WIN November 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).

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Vol 27 No 9 November 2019

Latest INMO CPD education

Journal of the Irish Nurses and Midwives Organisation

programme See page 33

World of Irish Nursing & Midwifery

Budget 2020 not the gamechanger needed page 8 Call for menopause support in workplace page 9

Palliative care for teens page 50

Benefits of mindfulness page 52

Evolution of care Special issue: ID nursing celebrates 60 years

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CONTENTS 3

News &views 5 Editorial

47 Midwife education

A look at a new CPD module from RCM i-learn on the use of epidurals in labour

The chronic lack of capacity in the health service must be addressed if Sláintecare is ever to be successfully implemented, writes Phil Ní Sheaghdha, INMO general secretary INMO president Martina Harkin-Kelly rounds up news from the Executive Council and beyond 8 News Budget not the ‘gamechanger’ the health service needs… Midwives are Brexit ready with all-Ireland partnership… INMO calls for greater support for women with menopausal symptoms… Issues discussed at the latest NJC forum… Members urged to check for all pay increases due… ‘Beyond unsustainable’: record numbers on trolleys… Most trolleys ever in an Irish hospital… CUH overcrowding and understaffing… Packed agenda for centenary celebration… Key issues addressed on advancing RNIDs’ role… Pressure against ‘employment control framework’… Tullamore beds closed due to recruitment pause Plus: Opinion by Dave Hughes, page 19 Plus: Section news, page 21

49 History

Laura Bambrick discusses the importance of recording living memories of the marriage bar

50 Children’s nursing

7 From the President

Tyrone Horne discusses the complex needs of teenage palliative care patients

52 Self care

Why mindfulness is not a luxury but a necessity for nurses and midwives

64 Update

Round up of healthcare news items

Clinical 55 Breastfeeding

Healthcare providers need to be more proactive from the outset to help women to breastfeed successfully

57 Diabetes

A look at research presented at the annual meeting of the European Association for the Study of Diabetes

59 Gastroenterology

Case study of a patient with ulcerative colitis who presented in ED

31 Students and new graduates

61 COPD

Neal Donohue updates readers on news for students and new graduates

WIN looks at the impact of this and other respiratory diseases on global health

Features 23 Questions and answers

Living 62 Finance

Your industrial relations queries answered

25 Cover story

Shop around before renewing health cover, suggests Ivan Ahern

Michael Pigeon talks to the RNID Section officers about life in ID nursing

63 Book review

26 RNID focus

Alison Moore reviews The Body: A Guide for Occupants by Bill Bryson Plus: Monthly crossword competition

A look back at the evolution of the role of the RNID

28 RNID focus

Jobs & Training 33 Professional Development

Jacinta Mulhere on the difficulties of trying to access ID services in Ireland

42 Quality and safety

Pull out section from INMO Professional

This month Maureen Flynn looks at the HSE quality improvement toolkit

66 Diary

Listing of meetings and events 67 Recruitment & Training

45 Nursing Now focus

This month, WIN focuses on Valerie Collins, RNID with Enable Ireland

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: RNID Section officers Jacinta Mulhere,Marian Spelman,Anne Marie O’Reilly,Patricia McCartney and Ailish Byrne

Breastfeeding : The best start

Health benefits for infants Breast milk is the ideal food for newborns and infants. It gives them all the nutrients they need for healthy development. It is safe and contains antibodies that help protect infants fromcommon childhood illnesses such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide. Breast milk is readily available and affordable, which helps to ensure that infants get adequate nutrition. Long-term benefits for children Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good health. Adolescents and adults who were breastfed as babies are less likely to be overweight or obese. They are less likely to develop type 2 diabetes and perform better in intelligence tests. Benefits for mothers Breastfeeding also benefits mothers. It reduces risks of breast and ovarian cancer later in life, helps women return to their pre- pregnancy weight faster, and lowers rates of obesity. Support for mothers is essential Breastfeeding has to be learned and many women encounter difficulties at the beginning. Nipple pain, and fear that there is not enough milk to sustain the baby are common. Health facilities that support breastfeeding – by making trained breast- feeding counsellors available to new mothers – encourage higher rates of breastfeeding. To provide this support and im- prove care for mothers and newborns, there are ‘baby-friendly’ facilities in about 152 countries thanks to the WHO-UNICEF Baby-friendly Hospital initiative. Work and breastfeeding Many mothers who return to work abandon breastfeeding partially or completely because they do not have sufficient time, or a place to breastfeed, express and store their milk. Mothers need a safe, clean and private place in or near their workplace to continue breastfeeding. Enabling conditions at work, such as paid maternity leave, part-time work arrangements, on-site crèches, facilities for expressing and storing breast milk, and breastfeeding breaks, can help.

The Irish Nurses and Midwives Organisation supports breastfeeding For more information log onto www.breastfeeding.ie

EDITORIAL 5

The INMO’s daily trolley count continues to be a mirror held to the face of those who make decisions about our public health system. It reflects the lack of capacity in our hospitals and the appalling conditions for patients and staff alike. Nurses, mid- wives and other colleagues can reasonably ask: whose interest are policymakers and employers serving with these unsafe, inap- propriate environments? It’s certainly not the interests of patients or staff, who are either simply seeking care or trying to pro- vide professional services. As winter approaches, the Emergency Department Taskforce met but, disappoint- ingly, the HSE did not produce a winter plan. Instead, they tried to justify increased overcrowding, pointing to increased attendances and admissions: this comes close to blaming the patients for being sick. The INMO highlighted members’ con- cerns at the lack of a winter plan with particular emphasis on the slow progress in plans to increase inpatient capacity. Additional staffed beds are needed this winter, especially in the seven constantly overcrowded adult hospitals and in the children’s hospitals affected by emerging overcrowding. The system can and must change: it is not good enough to justify the level of overcrowding without looking at immediate alleviation measures, such as additional capacity, recruitment of staff and fast tracking the implementation of Sláintecare. This year’s budget did have some allo- cation for Sláintecare – but not enough to instil confidence that any major shift from hospital-based care to community care will happen any time soon. The INMO met with the Department of Health’s Sláinte- care team after the budget and highlighted this missed opportunity. We strongly sup- port Sláintecare as a model and policy, but without adequate funding it will not deliver the scale of transformation at the pace that is required to meet the healthcare requirements of our growing population. Nursing and midwifery has a significant part to play in delivering positive change and should be supported in doing so. We believe that the modest allocation in this years’ budget should be focused on nursing Capacity must be addressed

Journalof the Irish Nurses and Midwives Organisation

World of Irish Nursing & Midwifery

(ISSN: 2009-4264) Volume 27 Number 9 November 2019 WIN, MedMedia Publications, 17 Adelaide Street, Dun Laoghaire, Co Dublin. Website: www.medmedia.ie

and midwifery-led services and their role in management of chronic diseases to deliver a new way of providing safe and profes- sional services. In this issue of WIN we highlight some important events and information for our members. First and foremost, we celebrate 60 years of registered intellectual disability nurses. We meet the Section officers, look back at the history of the specialty and dis- cuss the results of a recent study on service access (see pages 25-29) . We provide details on our final event to mark the INMO’s 100th year, which will be held on November 28. This will include the Nurse and Midwife of the Year Awards, which – despite the very difficult working conditions we find ourselves in – celebrate the magnificent work nurses and midwives do every day. Tickets for this event are available through branches and sections (see page 15) . We remind members to apply for the better-paid senior staff nurse grade if they have 17 years’ experience. Before the strike, this was only open to those with 20 years’ experience, so I encourage all eligi- ble members to take advantage of this new benefit. Allowances (backdated to March) and enhanced practice salary scales are now being processed by payroll depart- ments across the country. Ensure you get what you are owed and seek advice from your industrial relations officer or INMO information office if you have any difficul- ties (see page 11) . Finally, this is also the time of year to ensure you avail of the free flu vaccination. At the ED Taskforce meeting the Minister for Health confirmed that the nursing and midwifery-led peer vaccination programme has been the main positive contributor to the recent increased uptake among health- care staff. This is another example of real action, real results and real leadership by nurses and midwives.

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

Irish Nurses and Midwives Organisation Centenary Celebration

Thursday, 28 November 2019 in The Richmond Education and Event Centre, Dublin from 11.00am - 4.30pm Programme of Events - Professional Panel Chaired by Norah Casey - IR Panel Chaired by Eamon Dunphy - “Jury of Peers” Interactive IR workshop - Meet Milo or try out our Virtual Reality Room - Listen to or add your own story in the room of stories - Experience a 1919 ward environment - Memory lane artefacts and archives - Enjoy tea and a light bite in the wonderful Victorian Tea Room

Invitations to attend have been issued through your branches and sections. If you wish to attend please contact your branch or section secretary All other queries please email Michaela.Ruane@inmo.ie

Your priorities with the president

Martina Harkin-Kelly, INMO president

Nursing Now Ireland meeting Nursing Now Ireland held a meeting with representatives of the Department of Health, the HSE and Higher Education Institutes, with further meetings this year planned for November 12, December 11 and next year on January 8, 2020. The INMO continues to promote and raise the profile of the Nursing Now campaign, through a growing social media and online presence. For information on the campaign, you can visit nursingnowireland.ie The nomination process for the inaugural Nurse and Midwife of the Year Awards, sponsored by Cornmarket with prizes of €5,000 per winner, has now closed. The awards night will be held on November 28 and we look forward to announcing the winners. We discussed improving recognition across the EU for nursing qualifications, which – thanks to past work by the EFN – is the subject of a formal EU directive. We also discussed how nurses should have a real input in shaping the new EU system of digital health records, along with plans to expand our professional role further into pain man- agement. The EFN aims to empower nurses across Europe to recognise, assess and treat pain with a greater range of tools than they currently have. There were also elections held at the assembly and I am glad to report that we continue to be well represented in the organisation. Elizabeth Adams was re-elected president, while Ms Ní Sheaghdha was elected to the EFN’s six‑person Executive Council. Centenary celebrations RTÉ’s Nationwide team has completed filming a centenary tribute programme, which is likely to air in November. The centenary commemorative tapestry work by the Irish Patchwork Society is progressing and I would urge any member who wishes to get involved in the creation of this once in a lifetime commemorative piece to make contact through the general secretary’s office. Overcrowding and uncertainty As I write, a number of social and political factors are in focus, not least the ever- increasing winter trolley figures, flu season and – of course – Brexit. Trolley figures reached record highs once again in the past month, with the worst-ever September. Limerick had 82 people on trolleys on October 2, a staggering figure for one hospital and the highest ever recorded. We know what these numbers mean to our members in terms of patients languishing on trolleys in ED or on wards in inappropriate spaces. This is why your union advocates for serious change on a daily basis on behalf of you and your patients – we must curtail services in the short run and increase staffing beyond that. Meanwhile, with the Brexit debates continuing I am concerned for the many HSE employees living in Northern Ireland and the many cross-border initiatives that patients depend on. With much to play for, we continue to remind the key players that health is, and should always be, a top priority. European Federation of Nurses The European Federation of Nurses (EFN) represents more than three million nurses across the EU. It brings together 36 nursing associations from across the continent to ensure that nurses speak with one voice to the European policymakers, such as the European Commission and Parliament. I attended the EFN general assembly in mid-October with Phil Ní Sheaghdha, INMO general secretary, and Elizabeth Adams, previously of the INMO.

Quote of the month “Status quos are made to be broken” Ray A Davis

Report from the Executive Council

The National Executive met on Octo- ber 7and 8, 2019. As always there was a robust agenda dealing with internal and national issues, relevant to our members. The HSE’s disastrous recruitment pause was a key issue at the meeting, with further work planned on ending the pause for nursing and midwifery as soon as possible. The Executive was also made aware that progress had been made on the employment of graduates with over 1,400 offered contracts. The All-Ireland Midwifery Confer- ence took place this year in Armagh. Eilish Fitzgerald, INMO second-vice president, represented the president’s office at this event, as I attended the European Federation of Nursing’s (EFN) general assembly alongside Phil Ní Sheaghdha and Elizabeth Adams. The last meeting of the National Executive Council for 2019 is scheduled for December 2 and 3. Reminder for members: if you are working in conditions where you cannot provide safe care, please complete the disclaimer forms. This will be your only safeguard in the event of a near miss or an incident. 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

Budget not the ‘gamechanger’ the health service needs

“Giving more cash to the National Treatment Purchase Fund is an admission of failure, merely acting as a stopgap. Instead of building capacity in the public health service, the government is effectively investing in overseas and pri- vate health services.” INMO representatives have been meeting with Sláintecare management to discuss how to support the change to a new healthcare model. In addi- tion, the union is seeking more detail on funding allocated in this year’s budget. over 25 years, worked closely together and our annual joint all Ireland conference is a fantastic way to further strengthen our connection. Bringing midwives together from Northern Ireland and the Republic provides an opportunity for them to share their professional experiences and learn from one another particularly when it comes to best practice, which ultimately goes towards improving the care women and their babies receive.”

the HSE’s recruitment pause to be ended. INMO general secretary Phil Ní Sheaghdha said: “This is a business-as-usual budget. It’s not the gamechanger that frontline health workers need to end overcrowding and bring staffing up to safe levels. “We’ve been bandaging up the health service for far too long. It needs long-term, sys- temic change, but that comes with an upfront cost. The Sláin- tecare report set out a clear funding plan to transition to a new system, but the €3 billion which was formally launched in January 2018, was the first of its kind between two trade unions across borders and the Irish sea. Tony Fitzpatrick, INMO director of industrial relations said: “We’re proud to stand with our colleagues across the whole island. Working closely with the RCM and its members means that we can move mid- wifery forward on both sides of the border. “Midwifery faces real chal- lenges – particularly with

transition fund is nowhere to be seen.” On the homecare packages, she said: “New homecare supports are welcome and much-needed, as there have been very few approved since May of this year. “We now need to lift the HSE’s disastrous recruitment pause, if we are to make any dent in the hospital overcrowd- ing crisis. There are over 1,300 unfilled nursing and midwifery vacancies in the public health service.” Ms Ní Sheaghdha continued: Brexit looming. Short staffing, a global shortage of midwives, and unsafe working condi- tions are problems which our members have to face across Ireland, whether in the HSE, NHS, voluntary or private sec- tors. Working collaboratively to solve shared problems allows us to deliver effective solutions for the members of both the RCM and the INMO.” RCM director for Northern Ireland Karen Murray said: “The RCM and the INMO have, for

T h e b u d g e t i s n o t t h e ‘gamechanger’ the health service needs, the INMO has warned. The union criticised the government’s budget for the forthcoming year for failing to fund long-term systemic improvements to the health service – particularly the major funding needed to implement the Sláintecare reform plan. The union, however, wel- comed additional funding for homecare packages, along with commitments to hire extra frontline staff, but called for Professional challenges faced by midwives both in Northern Ireland and the Republic were examined at this year’s All Ireland Annual Mid- wifery Conference, which was held in Armagh last month. In the context of Brexit, the International Trade Union Part- nership forged by the INMO and the Royal College of Midwives (RCM), will strengthen the abil- ity of midwives to practise and access education and profes- sional training. This partnership,

Midwives are Brexit ready with all-Ireland partnership

RCM conference 2019: INMO general secretary Phil Ní Sheaghdha and INMO head of education Steve Pitman attended the opening day of the Royal College of Midwives Conference in Manchester in September.This two-day conference, which attracted over 3,500 delegates, offered the opportunity to debate the big issues affecting contemporary midwifery care. Pictured were (l-r): Cathy Ashwin, principle editor of MIDIRS; Steve Pitman; Phil Ní Sheaghdha; and Jon Skewes, RCM executive director, external relations

NEWS 9

INMO calls for greater support for women with menopausal symptoms

The INMO has called for greater workplace recogni- tion and support for women experiencing symptoms of menopause. Following a motion to its annual delegate conference, the union launched a posi- tion paper in conjunction with World Menopause Week designed to encourage discus- sions and lift taboos around menopause at work. Ke y r e c omme n d a t i o n s include: • Development of workplace policies that promote support of women during menopause • E du c a t i on a nd t r a i n i n g regarding the menopause The INMO believes that the profile of menopause in the workplace needs to be acknowledged, recognised as an important occupational issue and for resources to be invested in supporting women. The INMO calls on the wider trade union movement to embrace and campaign for greater recognition and sup- port on this issue. The INMO also calls on all healthcare employers, in both the public and private sectors, to develop menopause-friendly workplaces that recognise the importance of menopause. This includes the development of clear policies, training and dedicated resources to support women experiencing the men- opause at work. Unions also have a role to play in challenging attitudes to the menopause, ensuring that employers have proce- dures in place, and in offering support to women who are experiencing problems. Union representatives should raise the issue with their employer and ensure that the workplace meets the needs of menopau- sal women.

over 300,000 women work- ing in Ireland between the ages of 45 and 64, and around 80% of those will experience symptoms leading up to men- opause. We would like to work with employers to create pos- itive employment policies, as we do with other health and wellbeing-related issues. Cur- rently there is an absence of policies on this issue. “We have issued a position paper to assist our members and other women who might find they require assistance and support during this time in their lives.” Loretta Dignam, founder o f t h e Me n o p a u s e Hu b , said: “Education is central to removing taboos around menopause. We are all about helping women lead healthy and satisfying lives through the menopause both in work and at home, and this means having conversations and find- ing solutions. “We are hoping that this event will help many people understand how best to sup- port themselves and the women in their lives, and ulti- mately help them begin their own conversations around menopause.” The INMO Menopause@ Work Position Statement and Guide is available to download at www.inmo.ie

At the launch of the INMO position paper on Menopause at Work were (l-r): Loretta Dignam, founder of the Menopause Hub, and Steve Pitman, INMO head of education

One of the presenters at the launch was Dr BarbaraTaylor of ‘MenopauseTaylor’

Raising women’s health issues in the workplace will show that women can come to the union when they have difficulties. Menopause is an equal- ity issue and an occupational health issue, where work factors have the potential to impact significantly on a woman’s experience of the menopause. The INMO points out that this legislation is cov- ered under the Employment Equality Acts 1998-2015. The challenges faced by nurses and midwives in the workplace who are transition- ing through the menopause is

intrinsically linked to the dif- ficulties experienced everyday for nurses and midwives work- ing on wards and in the clinical environment. Women who a re e x pe - riencing menopause need support from line manage- ment, according to the INMO. “As with any longstanding health-related condition, this is crucial and can make a major difference. The workplace can affect women going through the menopause in various ways, especially if they cannot make healthy choices at work.” INMO general secretary Phil Ní Sheaghdha said: “There are

10 NEWS

Tony Fitzpatrick, INMO director of industrial relations, reports on issues

National Joint Council The National Joint Council (NJC) is the primary forum for the management of industrial relations in the health service. The NJC meets every two months when the staff panel and senior managers within the HSE and Sec- tion 38 organisations address national matters and local issues that require national input.

The INMO plays a pivotal part on the NJC staff panel, which also includes SIPTU, FORSA, IMO, MLSA, Con- nect and Unite. The purpose of the staff panel is to use the collective might of all the unions involved to work as one on behalf of all our members within the health sector. The most recent meeting of the NJC took place on October 2, 2019. I have written to the NJC chair seeking to progress a number of matters raised in that forum. Issues emanating from the acute division, community nursing, social care and intellectual disabilities nursing were all discussed at the meeting. An update on the issues discussed are outlined below. National Joint Council Update

Pension issues The NJC staff panel wishes to meet with the HSE regarding pensions before the end of October 2019. The unions wish to highlight significant issues such as delays in receiving pen- sions, calculations and matters pertaining to retirement on grounds of ill health. Investigations unit The unions outlined their ongoing concerns about inves- tigations units. These include de l ay, non - adhe renc e t o policies, non-agreement on investigators and terms of ref- erence, lack of coordination between commissions and investigations units, inability to communicate with the investi- gations unit, etc. The unions made a proposal, which was acceptable to management, that an agreed person with the relevant IR experience would be commissioned to meet with the unions to hear their issues of concern, subsequently meet with the unit, and then make recommendations to address the matter. The HSE committed to reverting within seven days with a proposed person to conduct this review as well terms of reference for consideration. Staff mobility/transfer panel The HSE commi t t ed t o arranging a meeting on this issue with the staff panel before the end of October 2019.

Temporary appointments

Employment control measures The HSE has failed to engage with the staff panel which represents the staff working within the health service with regards to the employment control measure being put in place at their inception. The staff panel was advised previ- ously that this was a temporary measure, however, it continues to be in place and therefore a meeting is required between relevant senior management across the various pillars of the HSE and the staff panel. A meeting on homecare sup- port services should involve all the unions and grades that link to these services. The unions are awaiting a date for this meeting from the HSE. Breastfeeding breaks Breastfeeding breaks within the health sector are to be increased from six months to 24 months. This follows a claim lodged by the unions on behalf of employees. The unions welcomed that the HSE has developed a policy with regards to same. The staff panel has provided feedback with regards to the policy and seeks an implementation date for its introduction. Homecare support services

will be arranged in regard to this matter. Red weather alerts The HSE is to revert with regards to its engagement with the Brothers of Charity regarding issues during the red weather alert and also on mat- ters raised with regard to the incomplete application of the red weather alert circular in the National Ambulance Service. The HSE is to arrange a ple- nary national meeting with voluntary bodies regarding intellectual disability services. The staff panel is to submit an agenda and the meeting will be convened as a matter of urgency. NiSRP The staff panel outlined that issues of concern remain with regards to the appropri- ate payment of staff within the eastern region through the National Integrated Staff Records and Pay Program (NiSRP). It also highlighted concerns about the lack of local engagement involv- i ng t rade un i ons and HR management. The staff panel suggested there should be no further roll out of this pro- gramme in the south east, pending the matters in the east being addressed. The staff panel will revert with specific issues of concern that remain outstanding. Intellectual disability service

The chair of the NJC com- mitted to the WRC offering a date for conciliation on this matter. The unions remain dissatisfied that over 2,000 individuals are acting up in a higher capacity as per HSE circular 017/2013. The circu- lar clearly outlines that after 12 months the post should be permanently advertised, how- ever this has not occurred, and individuals have acted up for as long as eight years. These individuals have rights with regards to the post they have been filling. The HSE agreed to revert within seven days on the staff panel’s request that none of the posts occupied by individ- uals acting up in a temporary capacity should be advertised, pending conclusion of the WRC process. Furthermore, the fact was raised that suc- cessful adjudication outcomes are being impeded by the HSE with regards to regularisation of individuals into these posts. Agency The staff panel outlined the continued excessive use of agency staff, with over €200 million being paid to agency to date, based on the data shared prior to the meeting. The HSE is to share its policy on con- verting the agency staff to direct employment which has not been shared to date. The HSE is to provide details as a matter of urgency. A meeting

Termination of pregnancy

Some specific matters on termination of pregnancy

NEWS XX

discussed at the latest NJC forum and other national IR issues

Non replacement of maternity leave In the Recruitment and Retention Agreement of 2017, it was agreed that all staff on maternity leave should be replaced. However, the HSE is not complying with this and is failing to replace many staff on maternity leave. T h i s i s s u e o f n o n - r e - placement has been further hampered by the employ- me n t c o n t r o l me a s u r e s currently in place. This issue will be discussed at upcom- ing meetings regarding the employment control process and overcrowding. Cath labs T h i s ma t t e r h a s b e e n referred to the WRC and the chair of the NJC is to seek an early date with regards to same. Candidate advanced nurse practitioners The matter of non-com- pliance with the HSE circular in Cork University Hospital is being looked at by Paul Byrne who will revert to the staff panel. manager/HR department and submit same. Once submitted and signed off by the director of nursing/midwifery and HR, they should be issued with a contract for signing and they should be paid on the enhanced salary scale. Also, retrospection with regards to this is due back to their incre- ment date arising after March 1, 2019 • It is vitally important and time sensitive that individu- als apply for the senior staff nurse/midwife and indeed the enhanced senior staff nurse/ midwife scale before Novem- ber 2019. The previously

Bereavement leave The staff panel raised the matter of the Labour Court Re c omme n d a t i o n wh i c h increased the quantum of bereavement leave from five working days to 20 working days, and from three working days to five working days. The parties met for two conciliation conferences where agreement could not be reached. The staff panel outlined its dissatisfaction that the Department of Health issued a circular with regards to this matter which is not agreed and is disputed.

on overcrowding in emergency departments and hospital wards throughout the coun- try, as it affects all levels of the service including pre-hospital care, acute hospital care and step down, including primary and social care. The staff panel highlighted the significant risks within the system as a result of unprece- dented overcrowding and the need for an urgent response from the HSE. Furthermore, the staff panel is seeking the early publication of the HSE winter plan, noting that plans have already been announced by the NHS in the UK. Scan for surgery Scan for surgery in St James University Hospital and other voluntary hospitals was raised: The unions will write to the HSE outlining the details with regards to same. Cervical Check audits/ liaison teams The unions are to receive details from the HSE with regards to this team and also details with regards to the recruitment process for same. departments in regard to: • If you are in receipt of a qual- ification/location allowance, it was due to increase by 20% retrospective to March 1, 2019 • T h o s e e l i g i b l e f o r n ew allowances, ie. maternity, community etc, should ensure that they have received this allowance and, again, with retrospection back to March 1, 2019 • If individuals have had incre- mental progression since March 1, 2019 or indeed are due an increment, they should seek the appropri- ate HR form from their line

services remain outstand- ing for particular unions. The unions have sought a meet- ing to review termination of pregnancy services since their introduction earlier this year. Joint declaration on life-long learning The unions were seeking a meeting to be convened before the end of October 2019 as the joint declaration on lifelong learning committed to by the HSE remains outstanding. The staff panel is awaiting contact from the HSE in order to con- vene this meeting. Time and one-sixth The HSE is to make contact with the chair of the staff panel to arrange a meeting between the parties on time and one- sixth retrospective payments. Unions are requesting that the remaining six-month ret- rospection is paid. In addition to the above, retrospection of time and one-sixth at St John of Gods, Kerry is outstanding. Overcrowding The unions are seeking high- level engagement with the HSE The INMO is urging members to ensure that they receive all pay increases due to them that were secured as part of the nursing and midwifery strike settlement. The union noted that the HSE was extremely slow to issue the circular to the system on the implementation of the two Labour Court Recommen- dations. However, the circulars have now been issued and it is important that INMO mem- bers seek their entitlements contained in these from their employer. Members should ensure to contact their payroll/HR

The staff panel has objected to the inclusion of “collective agreements” and footnotes regarding calendar days rather than working days. The unions will be seeking that the WRC conciliation officer would refer the matter back to the Labour Court for clarification. However, the chair of the NJC, Anna Perry, called on the par- ties to engage again in order to get a resolution so that the matter need not be returned to the Labour Court. The HSE is to revert with a date for this meeting. Members urged to check for all pay increases due

required 20 years’ service has been reduced to 17 years. Therefore, those with 17, 18, 19 and 20 years or more should apply if they are not currently on the senior staff nurse/midwife scale. Also, those at senior staff nurse/ midwife scale are eligible to move onto the enhanced senior staff nurse/midwife pay. It is important that members pursue these mat- ters as it is their pay that is due to them. All of these measures ensure significant increases in pay, which members should seek and secure.

12 NEWS

‘Beyond unsustainable’: record numbers on trolleys amid deepening staffing crisis

The worst affected hospitals in September were: • University Hospital Limerick – 1,405 patients • Cork University Hospital – 936 patients • University Hospital Galway – 884 patients • University Hospital Waterford – 707 patients • Mater Misericordiae Univer- sity Hospital – 639 patients. INMO general secretary Phil Ní Sheaghdha said: “These are

simply astonishing figures – especially outside of the winter months. It’s placing a massive strain on our members on the frontline and is seriously wors- ening patient care. “We have now seen 80 con- secutive days where the trolley figures are higher than 2018 – often by as much as 50%. This is equivalent to the bed capac- ity of Beaumont Hospital 15 times over. “This is absolutely beyond

unsustainable. At the root of the problem is capacity. We need more hospital beds and more nurses and midwives to staff them. The HSE’s disas- trous recruitment pause quite simply has to go. “Ireland needs to reform its health service and Sláintecare is the clear path forward. But it needs to be more than reports and press conferences. It takes real investment and a major shift towards primary care.”

September was the worst month of 2019 so far for hospi- tal overcrowding, with 10,641 admitted patients, including 101 children, left without beds across the country. According to the monthly INMO trolley and ward watch analysis (see below) , the fig- ures for September were the highest they have been since records began in 2006, and twice as high as the same month 10 years ago.

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

Sept 2006

Sept 2007

Sept 2008

Sept 2009

Sept 2010

Sept 2011

Sept 2012

Sept 2013

Sept 2014

Sept. 2015

Sept 2016

Sept 2017

Sept 2018

Sept 2019

Hospital

Beaumont Hospital

310 211 262

409 229 366

608 226 519 243 152 178 500 383

830 176 443 157 200 169 389 354

680 297 446 370 150 584 661 89

730 387 368 230 240 114 638 175

280 317 334 151 119

620 540 187 118 117 163 337 45

644 485 311 249 329 200 312 n/a

732 327 371 180 159 419 450 n/a

383 172 350 156 219 415 450 n/a

254 205 373 212 108 257 448 n/a

268 294 392 340 102 210 365 n/a

296 186 639 379 152 325 275 n/a

Connolly Hospital, Blanchardstown

Mater Hospital

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

85 32 22

17 29 39

St Vincent’s University Hospital

459 166

536 329

405

Tallaght Hospital

63 n/a n/a n/a

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

n/a n/a n/a

29 27

38 59

Eastern total

1,547

1,954

2,809

2,718

3,277

2,882

1,753

2,127

2,530

2,638

2,145

1,857

2,030

2,353

Bantry General Hospital Cavan General Hospital Cork University Hospital

n/a 74

n/a

n/a 91

n/a

25 39

36 78

32 33

267 235

262 437

433 567

341 529

142 146

206 304 176

180 477 158 118 142 453 147 302 14 n/a n/a 606 210 107 278 514 138 784 257 n/a 33 36 n/a

246 936 615 110 300 232 104 286 n/a 32 n/a 75 72 87 n/a 185 396 639 406 884 283

229 281

275

326 130

441 263

628 459

781 502

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

34 n/a 72 71

16 n/a 28

33 24

49 n/a

25 n/a 45

28 n/a

n/a 57

n/a 64

n/a

202 107

114

147 195 116 24 56 10 n/a n/a 331

145 149 186 25 96 12 n/a n/a 626

206 220 380 216 411

132 215 383 222 445

114 137 353 178 461

113

90 31 n/a

185 275 254 113 n/a n/a 842 3

134 146

240 255

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

22 38 n/a 43

6 8

79 13 n/a n/a

2 9 2

508 n/a n/a n/a 593

17 22 n/a 72 n/a 80 302

23 n/a n/a 323 169 105

16 n/a

24 n/a

n/a

Monaghan General Hospital Nenagh General Hospital

n/a

Our Lady of Lourdes Hospital, Drogheda

349

116

214

507

134 243

134

Our Lady’s Hospital, Navan

40 21 50 79 34 n/a

57 36 n/a 45

26 49 n/a

49 98 n/a 51

Portiuncula Hospital

149

26 n/a

94 n/a

114

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

60 56 92 n/a

50 55 64 n/a

113 168

n/a

153 125

102 123

200

323 396 229 598 114 902 505

247 365

10 n/a

13 34

224 209 282

350 188 499 133 825 333 154

128 446

126 129 139

209

380

321

356

642

271

609 282 894 259 138

11 72 63 42

166

201

502 164 336

384

279 136

345 152

551

1,405

n/a

n/a 19

707 234

189

178

490

144

Country total

2,177 3,724

1,540 3,494

1,634 4,443

2,546 5,264

3,727 7,004

4,804 7,686

2,647 4,400

2,803 4,930

3,981 6,511

4,992 7,630

5,406 7,551

6,244 8,101

5,794 7,824

8,288

NATIONALTotal

10,641

n/a

101

Of which were under 16

Percentage increase/decrease: 2018 compared to 2019: 36% 2014 compared to 2019: 64% 2010 compared to 2019: 52% 2006 compared to 2019: 186% 2017 compared to 2019: 31% 2013 compared to 2019: 116% 2009 compared to 2019: 102% 2016 compared to 2019: 41% 2012 compared to 2019: 142% 2008 compared to 2019: 140% 2015 compared to 2019: 39% 2011 compared to 2019: 38% 2007 compared to 2019: 205%

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15089 WIN AD Nurses 10-19

EXECUTIVE COUNCIL ELECTION 2020 All members are asked to note that 2020 is an election year for election, to the Executive Council, for a two year period (2020-2022). Elections will be conducted under the revised new Rule Book (Rule 8) adopted at the ADC in May 2016.

Management: 3 seats Includes all members at, or above, Clinical Nurse Midwife Manager 3 who are actively engaged in management. Undergraduate Student Nurses/Midwives: 1 reserved seat Open to all members undertaking the four year undergraduate degree programme. • Provided always that only those grades for whom the Organisation has negotiation rights shall be a member of the Executive Council • In the event of any of the seats allocated to the Education and Management categories not being contested, then those seats shall be filled by the candidates, in the Clinical Category, who receive the next highest vote, or votes, after the initial filling of the 16 seats taking into account the six reserved clinical seats. • In the event of any dispute, as to the category for which a member may be eligible for election, then the Executive Council shall deter- mine the category under which a member is eligible to contest the election. ELIGIBILITY FOR OFFICE OF PRESIDENT AND VICE PRESIDENTS (RULE 9) 9.1.1 The President, first Vice-President (Honorary Treasurer) and second Vice-President shall be elected at the 2018 Annual Delegate Conference at which elections are scheduled. 9.1.2 A separate election shall be held for President, first Vice-Presi- dent and second Vice-President, and such elections shall be by secret ballot of all voting delegates at the Annual Delegate Conference. 9.1.3 The elected candidate must secure an overall majority by exceeding 50% of the eligible votes cast. If no candidate has achieved an overall majority, as aforesaid, then the candidate, or candidates, receiving the lowest vote or votes, if their combined vote is less than the total vote of the highest candidate, shall be eliminated and a fur- ther ballot shall take place immediately. 9.1.4 If there shall be a tie, another vote shall be taken, and if the result is still a tie, the outcome shall be decided by lot (drawing the name of the successful candidate) by the chairperson of the Standing Orders Committee. 9.2 To be eligible for election to the office of President or Vice-Pres- idents she/he shall have been an elected member of the incoming Executive Council and shall have been a member of the outgo- ing Executive Council for the term immediately preceding her/his election. 9.3 Nominations for the office of President, first and second Vice Presidents, together with their written consent must be submitted in writing to the General Secretary not later than 21 clear days before the Annual Delegate Conference for notification to dele- gates to that meeting at which the election will take place. (Closing date for nominations is 5pm on Friday, April 3, 2020). 9.4 The President shall preside at the Annual Delegate Conference and Special Delegate Conferences held during the year and at all Executive Council Meetings. In the absence of the President the first Vice-President shall take the Chair; in the absence of the first Vice- President the second Vice-President shall take the Chair. 9.5 The office of President shall not be held by the same person for more than two consecutive terms.

ELIGIBILITY FOR NOMINATION TO EXECUTIVE COUNCIL (RULE 8) Nominations for the Executive Council shall be submitted, on the appropriate form, to the General Secretary, on, or before, 5pm on Wednesday, February 5, 2020.To be eligible for membership of the Executive Council a member must: i) have been a paid-up member of the Organisation, for not less than two years prior to the date of her/his nomination, and be on the Live Register of the Nursing and Midwifery Board of Ireland (NMBI); and ii) be proposed and seconded by Officers of their Branch or Sec- tion following endorsement of the candidate by that Branch or Section. To be eligible for election as an undergraduate student nurse/mid- wife member of the Executive Council an undergraduate student must: i) have been a member of the Organisation for not less than six months prior to the date of her/his nomination; and ii) be proposed and seconded by undergraduate student nurses/ midwives who have themselves been members of the Organisa- tion for not less than six months or be proposed and seconded by Officers from their Branch. COMPOSITION OF THE EXECUTIVE COUNCIL Clinical: 16 seats Includes all grades of Registered Nurse and Midwife (other than those eligible to go forward under the Education and Management Categories below), to be filled as follows: i) Registered General Nurse - at least two seats Registered Midwife - at least one seat Registered Nurse Intellectual Disability - at least one seat Please note persons elected, to these reserved seats, must be on that register and engaged in clinical practice in that discipline. ii) If these reserved seats are not filled, via the 16 candidates with the most votes, then they must be filled with reference to the next highest candidate, from that discipline, who is engaged in clinical practice in that discipline. iii) If there are no candidates meeting any of the six reserved seats (clinical) then the seats shall be filled by the candidate with the highest vote in the clinical category. Education: 2 seats i) One seat to be filled by members from all grades of Nurse/ Midwifery Teachers, Clinical Teacher, and/or others with a Nurse/ Midwifery Teaching qualification who are actively engaged in nurse/midwifery education. ii) One seat to be filled from members who are working in the wider field of nurse/ midwife education and its management including Clinical Placement Co-Ordinators/ Clinical Placement Facilitators/Specialist Co-Ordinators and Nurse/Midwife Prac- tice Development Co-Ordinators. Registered Sick Children’s Nurse - at least one seat Registered Public Health Nurse - at least one seat;

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