The decision of the state's 27,000 nurses to accept the Labour Court formula to settle their dispute will be broadly welcomed. Inevitably the leaders of some public service unions have begun to stake out claims for their members, based on the nurses' settlement. If such expectations become widespread they could spell the beginning of the end for Government pay policy and, with it, Partnership 2000. The director general of the Irish Business and Employers' Confederation (IBEC), Mr John Dunne, has voiced his concern that the successful nurses' claim should not provide "a springboard for other groups in the public service to seek similar special treatment".
The more thoughtful trade union leaders will be telling members that few groups of workers share the unique features that made the nurses such a formidable force. Not only did nurses have the will to engage in a national strike - born out of a deep sense of grievance - but they had the capacity seriously to disrupt essential services. They also had enormous public sympathy for their cause. Everyone, including the Government, recognised that the nurses had a very special case.
The profession has, of course, changed radically over the past 20 years. At one time nurses were little more than hand maidens to the medical profession. As doctors freely admit, nurses now perform tasks they themselves are incapable of performing with the same level of expertise. But nurses are also making beds and performing other duties which have long been carried out by less skilled staff in other health services.
The promised nursing commission provides an opportunity for the role of nurses to be fundamentally reassessed outside the adversarial atmosphere of the industrial relations arena. All nurses are not the same and all nursing duties are not the same. There is a need to create structures that recognise the special expertise of nurses in areas like theatre or intensive care, and the higher stress levels of those working in casualty wards and on night duty.
The commission also needs to look at career structures within nursing. In some ways the Labour Court settlement has added to the problem. The latest pay rises for staff nurses have seriously eroded the pay differential of ward sisters and higher management grades. There is already little to attract nurses to posts of responsibility beyond the challenge of the job itself. In the long term nurses, as a profession, will pay for the lack of career structures. It means that many of the best potential managers will not apply for promotion, or will leave nursing.
In Britain, career structures have been put in place for nurses at ward level. They are rewarded for having extra qualifications or performing onerous duties. But at a higher level in the health hierarchy, professional managers, usually men, are replacing nurses. As a consequence nursing remains one of the lower health professions. Doctors, a predominantly male profession, have always insisted on their right to be involved in health management. They have argued that health managers need clinical knowledge if they are to make informed decisions. The same argument surely applies to nurses.
Nurses have emerged from the present conflict with enhanced confidence and self esteem. Hopefully the commission can ensure these new assets are channelled constructively to refashion the profession for the benefit of all.