Waterford Institute of Technology, who outlined her experience as student nurse and her expec- tations and hopes as a nurse. Running until the end of 2020, the bicentenary of

Florence Nightingale’s birth and the WHO Year of the Nu rs e , t he Nu rs i ng Now campaign aims to improve perceptions of nurses, enhance their influence and maximise their contributions to ensur- ing that everyone everywhere has access to health and healthcare. F o r f u r t h e r i n f o r m a - tion visit or www. nu rs i ngnow. o rg o r follow the campaign on social media.

nurses in leadership are chang- ing the face of healthcare delivery in Ireland and world- wide. Innovative and effective developments in nurse-led and delivered healthcare are improving health outcomes and delivering more economic healthcare. Fundamentally, nurses are improving lives, our society and economies and we can do more when nurses are empowered to do their job.” Global speakers at the launch included: Howard Catton,


Trolley crisis plumbs new depths Worst-ever April for overcrowding in Irish hospitals – INMO

• University Hospital Galway, 683 • South Tipperary General Hos- pital, 623 • Tallaght University Hospital, 566. INMO general secretary Phil Ní Sheaghdha said: “This is the second month in 2019 where more than 10,000 patients have been forced to wait with- out a bed. The crisis is without question worsening.

“Overcrowding hits two main groups directly: those who depend on public health services and those who work in them, providing the safest care that they can in these conditions. “We started the trolley count ove r a decade ago becaus e o f unac cep t ab l e overcrowding. The problem has more than doubled since then.”

More than 10,000 admitted patients were made to wait without beds in Irish hospitals last month – the highest ever figure for April, according to the INMO trolley/ward watch (see Table 1). T h e mo n t h l y a n a l y s i s revealed that a total of 10,229 admitted patients, including 106 children, were left without beds on trolley or chairs, repre- senting an 8% increase on April

2018 and a 125% increase on April 2006 – the year INMO trolley/ward watch analysis began. University Hospital Limer- ick once again recorded the highest trolley figures in the country with 1,206 patients waiting on trolleys or chairs (see also page 10 and 16) . The other hospitals hardest hit in April were: • Cork University Hospital, 826

Table 1. INMO trolley andwardwatch analysis (April 2006 – 2019)

Apr 2006

Apr 2007

Apr 2008

Apr 2009

Apr 2010

Apr 2011

Apr 2012

Apr 2013

Apr 2014

Apr. 2015

Apr 2016

Apr 2017

Apr 2018

Apr 2019


Beaumont Hospital

283 133 306 272 121 215 337 425

350 135 415 100

758 298 590 225 210 559 722 35

784 313 421 382 278 200 498

812 163 496 194 148

534 352 233 377 157 138 462 476

624 338 321 109 170

753 716 387 158 124 297 450 434

546 318 148 190

646 517 413 269 385 355 309 n/a

732 245 356 307

134 156 437 246 238 192 327 n/a

178 346 415 390 258 391 451 n/a

452 237 524 432 277 328 566 n/a

Connolly Hospital, Blanchardstown

Mater Hospital

Naas General Hospital St Colmcille’s Hospital St James’s Hospital

62 53

n/a 89

n/a 80



St Vincent’s University Hospital

431 247

440 628

426 196

162 261

443 372

Tallaght Hospital


National Children’s Hospital,Tallaght Our Lady’s Children’s Hospital, Crumlin TempleStreetChildren’sUniversityHospital

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a

n/a n/a n/a



39 54

48 51

Eastern total















Bantry General Hospital Cavan General Hospital Cork University Hospital









19 24

27 11


61 19



324 344 226

165 285

307 551

159 297 48 n/a 44 46 49 n/a 15 19 n/a 20 34 46 45 n/a 104 305 171 311

186 523

448 484

295 543

222 440 137 230 258 440 105 171 n/a



199 826 420 272 251 208 197 313 n/a

380 343

289 299


658 320

890 254

Letterkenny General Hospital Louth County Hospital Mayo University Hospital Mercy University Hospital, Cork


55 46


32 n/a 48

55 n/a

41 n/a


4 5




n/a 89

n/a 94

171 132

148 110


198 116 283 11 89 23 n/a n/a 57 92 n/a 566 254 161

176 182 371 200 256 n/a n/a n/a 35 43 n/a 486 170 173 293 377 557 301 106 55

198 188 468 166 172

157 281 367 313 466


134 104

159 214 112 167

228 256 244 326

312 378 223 459

Midland Regional Hospital, Mullingar Midland Regional Hospital, Portlaoise Midland Regional Hospital,Tullamore Mid Western Regional Hospital, Ennis

4 8

17 29

17 52


n/a 42



53 18 n/a n/a


44 16 n/a

49 n/a n/a

51 n/a n/a

17 n/a

22 n/a

20 n/a 13


13 n/a 59

n/a n/a

Monaghan General Hospital Nenagh General Hospital


52 n/a




Our Lady of Lourdes Hospital, Drogheda



221 101


498 137




296 156

135 108 135 388 571 576 576 174 n/a


Our Lady’s Hospital, Navan

19 39 66

34 27 65 23 21 n/a




50 18 n/a


Portiuncula Hospital

48 87 85


65 87



73 n/a


Roscommon County Hospital Sligo University Hospital South Tipperary General Hospital St Luke’s Hospital, Kilkenny University Hospital Galway University Hospital Kerry University Hospital Limerick University Hospital Waterford Wexford General Hospital








166 176 155 512 801 203 264 88

323 229 269 470 120 544 172 206

408 561 273 587

140 493 319 410 143 649 393 163

446 623 411 683 238

77 n/a


58 n/a

39 57





399 116 171














186 101

222 111 287


620 317







80 55


386 131








Country total

2,463 4,555

1,533 3,326

2,926 6,323

2,270 6,157

2,403 5,355

3,907 6,636

3,599 5,854

4,966 8,285

4,547 6,261

4,966 7,860

5,610 8,145

5,469 7,199

6,906 9,433
















107 106

Of which were under 16

Percentage increase/decrease:  2018 compared to 2019: 8% 2014 compared to 2019: 63% 2010 compared to 2019: 91% 2006 compared to 2019: 125% 2017 compared to 2019: 42% 2013 compared to 2019: 23% 2009 compared to 2019: 66% 2016 compared to 2019: 26% 2012 compared to 2019: 75% 2008 compared to 2019: 62% 2015 compared to 2019: 30% 2011 compared to 2019: 54% 2007 compared to 2019: 208%


Limerick sees 81 on trolleys – highest ever daily count

World news

Nurses and midwives in action around theworld Australia • ANMF Tasmania formerly rejects latest state government wage offer Bahamas • Nurses and government at an impasse Canada • Minister of Health agrees with nurses on overtime • Mandatory overtime: 27-year-old nurse gives her account of burnout • Striking public health nurses rallying for new employer mandate Kenya • No pay increase for nurses as talks end Northern Ireland • Northern Ireland nurse crisis branded ‘public safety issue’ Portugal • Government approves specialist nurses. Union suspends strike for three days Spain • Nurses at General Hospital denounce risk of infection in ICU • Chuvi suspends non-priority surgeries due to a lack of available nurses UK • Nurses should be prepared to take industrial action to defend safe staffing levels US • US nurse shortages and the fight for better staffing ratios • Legislation improving hospital patient safety passes Senate Health Committee • Can community paramedicine provide relief to crowded emergency rooms? • RCN president tells of confronting bullies as student nurse

the day. This is the worst-ever figure we’ve recorded in an Irish hospital. “This comes less than a week after a 17-bed ward in UHL was shut. The beds that have been closed in UHL need to be reo- pened immediately. “We are calling on the Min- ister for Health to intervene and deal with the chronic over- crowding in the hospital as an urgent matter of patient and staff safety.” The INMO has launched an on l i ne pe t i t i on , c a l l - ing for the closed ward to be reopened and for bed capacity and staffing at the hospital to be increased, see: reopen-the-closed-beds-in- university-hospital-limerick

The I NMO r e c o r d e d 8 1 patients waiting for a bed at University Hospital Limerick on Wednesday, April 4, 2019 – the highest-ever daily figure recorded in an Irish hospital, according to INMO trolley/ ward watch. This record number took place just days after UHL management closed a 17-bed ward at the hospital, which the INMO said contributed to the problem. Five days after the ward was closed, there were 52 patients waiting in UHL’s emergency department and a further 29 on trolleys on hospital wards. INMO reps met with TDs from Limerick and the Mid- West to raise the overcrowding and understaffing problems at

UHL on April 9, 2019. INMO I RO i n L ime r i ck , Mary Fogarty said: “Staff and patients were under intoler- able pressure in Limerick on INMO IROMary Fogarty: “Worst-ever figure came less than a week after a 17-bed ward was shut by management in UHL”

Lobbying LimerickTDs on UHL overcrowding: The INMOmet withTDs from Limerick and the Mid-West in Dáil Eireann last month to outline the need for urgent action on Limerick University Hospital. Pictured were (l-r): TomNeville,TD, Fine Gael; Mary Fogarty, INMO IRO; SiobhanThornton, INMO rep UHL; Claire Burke, INMO rep, UHL; Willie O’Dea,TD, Fianna Fáil; Tony Fitzpatrick, INMO director of industrial relations; Ann Noonan, INMO Executive Council member who is a staff nurse at UHL; Maurice Quinlivan,TD, Sinn Féin; and Niall Collins,TD, Fianna Fáil

Parental leave reinstated for member

leave scheme, which offers two weeks’ leave and benefit to spend with their new babies during their first year. Ultimately, parents will be able to benefit from seven weeks’ leave each under the scheme as it develops incre- mentally over the next three years. – Mary Power, INMO IR O

negotiated by the INMO and granted to the Kerry-based member last month. Members who experience issues such as this in the work- place are urged to contact their local IRO. From this November, all new parents in employment in Ireland will be able to avail of a new national parental

An INMO member who had been denied continuation of her parental leave on suc- cessful appointment to a promotional position, has been successful in having it reinstated. After a protracted nego- tiation period, a revised but acceptable reinstatement of the parental leave was


This year marks 100 years of the INMO’s good service to the professions of nursing and midwifery , writes Dave Hughes

100 years of progress

first programme, run by the then Irish Nurses Union, was held in the old Richmond Hos- pital, which the INMO now owns and from which the Pro- fessional Development Centre provides a full range of post registration education. Patient advocacy has always been seen as a key function of the nurse and midwife. The INMO is a leading voice for patient advocacy in this country and daily, for almost two decades, has highlighted the scourge of long waits for patients in emergency depart- ments for access to a hospital bed. Highlighting the problems of the health service and the difficulty for patients including mothers and their children has not always been popular, but the Organisation and its mem- bers have never flinched from making the case for the most vulnerable in our society. In 2018 the INMO formed a partnership with the Royal College of Midwifery (RCM), strengthening the links between midwives in Northern Ireland and the Republic and deliver- ing access for INMO midwives to the educational, library and eLearning resources of the RCM. When the original 20 nurses gathered in 1919, the world was in turmoil following the First World War. Ireland was increasingly revolutionary since the 1916 uprising. Nurses and midwives working in Eng- lish hospitals at the time were paid substantially higher than in the voluntary hospitals in Ireland. Many married nurses and midwives saw their hus- bands go to war and faced the economic necessity of getting a better salary for their labour. The spirit of trade unionism and combining to improve their lot has been demonstrated in national campaigns, but only

twice in its 100-year history has the Organisation had to resort to a full national strike of nurses and midwives. In 1980, when Charles Haughey was Minister for Health, nurses and midwives took part in what became known as The Big March, protesting at the low level of their incomes. The Minister for Health settled with the nurses, and the media promptly dubbed the profes- sions ‘Charlie’s Angels’. Wage pressures again in the 1990s saw a campaign running from 1994 which cul- minated in a national nursing and midwifery strike in 1999. The outcome of that strike her- alded the implementation of the report of the Commission on Nursing, which had been established to avoid an earlier threatened strike in 1996. The Commission’s report with 200 recommendations became the blueprint for nursing and mid- wifery into the 21st century. Nursing and midwifery were severely impacted by the eco- nomic recession which almost broke the country in 2008. It left in its wake austerity meas- ures which saw the number of nursing and midwifery posts reduced by 5,000. An embargo on recruitment up to the end of 2013 ensured that most graduating nurses and mid- wives emigrated for work and out of economic necessity. This resulted in 20,000 nurses, midwives and newly qualified graduates leaving the country. That decrease in numbers, combined with the growing demand for health services and the inability of the Irish public health service to recruit and retain nurses and midwives, brought the INMO to the second national strike in its 100-year history in 2019. The action involved three days

The INMO, this year, cel- ebrates a centenary as the premier organisation repre- senting nurses and midwives in the Republic of Ireland. Professional regulation and registration in Ireland were first legislated for midwives in 1918 and for nurses in 1919. In that same year a group of 20 nurses combined to sow the seeds for what has grown into the 40,000 strong Irish Nurses and Midwives Organisation today. Originally a branch of the Irish Women Workers’ Union, it quickly grew and developed into the Irish Nurses Union. The first secretary of the union was Marie Mortished. Today the INMO is also led by a registered nurse – Phil Ní Sheaghdha, general secretary. The Organisation has always represented both nurses and midwives but the advent of direct entry to the midwifery profession led to the chang- ing of the name to encompass mi dw i v e s , w i t h t h e I NO becoming the INMO in 2008. Prior to that midwives were nurses in the first instance and, following further study and practice, became midwives. The history of the Organ- isation demonstrates that the professions have only progressed when nurses and midwives combined to put pressure on governments to recognise their value to soci- ety. The INMO has developed far beyond the original objec- tives of simply dealing with conditions of employment for nurses and midwives. As far back as the 1930s it lobbied for post registration education. After three years of pressure on government it was granted permission to provide the first week-long post-registration educational course for nurses and midwives in 1938. That

over two weeks and a public rally which garnered massive support. Ultimately that pres- sure brought the government to the negotiating table. The Labour Court intervened and recommended a set of propos- als which the Organisation is optimistic will, if accepted by members, turn the tide in terms of the ability of the Irish public health service to recruit and retain sufficient numbers of nurses and midwives to provide safe care for the population. The INMO represents most nurses and midwives in the Irish public and private health sectors. It is the internationally recognised organisation for Irish nurses and midwives and holds the presidency of both the International Council of Nurses and the European Fed- eration of Nurses in 2019. The Organisation, by provid- ing a comprehensive education and professional development centre as well as workplace representation and legally qualified defence, aims to cater for the needs of nurses and midwives from their com- mencement as students for the rest of their days. Irish nurses and midwives are the backbone of the health service and the INMO provides a voice for them, not only in their own interests, but also in the interests of their patients. 2019 marks a century of good service to the professions. Dave Hughes is deputy general secretary of the INMO

Section News 19

INMO celebrates two pioneering International Section members

In light of the 100th anniver- sary, the INMO International Section would like to honour two pioneering members, Bolatito Aderemi and Lina Ducao, for their contribution to the health service and the nursing profession in Ireland. Ms Aderemi has been instru- mental in recruiting many international members since joining the INMO in 2004, and Ms Ducao is a former dean of the College of Nursing in the Philippines who served as advi- sor to two past chairpersons of the Section. Bolatito Aderemi Bolatito Aderemi arrived in Ireland in 2002, recruited from Nigeria by the South West- ern Health Board, to work as a senior staff nurse. She was a pioneering member of the International Section and recruited many international nurses and midwives working in Ireland to join the INMO. Through her hard work and passion for the Organisation, the International Section was firmly established. As well as her role as section officer, Ms Aderemi is also an INMO workplace rep and was

Bolatito Aderemi (left) arrived in Ireland in 2002 and joined the INMO in 2004 – recruited by Phil Ní Sheaghdha; and Lina Ducao (right) is a former nursing college dean, chapter president of the Philippine Nurses Association, advisor of College Red Cross Youth and College Brotherhood of Nurses

treasurer of the Dublin South West Branch for a number of years. She has faced many challenges but takes her role seriously and actively encour- ages international nurses and midwives to join the INMO. She has visited many hospi- tals and nursing homes across Ireland with general secretary Phil Ní Sheaghdha, meeting and supporting her colleagues. She likens her role as local rep to being “the eyes and ears of the wider membership” as she keeps INMO management informed of members’ needs. We would like to honour Ms Aderemi for her contribution to the growth and development of the Section. Lina Ducao In March 2000, follow- ing a discussion with an Irish

started in May 2000, an influx which helped to address staff shortages in the hospitals and nursing homes. Ms Ducao was also asked a bou t qu a l i f i c a t i on s fo r healthcare assistants and submi t t ed qua l i f i ca t i ons and course descriptions for midwives, health aides and graduate nurses (without Philippines Nursing Licensure Examination). Many of these qualified to work as HCAs and were offered jobs in Ireland. Ms Ducao is now a clinical nurse manager at a nursing home in Kildare where she has worked for almost 20 years. She was planning to retire this year but due to staff shortages and her love of nursing, she has decided to continue to practise and care for the elderly. Date change: ODNSection The Operating Department Nurses Section conference will now take place on Sat- urday, November 30, 2019 in the Richmond Educa- tion and Event Centre. The price of attendance is €85 for members and €120 for non-members. The first 50 people to book will be entered into a draw to win a free place at next year’s con- ference, so please book your place early. To make your booking online, please visit

missionary priest serving as chaplain at a hospital in the Philippines about the short- age of nurses in Ireland, Ms Ducao submitted documen- tation to the NMBI (then An Bord Altranais) to assess the educational qualification and related learning experiences of Filipino registered nurses. The process of getting an NMBI decision letter and travel visa was quicker at that time. Employers from a group of Irish nursing homes and hospitals travelled to the Phil- ippines to interview hundreds of nurses. They offered jobs to many of them and facilitated their access to travel visas and clinical adaptation pro- grammes in Irish hospitals. The first wave of migration of Filipino nurses to Ireland

Retired Section visits JFK homestead

Around 25 members of the INMO Retired Nurses and Midwives Section enjoyed a four-night break in Dungarvan recently.They visited different places of interest each day, including Mount Mellery,Lismore,the Dunbroady famine ship in New Ross and the homestead of John F Kennedy (pictured above).They also visited a scenic part of the Gaeltacht inYoughal.The trip was part of a busy social committee calendar for 2019,which also includes a day trip to Athlone onTuesday,May 21 and a visit to Airfield Estate in Dundrum onThursday,June 20.Details of how to get involved are available on the INMO website –

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