Ruddle Report: Intensive care nurses are poorly rewarded, writes Eithne Donnellan, Health Correspondent.
The main focus of the independent report into the death of Róisín Ruddle is the nursing shortage at Our Lady's Hospital for Sick Children in Dublin which resulted in her operation being postponed.
It is disturbing that the shortage of intensive care nurses that led to her heart operation being put off in June 2003 persists to this day.
And while the report does stress that significant efforts have been made in more recent times to rectify this deficit, it blames management for not addressing the problem or taking it more seriously at an earlier stage. There was "a lack of urgency" by management in "applying resources to it", the report found.
The hospital has had difficulties recruiting intensive care nurses as far back as 1996.
It is no coincidence that its difficulties coincided with a change in the way these nurses were being trained.
In the mid-1990s the system of direct entry to paediatric nurse training was abolished. A nursing degree was introduced and all those wishing to train as paediatric nurses must now first sit a four-year degree programme followed by an 18-month post-registration programme. At this point a nurse is entitled to be placed on the sick children's nurses register. And after that, if the nurse wants to train as a paediatric intensive care nurse, he or she will have to study for a further 18 months.
It takes nearly seven years to qualify and there are only 12 places available per year in the Republic to train as paediatric intensive care nurses.
The general secretary of the Irish Nurses' Organisation, Mr Liam Doran, has been highlighting nursing shortages for years and campaigning for measures to address the problem.
He says a further obstacle to general nurses going on to train as paediatric nurses is that they go back to the basic point in the nurses' pay scale and lose about €6,000 over the 18 months of their training programme. Not surprisingly, then, the number of general nurses seeking to become sick children's nurses is falling steadily.
And while at the end they will be rewarded with a €2,500 annual specialist nurse allowance, in the current climate of a worldwide shortage of intensive care nurses, this is a very small incentive.
Mr Doran points out that a registered children's nurse with paediatric intensive care qualifications could walk into a job paying up to $100,000 (€78,000) a year in the US. Here the maximum salary is €38,000 plus their specialist allowance for what can be a very stressful job.
Given the laws of supply and demand Ireland will have to offer more to these highly qualified nurses if operations aren't going to continue to be postponed by the State's largest children's hospital.
An expert report calling for a change in the way paediatric nurses are trained landed in the offices of the Tánaiste and Minister for Health, Ms Harney, in December. It advocates a new 4½-year degree programme for paediatric nurses and midwives from this year, which would mean they could avoid training as general nurses first.
A decision on the recommendations is awaited but this is not surprising given that it will cost money - up to €30 million over four years in capital funding and €5 million a year to run the courses.
The Ruddle report stresses that the shortage of specialist nurses, precipitated by the change in the way they are trained, was "predictable" and in fact known to both hospital management and the Department of Health in the mid-90s.
While the Tánaiste will need to take urgent steps now, questions must be asked as to why the matter has not been addressed in any concerted way up to now.
Had there been sufficient intensive care nurses in Crumlin on June 30th, 2003, to allow Róisín Ruddle's heart operation to go ahead, her chances of survival would certainly have been greater. However, there weren't sufficient nurses, and as is well known now, the little girl was sent home and died within hours.
The question remains how many more children will be put at risk before the shortage of intensive care nurses is addressed in a meaningful way.