Aftermath of nurses' strike

Sir, - Silence in the face of a 95 per cent strike vote by nurses is the easy course for doctors

Sir, - Silence in the face of a 95 per cent strike vote by nurses is the easy course for doctors. However, physicians have a primary duty to act in the best interest of their patients. As patient advocates, consultants and GPs are ethically precluded from withdrawing from the care of the sick. Despite this, doctors have taken strike action in Ireland and in other countries. The strike issue has split the medical profession and led to the formation of the Irish Hospital Consultants' Association, which has a no-strike constitution. Caring for the sick is a privilege and doctors are generally well paid in Ireland. Medicine for many doctors is a vocation as well as a profession. For many, like myself, it is a consuming interest.

There is a moral issue involved in refusing care to the infirm. To knowingly inflict predictable physical and psychological hurt on the ill by the withdrawal of labour should never be undertaken lightly by any healthcare worker. Clearly, nurses considered their pay and conditions at work so intolerable that they felt a strike was appropriate. Only 5 per cent demurred, despite a 23 per cent pay rise over two years. The suggestion that no-one in authority had taken the nurses grievances seriously is absurd. However, it was blindingly obvious that as soon as academic pursuits replaced practical nursing as the initial training for nurses, dissatisfaction with the primacy of the fundamental caring and humane role of nursing would follow. This has happened.

The changes in nursing practice must be publicly debated. If nurses intend to practice medicine, relationships with the medical profession will change profoundly. It may well be cheaper to have nurse practitioners replace doctors in many areas. Some countries are heading in this direction, but whether this will prove acceptable to Irish patients remains unknown.

The development of specialist training for nurses in areas of hospital practice has been necessary. For example, in intensive and coronary care, dialysis, labour wards and special care baby units, the nurse's role is critical and is grossly undervalued in pay terms. It may be necessary to redefine these nurses as clinical technicians to allow them appropriate remuneration. However, the consultant who prescribes the patients' treatment must remain in charge and is responsible for setting down unit policy and treatment protocols.

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Layers of bureaucracy have been interposed widely within the Irish Health Service. There should be much greater public accountability for the activities of all within the service. Have hospital managements been in some way responsible for the exodus of nurses in some institutions? Claims that junior doctors are so unpractised that they lack skill in phlebotomy or in the insertion of intravenous lines, if true, should be corrected. Payment for health care is a societal issue as is its inevitable rationing. Politicians have a responsibility to properly value caring as a contribution to our well-being. Public opinion supports a higher relativity for carers.

The status of nurses in society and hospitals was much higher than might be deduced from their incomes. The strike has diminished that status and has altered relationships.

During the strike, why were public hospital general outpatient departments closed? There are no nurses in private clinics. The clerical staff remained available to retrieve case notes. The closure decision was not taken by consultants and private hospitals remained unaffected.

The warm humanity of the caring nurse must be preserved. It was the hallmark of Irish nurses in the past. Cultural dinosaurs like myself think that there are other, less lethal ways to redress grievances. - Yours, etc.,

Dr Bill Tormey, Glasnevin Avenue, Dublin 11.