WIN October 2019

WIN World of Irish Nursing & Midwifery is distributed to more than 40,000 Irish Nurses & Midwives Organisation members. It is published monthly (10 issues a year).

CONTENTS 3

News &views 5 Editorial

48 Family focus

A lack of understanding of family-centred care is a barrier to its implementation

We must keep applying the pressure in order to improve members’ working conditions and build a better health service, writes Phil Ní Sheaghdha, INMO general secretary INMO president Martina Harkin-Kelly rounds up news from the Executive Council and beyond 8 News INMO calls for multi-annual funding for Sláintecare from Budget 2020… Post-Brexit recruitment drive likely to hit Ireland… Solidarity with climate activists… Enhanced salary scale now applies… Trolley watch… WRC issues set of proposals for difficulties at St Patrick’s, Kilkenny… WRC hearing on students’ reflective practice issue…Talks on formation of union/management forum at Technological University Dublin Plus: Opinion by Dave Hughes, page 21 Plus: Section news, page 23 Your industrial relations queries answered 26 Cover story Freda Hughes talks to the founder of a company aiming to alleviate the stress of a hospital stay 28 Research focus A summary of the recent research activities of the Center for eIntegrated Care 29 Nursing Now focus This month, WIN focuses on Shirley Ingram, an ANP in cardiology 30 Leadership focus Rosemarie Sheehan describes her journey through a HSE programme designed to develop healthcare leadership 7 From the president 35 Students & new graduates Neal Donohue updates graduates on important information regarding pay Features 25 Questions and answers

50 Pharmaceutical focus

Access to Medicines Ireland is committed to ensuring much needed medicines are fairly priced, writes Ciara Conlon

52 Workplace focus

Kathleen Kinsella discusses coping with menopause symptoms at work

Clinical 55 Nutrition in pregnancy

Midwives can influence the health of pregnant women and their babies through nutrition advice, writes Eileen O’Brien

57 Breastfeeding

Measuring the milk supply of breastfed babies can help reassure concerned parents

59 Dermatology

Survey finds that 40% of households affected by atopic eczema report that the condition has an impact on finances

61 Diabetes

WIN takes a look at some recent diabetes research

63 Gastroenterology

A case of a paediatric patient with treatment-resistant Crohn’s disease

65 School nurses

Audiology screening by specialist school nurses is more cost effective than other referral sources, writes Pauline Roche

Living 67 Book review

Max Ryan reviews Kitchen Confidential by Anthony Bourdain Plus: Monthly crossword competition

69 Finance

Ivan Ahern on creating a financial plan and when you should ask for help

Jobs & Training 37 Professional Development

33 Education focus

Pull out section from INMO Professional

A look at a new CPD module from RCM i-learn on tuberculosis in pregnancy

74 Diary

Listing of meetings and events 75 Recruitment & Training

46 Quality and safety

Maureen O’Flynn looks at how nurses are using technology to lead quality care

Latest job and training opportunities

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: e 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.

On the cover this month: Nurse and INMO member Maeve Kinsella, page 26

EDITORIAL 5

No pressure, no progress

Journalof the Irish Nurses and Midwives Organisation

World of Irish Nursing & Midwifery

(ISSN: 2009-4264) Volume 27 Number 8 October 2019 WIN, MedMedia Publications, 17 Adelaide Street, Dun Laoghaire, Co Dublin. Website: www.medmedia.ie

“No pressure, no progress.” This is a line from the recent book on the INMO’s first 100 years and the backing track to nursing and midwifery issues for the past decades. The HSE and wider government can be a slow-moving machine, resistant to forward planning and slow to make changes. All members will doubtlessly share the frustra- tion at just how slow that machine can be. But with pressure there can be progress. And thanks to the pressure of 40,000 nurses and midwives standing together in their union, we are making progress. New graduates faced serious difficul- ties in securing the full-time, permanent contracts which the Minister for Health had pledged. Issues remain in three work- places, but thanks to INMO pressure and representation, we have ensured that well over 1,100 graduates have received what they were promised and what our under- staffed service needs. We will continue to apply pressure until every single qualified graduate gets a full offer. The implementation of the strike set- tlement has shown a similar pattern. The HSE has stalled, the departments of Health and Public Expenditure have debated, and progress in implementation has been hin- dered by attempts to undo the gains you achieved. We have not tolerated this. We have relied on the strong recommenda- tion of the Labour Court and reverted to the Court to prevent any dilution. This has resulted in HSE instructions to offer higher-paid contracts to staff nurses and midwives, increase existing allowances by 20% and roll out allowances to maternity services, PHNs who don’t get allowances now, and surgical and medical areas. All of that will be backdated to March 1, 2019. FromNovember, staff nurses andmidwives with 17 years or more experience can access the senior staff nurse/midwife increment, whichwill mean basic pay exceeding €50,000 – before allowances and premiumpay. Recent figures obtained via Freedom of Information, show that between 2015 and 2019, 1,800 nurses and midwives were victims of assault in HSE hospitals. That is inextricably linked with staffing levels, overcrowding and underinvestment. The real figure is far higher, as many cases go

unreported and the figures do not include vol- untary, Section 39 and community services. This is part of the reason that 40,000 nurses and midwives sought funding for safe staffing in the strike. This again is now being rolled out. Following much pressure, draft implementation documents have been issued to the INMO, confirming a rollout of the Safe Staffing Framework to medical, sur- gical and emergency areas in – initially – the nine Model 4 hospitals. Once complete, that will continue to Model 2 and 3 hospitals. The staffing systemwill come with a new IT system for monitoring staffing and patient load, a specific budget line in the HSE, an oversight group to implement, and eight new safe staffing co-ordinators. Furthermore, the safe staffing framework will now apply to the community and elderly care. This is a signifi- cant issue for our members in these services, which are traditionally very understaffed and difficult to recruit to. We will continue to apply pressure – to lobby, campaign, meet, debate, publicise and protest – to improve the working conditions of our 40,000 members and to support a decent health service. That means working to end the government’s destructive and counterproductive recruitment pause, which wreaks havoc with careers, leaves services understaffed, and endangers patients – while increasing agency and litigation costs. We have had some success breaking pieces off the pause and securing appointments, but it is clear that the policy must go in its entirety across nursing and midwifery. Progress also means working through our strike settlement line by line, ensuring that every hard-won piece is implemented in full. It also means looking at the wider national context, which our pre-Budget submission covers. Be in no doubt that this union will continue to work on your behalf, combining the power and knowledge of 40,000 skilled, trained, respected professionals to achieve change. No pressure, no progress.

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

Commercial director Leon Ellison Email: leon.ellison@medmedia.ie 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 (michael.pidgeon@inmo.ie) Freda Hughes (freda.hughes@inmo.ie) 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: inmo@inmo.ie Website: www.inmo.ie

www.facebook.com/ irishnursesandmidwivesorganisation

Phil Ní Sheaghdha General Secretary, INMO

twitter.com/INMO_IRL

Your priorities with the president

Martina Harkin-Kelly, INMO president

Care of Older Persons nursing conference The COOP Section’s annual conference, which had been postponed due to the industrial action, took place on September 10. The conference focused on the dementia epidemic, which affects so many of our older citizens. The speakers presented their evidence-based insights into improving care for such patients, which can be a particular challenge for frontline nursing staff. The conference also looked at the issue of sexuality in older person’s care – an issue which is sadly often ignored. The conference heard from representatives of LGBT Ireland along with speakers from the HSE. The day concluded with a session on com- plementary therapies for older people, including a ‘meeting’ with Mylo, a companion robot aimed at averting loneliness and improving companionship (see page 23) . After years in practice as a nurse, I left them with the following advice: never falter, believe in what you can do and the difference you can make, stay true to your profes- sional values and remember that learning is a lifelong mission. Centenary celebrations 2019 is, of course, the INMO’s 100th year, and we are planning to conclude the year in a number of ways, which were recently discussed by the National Centenary Commit- tee in early September. The Irish Patchwork Society and several INMO members are progressing with a tapestry to mark the union’s centenary. The design is by artist Robert Ballagh, with the intricate work being done in panels by the talented stitchers. The ban- ner will reflect the importance of the branches and sections, the four corners of Ireland where our members work, and our proud, international, multicultural workforce. If any member wishes to get involved in the project, please get in touch with HQ. There will be a celebratory event on November 28, which branches and sections will be contacted about in the coming weeks. The event will include the Nurse and Midwife of the Year Awards – I encourage members to get submissions in before October 31, via the INMO website. Finally, many local branches will be working with local councils and elected represent- atives to host civic receptions across the country, to recognise the incredible dedication and work of Ireland’s nurses and midwives. This is not only a celebration of our work, but also a chance to maintain our strong political profile. Planning for winter Fail to plan: plan to fail, or so I was led to believe in the family in which I was reared. The HSE is yet to publish a winter plan for 2019, to deal with the usual increase in demands on our health service in winter. The problems previously confined to winter have become a year-round issue. The impact falls heavily on frontline staff in the health service, who continue to work to keep their heads above water. This is simply not a safe environment for patients or members alike, given the high number of vacancies across the whole health service – from hospital wards to the community. That is why this union will con- tinue to pursue safe staffing levels, an end to the recruitment ban, and curtailment of services until that is achieved. Graduate symposium I was delighted to speak with the next generation of nurses and midwives at our grad- uate symposium in September. I aimed to motivate, but in turn found that I left with a renewed faith in our mission, thanks to the opportunity to talk with so many enquiring minds and fresh additions to our professions. I reminded them of the words of Roisin O’Connell, a recent graduate nurse who spoke at this year’s annual delegate conference: “Each and every Irish nurse is worth their weight in gold if not more”.

Quote of the month “Management is doing things right; leadership is doing the right things” - Peter Drucker

Report from the Executive Council

The National Executive most recently met on September 2 and 3, as ever, dealing with a mix of internal, profession and national issues. Union management updated the Execu- tive on the ongoing attempt by the Revenue Commissioners to remove tax entitlements for nurses and midwives, relating to uni- forms and uniform cleaning costs. Revenue bizarrely contend that “the laundry of a uniform does not arise in the actual perfor- mance of the duties of a nurse”. Needless to say, this is being robustly contended by the INMO. There was discussion about the HSE’s fail- ure to offer all graduate nurses and midwives contracts. The union has had success across the country in overturning this policy, with well over 1,100 permanent contracts issued. At time of going to press, there remain some issues, but officials are confident that they can be overcome. We also filled the vacant student post on Executive and I would like to welcome Corrinne Rushe as the student nurse repre- sentative on the Executive. She is a welcome addition. The Executive also supported Trade Union Friends of Palestine (TUFP), which is hosting a conference in Dublin in November. This will focus on the suffering of Palestinian children. The next Executive Council meeting will be held on October 7/8, 2019. You can contact me at INMO HQ at Tel: 01 6640 600, through the president’s blog on www.inmo.ie or by email to: president@inmo.ie Get in touch

For further details on the above and other events see www.inmo.ie/President_s_Corner

8 NEWS

INMO calls for multi-annual funding for Sláintecare from Budget 2020

undermine recruitment and retention initiatives. The INMO and the ICTU have made numerous submissions to Rev- enue on its position in relation to flat rate expenses, pointing to other areas that warrant greater attention such as cor- poration tax losses. The union also warned of the threat of Brexit to nursing and midwifery recruitment and retention. “Ireland is experi- encing a significant increase in the intensity of determined recruitment of nurses and mid- wives. The current recruitment pause introduced by the HSE must be removed and must exempt nurses and midwives,” the submission states. In addition, the INMO called for an increase in the number of undergraduate nursing and midwifery places. “This coun- try must become self-reliant with regard to training and retaining Irish trained nurses and midwives in our public health service, the INMO said. “This increase must, as a min- imum, grow the number of midwives, and resources to fully implement the safe staffing framework, as agreed following the INMO strike earlier this year. INMO general secretary Phil Ní Sheaghdha said: “Ireland’s nurses and mid- wives are prime targets for UK health service recruiters. After Brexit, it’s likely that British hospitals will step up their efforts to draw more nursing and midwifery staff away. “Even before Brexit, the vast majority of our graduating

seeking budgetary provision for the full implementation and expansion of this model across acute, primary and long-term care. This will require invest- ment to correct the current nursing and midwifery staffing numbers. In addition the INMO said that the government must now implement a sustainable workforce strategy to ensure Ireland can rectify the current nurse and midwife staffing problems in the public health service and compete within an international labour market for healthcare professionals. The INMO called for no changes to be made to the cur- rent flat rate allowances as has been announced, which allow employees to claim back on work-related expenses such as uniforms for healthcare pro- fessionals. This change would in effect reduce the income of frontline nurses and midwives, thereby penalising them to a greater extent at a time when the pay is being restored for all public servants, and would New figures from an INMO student survey show that, as of June 2019, over 68% of nursing and midwifery students have been approached by overseas recruiters. When asked for the main factors that might keep them wo r k i ng i n I re l and , 47% pointed to staffing levels and working conditions. The INMO’s pre-Budget submission calls for fund- ing to reach safe staffing levels throughout the health service, more undergrad- uate places for nurses and

undergraduate placements and see an increase of 250 by 2020 and a further 250 by 2021.” T h e I NMO s u bm i s s i o n detailed the staffing increases needed in the areas of: • Midwives, where a shortfall of 206.7 WTE staff currently exists in Irish maternity services • Children’s nurses, with the new National Children’s Hospital alone needing an increase of a minimum of 300 nursing posts over the next two years • Public health/community health nursing, in which Sláin- tecare has identified the need to invest in a further 900 gen- eralist nurses to work in the community. The INMO submission also calls for Budget 2020 to make allowances for several taxation and societal issues, including broadening the tax threshold, Brexit, climate change and housing. The full INMO Pre-Budget Submission 2020 can be viewed at: www.inmo.ie nurses and midwives have r e c e i v e d o f f e r s t o wo r k overseas – often in better conditions. “We need to make the Irish health service an attractive place to work – that means getting staffing levels right. “The upcoming Budget is a chance to kickstart that process, by investing in safe staffing, more student places, and implementing Sláintecare. The alternative is understaffed, overstretched services, where patients suffer and staff burn out.”

Budget 2020 must prioritise the delivery of an integrated, universal health service, as envisaged in Sláintecare, the INMO stressed in its pre- Budget submission to the government last month. To do this, the government must ensure appropriate fund- ing and staffing, which in turn will ensure high quality, safe patient care. Multi-annual transitional funding must commence from Budget 2020 to support the implementation of Sláintecare, the INMO states. On nursing and midwifery staffing and pay, the INMO is calling for a commitment to a funded workforce plan for nursing and midwifery, based on patient need and depend- ency. This is recommended in the Labour Court Recom- mendation and set out in the Department of Health’s Frame- work for Safe Nurse Staffing and Skill Mix and the Maternity Strategy for adequate nursing and midwifery staff. In addition, the INMO is The UK is likely to step up its recruitment of Ireland’s nurse and midwives following Brexit, the INMO warned in its pre- budget submission. UK ho s p i t a l s cu r ren t ly recruit nurses and midwives from across the European Union, but this is likely to become more difficult as migration controls are put in place following Brexit. The Common Travel Area for Ireland and the UK means that Irish nurses and midwives will be “prime targets” for UK health recruiters.

Seven in 10 nursing/midwifery students offered overseas posts Post-Brexit recruitment drive likely to hit Ireland

NEWS 9

Solidarity with climate activists

The INMO joined the youth- led and organised Global Climate Strike on Friday, Sep- tember 20. Students across the world took part in what has been described as the largest climate protest in history. Standing in solidarity with the young activists, the INMO took part in this action in Ire- land along with ICTU and many other Irish trade unions. In its pre-Budget submission to the government, the INMO said: “It is imperative that the government pushes forward on its Action Plan on Climate Change, including the transi- tion to a low carbon economy and investment research and development funding for alter- native energy sources.” However, it also stressed the need for a commission on just transition to “ensure real, valued

alternative jobs for sectors and communities depending on tradi- tional carbon-driven industries.” Pictured at the protest (right): are Ruairi Shelley and his daughter Lua Rose,with Caoimhe Kerins and her daughter Síofra

Masterclass for Directors of Nursing, Midwifery and Public Health Nursing and Assistant Directors of Nursing, Midwifery and Public Health Nursing INMO section members

‘Reflecting and looking forward: current and future direction of nursing and midwifery in Ireland’

Wednesday, October 30, 2019 Venue: INMO, The Richmond Education and Event Centre, North Brunswick Street, Dublin D07 TH76

Outline of Day Time

Topic

Speaker

11.00am: Opening Address

Martina Harkin-Kelly, INMO President Sinead McClelland, CEO NMBI Paul Reid, Secretary General, HSE

11.15am: Current and Future Direction of the Nursing and Midwifery Regulator 11.50am: Current and Future Development from the Perspective of the Health Service Executive 12.30pm: Developments in Undergraduate Nursing and Midwifery Education in Ireland

Times: 11.00am - 2.00pm Followed by Afternoon Tea

Professor Josephine Hegarty, Head of School of Nursing and Midwifery, UCC Edward Mathews, INMO Director of Professional and Regulatory Services

FREE TO INMO MEMBERS

Nursing Now Ireland and the International Year of the Nurse and Midwife 2020

1.10pm:

2.00pm: Afternoon Tea

www.inmoprofessional.ie

To book a place email: linda.doyle@inmo.ie or call 01 6640641

10 NEWS

Over 1,300 nursing and midwifery posts now vacant in acute hospitals “Recruitment ban has got to go,” says INMO

As trolley figures once again hit record high levels at Uni- versity Hospital Limerick, the INMO has called on the HSE to make a high-level intervention. With 81 admitted patients waiting without a bed at the hospital on Monday, Sep- tember 23, 2019 – a number which matches the record-high number of trolleys recorded in any hospital in the country, which also occurred in UHL on April 3, 2019 and July 11, 2019. UHL is consistently the most overcrowded hospital in the country, with over 10,000 waiting without beds in 2018 and, as we went to press, the hospital was set to record its worst September on record. In excess of 1,300 funded nursing and midwifery posts are being left vacant in Ire- land’s acute hospitals due to the HSE’s recruitment ban, recent figures from the INMO revealed. Across staff nursing and midwifery in acute hospi- tals, 7% of funded posts were vacant, with 1,251 vacancies out of 17,623 posts. There are also 66 unfilled nurse/midwife management roles in acute hospitals, bringing the total number of vacant posts to 1,317. In addition, there are 420 vacancies in the commu- nity health services, which covers care of the elderly, public health and intellectual disability. Midwifery staffing is being hit the hardest, with one in six (17%) of funded staff mid- wife posts now vacant: 284

2019, the number of midwives had gone down to 1,403. The INMO points to the HSE’s recruitment “pause” as the key driver of unfilled posts. The union has met with the HSE to call for curtailment of services until staffing reaches safe levels. The recruitment pause has been used as a reason not to offer graduating nurses and midwives full-time, permanent posts. However, following inter- vention by the INMO, over 1,100 students have now been offered contracts, with officials working to resolve the issue in the remaining workplaces where problems remain. INMO general secretary Phil Ní Sheaghdha said: “The figures are stark: the govern- ment is refusing to fill frontline healthcare posts. “Make no mistake: this will

on a n o r d i n a r y Mond a y. “It’s time for direct, high- l e v e l HS E i n t e r v e n t i o n . Services should be curtailed immediately to clear this overcrowding. “At the root of this is under- staffing. There are 100 unfilled nursing posts at the hospital, and the HSE is not allowing management to recruit grad- uating nurses and midwives. The recruitment ban has got to go. “Our members are looking to winter with a sense of dread. If this is what’s happening in temperate months, things can only get worse as accidents and illnesses increase in colder weather.” lead to compromised patient care and staff burnout. “Midwifery is being hit particularly hard by the gov- ernment’s recruitment ban. One i n s i x pos t s a re l e f t vacant. Even if we filled all of these posts, we would still fall far short of the safe staffing levels promised by the government. Midwifery vacancies disproportionately affect women. This is yet another unwelcome example of government’s approach to women’s health. “The recruitment ban has got to go. It breaches agree- ments with the INMO, drives up agency costs, puts frontline staff under extra pressure, and puts patients’ lives at risk. “Until we can get staffing up to safe levels, we are calling on the HSE to scale back services and close many non-essential wards.”

INMOgeneral secretary Phil Ní Sheaghdha: “The figures are stark: the government is refusing to fill frontline healthcare posts”

vacancies in a workforce of 1,687. In 2017, the HSE had pledged to increase the number of mid- wives from 1,409 by 210 by the end of 2018 to ensure safety levels. However, as of July

Call for direct, high‑level HSE intervention at UHL

The INMO has called on the HSE to make a high-level inter- vention at the hospital to: • Curtail services to clear the overcrowding • End the recruitment ban, which has led to 100 unfilled nursing vacancies in UHL alone • Immediately offer full-time, permanent contracts to grad- uating nurses and midwives, many of whom have still not been offered roles at UHL • Open a review into the ongo- ing trolley overcrowding at the hospital. INMO assistant director of industrial relations Mary Fog- arty said: “This is a matter of public safety – 81 patients on

trolleys is what you’d expect after a natural disaster, not INMO assistant director of IR Mary Fogarty: “At the root of the overcrowding is understaffing. There are 100 unfilled nursing posts in UHL and the HSE is not allowing management to recruit graduating nurses and midwives”

Nursing/midwifery salary scales as at September 1, 2019

Incremental point

Student nurse/midwife/intellectual disability Staff nurse/midwife (post qualification, pre-Registration)

14,688 (degree students 36 weeks rostered placement)

25,538

Staff nurse/midwife

29,860 31,654 32,734 33,951 35,487 37,019 38,546 39,866 41,189 42,506 43,824 45,119

LSI after three years on max

46,501

Senior staff nurse/midwife

48,736

Enhanced nurse/midwife dual qualified nurse/midwife

36,433 38,728 39,952 40,895 41,933 43,315 44,661 46,643

LSI after three years on max

48,027

Senior enhanced nurse/midwife dual qualified nurse/midwife

50,337

Clinical nurse/midwife manager 1

45,969 46,811 48,000 49,207 50,397 51,594 52,929 54,172

Clinical nurse/midwife manager 2/ specialist

49,914 50,741 51,439 52,582 53,843 55,081 56,320 57,714 59,010

(plus allowance of €801 pa payable on a red-circle basis to theatre/night sisters who were in posts on 5/11/'99)

Clinical instructor

52,081 52,923 53,547 54,705 55,872 57,131 58,397 59,662 60,924

Clinical nurse/midwife manager 3

57,436 58,572 61,446 62,576 63,712 64,863

Nurse tutor

58,747 59,545 60,339 61,139 61,936 62,735 63,528 64,329 65,127 65,924

Principal nurse tutor

61,611 62,774 63,835 67,151 68,311 68,354 69,682 71,462

Student public health nurse

33,738

Public health nurse

48,636 49,441 50,130 51,215 52,462 53,671 54,888 56,256 57529

(plus allowance of €1601 pa payable on a red-circle basis to staff who were in posts on 5/11/’99)

Asst dir of public health nursing

57,439 60,595 61,892 63,087 64,294 65,946

Director of public health nursing

75,408 77,694 79,987 82,376 84,569 86,862

Advanced nurse practitioner

57,991 59,113 60,197 63,523 64,571 65,787 66,924 68,054 71,466

Advanced nurse practitioner candidate

57,436 58,572 61,446 62,576 63,712 64,863

Asst dir of nursing band 1

57,991 59,113 60,197 63,523 64,571 65,787 66,924 68,054 71,466

Asst dir of nursing non band 1 hospitals

55,072 56,246 57,440 60,595 61,892 63,087 64,294 65,945

Director of nursing band 1

76,919 79,058 81,200 83,334 85,471 87,616 89,752

Director of nursing band 2

71,557 73,498 75,445 77,384 79,334 81,278 83,223

Director of nursing band 2a

71,005 72,226 73,450 74,669 75,893 77,112 78,335

Director of nursing band 3

67,106 67,530 68,969 70,395 71,816 73,248 74,669

Director of nursing band 4

62,703 64,601 66,491 68,390 69,219 71,060 72,898

Director of nursing band 5

58,658 59,928 61,196 62,462 63,729 65,003 66,272

Area director – nursing and midwifery planning dev unit Director – nursing and midwifery planning dev unit

80,912 83,330 85,724 87,777 90,065 92,401 94,703

73,716 75,707 77,900 80,310 82,952 85,665

Director centre of nurse education

67,446 68,496 70,540 72,585 74,629 76,674 78,718 80,849

Hospital group director of nursing and midwifery

99,863 104,301 108,739 113,175 117,615 122,053

Enhanced salary scale now applies In IR Update this month, Tony Fitzpatrick, INMO director of industrial relations, urges members to check their payslip

to withdraw or curtail due to understaffing. However, no answer was forthcoming. The INMO warned Saolta management that they should be “gravely concerned” due to the high levels of missed care, delayed care and poor patient outcomes arising from the number of nursing and mid- wifery vacancies. The union estimates there are more than 200 such vacancies in the Saolta group alone. Anne Burke, INMO IRO for For example, if you were due an increment on October 1, 2019 and you are currently on point 5 of the salary scale, you will go to point 6 on the staff nurse/midwife scale and then migrate onto the enhanced nurse/midwife scale. The application process involves completing the HSE HR form, which is attached at appendix 2 of the circular. The form must be signed by your director of nursing/midwifery and your local HR unit. Assimilation to the enhanced nurse/midwife salary scale will occur on an individual’s incre- ment date and is subject to submission of a completed and signed contract to the local HR department. The contract is the contract that was suc- cessfully negotiated by the INMO further to the Labour Court Recommendation. The INMO has prepared a full com- parison document of present contracts of employment, to the proposed contract which is available on www.inmo.ie . There has been some misin- formation circulating about the probationary period. Please be clear that in section 3.3 of the

Galway, Mayo and Roscom- mon, said: “There are 64 staff nurse vacancies in UH Galway and a further 20 in Mayo UH. Understaffing like this is a recipe for disaster. We provided management with specific examples of missed care and impacts on patients, but services have still not been cur- tailed to ensure safe staffing.” Maura Hickey, INMO IRO in the North West, said: “Nurses and midwives are struggling daily to deliver safe care in Senior staff nurse/midwife Those eligible for senior staff nurse/midwife status should apply as normal in September and October each year. Eligi- bility for senior staff nurse/ midwife status is now at 17 years, rather than 20 years. Therefore, as a result of the eligibility period being three years shorter, individuals with 20 years, 19 years, 18 years and 17 years service are eligi- ble to apply for the senior staff nurse/midwife this year. Those meeting the qualifying criteria contract, it clearly states that “where you have already com- pleted a probationary period with the employer or have completed 12 months tem- porary employment with the employer, no period of proba- tion applied to this contract of employment”. To be clear, assimilation onto the new enhanced nurse/ midwife salary scale occurs on everyone’s increment date. Assimilation will be to the near- est cost point upwards on the enhanced nurse/midwife salary scale immediately thereafter on that date. Individual increment dates will not change.

unsafe environments. Other hospitals have closed beds due to unfilled vacancies – it’s time for a similar approach in the Saolta group.” Dean Flanagan, IRO in the Midlands, said: “Nurses and midwives in Portiuncula UH are in a critical situation. The hospital is often crammed full, while patients and staff await a new unit to be built. Bed clo- sures in Tullamore hospital will only increase the pressure on Portiuncula.” Public health nurses, com- munity RGNs and community RMs currently in receipt of a specialist qualification allowance, should see that allowance increase by 20% to €3,350 per annum. Members should check their payslip to ensure that they have received retrospective payment of this increase back to March 1, 2019. PHNs not currently in receipt of a specialist qualification allowance are now entitled to a location allowance worth €2,230 retrospective to March 1, 2019. specified in section 1.2 of the contract will be entitled to go on to the senior enhanced nurse/midwife salary scale. The national circulars have been issued to payroll depart- ments, therefore your local line managers and HR departments should be implementing these. If you require any clarification or need any assistance, do not hesitate to contact the INMO at Tel: 01 664 0600. Community allowances Several circulars have issued by the HSE to implement the settlement terms further to the recent INMO strike.

INMO officials have warned that understaffed services must be curtailed for safety reasons in several hospitals in the Saolta University Health- care Group. The a f fe c t ed ho s p i t a l s include Galway, Letterkenny, Mayo, Merlin Park, Portiuncula, Roscommon, and Sligo Univer- sity Hospitals. INMO officials met with senior hospital group man- agement to establish which services the group planned HSE HR circular 022/2019 implements the enhanced nurse/midwife salary scale. This applies retrospectively to March 1, 2019 and therefore, individu- als who have progressed on the increment scale since March 1, 2019 and who have reached the fourth point of the staff nurse/midwife salary scale should apply to go on to the enhanced nurse/midwife scale. Staff whose increment dates are due should ensure to apply for the enhanced scale. The process is that you would move from your current point on the scale to the next point on the staff nurse/midwife scale and migrate onto the enhanced nurse/midwife scale at the next upward point. All grades of nurses and mid- wives received a pay rise of 1.75% on September 1, 2019. Members are advised to ensure they are being paid correctly – see opposite page for the updated salary scales. In recent weeks, the HSE issued two circulars which allow implementation of the two Labour Court Recommen- dations and strike settlement secured by the INMO.

Alarm at unsafe understaffing at Saolta hospitals

14 NEWS

Recruitment ban at the core of now year-round dangerous overcrowding

– but only a 20% increase on August last year, as figures this high are fast becoming the norm. The daily national trolley figure was also higher every day in August than the same day in 2018, with a 28% higher average daily total. The hospitals with the high- est figures in August were: • University Hospital Limerick – 1,197 patients • Cork University Hospital

figures signal an even more dangerous winter, when extra demands are typically placed on hospitals. “At the core of the prob- lem is staffing, as there are well over 1,300 nursing and midwifery vacancies in Ire- land’s acute hospitals. This is no time for recruitment bans. Vacancies need to be filled so that patients get the care they need. The HSE’s recruitment ban has got to go.”

– 1,051 patients • University Hospital Galway – 655 patients • South Tipperary General Hos- pital – 597 patients • University Hospital Waterford – 561 patients. INMO general secretary Phil Ní Sheaghdha said: “This is the tragic ongoing reality in Ireland’s health service. To see nearly 10,000 patients on trolleys is bad in itself, but this is a summer month. These

More than 9,500 admitted patients were forced to wait without a bed in Irish hospitals in August, according INMO trolley/ward watch analysis. The total figure of 9,562 – of which 48 were children – is the highest ever recorded in the month of August. The record-breaking total represents a 197% increase on August 2007, a 167% increase on August 2006 – the year INMO trolley records began

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

Aug 2006

Aug 2007

Aug 2008

Aug 2009

Aug 2010

Aug 2011

Aug 2012

Aug 2013

Aug 2014

Aug. 2015

Aug 2016

Aug 2017

Aug 2018

Aug 2019

Hospital

Beaumont Hospital

408 259 315

713 255 487

520 152 385 199 145 174 354 237

504 359 354 292

596 354 333 221 126

304 386 328

508 464

490 271 285 230 165 191 188 n/a

678 364 218 273 101 335 395 n/a

335 138 316

265 187 436 304 117 134 381 n/a

177 260 288 266

Connolly Hospital, Blanchardstown

162 197 206

241 489 331

Mater Hospital

82 40 47

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

68 42 41

2122

95 n/a

96 31

171

n/a 99

n/a 75

120 271 319

104

108 284 121

St Vincent’s University Hospital

385 227

545 399

509 457

587 335

432

289 330

387 390

Tallaght Hospital

47 n/a n/a n/a

357

National Children’s Hospital,Tallaght Our Lady’s Children’s Hospital, Crumlin Temple Street Children’s University Hospital

n/a n/a n/a

n/a 14 11

10 34

Eastern total

1,456

2,077

2,335

2,166

2,602

2,629

1,793

1,676

1,820

2,364

1,397

1,824

1,734

2,049

n/a

n/a 42

15 27

68 67

37 13

Bantry General Hospital Cavan General Hospital Cork University Hospital

n/a

216 319 330 131 90 16 31 94 13 n/a 23 56 12 n/a 76 94 29 n/a 5 301 77 2 34

141 189

263 329

177 272

168 453

382 418

142 151

228 261

149

115 152

399 235

473 128

457 241

604 359

1,051

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

24 n/a 28 69

35 12 64 38

36 n/a

70 n/a

32 n/a

409

n/a 15

n/a 10

n/a

126 117

109 137 109 20 77 24 n/a n/a 13 32 n/a 604 277 153

105

175 243 254 287 290 20 n/a n/a 35 40 n/a 391 144 470 197 400 148 610 291 101

114 256 391 260 452

118 183 304 215 431

115 333 203 114 244

108

122 178 100 22 n/a n/a n/a 36 45 n/a 81 165 166 139 146

130 410

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

2 8 2 9 4

5 7 7

264 125 89 20 n/a n/a 93 97 n/a 24 776

149

71 26 n/a n/a

169 n/a n/a n/a 33 48 n/a 71 82 84 346 319

267

17 17 n/a

23 n/a n/a 57 67 25 34 33 n/a 289 256

n/a n/a n/a

n/a n/a

20 n/a 40 89

n/a

Monaghan General Hospital Nenagh General Hospital

n/a 91 34 10 70 82 n/a 55 32 n/a 13 9 123

Our Lady of Lourdes Hospital, Drogheda

293

236

680

192

Our Lady’s Hospital, Navan

50 62

56 49 n/a

164

106 129

Portiuncula Hospital

52 n/a 90

162

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

14 13 52 n/a

106 140

n/a

158 115 255 458 108 618 159

264 342 365 619 300 969 435 220

416 597 455 655 266

489 432 643 170 835 486 197

238

232

554

195

85 25

105

186

342

247 120

224 180

458

1,197

561 286

293

189

344

140

490

135

Country total

2,242 3,698

1,142 3,219

1,780 4,115

1,877 4,043

2,322 4,924

3,995 6,624

2,622 4,415

2,237 3,913

2,828 4,648

4,154 6,518

4,739 6,136

5,957 7,781

6,202 7,936

7,513 9,562

NATIONALTotal

Of which were under 16 48 Percentage increase/decrease: 2018 compared to 2019: 20% 2014 compared to 2019: 106% 2010 compared to 2019: 94% 2006 compared to 2019: 159% n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 30

2017 compared to 2019: 23% 2013 compared to 2019: 144% 2009 compared to 2019: 137% 2016 compared to 2019: 56% 2012 compared to 2019: 117% 2008 compared to 2019: 132% 2015 compared to 2019: 47% 2011 compared to 2019: 44% 2007 compared to 2019: 197%

NEWS 17

WRC issues set of proposals for difficulties at St Patrick’s, Kilkenny Problems relate to rostering and stepping back from promotional posts

of 8, 9, 10, 11 and 12 hour shifts can apply to any roster, but each roster should incorpo- rate a reasonable mix of these, subject to a maximum of eight shifts per fortnight. This will apply on a pro-rata basis for those on reduced hours as is the norm.” Post-2017 contracts Staff employed after March 2017 will also be encompassed by t he ro l l i ng p red i c t i ve element of the roster, irre- spective of being employed on contracts requiring them to work a maximum of five shifts a week. In addition, in the event of 39-hour contracts becoming available in the future, staff on post-2017 contracts of 30 hours per week will be given first offer of increasing their existing contracts to 39 hours per week. Stepping back/down from promotional posts In relation to ‘stepping back/down’ from promotional posts in the service, manage- ment committed at the WRC

to reviewing the role of team leaders in the service “in the context of full de-congrega- tion and stabilisation” of the service. The unions have insisted that such a review be a joint exercise involving the three unions representing staff in St Patrick’s Centre, and focusing on the workload of the team leader posts in the context of the previously agreed team leader job description. Speaking on the matter, INMO IRO Liz Curran said: “This WRC outcome addresses some of the long-running issues in dispute in St Pat- rick’s Centre, particularly with regards to rostering arrange- ments and contracted hours for part-time staff. “A joint general meeting of the INMO, SIPTU and FORSA members was held on Septem- ber 10 to discuss the proposals with staff in St Patrick’s Centre, and a ballot on the propos- als will be held in the coming weeks for INMO members working at the centre.”

A number of issues of dispute in St Patrick’s Centre, Kilkenny were jointly referred to the Workplace Relations Commis- sion by the INMO, SIPTU and FORSA trade unions, who rep- resent members at the centre. Among the long-running issues in dispute are roster- ing arrangements, ‘stepping back/down’ from promotional posts, and matters relating to part-time contracts for staff employed since 2017 in the service. A conciliation conference was held on June 17, 2019 and the WRC issued proposals on August 19, 2019. Rostering arrangements These proposals commit management and unions to adhering to the Roster Toolkit which was agreed in the ser- vice in 2018, including the consultation process included therein. This is important as members had been reporting that management was not consulting appropriately with them in relation to rosters prior to the WRC hearing. Mater Private pay increase The INMO sought payment of the 1.75% increase for its members in the Mater Private Hospital from Sep- tember 1, 2019 in line with the Public Service Pay Agree- ment (PSSA). The Organisation has now received confirmation from the hospital that the pay- ment has been approved. It is expected that the increase will be paid to members shortly. – Albert Murphy, INMO IRO

Liz Curran, INMO IRO: “TheWRC outcome addresses some of the long-running issues in dispute”

It was also proposed that, for staff employed prior to March 2017, management in St Patrick’s Centre will draft eight-week ‘rolling predictive rosters’ which will mean that “the first week of a roster rolls over onto the ninth week of the roster”. In addition, theWRC propos- als state that “a combination A very successful Basic Rep Training course was held for INMO activists in Cork and Kerry on September 17-18, 2019. “Members said the training course was both relevant to them and met their require- ments to represent local members and potential mem- bers of the Organisation. With enthusiasm they headed back to their workplaces to encour- age local activism, and update and share information with colleagues. They look forward

Rep training for Cork and Kerry activists

to attending more INMO train- ing events,” said Mary Power INMO assistant director of industrial relations, who ran

the course with colleagues Dave Hughes, deputy general secretary, and Liam Conway, IRO in the region.

NEWS 19

WRC hearing on students’ reflective practice issue

News update

• Workplace Relation Com- mission: Recently in the Longford area the INMO has been successful in ensuring that a member had her substantive post recog- nised and returned to same after covering a period of extended maternity leave. This was a good outcome and it was supported and underpinned by the WRC. If you are in a similar position please contact the INMO to progress the issue. • St Hilda’s, Athlone: The INMO remains engaged with a number of issues in St Hilda’s Services, Ath- lone and will be meeting management again in early October to discuss the pro- posal to change sick leave. This is being undertaken with the WRC and local workplace representatives have been present at all engagement to date. • P o r t i u n c u l a U n i v e r - sity Hospital: The INMO r e c e n t l y u n d e r t o o k a survey in relation to pay periods in the hospital and is currently collating the answers to formulate a claim regarding pay periods which are predominately pa i d mon t h ly. We wi l l update members in due course regarding same. • New 50-bed unit at Por- tiuncula: The INMO has undertaken a lobbying exer- cise with local politicians in relation to the status of the new 50-bed unit in Porti- uncula University Hospital. The Organisation has also met with representatives of the SAOLTA Group on progress of the proposed new unit, which is hoping to begin a rollout shortly. – Dean Flanagan, INMO IRO

compliance with the spirit of the WRC agreement. The WRC process has been adjourned to allow for detailed consideration of documenta- tion by both parties and will be reconvened in the coming weeks. Student Officer Neal Dono- hue commended the students of the Daughters of Charity for raising this issue through the industrial relations process and reiterated how important it was for students to be aware of their entitlements and to be active in the INMO.

an opportunity for students to reflect on their practice and improve their learning experience. Among other things it was argued that the inclusion of routine mandatory orientation that is given to any employee does not constitute reflective practice time within the rele- vant definitions. David Miskell, INMO IRO for Dublin North East, said that protected time for internship students forms an integral part of the learning experience and it is essential that there is

A dispute over the issue of protected reflective time for student nurses at the Daugh- ters of Charity Services was heard recently at the Work- place Relations Commission. The matter relates to what is contended is the incorrect and insufficient allocation of pro- tected time of four hours per week for students undertaking internship placements. Protected reflective is part of an agreement reached under the auspices of the WRC in 2014 and covered by HSE Cir- cular 030-2009. It provides

Talks on formation of union/ management forum at TUD

first Technological University. Established in January 2019, it was formed by the amalga- mation of three Institutes of Technology in the Dublin area – Dublin Institute of Technol- ogy, Institute of Technology Tallaght and Institute of Tech- nology Blanchardstown.

Da v i d Mi s ke l l , I RO fo r Dublin North East, noted that this forum process will pro- vide an important voice for INMO members and ensure that issues relevant to the nursing profession in the new university are addressed appropriately.

Engagement on a terms of reference document for a union/management forum at Technological University Dublin (TUD) is ongoing. The forum will comprise a series of joint meetings and an INMO-specific series of annual meetings. TUD is Ireland’s

Tools for Safe Practice workshop

ATools for Safe Practice workshop was held in St Raphael’s Centre, Youghal, Co Cork last month. It was organised by local reps in the region and saw 22 INMOmembers attend from the East Cork area, including from St Raphael’s Centre, Youghal Community Hospital and Cois Abhainn CNU.

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