World of Irish Nursing February 2014

€5.75 Vol 23 No 1 February 2015

Journal of the

Irish Nurses and Midwives Organisation

Campaign against NMBI fee hike going strong See pages 6-7

World of Irish Nursing & Midwifery

Minister calls on NMBI to enter talks with INMO and other unions on fee row page 6

Public supports INMO Dáil protest on ED crisis page 10

Dealing with debt page 30

New fitness to practise hearing protocol explained page 42

Black day – never again?

Emergency department action plan by February 2

CONTENTS 3 News & views

5 Editorial

It is time for decisions to be made as more than 600 patients languish on trolleys in our nation’s hospitals, writes INMO general secretary Liam Doran

7

6 News

Minister calls on NMBI to enter direct talks with unions over fee dispute... INMO reaffirms advice to pay €100 fee to NMBI...

NMBI protest social media ‘Thunderclap’...

INMO foresaw national emergency... Day of shame – 601 patients on trolleys... ED Taskforce to produce action plan... INMO seeks immediate recruitment drive... Public support for INMO Dáil protest... Forceful ‘Yes’ vote for industrial action... Public sector pay talks to recommence... Showing solidarity after Charlie Hebdo attack... Landmark victory in EC pay case... Maternity benefit and overseas travel... Recruitment drive urgently required... Call for nurse managers to get more involved in INMO... ID clients denied basic human rights... Overcrowding continues in Beaumont... UL hospitals bed management in chaos... Galway to close beds despite crisis... Steps needed to alleviate ove rc ro w d i n g i n n o r t h w e s t . . . Ta l l a g h t recruitment drive underway

Plus: Section news, page 23

24 International news

47

in the news

49 Midwifery Matters

Brenda Harkin takes a look at the role of midwives in supporting hypnobirthing mothers in Ireland

50

10

45 From the President

INMO president Claire Mahon rounds up news from the Executive Council and beyond

eHealth focus

We must be prepared for change if we are to successfully negotiate the uncharted waters of eHealth Ireland, writes Pamela Hussey

57

Update

Round-up of Irish and international news items

Clinical 53 Palliative care

Ongoing education supports nurses implementing palliative care for patients with COPD, writes Ann Cronin

Living 61

Book review

A l i s o n M o o re re v i e w s I r i s h p re g n a n c y handbook Preparation for Pregnancy, Birth and Motherhood - Recommended Reading for Prospective Parents by Nancy Murphy

I reland is central to the UN’s post 2015 development agenda, writes Elizabeth Adams reports

Media Watch

Ann Keating reviews INMO activities reported

Plus: Monthly crossword competition

63 Finance

Dermot Wells advises readers not to give up on their health insurance without careful consideration

Features

26

Questions and answers

29

Quality and safety

Bulletin board for industrial relations queries

This month Maureen Flynn discusses the value of patient partnership

30 Insolvency

The Insolvency Service of Ireland discusses the various services it can offer to those in debt crisis

42

30

Legal focus

I n the first of a series of articles, Edward

Jobs & Training 33

Professional Development

E i g h t - p a g e p u l l - o u t s e c t i o n f ro m t h e INMO PDC

64 Diary

Listing of meetings and events nationally and internationally

65 Recruitment & Training

Latest jobs and training opportunities in Ireland and overseas

Mathews explains the process involved in a fitness to practise hearing

WIN Vol 23 No 1 February 2015

WIN – World of Irish Nursing & Midwifery is distributed by controlled circulation to over 36,000 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: e145 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.

EDITORIAL 5

Journal of the

Irish Nurses and Midwives Organisation

World of Irish Nursing & Midwifery (ISSN: 2009-4264)

Volume 23 Number 1 February 2015 WIN, MedMedia Publications, 17 Adelaide Street, Dun Laoghaire, Co Dublin.

Website: www.medmedia.ie

Editor Alison Moore Email: alison.moore@medmedia.ie Tel: 01 2710216 Production editor & news Tara Horan Sub-editor Sharon Murphy Designers Fiona Donohoe, Paula Quigley Advertising manager 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: Liam Doran INMO editorial board: Claire Mahon; Geraldine Talty; David O’Brien; Moira Craig; Theresa Dixon; Martina Harkin-Kelly; Eileen Kelly; Catherine Sheridan; Mary Leahy INMO editor: Ann Keating Email: annkeating@inmo.ie INMO editorial assistant: Freda Hughes INMO photographer: Lisa Moyles

Email: inmo@inmo.ie Website: www.inmo.ie

twitter.com/INMO_IRL

nified and quality assured, through the provision of adequate frontline staffing.

This problem cannot be solved without more resources. We do not need any more strategies, reviews or action plans; we require additional resources that provide the health service with additional capacity to care for patients.

It was disappointing therefore, even when we had over 600 people on trolleys, to hear at least two government ministers say that the problem was not all about money. Regrettably these ministers in arguing that funding was not the solution, failed to indicate what they thought would rid us of this terrible situation.

The situation can, undoubtedly, be improved by improving work practices including expanding the authority of the triage nurse, increasing the number of nurses working at practitioner level and wider, cross-consultant, protocols particularly in the area of patient discharge.

However, even bringing these desired changes forward, will not alter the blunt fact that our health service is too small to meet demand. Cancellation of planned routine admissions, to assist with dealing with the overcrowding, is, while necessary, only available in the short-term. Patients who have their treatment deferred will, without doubt, present, sooner rather than later, in EDs and, therefore, the circle of inadequacies continues.

So, we now have decision time for government, and this Minister, the clock is ticking and positive actions are necessary right now – not more words or empty promises.

Liam Doran General Secretary, INMO

No 1 February 2015

www.facebook.com/ irishnursesandmidwivesorganisation

The INMO has been counting since 2004 the number of admitted patients left on trolleys because there is no available hospital bed. On Tuesday, January 6 the Organisation found that 601 patients in need of inpatient care were languishing on trolleys in emergency departments (ED) or on trolleys placed on wards, above the inpatient complement. This level of overcrowding, bringing with it loss of dignity and privacy, compromising of care and a general absence of decency and humanity, represented a new low as it exceeded the previous highest figure of 563.

Apart from the misery and discomfort, that this level of overcrowding brings, one of the most disconcerting aspects, of the recent steep increase in patients on trolleys, is the fact that it was entirely predictable. Every month since last July, this Organisation has reported a steady increase in the numbers of patients on trolleys, as compared to the previous year.

The level of overcrowding increased by 8% in July 2014 compared to 2013 but this had dramatically increased to 44% when comparing November 2014 to November 2013. Notwithstanding such clear evidence of a need for emergency measures, the health system continued to fail to prepare with management, and indeed government, staring at the problem but making no efforts to address it in the interests of patients and frontline staff.

I n m i d - D e c e m b e r, t h e M i n i s t e r, belatedly, established the Emergency Department Taskforce which met for the first time on December 23. In the eye of the recent storm, in the first days of January, the Taskforce met again and an action plan, with both short and medium-term measures, is to be produced, and adopted by the time you read this.

However, it is evident what has to be done to alleviate this problem. This involves a mix of additional bed capacity, additional staff, new work practices and the restoration of community services including community nursing and home help provision. While we know what has to be done, the government must make up its mind, once and for all, and decide whether it is prepared to properly fund our health service. It must decide to make it fit for purpose so that it meets the needs of patients, in a manner that is both dig-

WIN Vol 23

INMO correspondence to: Irish Nurses and Midwives Organisation, Whitworth Building, North Brunswick Street, Dublin 7.

Tel: 01 664 0600 Fax: 01 661 0466

Decision time as 601 patients lie on trolleys

6 NEWS

Minister calls on NMBI to enter direct talks with unions over fee dispute A s a d i re c t re s u l t o f t h e success of the continuing campaign of opposition to the 50% increase in the annual retention fee levied by the Nursing and Midwifery Board of Ireland (NMBI), Health Minister Leo Varadkar has called on the Board to enter into direct talks with the INMO and other unions.

The Minister’s direct written request to the NMBI on January 14 was discussed at a special meeting of the Board the following day and, at the time of going to press, direct discussions between the NMBI and the unions were expected to commence shortly.

This development came at a time when, despite repeated attempts at intimidation by the NMBI, tens of thousands of nurses/midwives had not paid the increase and were, as advised under the campaign, sending just the existing fee of €100 to NMBI. This initiative also came after the very effective and successful workplace initiative ‘The Thunderclap’ just before Christmas.

Minister for Health, Leo Varadkar: Letter to the NMBI calls for the Board to recommence discussions with the unions to ensure no nurse/midwife is removed from the register due to the dispute over the fee increase

At that time hundreds of workplaces captured their support for the campaign by posting photographs on social media platforms, such as Facebook.

This served to highlighted the issue to all TDs, senators and public representatives (see opposite page).

The INMO, SIPTU and the PNA have welcomed the Minister’s call for the Board to enter into talks with them to resolve the dispute. The unions note that the letter from the Minister called on the Board to recommence discussions

to ensure no nurse/midwife is removed from the register arising from the current dispute.

Commenting on this latest development, INMO general secretary, Liam Doran said: “To date the campaign of opposition to this totally unacceptable fee increase has been very effective, well supported and followed by literally tens of thousands of members. There is no doubt the call, from the Minister, on the NMBI to recommence discussions, is as a direct result of the campaign’s effectiveness

and the reality that so many nurses and midwives cannot be removed from the register so the issue must be resolved.

“The INMO will enter any further discussions with NMBI, reaffirming our call that nurses and midwives must be treated equitably, as compared to other health professionals. In addition, the Board must be much more transparent, in its cost base and areas of expenditure and, fundamentally, must be much more overtly supportive of nurses and midwives as they strive to deliver safe care through safe practice in the clinical environment.”

INMO members will be kept fully appraised of all developments arising from these renewed discussions via news updates and on the Organisation’s website www.inmo.ie In the interim, members are reminded to: • P a y t h e e x i s t i n g € 1 0 0 retention fee, when their circumstances allow • Keep a record of the payment • Submit their PIN number with any payment.

Vol 23

No 1 February 2015

INMO reaffirms advice to pay €100 fee to NMBI As the Nurses and Midwifery Board of Ireland (NMBI) continued to issue threatening statements in recent weeks about payment of the increased annual retention fee for 2015, the INMO reaffirmed its advice to members as follows: • T he retention fee does not need to be paid by January 1 • T he NMBI itself has confirmed it will issue a second renewal notice on February 2, allowing a further 28 days for payment, before the issue would go before a board meeting in March/April

• The HSE confirmed in a circular that April 30, 2015 is the date by which it requires confirmation of registration • M embers should pay €100, by cheque, postal order or credit transfer when their personal circumstances allow and keep a record of payment • This issue remains under discussion with the Department of Health under the Haddington Road Agreement.

In each of the past three years the board has increased the licence fee and this year sought to increase it by 50% to €150. All other comparable

health professionals have had their registration fee capped at €100 for the next three years.

INMO general secretary Liam Doran said: “Notwithstanding further threatening statements from NMBI, all nurses and midwives should pay €100 as a retention fee payment for 2015. No regulator can expect to increase its fees by 50% (80% over the past two years) at a time when the income of nurses and midwives has been cut by over 20% and inflation is less than 1%.

“The efforts of NMBI to intimidate nurses and mid-

wives are most regrettable and further illustrate the divide between the regulator and those it regulates,” he said.

“Our advice continues to be that nurses and midwives should pay €100, as we all support the need for a regulator that protects the public by ensuring nurses and midwives can practise safely, and allow for the ongoing discussions to reach a conclusion. Demanding a 50% increase in fees to cover increased legal and public relations costs neither protects the public nor ensures nurses/midwives can practise safely.”

NMBI PROTEST

Social Media Thunderclap

No 1 February 2015

received were shared on social media sites, in particular Twitter, and each picture was aimed at the politicians and news sources in the catchment area of the hospital or healthcare facility concerned.

The pictures created a fantastic visual of solidarity and the event was picked up on by numerous news feeds, journalists and politicians. Many politicians from both the government and the Opposition pledged their support for the campaign, and even shared the pictures themselves.

This page provides a snapshot of the event. Join the INMO on Twitter by following @INMO_IRL to view all the pictures received.

– Dean Flanagan, INMO new graduate and student officer

WIN Vol 23

From Wednesday December 17 to Friday, December 19, 2014 the INMO, along with SIPTU and PNA, staged a national ‘Social Media Thunderclap’. This was the first time nurses and midwives took part in such an event, and it was great to see everybody taking five minutes out of their busy day to show support for all their colleagues around Ireland.

The message was simple: nurses and midwives will not pay the NMBI retention fee increase.

Almost 200 work locations took part in the nationwide event, covering most of the country’s large hospitals and community units. The INMO sends thanks to everybody who sent their photos in. All the pictures

8 NEWS

INMO foresaw national emergency NOVEMBER/DECEMBER 2014 Before Christmas, the INMO c a l l e d re p e a t e d ly fo r t h e increasing levels of overcrowding in emergency departments (ED) throughout the country to be declared a national emergency. Such calls were made in the context of: • B eaumont Hospital asking patients not to come to its ED because of chronic overcrowding • L imerick Regional Hospital proposing to place extra beds on wards, thus compromising the care of its entire patient population • Our Lady of Lourdes Hos-

pital, Drogheda and several hospitals in Dublin continuing to face critical levels of overcrowding • Record levels of overcrowding recorded in other hospitals, including Midlands Regional Hospital, Tullamore; Sligo General and Wexford General.

The situation was compounded by the fact that almost 800 patients occupied acute beds, despite being clinically discharged, because of the lack of appropriate continuing care beds or adequate homecare nursing services.

The problem was exacerbated further by the acute shortage of nursing staff, which

Day of shame – 601 patients on trolleys

Vol 23

No 1 February 2015

January 6, 2015 On January 6, with 601 patients on trolleys in emergency departments (ED) or wards across the country, the INMO called for an immediate meeting of the ED Taskforce to agree measures to alleviate this crisis.

That day’s figures represented the highest number of patients on trolleys recorded since the INMO began its trolley watch initiative in 2004.

The INMO reaffirmed its view that this was a national emergency requiring a range of special initiatives.

The Organisation also called for the HSE, and other acute hospital employers, to immediately audit their compliance with health and safety legislation in relation to the working environment of nursing and other frontline staff in these overcrowded departments.

The INMO reminded employers that they are legally obliged to ensure a

safe system of work for their staff, pointing out that health employers are failing in this regard in overcrowded units.

INMO general secretary Liam Doran said: “We must act collectively, in the interests of these vulnerable patients and the staff trying to provide care to them, to alleviate the indignity, loss of privacy and compromising of patient care arising from this overcrowding crisis. The need for additional resources is self-evident and no party should now hinder the allocation of the required resources to deal with this deplorable care environment, immediately”.

the INMO said arose from five years of flawed manpower planning policies, which has left many hospitals, even when resources are available, unable to find additional nursing staff.

The Organisation said this critical situation, which sees patient care being compromised continuously, could only be addressed by the declaration of a national emergency, by the government, leading to: • T he allocation of additional financial resources to allow the opening of closed beds and increased community homecare nursing support • Emergency recruitment initiatives, initiated at local level,

targeted at nursing staff, at home and abroad, offering permanent, long-term posts with educational supports • The re-establishment of the national ED Forum involving all stakeholders with a view to bringing forward additional local initiatives, including work practice changes within the hospital system.

INMO general secretary Liam Doran said: “The initial €25 million, allocated in the Service Plan for 2015, while welcome, is simply not enough to address the shortcomings which now exist following five years of underfunding and the absence of a proper manpower plan”.

INMO Trolley Watch and Ward Watch January 6, 2015 Hospital Beaumont Hospital Connolly Hospital Mater Misericordiae University Hospital Naas General Hospital St Colmcille's Hospital, Loughlinstown St James's Hospital St Vincent's University Hospital Tallaght Hospital Eastern total Bantry General Hospital Cavan General Hospital Cork University Hospital Kerry General Hospital Letterkenny General Hospital Louth County Hospital Mayo General Hospital Mercy University Hospital, Cork Mid Western Regional Hospital, Ennis Midland Regional Hospital, Mullingar Midland Regional Hospital, Portlaoise Midland Regional Hospital, Tullamore Monaghan General Hospital Our Lady of Lourdes Hospital, Drogheda Our Lady's Hospital, Navan Portiuncula Hospital Roscommon County Hospital Sligo Regional Hospital South Tipperary General Hospital St Luke’s Hospital, Kilkenny University Hospital Galway University Hospital Limerick University Hospital Waterford Wexford General Hospital Country total National total

Trolley 35 20 30 32 0 15 17 11 160 0 5 14 6 27 0 33 22 0 20 16 28 0 39 5 12 0 13 12 9 17 29 13 11 331 491

Ward 6 11 0 0 0 0 0 10 27 3 0 0 0 4 0 3 0 0 10 0 0 0 6 23 0 0 3 0 0 11 12 1 7 83 110

Total 41 31 30 32 0 15 17 21 187 3 5 14 6 31 0 36 22 0 30 16 28 0 45 28 12 0 16 12 9 28 41 14 18 414 601

NEWS 9

ED Taskforce to produce action plan INMO general secretary appointed joint chair of new taskforce

INMO seeks immediate nurse recruitment drive

January 20, 2015

Liam Doran, INMO general secretary and joint chair of the ED Taskforce : “What needs to be done is well known but it cannot be done without additional financial and other support from government”

land that offering yellow pack salaries, short term contracts and agency e m p l oy m e n t w a s s h o r t sighted, ineffective and, undoubtedly, was leading to large numbers of young nurses seeking work overseas.

Ms Ní Sheaghdha said: “All parties at the taskforce meeting agreed resolving this overcrowding crisis must remain an absolute priority.

The INMO sought an immediate, flexible and localised recruitment campaign for nursing posts, which would offer permanent posts, with attractive terms and conditions, comparing favourably with what is being offered in other countries, particularly the UK. This will have to form part of any final action plan. In the interim we will be seeking localised recruitment to allow for the opening of additional beds to deal with the current overcrowding crisis”.

tional bed capacity, additional staff and, ultimately, significant additional funding.

“What needs to be done is well known but it cannot be done without additional financial and other support from government. The implementation of the action plan will indicate whether or not the government is prepared to properly fund a public health service capable of looking after, with dignity and quality, our sick and vulnerable citizens”.

At the first meeting of the taskforce on December 22, the INMO had called for the cancellation of all elective admissions, to acute hospitals

for the month of January. This call was made in the context of the worst level of ED overcrowding, coupled with the highest number of delayed discharges, in over 10 years.

The INMO said cancellation of all elective admissions was necessary in the interest of maintaining safe patient care, manageable workloads for staff and in recognition of the limited bed capacity which exists.

Mr Doran said: “The system cannot pretend it can continue to deal with elective admissions and the demand for emergency admissions that will present. Safe patient care must be the priority.”

No 1 February 2015

ity must be given to addressing delayed discharges.

The INMO believes that the action plan, which will pull together all the various ideas raised at the second meeting of the taskforce, must contain: • T he continued opening of additional bed capacity (acute and non-acute) • The immediate recruitment, into permanent posts on excellent terms and conditions, of additional nurses • New work practices involving greater authority for the triage nurse, increased numbers of nurses working at advanced practitioner level and revised arrangements involving cross consultant discharge • R e s t o r a t i o n o f c o m m u nity supports including less b u re a u c r a t i c s t r u c t u r e s under the Fair Deal scheme, enhanced community nursing and further investment in home help services.

Liam Doran said: “We are now approaching decision time for this government which will test whether or not it is absolutely determined to reduce the number of patients on trolleys every day. It is quite clear that this problem cannot be solved in either the short or medium term, without addi-

At the mid-January meeting of the ED Taskforce, INMO representatives sought an immediate recruitment campaign for nurses, specifically targeted at the UK. It was acknowledged that the additional beds necessary to address the overcrowding crisis can only be opened when additional nursing staff are available.

The meeting heard demands from INMO representatives, Phil Ní S h e a g h d h a , d i re c t o r o f industrial relations, and Tony Fitzpatrick, IRO, for an immediate recruitment campaign to fill permanent posts for nurses. As well as being focused at home, the INMO delegates said this campaign must specifically target the UK, so as to attract back large numbers of young graduate nurses who have taken posts in recent months in the NHS. The INMO pointed out the simple reality in Ire-

Vol 23

The Emergency Department Taskforce, established by the Minister for Health in response to the INMO demand, has met twice to date and is due to meet again on February 2.

The taskforce, which consists of health service unions and management representatives from across the health sector, convened to review the ongoing overcrowding crisis in EDs, and discuss actions necessary to address this longstanding problem.

At its next meeting, the taskforce is due to agree a national action plan, comprising both short and medium term initiatives, designed to significantly reduce the number of patients on trolleys in hospitals across the country.

At its meeting in mid-January INMO general secretary, Liam Doran, following nomination by health service unions, was appointed as joint chair of the Taskforce, with the new HSE director of acute services, Liam Woods.

At this meeting, Health Minister Leo Varadkar committed to remain involved in the process and said that a significant reduction in the number of patients on trolleys was his absolute priority at this time.

All parties put forward possible actions to alleviate the situation. These will now form the basis of an action plan, with a mix of short term/immediate actions and medium/longer term initiatives, which will be presented to the next meeting.

At the time of the meeting there were 751 patients, clinically discharged, but remaining in acute hospitals because the necessary supports for patients were not currently accessible.

There was consensus that prior-

Protesters outside the Dáil last month included (l-r): Dave Hughes, INMO deputy general secretary; Bertie Corr, Athlone; Laura Egan, Our Lady of Lourdes Hospital, Drogheda; Naomi O’Donovan, INMO Executive Council member; and Ibukan Omotayo Oyedele, chairperson of the INMO International Nurses Section

Public support for INMO Dáil protest The INMO was joined by patient groups and members of the public in its protest outside Dáil Éireann last month at what it described as “the appalling overcrowding of our hospitals”.

The protest took place on

January 14 on Kildare Street and was also supported by the Irish Congress of Trade Unions and some politicians.

INMO, deputy general secretary, Dave Hughes said: “We are grateful that members of the public, patient groups and

workers in the city centre gave up their time to show their disgust at chronic overcrowding in emergency departments throughout the country, which the previous week reached a record high of 601. Chronic overcrowding of EDs is now

an annual event that means hundreds of patients daily are deprived of basic dignity and exposed to even greater health risks simply because successive Irish governments have failed to adequately fund the health service.”

Vol 23

No 1 February 2015

Beyond breaking point: a record high of 601 patients At the peak of the overcrowding crisis last month, 601 admitted patients nationwide lay waiting on a trolley or a chair in an overcrowded emergency department (ED).

The same day news broke that ED nurses at Beaumont Hospital, Dublin had voted unanimously in favour of industrial action. Meanwhile, patients nationwide were interviewed on live radio across the country in testimonials that declared the indignity and suffering they had gone through in their local ED and their disbelief at how nurses and doctors could be expected to work in such intolerable conditions. Yet the same patients believed those health workers had done their very best for them individually.

The INMO has been balloting for industrial action across all major EDs and the results have inevitably be in favour of taking action. But how will industrial action help the situation – won’t it only make it worse for patients?

The unfortunate answer is that when a situation becomes intolerable, then the highest

risk to patients is to continue admitting them into a full hospital – this is actually putting them at higher risk than they were already exposed to by their original illnesses.

No one would suggest a ‘standing room only’ policy on an aeroplane. Even on buses the standing room only policy has a limit at which point the driver can pass waiting passengers because the bus is full.

Yet every day for over a decade now, nurses are expected to accept all presentations to EDs, even when all cubicles are full, all chairs are occupied by waiting patients and every available space in the department is filled with trolleys.

Stories are commonplace of patients being treated literally side by side with other ill patients without any privacy or dignity for their individual circumstances. The risk of cross infection is manifest and the stress for patients and staff, who are at breaking point, is patently obvious. Yet this situation is acceptable to the HSE, the government and, unfortunately, the wider public who have not had to endure such

circumstances. It will continue until someone cries halt. The ballot for industrial action by INMO members has demonstrated that cry for help.

One solid statistic There is no silver bullet or quick-fix solution to ED overcrowding, but the INMO is not seeking such a solution. For the past 10 years, the Organisation has counted the number of admitted patients waiting on trolleys and publicised the figures. It is the one consistent and solid statistic which, on a daily basis, notifies the public of the state of our health service. Yet the stark fact that overcrowding happens every single day gets forgotten; it is only when it reaches the crisis of 601 patients on trolleys that the majority of people become aware of the issue.

The HSE and the governm e n t c a n n o t d e fe n d t h i s situation but they do. It is no surprise that demand for the health service increases in winter and that the more severe the winter, the higher that demand becomes. It happens every year and it is entirely predictable. This year is worse

because five years of successive cutbacks has meant that excessive overcrowding continued throughout the summer and hospitals this winter were already under pressure coming into the cold period.

Ironically, the situation would be much worse except for the fact that we have had a mild winter so far. The reality is that ED overcrowding is the itch that no government will scratch because the solution lies not only within the ED, but also throughout the provision of health services which are costly and are demand driven.

When patients attend an ED and are deemed appropriate for admission they should, within a short period of time, find themselves in a bed suitable to the their condition. That is, patients with heart conditions should end up in coronary wards, medical patients should end up in appropriate medical wards, orthopaedic patients in orthopaedic wards, etc. If admitted patients are waiting long periods and in excessive numbers, it is an indication that the appropriate wards are already

NEWS 11

Patrick Coughlan from Santry in Dublin was one of the many members of the public who joined the INMO in protesting against overcrowding outside the Dáil last month. Mr Coughlan also protested with the INMO 10 years ago against the same issue and had the T-shirt to prove it. Among those cheering him on is INMO president, Claire Mahon (left)

left waiting on trolleys in overcrowded hospitals signed off for discharge by the relevant consultant or a member of his/her medical team.

But large acute hospitals have many consultants working in them, and admission and discharge practices can vary from one to another and can have an impact on the pace at which patients progress through the hospital system.

Much of the efficiencies which can be extracted from improving admission and discharge policies have been achieved but there is still progress to be made in having consistent practices across all divisions and specialties applied uniformly and every day, summer and winter.

Within hospitals, admission and discharge policies must be fine-tuned and operate consistently. Sufficient beds must be supplied in the first instance to meet the demand for the particular specialty or geographic area, and where smaller hospitals have been closed, additional beds are manifestly required in the larger hospital. These issues must be dealt with proportionately to ensure that both

beds and staff adequate to the demand which is predictable are put in place in every acute general hospital.

Delayed discharges The other reason for much of the overcrowding is the inappropriate detention of patients in an acute general hospital where their condition does not require that level of medical intervention but they do require alternative residential or home care. This is really community care and is an area that the Irish health service has struggled to provide in circumstances where the overall funding has been less than adequate.

Investment needed Change programmes of the scale required in the health service require investment. It has been a well-recognised practice in business that to achieve long-term gains very often significant investment is required and becomes costly in the change period. Long-term savings are generated only when the investment has been put in.

In Ireland unfortunately, that has not been the case.

While a significant percentage

of health service funding has been shifted from hospital care to community care over the past two decades and hospital stays have diminished, investment in community services is underwhelming in terms of the demand for those services.

The solution will only come with a sustained commitment over a five-year period. This must involve: • A determination as a community that ED overcrowding is unacceptable in any circumstance • Sustained investment in community services that allow for appropriate care without hospital admission or discharge to appropriate care settings • Adequate registered nurse to patient ratios and sufficient beds in the major acute hospital sector to deal with the demand of the speciality and geographic area demographic of the patient population • Immediate opening of all beds currently closed with a recruitment of staff to care for the admitted patients.

– Dave Hughes, INMO deputy general secretary

Vol 23 No 1 February 2015

full and there are no available beds. When that situation continues over several days and the number of patients waiting continues to increase, that indicates that the hospital is already full.

Internationally, for a hospital to run efficiently an 85% bed occupancy is considered ideal, with a 90% bed occupancy seen as being tolerable.

In Ireland for the past decade, hospitals are consistently running at 100% occupancy.

In some of the regions most chronically hit by overcrowding, the relief hospitals that had smaller EDs have been closed. This has led to even more pressure on hospitals that were already operating at 100% bed occupancy.

How can the hospital at capacity get back to a situation where it operates on the basis of 85% bed occupancy?

There is a complexity about how that can happen but it is not complicated. Patients can only be admitted to a hospital when deemed appropriate for admission by the relevant consultant. They can only be discharged from hospital when

12 NEWS

Forceful ‘Yes’ vote for industrial action Members set to commence work-to-rule as overcrowding soars The INMO has balloted members in five hospitals/groups seeking a mandate for industrial action due to the current overcrowding crisis in order to protect patients and staff.

This action was set to begin in January if immediate measures were not taken to alleviate the current pressures. It is inevitable that

members in other hospitals will also begin balloting due to the environment that currently exists.

All industrial action will take the form of a work-to-rule, meaning that nurses will not perform any administrative, clerical or non-clinical tasks.

Nurses will only engage in their direct care duties involv-

ing the provision of clinical care to patients.

At the time of going to press, the situation was: • O u r L a d y o f L o u r d e s , Drogheda had balloted, but postponed action following the intervention of the Labour Relations Commission • Beaumont due to begin workto-rule on January 27

• Naas General was set to commence action on February 4 • U niversity Galway Hospital to commence industrial action on February 3 • Industrial action to commence in Limerick, Ennis, Nenagh and Croom on February 3 • Mullingar to hold a lunchtime protest on January 27.

– Further details, page 19

Table 1. INMO Trolley Watch and Ward Watch Analysis 2006-2014 (Trolley Watch, which commenced in late 2004, relates to trolleys in Emergency Departments. Ward Watch, launched in April 2013, is a count of the number of additional patients on beds, trolleys or chairs, on inpatient wards/units above the stated complement of that ward/unit and provides a picture of whole hospital overcrowding. Ward Watch commenced on March 1, 2013)

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Hospital Beaumont Hospital Connolly Hospital Mater Misericordiae University Hospital Naas General Hospital St Colmcille's Hospital, Loughlinstown St James's Hospital St Vincent's University Hospital Tallaght Hospital Eastern total Bantry General Hospital Cavan General Hospital Cork University Hospital Kerry General Hospital Letterkenny General Hospital Louth County Hospital Mayo General Hospital Mercy University Hospital, Cork Mid Western Regional Hospital, Ennis Midland Regional Hospital, Mullingar Midland Regional Hospital, Portlaoise Midland Regional Hospital, Tullamore Monaghan General Hospital Our Lady of Lourdes Hospital, Drogheda Our Lady's Hospital, Navan Portiuncula Hospital Roscommon County Hospital Sligo Regional Hospital South Tipperary General Hospital St Luke’s Hospital, Kilkenny University Hospital Galway University Hospital Limerick University Hospital Waterford Wexford General Hospital Country total National total Increase between 2013 and 2014: 14% Increase between 2012 and 2014: 16% Decrease between 2011 and 2014: -12%

2006

2007

2008

2009

2010

2011

2012

4,304 2,418 4,248 3,025 1,267 2,008 4,190 4,941 26,401 n/a 2,816 3,867 1,144 3,059 200 2,285 1,431 867 169 469 64 106 3,444 520 403 589 784 727 n/a 1,654 1,814 n/a 2,907 29,319 55,720

6,164 2,709 5,083 1,323 751 1,022 6,093 3,962 27,107 n/a 2,779 3,615 507 1,253 88 1,391 1270 961 91 283 34 287 2,811 847 281 764 732 784 n/a 2,414 1,367 n/a 736 23,295 50,402

8,065 2,706 5,984 2,268 1,104 2,471 5,694 5,782 34,074 n/a 2,189 4,516 763 388 152 1,207 1,534 252 183 425 95 293 2,927 851 306 725 667 881 n/a 3,470 1,735 496 1,306 25,361 59,435

8,748 2,667 4,910 3,797 2,589 2,441 5,427 6,044 36,623 n/a 1,975 4,539 337 378 146 1,454 1,270 368 528 297 77 119 3,415 1,084 605 755 955 500 n/a 3,444 2,422 589 1,833 27,090 63,713

8,195 3,562 5,425 3,282 2,231 1,366 6,063 7,011 37,135 n/a 3,291 7,021 623 474 25 1760 1,910 431 1,921 426 766 n/a 3,484 453 840 1,036 1,754 666 140 4,103 3,715 1,349 2,536 38,724 75,859

7,410 4,207 3,936 4,409 2,208 1,590 6,403 4,784 34,947 n/a 4,572 6,649 672 592 n/a 599 1,943 411 3,204 1926 1857 n/a 7,449 1,469 941 719 1,505 768 1,034 6,544 3,658 1,165 3,857 51,534 86,481

6,327 3,937 4,213 2,116 2,201 1,288 4,735 1,906 26,723 n/a 2,569 4,230 606 539 n/a 1525 1,922 324 2,398 539 1303 n/a 6,761 745 821 n/a 2,086 2,138 695 4,193 3,626 1,590 975 39,585 66,308

Increase between 2010 and 2014: 2% Increase between 2009 and 2014: 21% Increase between 2008 and 2014: 30%

2013 2014 ED & Ward ED & Ward 7,062 5,852 2,854 1,836 1,130 1,706 2,872 3,943 27,255 n/a 1,954 4,102 694 1277 n/a 1145 2,491 333 2,845 824 1156 n/a 3,349 1,029 813 n/a 963 2,762 1,817 3,907 5,504 2,269 1,374 40,608 67,863

6,565 5,062 3,576 2,951 n/a 2,220 2,478 3,717 26,569 147 460 3,574 1,005 2,755 n/a 1908 2,196 7 3,908 1,589 3,746 n/a 6,249 1,059 912 n/a 2,017 1,959 1,921 5,312 6,150 2,249 1,399 50,522 77,091

Increase between 2007 and 2014: 53% Increase between 2006 and 2014: 38%

14 NEWS

Recruitment drive urgently required INMO says Minister underestimates crisis arising from nurse shortage Referring to the comments made by Minister of State for Health Kathleen Lynch regarding the imminent retirement of 1,000 nurses, the INMO said it firmly believes the Minister is completely underestimating the crisis and its impact on the provision of health services.

The INMO issued a statement to remind the Minister, health employers and the government that, over the past five years, they have implemented a recruitment embargo that has resulted in the loss of more than 5,000 nursing and midwifery posts.

“The impact of this misguided policy is that services have been left understaffed, posts have been left unfilled and our young graduate nurses/midwives have left, in their thousands, to work in other countries where they are sought after and valued,” said INMO general secretary, Liam Doran.

The INMO has consistently pointed out the complete

absence of manpower planning. “The Minister’s belated recognition of this, while welcome, must be followed by concrete actions,” Mr Doran said.

In this regard the INMO has called for an immediate, and sustained, recruitment campaign which must involve the: • Immediate abolition of the flawed, insulting ‘yellow pack’ graduate nurse programme • Offering of permanent posts, not short-term temporary posts • Granting of full incremental credit to all nurses/midwives • Re-introduction of nationwide postgraduate education opportunities that are fully funded by health employers • P a y m e n t o f r e l o c a t i o n expenses.

INMO general secretary, Liam Doran, said: “The Mini s t e r ’s c o m m e n t s , w h i c h recognise that this shortage is already upon us, must be followed by concrete measures. It is a reality that nurses/

Kathleen Lynch, Minister of State for Health, is completely underestimating the staff shortage in nursing and midwifery, according to the INMO

midwives in Ireland find themselves working with lower staffing levels, higher levels of overcrowding, enduring longer working hours and with minimal promotional opportunities when compared to other countries, particularly our near neighbour, the UK. “The recruitment embargo of the past five years has done untold damage to our health service, as the nurses and

midwives who stayed faced excessive workloads, while our young graduates were left with no alternative but to emigrate.

No one wins in that situation and policymakers must accept the responsibility for creating this crisis.”

Mr Doran concluded: “In January, the HSE was still offering three-month contracts to new graduates and highly skilled nurses/midwives.

This, at a time, when the UK is seeking to recruit up to 20,000 nurses offering them permanent posts with early opportunities for further professional development.

“This is a crisis and Ireland must aggressively compete, in the labour market, to attract and retain nurses and midwives who are highly sought after and valued in other countries. Any failure to fully address this crisis will ensure our health service can never meet the demands being placed on it in a safe and quality ensured manner.”

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Call for nurse managers to get more involved in INMO Nurse and midwife managers, now more than ever, need to use the INMO to protect both their individual positions and the standing of their profession in the face of crude attempts by HSE management to diminish the influence of nursing in healthcare.

This stark warning was issued

by Dave Hughes, INMO deputy general secretary, who said the HSE is lethargic in its approach to the commitment it gave to prioritise a review of nurse management structures under the Haddington Road Agreement. Evidence is emerging of plans to reduce the number of director of nursing positions

and other nurse manager roles, while casting major statutory responsibility onto CNM2s who will not be given the necessary resources to deliver safe care.

According to Mr Hughes, the INMO has had to repeatedly push for engagement with the HSE through the Labour Relations Commission and, when it finally engaged in December, only proposals relating to the care of older persons emerged.

Yet a week later, group director of nursing positions were advertised for the hospital groups as ‘Band 1 director of nursing’, while the other management post in the hospital group hierarchy is graded at ‘assistant

national director’ level. The INMO has demanded the assistant national director grade for the group DON position.

Mr Hughes said discussions on nurse management structures are going to be very difficult. “Under proposals for care of the older person there would be a significant reduction in the number of directors of nursing and the introduction of a cluster model, which previously was tried and failed within the Irish health service.

The new Community Health Organisation’s documentation is vague on where the director of public health nursing position fits in and seems to relegate

the reporting relationship of the most senior nurses in the community to a level far removed from the chief officer of the new organisations. In the Group hospitals, the idea that the group director of nursing should be a lower graded and lower paid level than the group financial manager demonstrates the low priority given to clinical nursing practice in the delivery of health services and is unacceptable.”

Mr Hughes concluded by encouraging all INMO nurse managers to become more involved in their sections and, if not yet members, to immediately join the INMO, in their own and the profession’s interest.

NEWS 15

Public sector pay talks to recommence As a result of the improved economic situation, the Public Services Committee (PSC) of the Irish Congress of Trade Unions (ICTU) of which the INMO is a member, is expected to seek early discussions, with government, on the restoration of pay and conditions which were cut, and attacked, during five years of austerity under emergency legislation.

It is expected that the PSC will seek discussions with government in the second quarter of this year, with the expectations that the discussions begin and are completed by late summer.

From an INMO perspective, these talks will offer the opportunity for members to demand the reversal

of pay cuts, the reduction of the pension levy, the restoration of time-and-one-sixth for unsocial working in the evening and, also, the return to a working week in line with other health professionals and administrative colleagues.

In preparation for these t a l k s , a n d a r i s i n g f ro m a decision at the INMO Special Delegate Conference in N ove m b e r, m e m b e rs w i l l be asked to consider, before Annual Conference this May, a briefing document on all of the issues which the Organisation will be seeking discussion/progression on.

ADC 2015 will also give delegates an opportunity to discuss the Organisation’s approach to any talks, in some detail, and to give some indi-

cation of priorities in all of these issues, when the negotiations commence.

INMO general secretary Liam Doran said: “It is quite clear, from public statements from various government ministers, that discussions will begin, on a post-Haddington Road scenario, later this year.

The INMO and other unions will all have priorities when entering talks, as we collectively seek the restoration of pay and other conditions of employment lost/attacked by government in the name of austerity in recent years.

“The full restoration of all of these cuts, which took place over five years, is likely to take some time. While it cannot be expected that everything will be restored in this first round

of discussions, the INMO will be demanding progress on as many issues as is possible. We will have a particular focus on reducing the levy, restoring the time-and-one-sixth and creating a process within which the working week can be brought into line with other health professions.

This issue, notwithstanding the unique pressure on the health service from overcrowding and other issues will, dominate the Organisation’s activities at national level, in the middle of the year. Every effort will be made to establish, and maintain, a strong line of communication with members across the country, as we enter into this overdue process of restoring pay and conditions to our members”.

Showing solidarity after Charlie Hebdo attack

Charlie Hebdo commemoration at Dublin Castle: INMO members joined members and supporters of the NUJ at a commemoration ceremony organised by NUJ for Freedom of the Press in Dublin last month. Photo: Sasko Lazarov/Photocall Ireland

with those attacked, their families, and free societies all over the world in ensuring the continued freedom of the press.”

Commemorations, rallies and demonstrations took place

worldwide with the slogan ‘Je suis Charlie’ prevalent on signs and banners as people rallied together in defence of free speech and freedom of the press.

No 1 February 2015

of the press that is so vital to our democratic societies. No cause, and certainly no cause carrying a veil of religion, can justify the atrocities which were perpetrated. We stand

Vol 23

A remembrance ceremony to commemorate the 17 people, including 12 magazine staff, killed in the attack on the offices of satirical magazine Charlie Hebdo was held in Dublin Castle on January 10.

The event was organised by the National Union of Journalists. A rally to commemorate those killed was also held in Dublin city centre on January 11, where a crowd of at least 5,000 marched from the GPO in O’Connell Street to Leinster House in solidarity with the people of France.

M e m b e rs o f t h e Fre n c h Community in Ireland were joined by journalists, trade unionists, public representatives and members of civil society at both events. Edward Mathews, INMO director of social policy, represented the INMO in Dublin Castle saying: “An attack on journalists in the course of their work represents an attack on the freedom

16 NEWS

ID clients denied basic human rights

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No 1 February 2015

INMO unreservedly condemns care practices at Áras Attracta The INMO, which represents more than 2,250 registered nurses in intellectual disability (RNID), unreservedly condemned the practices in Áras Attracta, Swinford, Co Mayo identified by the RTE Investigations Unit and broadcast on Primetime in December.

At a meeting following the programme, members of the INMO RNID Section, who work in residential, community and other support services across the country, expressed their horror, sadness and shame at what was shown on the Primetime programme.

The Section, on behalf of its entire membership, collectively apologised to the vulnerable clients, and their families, who were cared for in such an “unacceptable and abusive manner”. The clients’ human rights were violated, abused and ignored. Any staff involved must be the subject of immediate investigations, including referral to the Fitness to Practise procedures laid down in the Nurses and Midwives Act 2011, the Section said.

The RNID Section ident i f i e d t h re e i n t e r- re l a t e d re a s o n s w h y t h e s e u n a cc e p t a b l e , d e p l o ra b l e a n d objectionable practices were exposed, including the failure of frontline staff; the constituent makeup of the Health I n fo r m a t i o n a n d Q u a l i t y Authority (HIQA) inspectorate team; and HSE policies and managerial approaches.

Failure of frontline staff The investigative report clearly demonstrated that, with regard to this particular cohort of staff, unacceptable practices were allowed to exist. This was regardless of whether they were engaged in by registered nurses or care

Áras Attracta Care Home , Swinford, Co Mayo

support staff. This is as a direct result of lack of professionalism, inadequate frontline management, poor training and a general culture that the clients were not deserving of their basic human rights which should be delivered and maintained with professionalism, care, warmth and attention.

However, none of these systems-related failings excuse the individual actions of staff shown on the programme.

HIQA HIQA commenced an inspectorate function within ID services, without having the necessary inspectorate staff, with the specialist skills, competencies and knowledge, to carry out this statutory function. The INMO believes all inspectorate teams must have an RNID with the specialised knowledge and experience to really measure the quality of services in this sector.

HSE policies and managerial approaches In relation to ID services, the HSE has adopted an overt approach of reducing staffing levels, lowering the mix of qualified and unqualified staff, and minimising any level of autonomy about policies, staff training and development. Too many service-related decisions are dictated by a detached, isolated and ill-informed central management. According to the INMO, this has been

done in the name of cost containment and reducing staffing levels so that they conform with budgets that have no connection to high quality, patient-centred care and the human rights of the clients.

At its meeting, the INMO RNID Section reaffirmed its view that the health system as a whole views ID services as requiring lower standards of professional practice than other areas, such as mental health, general hospitals etc.

This suggests that the human rights of these most vulnerable of citizens are not afforded the same weight as those who can speak up for themselves.

The RNID section meeting directed the INMO, on behalf of its membership, to: • Ensure the meeting with Kathleen Lynch, Minister of State at the Department of Health with special responsibility for Disability, Mental Health and Older People, deals comprehensively with this matter and agrees strategies to ensure any bad practices are identified and addressed immediately • Seek an immediate meeting with HIQA to further develop and enhance its inspectorate function for disability services, which must include an RNID on all inspectorate teams • Call on all staff working in ID services to immediately bring

to local management and the INMO’s attention, examples of bad practice and to act as whistleblowers and advocate for clients at all times • Work with Inclusion Ireland, and all other voluntary entities working in the ID field, to highlight the needs, requirements and human rights of those with intellectual disability • Seek the nationwide implementation, by working with HIQA, the HSE and the Nursing and Midwifery Board of Ireland, of the same professional standards, as exist for all other services.

INMO general secretary Liam Doran said: “These revelations are utterly condemned and abhorred by every member of the INMO, but particularly our 2,250 members holding the RNID qualification.

“These unacceptable, objectionable and abhorrent practices occur when individuals fail those they are caring for, management bureaucracies lose sight of the core values and objectives of a health service, and when independent inspectorates are not equipped to carry out their duties.

“The INMO will now work with all parties to ensure all practices are of the highest quality and there is no hiding place for those who abuse our fellow citizens”.

18 NEWS

Landmark victory in EC pay case Decision confirms no difference between EU and Irish experience The INMO received official confirmation from the European Commission (EC ) on January 5 that the HSE had agreed to review the Organisation’s complaint of pay discrimination of two nurses who were placed on a new entrants pay scale despite previous public service work in another member state.

The HSE has now confirmed its intention to reverse new entrants’ pay scales (10% less in 2011) and instead apply 2010 salary scales to the two INMO members working in Cork.

T h e b a c k g ro u n d t o t h e case involves two nurses who returned to Ireland in 2012 from working in the UK Public Service. The HSE refused 2010 salary scales and instead placed them on new entrant salary scales. The Irish government attached a 10% reduction in pay scale to anyone who had not worked in the Irish public service on or before December 31, 2010.

The INMO made an extensive complaint to the HSE and appealed the decision via the

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No 1 February 2015

Training courses for workplace reps Arrangements are being finalised for training courses for INMO representatives for 2015, which will concentrate on basic level training. Dates for courses will be notified in WIN and on the website www.inmo.ie The following dates are confirmed: • February 11-12 – Tower Hotel, Waterford • March 18-19 – Galway (venue tbc) • A pril 28-29 – Mount Errigal Hotel, Letterkenny • June 25-26 – INMO HQ, Dublin.

For further information contact Albert Murphy, INMO organiser: albertmurphy@inmo.ie

Patsy Doyle, INMO IRO: “This outcome has far-reaching consequences for other nurses and midwives returning or already returned from other EU countries”

Labour Relations Commission, the Labour Court and latterly the EC as a breach of Article 45 (Treaty of the Functioning of the EU) as the fundamental right of EU workers to freedom of movement in the EU. I n o rd e r t o p ro t e c t t h e pay from commencement of employment, the INMO initiated a parallel action through the Labour Relations Commission and the Labour Court.

The EC served infringement p roce d ure s on N ovem b er 13, 2014 and the HSE then informed the EC that it would

accept its opinion that the nurses’ service within the UK public sector entitled them to 2010 pay scales. The Irish authorities also stated that arrangements have been made to place the nurses concerned on the 2010 scales with retrospection.

These arrangements will also be applied to other midwives/nurses with relevant public sector employment in any EU member state.

INMO IRO, Patsy Doyle said: “The INMO welcomes this exciting development which does justice to the claimants. They knew the 2011 scales were wrong and they approached the Organisation to argue their case. The INMO was happy to research and plan the way forward and worked well with the members to obtain this fair outcome.

“We are delighted that this outcome has far-reaching consequences for other nurses and midwives, and ask all claimants to stand forward now and ask for a salary review if you believe you were wrongly placed on 2011 salary scales.

This matter was raised at the National Joint Council on January 20 with a view to obtaining a National Circular to guide the realignment of salary to all nurses and midwives with past EU service.

Ms Doyle said: “This is a landmark victory for our members who had the courage and tenacity to challenge an incorrect pay scale which breached their rights as EU citizens.

“We are emerging from an extraordinary period of restriction in the Irish health service.

Ireland needs to welcome back the EU diaspora to fill nursing and midwifery vacancies. This is one development which would attract back the previously disenchanted nurse who left Ireland in response to the graduate programme. We will now seek that the Department of Health and the HSE ensure the correct salary is in place for those in this situation working in the Irish health services and made known to nurses working in the EU, particularly in the UK, whom they need to attract back to the Irish health services.”

Maternity benefit and overseas travel A recent case of maternity benefit and how it is applied to an overseas nurse who was to leave the jurisdiction during maternity leave came to light in St James’s Hospital, Dublin.

The INMO member, who is from outside the EU, informed the Department of Social Protection that she was travelling to her home country during maternity leave.

As she was leaving the EU, she was informed correctly by the Department that she would not be entitled to maternity benefit. She then

brought Department’s letter to payroll in St James’s Hospital who informed her that the hospital would pay her maternity benefit for the duration of her maternity leave.

In the presence of the INMO member, payroll stamped her welfare form and made a note saying “maternity benefit to be paid”.

The member received maternity benefit in full from St James’s Hospital while she travelled home.

However, one year later St James’s Hospital informed her

in writing that she had been overpaid and that this matter had just come to their attention. The hospital was then seeking to recoup the money.

Following representation by t h e I N M O , S t J a m e s ’s Hospital decided not to seek reimbursement of the money as the Organisation argued that a clear agreement existed between St James’s Hospital and the member to pay her maternity benefit.

The full amount of benefit paid was €6,000 gross.

– Joe Hoolan, INMO IRO

NEWS 19

Overcrowding continues in Beaumont to provide safe patient care, yet the situation persists.

Patients are faced with deplorable conditions where they are crammed together on trolleys and chairs for days waiting for a bed to become available, according to INMO IRO Lorraine Monaghan.

“Major change is required to bring an end to the untold suffering of patients. The solutions are there but it requires management, the HSE and the

Naas set to commence work-to-rule

UL hospitals bed management in chaos

Mary Fogarty, INMO IRO: “Additional bed capacity is required but this requires the recruitment of nurses and other support staff for all proposed new inpatient areas”

• A HSE plan to open decommissioned beds in Ennis and Nenagh Hospitals without any additional nurses/support staff • A c r i t i c a l s h o r t a g e o f a 70-100 nursing posts in Lim-

erick and more if beds are to open in Ennis and Nenagh • A H S E p l a n t o t r a n s f e r patients to Croom Orthopaedic Hospital pending a review by a medical team.

INMO IRO Mary Fogarty said: “All of these are issues of patient safety which the INMO has raised directly with the HSE. We acknowledge that additional bed capacity is required in the region but equally this requires the recruitment of nurses, and other support staff, for all proposed new inpatient areas.

Meanwhile in the region, agreement was reached at Regina House Community Nursing Unit, Kilrush for the employment of three additional WTE nurses to address a current acute staff shortage.

Galway to close beds despite crisis ing levels. The situation is further compounded by management’s plans to temporarily close 19 acute beds to facilitate a building project.

Clare Treacy, INMO IRO, said: “The idea of closing beds in the current circumstances is simply incredible and alarming. Major change is required to turn this degrading situation around. Industrial action will

begin in GUH on February 3.”

Anne Burke, INMO Executive Council member and clinical nurse manager at the GUH ED, said: “The conditions in the ED have reached an intolerable and grossly unsafe state. It is no longer possible to provide professional and high standards of care to vulnerable patients in such unsafe, understaffed and immoral conditions.”

No 1 February 2015

INMO members at Galway University Hospital emergency department (ED) have voted 100% in favour of industrial action.

This action is being taken as the situation in the ED continues to escalate, with patient care being compromised by excessive overcrowding, limited space, lack of beds and dangerously low staff-

Vol 23

INMO members at Naas General Hospital voted overwhelmingly (97%) in favour of industrial action due to continued severe overcrowding at the hospital.

The action is set to commence on February 4 in the form of a work-to-rule.

Tro l l e y f i g u re s i n N a a s increased by 61% in 2014 compared with 2013. In response to the crisis, an additional 46 beds within the hospital have been opened, however, these beds are unfunded and are not adequately staffed. An additional 50 nurses needs to be recruited for the hospital as a matter of urgency.

Meanwhile, a lunch-time protest was due to be held at Midland Regional Hospital, Mullingar on January 27 to highlight staff shortages and overcrowding.

Overcrowding throughout the hospital is now at record levels. Nurses and midwives in Mullingar have been working in intolerable conditions continuously and they saw no let up in this over the Christmas period.

– Derek Reilly, INMO IRO

With 93% of INMO members working in the University of Limerick Hospital Group voting in favour of industrial action, a work-to-rule will commence at the University Hospital Limerick, Ennis Hospital, Nenagh Hospital and Croom Orthopaedic Hospital on February 3.

The industrial action commencing in each of the above locations is in response to: • The unabated overcrowding at the University Hospital Limerick, including the ED • A claim for additional nurses for the ED • The placement of additional trolleys and beds on inpatient wards • T he failure of the HSE to recruit additional nurses prior to the opening of a 23-bed ward in the hospital

Minister for Health to declare the situation a National Emergency and take the necessary actions to tackle the chronic overcrowding problem once and for all,” she said.

At the time of going to press a second conciliation conference was due to be held at the Labour Relations Commission with a view to seeking resolutions to matters in dispute.

Meanwhile, a high number of delayed discharges in Connolly

Hospital is one of the main contributors to the overcrowding problem there. A series of meetings with members is planned for the coming months.

Safe practice workshops were organised in both Beaumont and Connolly hospitals in January, to update members on steps to take when they feel their working environment is unsafe. In addition, two fitness to practise presentations are due to be held in Beaumont.

INMO members in Beaumont Hospital emergency department (ED) voted 100% in favour of industrial action. ED nurses are now set to commence an ongoing work-to-rule on January 27. The action will escalate to work stoppages if the situation does not improve.

INMO members have continued to advise management that the chronic overcrowding and staffing shortages are impinging on their ability

20 NEWS

North East region round-up Study leave The INMO has ensured that the study leave policy of Our Lady of Lourdes Hospital, Drogheda and Louth County Hospital was amended so that part-time staff receive appropriate study leave in line with their full time colleagues.

Virginia Unit The INMO secured an agreement from the Labour Relations Commission with regards to the transfer of 26 patients into a new facility at Virginia Nursing Unit. The agreement ensures that management cannot increase the number of patients above 26 under any circumstances unless agreement has been reached between the parties on staffing. Negotiations have commenced with management with regards to the staffing of the planned 56-bed unit.

Hourly pay rate The INMO successfully secured an LRC agreement with the HSE with regards to the application of the correct hourly rate of pay in the calculation of premium payment in Cavan/ Monaghan Care of the Older Persons Services.

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No 1 February 2015

St Oliver Plunkett’s LRC agreement has been reached on the provision of full-time permanent contracts to 13 staff in St Oliver Plunkett’s Hospital, Dundalk. The INMO lodged a claim on their behalf that they receive permanent contracts of indefinite duration with full time hours recorded in the contract.

– Tony Fitzpatrick, INMO IRO

Steps needed to alleviate overcrowding in northwest Sligo Regional Hospital and Letterkenny General Hospital both fell victim to the usual post-Christmas overcrowding in their emergency departments.

Patients were placed on corridors and in treatment rooms with no privacy, confidentiality or dignity. Management responded by cancelling elective surgery and day procedures, and by drawing down of additional funds secured for home care packages from the €3 million allocated by the Minister for Health. In addition, more agency staff were brought in to alleviate work conditions.

Maura Hickey, INMO IRO,

said: “The initiatives required to address the problem of overcrowding in Letterkenny and Sligo hospitals is one of increased resourcing in the c o m m u n i t y. Pe o p l e w a n t to stay in their homes with appropriate support. Additional PHNs, community RGNs, nurse specialists, home helps, interventional teams, GPs and ancillary health requirements are needed to allow this to happen.

“Nursing staff are to be c o m m e n d e d fo r a l l t h e i r hard work and are on a daily basis juggling patient safety a n d s a fe c a re i n w o r k i n g

Tallaght recruitment drive now underway A major recruitment campaign for Tallaght Hospital was undertaken at the airport recently. This was advertised in the national and UK media and resulted in the region of 90 enquiries being made to Tallaght Hospital.

The hospital interviewed for approximately 60 nursing posts in November 2014.

These initiatives are a direct result of continued pressure by the INMO for nurse vacancies to be filled.

Placement of trolleys on the ward has become the norm and a proposed escalation pol-

icy was rejected by the INMO. The Organisation is seeking that an area of the hospital be designated to care for these patients with an appropriate ratio of staff. Problems also continue in relation to the management of patient flow within the hospital.

An independent review is taking place into the viability of the crèche in Tallaght. This is expected to see the crèche continue to operate. Management had made a decision last year to unilaterally close this facility.

– Derek Reilly, INMO IRO

More staff for Dungarvan INMO IRO Mary Power met with management at Dungarvan Community Hospital in December with regard to the ongoing staffing crisis at the hospital, particularly compounded by the recent non-availability of agency nurses. Mary Power said: “We

were advised that an additional 4.5 WTE nurses will be commencing at the hospital in December to January. The hospital also recently advertised for the permanent filling of a CNM2 position and to establish a panel for future vacancies.”

environments that are not conducive to same. Members firmly believe that the recent comments from the minister for health requesting that they put their shoulder to the wheel will serve only to de-motivate as opposed to motivate and promote their extraordinary efforts in maintaining patient safety to date.”

Meanwhile, three ‘Tools for Safe Practice’ workshops were held in Sligo and Letterkenny and Ms Hickey also had an information stand in Letterkenny General Hospital for two days during ‘Promoting Nursing and Midwifery Week’.

Nazareth House Protracted negotiations regarding the future viability of Nazareth House, Mallow reached its conclusion with members accepting the final proposal that emanated, following numerous management m e e t i n g s a n d t w o L RC h e a r i n g s , re p o r t s Mary Power, INMO IRO

Sick leave ‘Sick Leave Workshops’ were organised by Mary Power, IRO, in Clonmel and Waterford recently, where many questions and issues were raised by those in attendance.

North West update INMO IRO, Maura Hickey reports from the Northwestern area that members at Nazareth House, Sligo and Ballymote Nursing Unit are awaiting a date for a Labour Court hearing on Management’s cost saving plan. Management has made this referral following a number of failed conciliation meetings.

Section News 23

Midwifery conference hits high notes

October 2014 saw the gathering in Dublin of more than 140 midwives from north and south of the island, for the 20th allIreland midwifery conference.

There was a vast array of speakers, covering the overall theme of ‘Pregnancy Pathways’, the focus on the day being women and their choices in childbirth.

The concurrent sessions were of an exceptional standard this year. There was a workshop on human trafficking, which was jointly facilitated by the Human Trafficking Investigation Unit of An Garda Síochana and the Organised Crime Branch of the PSNI. There was a session on ‘Breaking Bad News’, facilitated by Jane Dalrymple CMS, Rotunda Hospital. Stephen Hamilton delivered an excellent session on ‘Maximising Wellbeing and Resilience’ and a talk was given

by Prof Agnes Higgins on ‘Enabling Disclosure – creating the context and space to discuss sensitive issues’.

The poster competition was also well subscribed, and for the first year there was a joint winner. The first was Jean

Doherty, a student midwife in the National Maternity Hospital, with her poster entitled “Paternal skin-to-skin after Caesarean Section”. Her poster showcased the findings from a review of literature, questioning should paternal skin-to-skin contact be routinely promoted for full-term healthy infants whose mothers have undergone Caesarean section.

The second joint winners were Caroline Keegan and Mairead Martin from Our Lady of Lourdes, Drogheda with their poster entitled “Midwifery Model of Care”. The message conveyed through this poster was that the relationship between women and midwives is central to the experience of birth for both parties. This relationship includes choice, education, continuity of care, trust, respect and time, all of which are underpinned by evidence based practice, support, and the belief in a woman’s right to a positive birth experience.

Sincere thanks go to our industry partners for their continued support of this con-

Pictured at the All-Ireland Midwives conference were the conference planning committee (l-r): Breedagh Hughes; Mary Higgins;Mary Caddell; Margaret Carroll; Claire Mahon, INMO president; Dale Spence; Deirdre Daly; Deirdre Monroe; and Colm O’Boyle

Sheena Byrom, OBE, author and midwife, pictured speaking at the All-Ireland Midwifery Conference

ference, and, in particular, to Johnson & Johnson Limited for very generously granting us their educational bursary.

This day was perhaps the best evaluated midwifery conference that has ever been h o s t e d by t h e I N M O a n d RCM, with the ‘how did you

rate the conference overall’ question scoring either 8, 9 or 10 on every evaluation form received. Sincere thanks to the midwifery conference planning committee who put so much time and effort into ensuring this event remains of such an exceptional calibre.

IONS to promote education and collaboration Louise Brent, IONS secretary pictured with China’s ICON representative Lingli Peng, at the recent World Congress of Orthopaedics Conference

presentation on “Improving hip fracture care: An Irish Perspective” was well received at the conference.

There is a lot happening in the coming months. Galway University Hospital is hosting its annual orthopaedic nursing conference on February 26 in the Clayton Hotel Galway.

For more information on the

conference or to book a place email: fiona.heaney@hse.ie The Irish Hip Fracture Database will also be hosting its annual meeting on March 6 in the RCSI. This is a multidisciplinary conference, and you can register for free by logging onto www.noca.ie Fiona Heaney IONS chairperson

No 1 February 2015

IONS committee members would commit to developing an evidence-based information leaflet for nurses on best practice in the prevention and management of constipation in orthopaedic patients. Work is currently underway on this project.

IONS continues its links with the International Collaboration of Orthopaedic Nurses (ICON), and work continues on an international project comparing and benchmarking standards of care for patients who sustain a hip fracture.

IONS secretary Louise Brent recently represented IONS and ICON at the World Congress of Orthopaedics Conference. Her

WIN Vol 23

The Irish Orthopaedic Nurses Section (IONS) was established to provide a forum for orthopaedic nurses to network, to exchange practice information and to promote education events relevant to this specialist area. The Section is open to all nurses engaged in orthopaedic nursing or any related specialty, as well as members who have an interest in orthopaedics irrespective of their work location.

Recently IONS had its annual face to face meeting at Sligo Regional Hospital and we would like to extend thanks to Charlotte Hannon and Gerry Tuohy for hosting the meeting. It was agreed that the

24 INTERNATIONAL NEWS

Vol 23

No 1 February 2015

Ireland central to UN post2015 development agenda The United Nations (UN) is in the process of defining a post-2015 development agenda. This agenda will be launched at a Summit in September 2015. It is currently being developed through informal consultations of the UN General Assembly (GA). The President of the GA has appointed two co-facilitators to lead those informal consultations. The co-facilitators are David Donoghue, who is the UN-appointed Permanent Representative, Permanent Mission of Ireland and Macharia Kamau, Permanent Representative Permanent Mission of the Republic of Kenya to the UN. The first session of the intergovernmental negotiations on the post-2015 development agenda took place in January 2015 at UN Headquarters in New York. The process of arriving at this new development agenda is member state-led with broad participation from major groups and other civil society stakeholders. The new agenda will be launched at a Summit to be held on 25 to 27 September 2015 in New York, which is the target date for realising the Millennium Development Goals (MDGs).

The MDGs are eight international development goals that were established at the Millennium Summit of the UN in 2000, following the adoption of the United Nations Millennium Declaration. MDGs take a holistic approach to reducing poverty. The Goals cover not only income poverty reduction but also education, gender equality, health and environmental sustainability and the need for a ‘global partnership for development’ that will facilitate the delivery of these aims. The MDGs consist of eight goals: • Goal 1: Eradicate extreme poverty and hunger • Goal 2: Achieve universal primary education • Goal 3: Promote gender equality and empower women • Goal 4: Reduce child mortality • Goal 5: Improve maternal health • Goal 6: Combat HIV/AIDS, malaria and other diseases • Goal 7: Ensure environmental sustainability

• Goal 8: Develop a global partnership for development.

Over the lifespan of the MDGs agenda, unprece dented efforts have been undertaken to meet the needs of the world’s poorest. The UN is also working with governments, civil society and other partners to build on the momentum generated by the MDGs and continue with an ambitious post-2015 development agenda.

As the target date of the MDGs in 2015 approaches, it has been noted that there are serious variations in progress despite the achievements made globally.

Therefore, the UN is now in the process of defining a post-2015 development agenda. The process of arriving at the post-2015 development agenda is member state-led. There have been numerous inputs to the agenda, notably a set of sustainable development goals (SDGs) proposed by an open working group of the GA, the report of an intergovernmental committee of experts on sustainable development financing, GA dialogues on technology facilitation and many others.

The INMO Executive Council recognised the importance of the UN SDGs and the opportunity to strategically influence global policy in relation to the health workforce,

particularly the significant contribution of nursing and midwifery as a catalyst for change and delivering quality healthcare to all populations. The INMO with the Health Workforce Advocacy Initiative (HWAI) and 39 other international organisations (see box for details) co-signed a letter (reproduced on the opposite page) that was sent to both UN co-facilitators the Irish and Kenyan Permanent Representatives, in advance of the January intergovernmental negotiations.

The HWAI promotes the development of human rights-based health workforce strategies designed to achieve universal healthcare, and other global health goals.

HWAI seeks to empower health workers themselves to become advocates. This letter highlighted the need for strengthening the health workforce language in the UN SDGs and contained three main requests: • That the health workforce sub-target contained in the SDGs zero draft is maintained and strengthened • That the universal health coverage sub-target include access to a health worker

INTERNATIONAL NEWS 25

Health Workforce Advocacy Initiative The Health Workforce Advocacy Initiative (HWAI) is an international civil society network addressing the global health workforce crisis, a fundamental and critical barrier to achieving universal access to a well-staffed and functioning health system. The HWAI network has a shared strategic vision of a “health worker for everyone, everywhere.” Complementary to the work of HWAI’s members in the field of advocacy for health workforce issues and affiliated with the Global Health Workforce Alliance, the initiative is a platform for strategising, generating and sharing knowledge and information, actively seeking and achieving synergies, and developing joint positions and activities related to advocacy for health workers (HWAI 2015).

Fo r f u r t h e r i n f o r m a t i o n i s accessible at: www.hwai.org

• T hat the indicators developed for the health target include strong, measurable indicators for the health workforce.

The HWAI works to ensure that health workers in all countries are adequately supported. To ensure that health workforce strengthening becomes a global health priority in the coming years, the HWAI and the INMO with other international partners are advocating for support for the health workforce sub-target in the UN SDGs ‘zero draft’, which emphasises the need for all people to have access to a health worker.

There is also a need to advocate for health worker accessibility to be specified as an essential component of the universal health coverage sub-target. As Ireland is one of the co-facilitators (along with Kenya) for the SDG negotiations, this will therefore play a very important role in determining the post-2015 agenda.

Elizabeth Adams is the INMO director of professional development

Dear Ambassador,

No 1 February 2015

Re: Strengthening the Health Workforce Language in the United Nations Sustainable Development Goals We, the undersigned 40 organisations, are non-governmental organizations, private sector partners, and health professional associations from five continents and eleven countries including Ireland. In an initiative led by the HWAI, we collectively are advocating for a strong international response to the global health workforce crisis.

We thank you for your crucial leadership in pushing for a strong compact for the post2015 United Nations Sustainable Development Goals (SDGs), and we applaud your activism in helping to ensure a healthier, more secure, progressive, and united global future. We ask that you utilise your leadership and expertise to support and improve language in the SDGs aimed at strengthening the global health workforce.

A robust, empowered health workforce — which includes community health workers, midwives, nurses, pharmacists, doctors and other health workers — is the backbone of effective health systems, ensuring universal health coverage and healthy lives for all people. The WHO in 2013 estimated the at least 7.2 million more doctors, nurses and midwives are currently needed to provide essential services to everyone, a devastating gap that will keep growing if it continues to be neglected.

The SDGs can provide an excellent platform to drive progress in filling these health workforce gaps. It can inspire governments worldwide to commit to working towards healthier communities serviced by a robust, well-trained, and well-equipped national health workforce at its core. As made evident by the recent devastating spread of Ebola, a sustainable and resilient health workforce is essential for safeguarding the health of people everywhere.

During the last quarter of 2014, HWAI led a broad consultation process on the current health workforce language in the SDG zero draft, and responses from over 130 global stakeholders engaged in a range of health workforce issues emphasized the need for stronger health workforce language in the SDGs. The SDG ‘zero draft’ submitted by the Open Working Group to the United Nations General Assembly includes the following health workforce target under Goal 3, which aims to “ensure healthy lives and promote well-being for all at all ages”: “3c: Increase substantially health financing and recruitment, development and training, and retention of the health workforce in developing countries, especially LDCs and SIDS.” We strongly support inclusion of a target specific to strengthening the health workforce in the SDGs, and commend the Open Working Group for recognising health workforce needs in target 3c to meet the “health for all” goal.

We encourage 3c to be modified as a measurable target to increase financing for and numbers of health workers, and that this target be inclusive of all countries – not just LDCs and SIDS. Given diverse interpretations of what qualifies as reasonable access to a trained health worker, a measurable target (ie. minimum X skilled health workers per 10,000 population) can clarify how many health workers need to be recruited, trained, supported and retained to achieve reasonable access. We also strongly support the development of robust and measurable indicators for health workforce development to track progress of all aspects of the proposed SDG Goal 3 on health.

The SDGs also must explicitly recognise how improving access to health workers is a crucial and indispensable requisite to achieving universal health coverage (UHC). UHC has been identified as a critical global health priority in the post-2015 development agenda, but inadequate numbers of health workers will be one of the biggest barriers to achieving this goal.

In this light, we recommend that access to trained and supported health workers for all be included in the UHC target in the SDGs, and propose the following language: 3.8: Achieve universal health coverage (UHC), including financial risk protection, access to quality health care services, access to trained and supported health workers for all, and access to safe, effective, quality and affordable essential medicines and vaccines for all.

We respectfully request that as a leader in the SDG negotiations, you articulate and support this stronger health workforce language in the final version of the SDGs. During the series of preparatory meetings until the next round of main UN discussions in January 2015, you can play an important role in driving momentum towards ensuring there is a health worker for everyone, everywhere.

We greatly appreciate your consideration of this issue and look forward to your reply.

Vol 23

Signatories to the letter: AGHA, Uganda, ADRA, US, African Population and Health Research Center, Kenya, Amref Health Africa, Kenya, Aspen Institute Health Worker Migration Global Policy Advisory Council, US, Association of Women’s Health, Obstetric, and Neonatal Nurses, US, BRAC, Bangladesh, Center for Equity and Health Systems, Bangladesh, CHEDRES, Nigeria, CORE Group, US, Eminence Associates, Bangladesh, Frontline Health Workers Coalition, US, ForoSalud, Peru, GSK, UK, Global Alliance to Prevent Prematurity and Stillbirth, US, Global Health Council, US, GHETS, US, The Global Network for Neglected Tropical Diseases, US, Health Alliance International, US, Health Poverty Action, UK, Health Rights and Education Programme, Malawi, Health Workforce Advocacy Initiative, US and Kenya, Hesperian Health Guides, US, International Confederation of Midwives, Netherlands, IntraHealth International, US, INMO, Ireland, Kenya AIDS NGOs Consortium, Malaria Consortium, UK, mPowering Frontline Health Workers, US, One Million Community Health Workers Campaign, US, Pathfinder International, US, Public Health Institute, US, ReSurge International, US; Save the Children, UK, Wemos Foundation, Netherlands, Women Deliver, US, World Medical Association, France, University Research Co, US, University of Utah, Division of Physician Assistant Studies, US, VSO International, UK

Letter signed by INMO and 39 other agencies to UN co-facilitators in advance of first negotiations

26 Questions & Answers

QA Query from member I seek confirmation of the current overtime rates for nurses in the Public Service. I have recently been advised that if I work overtime I will be paid a flat rate.

I don’t think this is correct. Can you please explain?

Reply Thank you for your question and you are correct in that a change to the overtime rates did result from the Haddington Road Agreement. However, the INMO and other health service unions secured the maintenance of: • Any hours worked between midnight and the start of normal day duty overtime will continue to be paid at double time In respect of Monday-to-Friday day duty any additional hours worked between start of normal day duty and midnight, overtime is paid as follows: (i) Staff nurses and midwives on salaries of up to €35,000

Query from member I have recently been advised that I have to attend a meeting under the Trust in Care Policy. I have been advised that a complaint has been received and that a preliminary screening has been carried out and that I have to attend a meeting to respond to the allegation. I have not been advised of the nature of the complaint nor indeed was I aware that a preliminary screening had taken place. Can you please advise what my rights are in this regard?

WIN Vol 23

No 1 February 2015

Reply Trust in Care sets out ‘the rules’ in respect of employers’ obligations on receipt of a complaint or an allegation of abuse. The policy sets out that preliminary screening should be carried out to establish the facts pertaining to a complaint. The purpose of the preliminary screening is to ascertain if it is possible that an abusive interaction could have occurred. The policy directs that the preliminary screening of the complaint should be carried out by the immediate line manager of the person against whom the allegation is made. The policy is quite specific that under no circumstances should the preliminary screening attempt to establish whether or not the abuse actually occurred.

Bulletin Board With INMO director of industrial relations Phil Ní Sheaghdha

(inclusive of allowances in the nature of pay) overtime will be paid at a rate of time and a half • At the first incremental point of the merged staff nurse/ midwife scale for those on the first and second incremental point, and • At the third incremental point of the revised/merged staff nurse/midwife scale for those on or above the third incremental point (ii) For all grades of nurse/midwife on salaries of €35,000 or greater (inclusive of allowances in the nature of pay) overtime will be paid at the rate of time and a quarter at the individual’s scale point • For Saturday, the first four hours worked overtime will be paid as appropriate as specified at (i) or (ii) above. For additional hours worked in excess of the first four hours, overtime will be paid at double time.

The INMO has produced an information leaflet that sets out the overtime rates. Please feel free to contact us in relation to the above or you can access this leaflet on our website: www.inmo.ie

The policy also makes very clear the responsibility of management in dealing with an allegation once received. It states: “The manager must immediately notify the staff member against whom the complaint is made of the details of the allegation and advise him or her that a preliminary screening process is being undertaken. The staff member must be advised in advance of his or her right to be accompanied at this meeting by a trade union representative or work colleague.”

It is very important that you contact your industrial relations officer and that your rights are upheld prior to any meeting with management. As set out in the policy you must know the complaint against you prior to making any response.

This is a basic principle of natural justice and fair procedure.

Therefore your employer should have notified you and given you a copy of the allegations made against you. The employer should also have advised you at the time that a preliminary screening was being carried out in accordance with the agreed policy.

I urge you to contact your IRO as a matter of priority and not to attend any meeting in respect of this issue unless you are accompanied by a trade union official. If your trade union official is not available on the date set out by management, the INMO can make contact with them to organise a date that is suitable in order to ensure your right to be represented is upheld.

If you have any further questions or queries in respect of this issue do not hesitate to contact us.

QUALITY & SAFETY 29

O&uality

A column by Maureen Flynn

Safety

Patient partnership

Inclusion: Did I include patients in decisions that affect them? If not, did I find a way to ensure that their voice is heard?

Assessing: Did the questions I raised about statistics put a human face on the numbers, so that we have an understanding of what the numbers mean from a patient perspective?

Learning: What did a patient teach me today? This requires direct conversation with two to three patients per week Sharing: Have I shared a story about something that made a positive difference to the experience of patients?

cil, all hospital committees, process improvement teams and review all policies procedures and guidelines prior to authorisation. PEAs partner with staff to facilitate patient-led feedback forums locally in wards, units and departments focused on continuous improvement cycles.

Patient-centred leadership checklist At the heart of patient-centred care is a commitment to working with patients as partners, which is a shift from a ‘doing to and doing for’ approach to patient care to a ‘doing with’ approach. Moving to this approach from the care domain to the leadership domain requires a deliberate and focused effort.

The CEO has led the way by developing a patient-centred leadership (PCL) checklist (see box). In essence, PCL is a leadership approach that takes the same patient-centred care principles applied when working directly with patients and applies them to the way leaders and organisations make decisions, such as how senior management teams or directorate teams operate. In fact the checklist can be used by anyone in the organisation.

Patient and family-centred care is embedded in strategy so that there is someone at every level thinking about how it can be incorporated at every turn.

Family presence KGH decided to abolish visiting hours in 2010 and officially instituted their ‘Family Presence Policy’ in 2012. The idea to get rid of visiting hours came from patients and families and was one of the first changes KGH made in the commitment to patient- and family-centred care. During my visit, hospital staff stated that their initial concerns regarding increased noise, risk of infection, safety and staff being able to get their work done did not materialise. Arising from this open policy families are able to participate in care team discussions, monitor their loved one’s condition and provide comfort.

Opportunity to get involved At your next team, ward or unit meeting, you might consider how you could focus further on partnering with patients and families attending your service. What is your visiting policy, do you have a patient forum or advisory council to link with? Check out the Kingston General Hospital website for further details at: www.kgh.on.ca/en/Pages/default.aspx To learn more?

For more information on the visit contact Maureen Flynn via email at: maureena.flynn@hse.ie.

To learn more about Irish resources for patient and family centred care visit the National Advocacy Unit section of the HSE website at www.hse.ie/eng/about/Who/ qualityandpatientsafety/nau Maureen Flynn is director of nursing and midwifery and national lead supporting staff to improve quality, Quality Improvement Division, HSE Acknowledgements: A special thanks to Leslee Thompson, CEO, Eleanor Rivorie, director of nursing, and Daren Bell, lead for Patient and Family Centred Care, KGH, for their very warm welcome, generosity in sharing experiences and their assistance in preparing this column.

The Quality Improvement Division (QID) was established in January 2015. The vision for QID is: working in partnership to create safe quality care. Our mission is to provide leadership by working with patients, families and all who work in the health system to innovate and improve the quality and safety of care. The division has four strategic priorities: (i) supporting person-centred care; (ii) supporting staff to improve quality; (iii) innovation, communications and connectivity; and (iv) information and evaluation for quality improvement

No 1 February 2015

Quality Improvement Division

Patient-centred leadership checklist

WIN Vol 23

This month’s column follows up on the person-centred theme. During a recent visit to the Kingston General Hospital (KGH), Ontario, Canada, I had the opportunity to observe a whole hospital approach to patient partnership.

Kingston is a 430-bed university hospital serving an urban and rural population of over 500,000. The hospital strategy is to transform the patient experience through the implementation of an ‘interprofessional collaborative practice model’.

Areas identified for improvement included communication, discharge planning, and purposeful engagement of patient and families in the care process.

What is a patient partnership?

At Kingston patient partnership is described as ‘respect me, hear me, and work with me’. To honour this approach, the hospital made the commitment that a patient will be at the table for any decision that has a material impact on their experience at KGH. Patient experience advisors A key part of this approach is the development of the role of the ‘patient experience advisor’ (PEA). People can be considered for the advisor’s role if they or a family member received care at KGH in the past five years; there is no specific qualification required.

These volunteers are recruited through referral by patients’ relations, by staff or by self referral, interviewed and oriented following police check and signature of a confidentiality clause, they are provided with a workplace, security badge, email and access to all areas and documents in the hospital.

The 65 PEAs represent their individual/ family experience while partnering with staff and physicians to help improve the quality of hospital care. PEAs are members of the nine programme management councils (similar to Irish Directorates), participate in all staff interviews, provide input at staff induction, are members of the patient and family advisory coun-

30 Insolvency

Dealing with debt

Vol 23 No 1 February 2015

Tens of thousands of people are struggling with personal debt problems and if you are one of them the Insolvency Service of Ireland can help According to Central Bank statistics, the number of people entering into longterm mortgage arrears (those lasting more than two years) on their homes continues to grow despite the fall in the overall mortgage arrears figures. In addition, there is an increasing number of home repossession orders being granted by the courts.

In each of these cases the Personal Insolvency Act might have provided a solution that allowed the family to keep their home, but at the very least it could have provided a fresh start for that family as opposed to the residual debt they may be left with after a repossession.

The reality is that there are thousands of people struggling to make ends meet, but often people do not realise that there is a solution for every type of debt problem. You need to take the first step and contact the services put in place to help, so that they can find a solution that will give you a fresh start financially.

How do you know if you are insolvent?

The word insolvency is often associated with companies, but the reality in Ireland at the moment is that many people are insolvent. Personal insolvency is really just another term used to describe serious financial problems. You might not realise it but you could be insolvent if: • You are not able to pay your bills in full when they are due • You are paying a little off each bill trying to keep creditors (the people you owe money to) at bay • You are reluctant to set up direct debits to pay bills in case your money cannot stretch to meet them • You are receiving calls and letters from creditors about missed payments and threats of repossession • You have made personal sacrifices to pay your debts.

What help is available?

There is a personal insolvency solution for every debt problem and this is where the Insolvency Service of Ireland (ISI) can help. The ISI can provide debtors with pro-

Types of debt resolution available through the ISI Service

Level/ type of debt

Income

Assets

Debt relief notice (DRN)

Under €20,000

Under €60 per month1

Max €4002 Approved intermediary

Debt settlement Unsecured only arrangement (DSA)

No max

No max

Personal insolvency practitioner

Personal insolvency Secured3 and arrangement (PIA) unsecured

No max

No max

Personal insolvency practitioner

Bankruptcy

No max

No max

None4

Over €20,000/ secured and unsecured

Required intermediary

1. After reasonable living expenses are deducted 2. Subject to certain exemption 3. Subject to a cap of €3 million, unless creditors consent to a higher level 4. While it is possible to apply for bankruptcy yourself, it is advisable to seek professional advice to assist you in the process

tection from their creditors, so there are no more unwanted phone calls, letters or visits once an arrangement has been entered into.

The solutions available provide for some unsecured debt, eg. credit cards, credit unions, overdrafts etc, to be written off and for secured debt, eg. mortgages, to be either written off or restructured so that the debtor can make revised repayments.

Furthermore, the solutions ensure that the debtor has a permanent solution that deals with all of their debts. This is an important distinction, as many of the informal arrangements that fall short of a full personal insolvency arrangement only deal with some of the individual’s debt, and as a result may be unsustainable, leaving them back where they started.

What are the solutions?

Every situation is different and for that reason the ISI has three debt solutions to help people struggling with debt (see Table above).

Is there a bank veto?

Creditors do vote on the arrangement proposed on your behalf by your personal insolvency practitioner (PIP), but it is important to note that three out of four of the arrangements put forward are agreed by creditors.

How much will a solution cost?

The ISI has waived its fees until the end of 2015. Practitioners, the people licensed by the ISI to assist debtors apply for a debt settlement arrangement (DSA) or personal insolvency arrangement (PIA) tend not to charge debtors more than €200-300, if at all. They get the bulk of their fees from the arrangement – in other words, it is the creditors who ultimately pay.

Who can I speak to about getting help?

The ISI has put in place a network of qualified professionals – personal insolvency practitioners (PIPs) and approved intermediaries (AIs) – to provide you with debt advice and to work with your creditors on your behalf to work out a solution.

Every New Year provides an opportunity for a fresh start so people struggling with personal debt should, in the words of one of our applicants, ‘have confidence in yourself, deal with it now, do not let it go on another year’. If you are in need of assistance, speak to the ISI today and let us help you access the information you need to resolve your personal debt problem.

F u r t h e r i n fo r m a t i o n a n d contact details for these professionals are available at www.backontrack.ie or Tel: 076 106 4200.

Pu ll

Ou

Continuing Professional Development

for Nurses and Midwives

Maintaining your competency – Maintaining your registration

t

inmoprofessional.ie Welcome to the INMO Professional Development Centre – a dedicated education and professional development hub for nurses and midwives, offering access to professional networks, educational programmes, conferences, library services and focused research for nurses and midwives.

This month I am very pleased to inform you about our new online booking system for education programmes and conferences available at: www.inmoprofessional.ie. This service provides you access to booking all events, such as education programmes and conferences 24 hours a day, seven days a week. It is in addition to our telephone booking service which is available to you during office hours.

The INMO Professional website: inmoprofessional.ie, provides a one-stop-shop to customised, quality education programmes and research services that are tailored to meet your educational requirements.

We offer a wide variety of outstanding meeting and education options for nurses and midwives in a range of geographical areas, with face-to-face workshops, seminars, conferences with online research and reading options. Our contemporary, clinically relevant education programmes assist nurses and Elizabeth Adams Director of Professional midwives to consolidate foundation knowledge, update their professional and specialty knowledge and contribute to life-long learning within the profession. Education programmes include a range Development, INMO of one- and two-day continuing professional development (CPD) opportunities that are Category 1 Approved by the Nursing and Midwifery Board of Ireland (NMBI), with Continuing Education Units (CEUs) awarded to each event. Our facilitators have a proven track record in training and education and all are experts in their field of practice.

In this issue we feature a wide variety of dedicated and affordable nursing and midwifery continuing education programmes covering such topics as: academic writing and research appraisal; assessment and care planning in residential care settings; assessment and management of sepsis; competency-based interview skills; caring for people with Parkinsons/renal impairment; chronic disease management (diabetes and respiratory care), clinical audit; delegation and supervision, ECG interpretation and caring for the cardiac patient, medication management; non-violent crisis intervention; peripheral intravenous cannulation; presentation skills; management skills for clinical managers and staff nurses and many more.

In addition to our flexible and affordable nursing and midwifery continuing education programmes you can access a full range of library services through the site. The inmoprofessional.ie website provides a facility to maintain your professional profile, and demonstrates evidence of your on-going learning with your continuing education units (CEUs) accumulated automatically and certificates uploaded on completion. You can browse the programme content anytime which includes outlines, aims, objectives and reading lists.

The new online booking system has been designed to ensure safety and security. As an introductory offer for booking online there is a 10% discount until May 31, 2015. You can logon to: www.inmoprofessional.ie with your existing INMO username and password to book an event online. If you do not know your username and password or do not have one please contact us directly by telephone (01 664 0641 or 01 664 0625) or email (pdc@inmoprofessional.ie). If you need assistance with your online booking or wish to book an education programme or conference by telephone, please do not hesitate to contact the Professional Development Centre during office hours.

On-site Training: Let us come to you

The Professional Development Centre successfully delivers on-site training throughout the country each year.

On-site training is a more cost-effective solution for larger group training. We currently have 99 tailored education programmes which can be brought directly to you for a standard fee. We use highly skilled facilitators, who are experts in their fields.

Each participant on completion of a course is awarded with a certificate that is Category 1 approved by the Nursing and Midwifery Board of Ireland with Continuing Education Units (CEUs).

For further information on our courses please contact: Marian Godley, Course Co-ordinator, Email: pdc@inmoprofessional.ie Tel: 01 664 0642 inmoprofessional.ie 2 (CEUs)

3.5 (CEUs)

4/4.5 (CEUs)

inmoprofessional.ie

5 (CEUs)

5.5 (CEUs)

6 (CEUs)

7 (CEUs)

10 (CEUs)

13 (CEUs)

Education Programmes Venue: INMO Professional Development Centre, The Whitworth Building, North Brunswick Street, Dublin 7 Tel: 01 664 0641/2. Email: pdc@inmoprofessional.ie Registration for most courses will take place at 9.45am unless otherwise stated.

All programmes have Category 1 approval from the Nursing and Midwifery Board of Ireland (NMBI) with Continuing Education Units (CEUs).

Courses are colour coded for ease of reference.

2 (CEUs)

3.5 (CEUs)

4/4.5 (CEUs)

5 (CEUs)

5.5 (CEUs)

6 (CEUs)

7 (CEUs)

10 (CEUs)

13 (CEUs)

CEUs = Continuing Education Units

Check out our New Courses at the Professional Development Centre!

For more information log onto inmoprofessional.ie Date

Programme

Fee

Feb 6, 2015

Healthcare Provider CPR and AED

€125 members; €195 non-members (including cost of book)

(CEUs)

6

This Healthcare Provider Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillation (AED) course provides the information, rationale and practical skills training for the 2010 CPR and ECC guidelines. Nurses and midwives are required to adhere to the two-year certification period for both basic and advanced life support, as recommended by International Liaison Committee on Resuscitation as the best practice standard. Limited to six participants per instructor. A fee of €50 will be charged if you wish to cancel your booking 10 days before the course begins. Time: 9.15am-4.00pm

Feb 10, 2015

Caring for a Person with Parkinson's

€80 members; €140 non-members

4

This one day interactive course is designed to deliver up-to-date information while outlining care practices to all nursing staff with an interest in the management of a patient with Parkinson’s. It covers process of diagnosis, clinical features, holistic care approaches, medication therapy, assessment, care planning and evaluation across all activities of daily living. The course outlines the role of the nurse and the interdisciplinary health care team in assessment, planning, implementing and evaluating care with the patient and their carer/family.

Feb 12, 2015

Management Skills for Clinical Managers and Staff Nurses

€80 members; €140 non-members

5

This course is focused on the key competencies required for ward managers to be effective in their roles as leaders and managers in healthcare delivery. Clinical managers perform both managerial and leadership functions in order to provide effective healthcare delivery to patients. For this reason, this workshop explores both management and leadership functions and how these are applied in practice so as to promote quality and safety of care. It also highlights the importance of the role of ward manager in leading a team and its role in both national and international initiatives aimed at improving care.

Feb 17, 2015

Competency-based Interview Training

€80 members; €140 non-members

6

This one-day course helps participants prepare for a competency-based interview. Competency-based interviews, which are based on the premise that past experience can predict future behaviour, are an increasingly common style of interviewing that enables candidates to show how they would demonstrate certain behaviours/skills in the workplace, by answering questions about how they have reacted to, and dealt with, previous workplace situations. This course is suitable for all levels of nurses/midwives.

Feb 17, 2015

Understanding Obesity and Weight Management

€80 members; €140 non-members

5

This one-day workshop aims to provide a comprehensive understanding of the causes of obesity and knowledge of the physiological principles involved in the onset of obesity and associated illnesses. Lifestyle treatment options such as dietary, exercise and behavioural interventions will be covered in depth on the day, as well as non-pharmacological, pharmacological and surgical interventions.

Feb 18, 2015

Nutritional Requirements for Community and Residential Care Settings

€65 members; €120 non-members

3.5

This three hour workshop is aimed at nurses working in community and residential settings. This workshop will focus on a number of key areas in implementing standards and meeting regulations outlined in HIQA’s Food and Nutritional Requirements. The basic nutritional needs of residents will be covered, as well as an introduction to the HIQA guidelines. A brief explanation of feeding practices, therapeutic diets, nutritional screening, safe handling of food, monitoring and documenting food/fluid intake will be covered. There will also be some discussion on sample policies and audit tools. 9.45am-1.00pm.

Official Sponsor of the Professional Development Centre

All programmes have Category 1 approval from the Nursing and Midwifery Board of Ireland

Date

Programme

Fee

Feb 18, 2015

Presentation Skills

€80 members; €140 non-members

(CEUs)

6

Presenting yourself and your ideas with confidence, impact and great conviction is of primary benefit for all nurses and midwives. This course provides you with strategies on how to make an effective presentation; how to speak in order to hold interest while remaining professional in your tone as well as how to effectively compile and deliver presentations. Time: 9.15am-4.30pm.

Feb 24, 2015

Preparing for HIQA Inspections within the Acute Services

€80 members; €140 non-members

6

The National Standards for Safer Better HealthCare (HIQA, 2012) drive continuous improvement in Ireland’s health and personal social care services within the acute setting. This one day programme aims to assist staff to identify strengths and challenges within their services and create a clear framework for quality improvement. From this perspective the monitoring of safety and quality within these services can enhance a person-centred care approach to all service users and individuals within the hospital setting. Time: 9.30am-4.15pm.

Feb 24, 2015

Subcutaneous Administration of Fluids

€80 members; €140 non-members

5

The role and responsibilities of the nurse’s role has expanded rapidly during the last few years, this course aims to provide the nurse with the competencies necessary to administration fluid by the subcutaneous route. 9.30am-2.30pm.

Mar 6, 2015

Healthcare Provider CPR and AED

€125 members; €195 non-members (including cost of book)

6

This Healthcare Provider Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillation (AED) course provides the information, rationale and practical skills training for the 2010 CPR and ECC guidelines. Nurses and midwives are required to adhere to the two-year certification period for both basic and advanced life support, as recommended by International Liaison Committee on Resuscitation as the best practice standard. Limited to six participants per instructor. A fee of €50 will be charged if you wish to cancel your booking 10 days before the course begins. Time: 9.15am-4.00pm

Mar 10, 2015

Wound Care Management

€80 members; €140 non-members

5

This programme will allow participants to ensure professional competency in the area of wounds as per NMBI’s Code of Professional Conduct and Scope of Practice for Nursing and Midwifery, which state that nurses/midwives must work within their competence. Furthermore, it will provide participants with continuing professional development to ensure that their practice is founded in the latest research and guidance as per the Health Service Executive National Best Practice and Evidence-based Guidelines for Wound Management.

Mar 11, 2015

Principles and Practices of Infection Control

€80 members; €140 non-members

5

This study day has been developed in response to the many challenges nurses/midwives face regarding infection control. It is suitable for nurses/midwives working in acute care and community care settings.

Mar 12, 2015

Practical Skills in the Management of People with Diabetes

€80 members; €140 non-members

5

This course aims to provide nurses/midwives with understanding, knowledge and confidence when delivering care to individuals with diabetes. This course offers a practical approach to diabetes, whether based in the hospital or community setting. Many theoretical aspects of diabetes are covered such as: the different types of diabetes, national and international guidelines, how to offer lifestyle advice to patients, treatment options, and understanding blood results, as well as dealing with complications in diabetes.

Mar 19, 2015

Nursing the Cardiac Patient

€80 members; €140 non-members

6

This study day provides a forum to update nurses on national and international trends in the holistic management of patients with cardiac disease. A particular focus on the day is to ensure that presentations are based on current evidence-based practices within the field of cardiology. The day is designed to examine new developments in cardiac nursing, particularly in the area of medications and chronic heart failure. This reflects the diversity of, and challenge in, providing quality care which is individualised to cardiac patients. 9.15am-4.15pm.

Mar 20, 2015

ECG Interpretation

€80 members; €140 non-members

6

This one-day workshop is aimed at enhancing the general nurse’s knowledge of cardiac electrophysiology. It will provide participants with knowledge of cardiac rhythms, rhythmanalysisandECGinterpretation. Itisadvisabletocompletethe‘NursingtheCardiacPatient’coursepriortoregisteringforthiscourse.9.15am-4.15pm.

Mar 24, 2015

Assessment and Care Planning in Residential Care Settings for Older People

€80 members; €140 non-members

6

This workshop is aimed at providing nurses working in this sector with the most up-to-date information regarding policy and standards in older person care and will focus on the need for comprehensive assessment, including risk assessment and care planning for older people in residential care settings.

Mar 24, 2015

Leg Ulcer Study Day

€80 members; €140 non-members

5

This study day provides participants with information to best inform their practice in accordance with patients’ needs. Participants will learn to distinguish between the different causes of ulceration and associated pathophysiology and relate to epidemiology, risk factors and assessment.

inmoprofessional.ie

inmoprofessional.ie Date

Programme

Fee

Mar 25, 2015

Best Practice in Medication Management

€80 members; €140 non-members

(CEUs)

5

This programme has been developed to support nurses in providing safe evidenced-based practice in the area of medication management. It supports nurses/midwives by ensuring that they are up to date and meet the requirements of the Nursing and Midwifery Board of Ireland (NMBI) and HIQA in the area of medication management.

Mar 25, 2015

Peripheral Intravenous Cannulation

e65 members; e120 non-members

4

The aim of this course is to provide guidance to the registered nurse/midwife in the skill of intravenous peripheral cannulation. Instruction will be provided on the sites used for peripheral intravenous cannulation. Advice will be given on identifying criteria for evaluating a vein, as well as guidance on adhering to the principles of an aseptic technique.

The course will also provide information on techniques for reassuring the individual in relation to the procedure and in gaining their consent. The overall aim is for participants to be able to carry out the procedure in a competent and safe manner.

Mar 26, 2015

Introduction to Dementia Care

€80 members; €140 non-members

5

This one-day programme is designed to enhance the healthcare practitioner’s knowledge, strategies and skills that will improve quality of life for clients with dementia. This interactive day, inclusive of case studies, DVD analysis and group work, aims to enhance the participant’s knowledge, while providing practical strategies in promoting a personcentred approach to caring for a person with dementia.

Mar 26, 2015

Strategies for Managing Conflict

€80 members; €140 non-members

6

Conflict in the workplace can be incredibly destructive to good teamwork. Managed in the wrong way, real and legitimate differences between people can quickly spiral out of control. Conflict is not necessarily destructive; managing conflict effectively may result in positive outcomes. This course takes a very practical approach utilising a blend of group work, self-evaluation and case-study based discussion.

Mar 31, 2015

Assessment and Management of the Patient with Sepsis

€80 members; €140 non-members

5

This study day is designed to provide an innovative academic opportunity to increase the knowledge, experience and clinical skills needed to meet the complex and varied needs of patients with sepsis. Sepsis can occur at any age and in any clinical situation. It is considered a medical emergency and continues to have a high mortality rate despite advances in treatment. This course assists nurses/midwives with the skills and knowledge to take the lead in the assessment and management of sepsis.

Mar 31, 2014

Caring for a Patient with Epilepsy

€80 members; €140 non-members

5

This one day interactive course is designed to deliver up-to-date information while outlining care practices to all nursing staff with an interest in the management of a client/ patient with Epilepsy. This programme content includes process of diagnosis, assessment and treatment relating to a client whom is diagnosed with epilepsy. In addition this course outlines and reviews a range of topics covering epilepsy syndromes, seizures in adults, anti-epileptic drugs, comorbidities, treatment options, epilepsy immediate management, the role of the nurse and the healthcare team in assessment, planning, implementing and evaluating care with the client in healthcare settings.

Apr 15, 2015

Delegation and Clinical Supervision

€80 members; €140 non-members

5

This workshop explores the issues surrounding delegation and decision making, including appropriate clinical supervision for delegated functions. Participants will learn what is meant by delegation and how it differs from assignment of a task. The course also provides an understanding of the professional, legal and quality of care issues involved when deciding to delegate a function to a healthcare assistant.

Apr 16, 2015

Falls: Prevention, Management and Review

€80 members; €140 non-members

5

The purpose of this programme is to promote a consistent approach to falls reduction for older people through assessment, individualised care planning and post-falls review.

It promotes excellence amongst nurses who provide care to the patients at risk of falls, informed by current evidence.

Apr 21/22, 2015 Art and Science of Antenatal Education

€150 members; €280 non-members

10

This two-day workshop will prepare midwives to design an effective antenatal education programme for expectant mothers and fathers. The philosophy of this course is based on the principles of adult learning and on the belief that antenatal education is a health promotion activity. This course will prepare midwives to encourage expectant parents to see themselves as competent and able to make informed choices for themselves and for their baby.

Apr 21, 2015

Assessment and Management of the Diabetic Foot

€80 members; €140 non-members

5

This programme will support the professional decision making of nursing staff who care for patients with, or who, are at risk of diabetic foot. It ensures that nurses/midwives use evidence-based practice to ensure patients’ needs are met. It allows nurses/midwives to ensure they are competent and working within their scope of practice in accordance with their Code of Professional Conduct.

Apr 23, 2015

Introduction to Clinical Audit

€80 members; €140 non-members

5

This one-day course is designed to equip participants with the necessary skills to implement Clinical Audit in their practice and to be able to deliver evidence of improved performance for safer and better care for patients. Participants will be provided with an overview of Clinical Audit and be taught about each stage in the Clinical Audit Cycle topic selection, standards development, data collection, data analysis, reporting, implementing changes and re-audit.

Official Sponsor of the Professional Development Centre

Education programmes coming to the Cork Office, Sheraton House, Hartlands Avenue, Glasheen, Co Cork Date

Programme

Fee

Feb 11, 2015

Non-Violent Crisis Intervention

€80 members; €140 non-members

(CEUs)

7

This one-day programme is designed to assist staff to provide the best care, safety and security for staff working in healthcare environments. The programme identifies behaviours that contribute to the development of a crisis and outlines appropriate staff intervention for each response. It also identifies verbal and non-verbal techniques to de-escalate behaviour. In addition, the course outlines break-away techniques that can be adopted in a physical crisis situation while maintaining the care, welfare, safety and security of clients and staff. It also helps participants to identify the triggers and patterns of behaviour and, therefore, develop a person-centred care plan and a consistent approach in order to prevent the behaviour from reoccurring. Time: 9.15am-5.00pm.

Feb 25, 2015

End of Life Thematic Inspections

€80 members; €140 non-members

6

The aim of this workshop is to outline the legal and professional requirements for end of life care in designated centres and to identify how to apply this to practice, so as to provide effective, evidence-based care to residents. HIQA standards, regulations and guidance will be used to prepare participants for thematic inspections. Time: 9.30am-4.00pm.

Feb 26, 2015

Food and Nutrition Thematic Inspections

€80 members; €140 non-members

5

This course is aimed at nurses working in residential care settings for older people. It aims to enable participants to implement national standards, regulations and professional guidance for meeting residents’ food and nutrition needs. During the course participants will learn how to apply these standards and regulations to assessment, care planning and monitoring of resident’s nutritional needs.

Mar 5, 2014

Delegation and Clinical Supervision

€80 members; €140 non-members

5

This workshop explores the issues surrounding delegation and decision making, including appropriate clinical supervision for delegated functions. Participants will learn what is meant by delegation and how it differs from assignment of a task. The course also provides an understanding of the professional, legal and quality of care issues involved when deciding to delegate a function to a healthcare assistant.

Apr 16, 2014

Assertion Training

€80 members; €140 non-members

5

This course is designed to help nurses and midwives to understand themselves in various situations and also to enable individuals to generate their own solutions to achieve what they want. Learning self-management skills is an important part of development and can help replace passivity and dependent behaviours with behaviours that will increase personal effectiveness at work, as well as in all areas of life.

Apr 23, 2014

Advanced Diabetes Management

€80 members; €140 non-members

5

This one-day workshop is aimed at nurses and midwives who already have a very good understanding of basic diabetes management and who want to build on their knowledge.

The workshop will focus on a number of key areas such as: injectable therapies for both Type 1 and Type 2 diabetes, carbohydrate counting for Type 1 diabetes, complications of diabetes, the nursing role and management of diabetes, as well as advances in the future of diabetes management.

Applying for PDC Courses

inmoprofessional.ie Log on to our website and get a 10% discount when you book a course online (for a limited period) IfyouforgotyourUserName/Password–Tel:016640641/25oremail:pdc@inmoprofessional.ie

inmoprofessional.ie

inmoprofessional.ie Education programmes coming to the Limerick Office, Unit 4B, Courtfields, Raheen, Limerick Date

Programme

Fee

Feb 23, 2015

Assessment and Care Planning in Residential Care Settings for Older People

€80 members; €140 non-members

(CEUs)

6

This workshop is aimed at providing nurses working in this sector with the most up-to-date information regarding policy and standards in older person care and will focus on the need for comprehensive assessment, including risk assessment and care planning for older people in residential care settings.

Mar 30, 2015

Non-Violent Crisis Intervention

€80 members; €140 non-members

7

This one-day programme is designed to assist staff to provide the best care, safety and security for staff working in healthcare environments. The programme identifies behaviours that contribute to the development of a crisis and outlines appropriate staff intervention for each response. It also identifies verbal and non-verbal techniques to de-escalate behaviour. In addition, the course outlines break-away techniques that can be adopted in a physical crisis situation while maintaining the care, welfare, safety and security of clients and staff. It also helps participants to identify the triggers and patterns of behaviour and, therefore, develop a person-centred care plan and a consistent approach in order to prevent the behaviour from reoccurring. Time: 9.15am-5.00pm.

April 15, 2015

Understanding Obesity and Weight Management

€80 members; €140 non-members

5

This one-day workshop aims to provide a comprehensive understanding of the causes of obesity and knowledge of the physiological principles involved in the onset of obesity and associated illnesses. Lifestyle treatment options such as dietary, exercise and behavioural interventions will be covered in depth on the day, as well as non-pharmacological, pharmacological and surgical interventions.

inmoprofessional.ie There is a 10% discount when you book a course online (for a limited period). If you forgot your User Name / Password – Tel: 01 664 0641/25 or email: pdc@inmoprofessional.ie All programmes have Category 1 approval from the Nursing and Midwifery Board of Ireland (NMBI) with Continuing Education Units (CEUs)

INMO Safe Practice Workshops The Professional Development Centre is providing a nationwide series of workshops in venues across the country. This programme provides safe practice tools to protect the nurse and midwife and patient within current healthcare settings. This is an awareness session to ensure all staff have an understanding of the process involved regarding patient alerts, clinical incidents and thorough assessment, while remaining focused on patient and individual staff. The programme addresses patient safety and staff safety and provides five key tools on areas of documentation, clinical incident reporting, safety statements, best practice guidelines regarding assessment, and communication practices in a complex multifaceted healthcare arena. ‘Tools for Safe Practice’ is Category 1 approved by the Nursing and Midwifery Board of Ireland and awarded with 4 CEUs.

Dates and venues for safe practice workshops: Feb 18 – Our Lady’s Hospital, Navan; Feb 19 – Woodlands Hotel, Waterford; March 4– Our Lady of Lourdes Hospital, Drogheda; March 6 – Monaghan General Hospital; March 9 – Hibernian Hotel, Mallow; March 24 – Louth County Hospital; April 15 – Cavan General Hospital

More dates and venues are available on our website inmoprofessional.ie If you would like to arrange this workshop in your area and can guarantee a minimum of 25 participants, please contact your IRO. Log on to inmoprofessional.ie to book your place Fee: INMO members FREE; €150 non-members

Official Sponsor of the Professional Development Centre

INMO Professional Development Centre – Library Services

Delegation, responsibility and clinical supervision The Professional Development Centre Library is a valuable resource for information on delegation, write assistant librarians Edel Reynolds and Niamh Adams With the recent publication of the Code of Conduct and Ethics for Nurses and Midwives by the Nursing and Midwifery Board of Ireland, there have been many queries relating to subjects such as accountability, responsibility and in particular delegation received into the library. To assist members, the library team have put together some useful information including recent literature on the topic.

Below are a number of articles and international guidance documents covering the area of delegation. These can be located by logging on to www.nurse2nurse.ie and selecting the N2N Directory and then selecting the topic delegation.

Articles Accountability and responsibility • Mueller C, Vogelsmeier A. Effective Delegation: Understanding Responsibility, Authority and Accountability. Journal of Nursing Regulation 2013; 4(3): 20-27 Midwifery • Solon M. Delegation and beyond: what happens when things go wrong? Practising Midwife 2013; 16(7): 31­32.

Leadership style • Saccomano S, Pinto­Zipp G. Registered nurse leadership style and confidence in delegation. Journal of Nursing Management 2011; 19(4): 522­533.

Student nursing • Hasson F, McKenna H, Keeney S. Delegating and supervising unregistered professionals: The student nurse experience. Nurse Education Today 2013; 33(3): 229­235.

Nursing management • Potter P, Deshields T, Kuhrik M. Delegation practices between registered nurses and nursing assistive personnel. Journal of Nursing Management 2011; 18(2): 157­165.

Intellectual disabilities • Eaton J. Delegation: a powerful tool in the right hands. Learning Disability Practice 2009; 12(8): 30­31.

International Guidelines • Royal College of Nursing (RCN). Accountability and Delegation: What you need to know. The principles of delegation for nurses, students, health care assistants and assistant practitioners. Royal College of Nursing. 2011 • Nursing Council of New Zealand. Guideline: Delegation of care by a registered nurse to a healthcare assistant,. Nursing Council of New Zealand. 2011.

• Australian Nursing Federation. Delegation by registered nurses and registered midwives. Australian Nursing Federation. 2004.

INMO PDC Educational Programme The PDC run an educational programme entitled Delegation and Clinical Supervision. This course will be run in the INMO Headquarters on April 15 and June 25, 2015 and also in the INMO Cork office on the March 5, 2015 This course is Category 1 approved by the Nursing and Midwifery Board of Ireland (NMBI) and awarded five Continuing

inmoprofessional.ie

Education Units. The course explores the issues surrounding delegation and decision making, including appropriate clinical supervision for delegated functions.

Participants will learn what is meant by delegation and how it differs from assignment of a task. The course also provides an understanding of the professional, legal and quality of care issues involved when deciding to delegate a function to a health care assistant. It is aimed towards all nurses/midwives and clinical nurse/midwife managers working with healthcare assistants.

The cost of the programme is €80 for members and €140 for non-members. For a limited time there is a 10% discount when you book online. For fur ther information go to inmoprofessional.ie or Tel: 01 664 0641/2.

How the INMO Professional Development Centre Library can help Contact us for further assistance: • For log in details for www.nurse2nurse.ie • For search advice/copy of Cinahl guide • T o book an appointment for a one to one training session on how to effectively search databases • For literature searching service (€6 fee for this service) For further information or assistance from the Professional Development Centre Library, please call: 01 664 0614 or email: library@inmo.ie. Opening hours: Monday to Thursday: 8.30am5.00pm, Friday: 8.30am-4.30pm.

Edel Reynolds and Niamh Adams are assistant librarians at the Irish Nurses and Midwives Organisation

Get 10% off when booking your PDC educational programme by booking online at inmoprofessional.ie

42 LEGAL FOCUS

Fitness to practise focus

Vol 23 No 1 February 2015

In a series of articles Edward Mathews explains how the NMBI fitness to practise process operates. Part one looks at preliminary proceedings In a series of articles, I will be explaining to members how the Fitness to Practise (FTP) process of the Nursing and Midwifery Board of Ireland (NMBI) operates.

Thankfully, only a relatively small number of registrants are subject to an FTP hearing in a given year. However, more do have complaints made against them and the stress, strain and financial expense involved in dealing with even the most minor of matters make this an essential topic to understand.

The advent of public hearings before the FTP Committee has fundamentally changed the experience of members in this arena. Members are now subject to intense, lurid, and speculative media coverage, which makes preventative elements of practice all the more important to avoid a referral to the Committee. In addition, makes the availability of expert assistance essential to obtaining a desirable and just outcome throughout the entire process, from the moment a complaint is received, to the conclusion of the proceedings.

The FTP process is essentially divided into two stages: the first involves the consideration of a complaint against a nurse or midwife by the Preliminary Proceedings Committee (PPC). This is a committee that considers the complaint and makes a recommendation as to whether or not a full inquiry should take place. Where a hearing is to take place, this finding then leads to the inquiry stage, where a nurse or midwife is presented with evidence ahead of the hearing, and subsequently will participate in a public hearing to determine fitness to practise.

In this article, we will consider the PPC stage of the process, and later articles will deal with applications to suspend registration pending an inquiry, preparation for an inquiry, the public nature of the inquiry, the test for a hearing to take place in pri-

vate, the hearing itself, the publication of the results of the hearing, and what happens where a nurse or midwife is convicted of certain criminal offences.

Any person can make a complaint regarding a nurse or midwife’s fitness to practise based on professional misconduct, poor professional performance, a relevant medical disability, non-compliance with a code of professional conduct, and a number of other headings set out at section 55 of the Nurses and Midwives Act 2011. Our experience shows that complaints may emerge from patients, their family, other professionals, employers, regulatory bodies such as HIQA, the Department of Health Nursing/Midwifery Officers, and indeed the NMBI itself may initiate a complaint where they become aware of matters they believe to be of concern.

Once the complaint is made to, or initiated by, the NMBI, then the nurse or midwife concerned will receive correspondence from the NMBI. This correspondence will explain that a complaint has been made, who made it and the process for dealing with it, which includes the option of submitting a statement to the committee to assist it in its deliberations as to whether or not the matter should proceed to a full inquiry. Attached to that correspondence will be a copy of the complaint, and a copy of the procedures of the PPC. Representation is imperative At this stage, and indeed the correspondence from the NMBI will state this explicitly, it is imperative that the nurse or midwife concerned obtain representation prior to responding to the complaint. Any response made will be used by the committee to assist them in determining whether or not a full inquiry should take place, or if another form of action should be taken.

An important point, which is not

explained in the NMBI correspondence, is that a copy of any statement submitted by the nurse or midwife at this stage will be available to the team presenting the case against the nurse or midwife before the FTP committee if an inquiry later takes place, and may be considered by the committee itself.

Therefore, at this stage, there are two key reasons for having representation: first, in many cases, a comprehensive, properly-worded, and well-informed statement by a registrant may assist the PPC in determining that there is no cause for a full inquiry to take place, and this may end the matter. Further, where an inquiry is directed, you want to make sure that the contents of your statement do not prejudice you at a later inquiry.

The FTP process takes places in an exceptionally legalistic forum, based on law and the rules of evidence, and in this context you need to ensure that the position you advance at this stage does not prejudice your later defence against the allegations made before the FTP committee. For many who are not represented, or not properly represented, mistakes made at this stage have a significant, negative impact at a later date.

An additional point to note here is that the PPC is not in any way confined to the complaint made against you. By this, we mean that while a complaint may relate to the manner in which you spoke to a patient, if the records, statements of other individuals, or your own statement disclose conduct that may amount to other wrongdoing, then the PPC may make a decision that an inquiry is warranted not based on, or not solely based on, the original complaint, but on other matters that have come to light. Thus you can see immediately the importance of sound

LEGAL FOCUS 43

employer that a complaint has been made against you. The simple answer is that you are not, though in certain circumstances it may be advantageous to do so, but we decide that on a case-by-case basis.

The PPC carries out its functions in accordance with Part 7 of the Nurses and Midwives Act 2011, and its activities are also guided by the procedures of the committee. While in many cases the PPC simply considers the complaint made, and any response by the registrant, and makes its decision, there are other powers and functions available to the committee. Often consideration of the complaint will be deferred if there is an on-going criminal investigation.

The committee may also direct the complainant to provide additional information or to verify existing information by means of a legal declaration, and where the complainant fails to do so, without reasonable excuse, the committee may refuse to consider the complaint any further. If any additional information is furnished to the committee, a further opportunity to comment on this information will also be provided. The committee may also direct the nurse or midwife subject to the complaint to provide certain information, and they must comply with that direction.

The PPC may also commission an expert report in relation to the complaint, or appoint an investigating officer to prepare a report on the complaint using all the documentation compiled, including taking statements from relevant persons. The nurse or midwife will be offered an opportunity to comment on that material prior to the PPC making its determination.

One final step is that the PPC may ask the complainant for their views on your statement, and we have a further opportunity to respond if they do so.

PPC determination The PPC will then consider all the information it has gathered and make a determination as to whether or not there is a prima facie, or face value, case against the nurse or midwife for further action to be taken, or whether it is trivial, vexatious, without substance, or made in bad faith. The committee will provide reasons for their decision. If they find that a case exists, then the matter will be referred to the FTP committee, and a hearing will take place in due course. However, where the PPC determines that the matter does not evidence sufficient cause to warrant further action then it informs the overall Board of the NMBI of that opinion.

Thus, where the PPC determines that

further action should not be taken, they bring this to the attention of the Board. The Board then, pursuant to section 59 of the Act, may accept that view and the matter is then closed, or they may direct that the matter should be subject to a FTP inquiry notwithstanding the view of the PPC. These options are all based on the current state of the legislation. In the future, there may be further options open to the PPC or the Board of the NMBI, including referring a complaint to a mediation process for resolution or to the professional competence scheme once established, instead of the current situation, which in general involves either the matter being closed or proceeding to a full inquiry.

One matter that can arise is where a complaint is withdrawn while still being considered by the PPC. In these circumstances, and in accordance with Section 57(11) of the Nurses and Midwives Act 2011, the PPC may, with the agreement of the overall Board of the NMBI, either decide that no further action should be taken in light of the withdrawal, or proceed as if the complaint had not been withdrawn. As such, it can be seen that a withdrawal does not necessarily end the matter, and this should be borne in mind, particularly by employers, who we have noted to make premature referrals before employment procedures have concluded.

As a consequence of hasty referrals, we have often encountered cases where no wrongdoing was found on the part of a nurse or midwife at the end of a disciplinary investigation, but the matter was referred to the NMBI precipitately, and may proceed to an FTP hearing even though no wrongdoing was evident locally.

This is a complex process that can take many turns on the road to conclusion. The essential point is that expert representation at this stage has the potential to either prevent a complaint proceeding any further, or, where it does, in ensuring that a nurse or midwife’s career is not prejudiced by poor decisions at this stage.

The INMO FTP department manages all matters relating to complaints at this stage under your membership fee. Were you to obtain independent advice, it could cost anything from €5,000 to €15,000 even at this initial stage. Where you are dealing with a regulatory body, you want professionals who are experienced and expert in both law and our professions by your side, you have that with the INMO. Next month we will look at how matters proceed if the PPC decided that further action is warranted

Vol 23 No 1 February 2015

advice when responding to the complaint.

Once this initial correspondence is received it is imperative that you do not contact the NMBI and that your first port of call is the INMO. You can contact either your IRO, or my office, and we will take over management of the case for you.

In order to qualify for representation by the INMO when dealing with a complaint to the NMBI, you must have been a member of the Organisation both at the time that the subject matter of the complaint occurred, and when the complaint is made. Once you meet the criteria for representation then we will ‘come on record’ as representing you, and we will then receive all the relevant correspondence.

Preparing a statement The next step is the preparation of a statement. Our office will invite you to a meeting where we will discuss the contents of the complaint, your response to the complaint, and the best possible statement we should submit depending on the circumstances of the case. In general you will have six weeks to submit a statement, if you wish, and we can request an extension of four weeks to allow us prepare a statement. At the conclusion of our meeting, I will ask you to prepare a draft statement, and I will provide you with detailed guidance in relation to the format and content of the statement, based on the instructions that I take at our meeting.

You then submit the statement by email to me, and we exchange drafts, and meet again to discuss the statement, until you are satisfied with the contents, and ultimately you sign the final document as an accurate representation of your position in relation to the complaint. We then submit this to the PPC on your behalf.

There may be some delays at this stage if we feel that sufficient documentation has not been provided, or if we feel that further materials are required. In addition, we may ask you to obtain documentation from your hospital or employer to assist you in answering the complaint. It is very important that you do not obtain any patient records or confidential information without the express permission of your employer, and in accordance with the legislative and professional boundaries in relation to dealing with confidential records.

In certain cases, we may ask you to obtain a reference from your current or former managers if we feel this would assist the PPC in its deliberations.

One point that often arises is whether or not you are obliged to tell your

FROM THE PRESIDENT 45

On the ground

with the president Happy New Year

Branch AGMs

As this is our first issue of 2015 I would like to wish you all the very best for this year and to thank you for your participation in our many on-going campaigns. We commenced 2015 with a bang as unsurprisingly we had a trolley crisis. Notwithstanding this, I want to assure you that staffing is still a key priority for me and hopefully as the year progresses we will achieve some success.

Once again, as we prepare for annual delegate conference in May, branch and section AGMs are being organised, and motions are being formulated. I encourage all members to participate in their local branches in order to ensure that issues of priority for your area are on the agenda during ADC. I aim to attend as many meetings as possible around the country. Many sections are also in the process of organising their annual conferences which I ask you to support. Dates are available on our website and elsewhere in this magazine. Please do not hesitate to contact me if you wish me to attend. I would like to take this opportunity to extend a big thank you to all our section and branch officers for all their hard work on behalf of members.

Overcrowding crisis One of our key challenges for the New Year is the very familiar issue of overcrowding in hospitals nationwide with trolley numbers rising to an all time high of 601 in early January. As you have seen over the last few months we have participated in many lunchtime protests and as Claire Mahon, president of the INMO, pictured addressing the we go to press are about to crowd at the protest outside Leinster House in Dublin last month embark on industrial action in the worst hit hospitals across the country. Recently we held a protest at the gates of Dáil Éireann and, although it was an extremely cold day, we were delighted with the turnout and realise many members could not make it due to the bad weather conditions but we know they were there in spirit. We were joined by many politicians and were delighted to have Patrick Coughlan, a gentleman who campaigned with us 10 years ago when we started to highlight this, with us once more. He still had the T-shirt from 2005 and joined ranks with us again in our call to all government parties to end this blight on the health service once and for all. No one knows more than nurses the impact that overcrowding has on both patients and staff. We are determined to keep this issue high on the agenda in the coming weeks in order to keep the pressure on government and the HSE. I would ask you all to support your colleagues across the country when they commence their industrial action as we must stand together in solidarity.

NMBI campaign ‘Thunderclap’

You can contact me at the INMO headquarters at Tel: 01 6640 600, through the president’s corner on www.inmo.ie or by email to: president@inmo.ie

No 1 February 2015

Get in touch

I attended, along with some Executive Council members, the first All Ireland Chief Nursing Officers’ Conference, which was held in Dublin Castle in early December. The aim of the conference was to enable opportunities for nurses to engage in discussion and network from an all-Ireland perspective. It was a very interesting day with thought provoking speakers from across the island who spoke on many issues of relevance. It is hoped to build on this conference into the future.

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I would like to thank all my colleagues who participated in our recent social media event – Thunderclap – which was a great success. I had an interesting two days acquiring photographs in my own region and meeting with members (see page 7). I would appeal to you all to continue with the campaign to oppose the fee increase by the NMBI. Watch out for updates on our website www.inmo.ie

All Ireland Chief Nursing Officers’ Conference

MEDIA WATCH 47

ED crisis hits all-time peak The overcrowding problem continued to escalate throughout January, dominating the news agenda. Ann Keating reports

by Health Minister Leo Varadkar to their regulatory body to re-engage in talks with unions in an effort to resolve a dispute around a 50% hike in registration fees.”

Union’s said “Mr Varadkar’s call came at a time when nurses and midwives remain united in opposition to the fee hike they argue is unjustified.”

1,000 nurses set to quit The Herald (January 21) told of Fears as over 1,000 nurses set to quit by this summer. According to Junior Minister for Health, Kathleen Lynch “We have a difficulty coming down the road which I discussed with the Taoiseach in relation to the number of nurses that are going to be retiring, or having the opportunity to retire, between now and June. There is a possibility of well over 1,000 leaving but we are hoping we can encourage a substantial number of those people to remain on… The exodus is due to retirements, contracts ending and personnel indicating they are leaving to work overseas.” The INMO “has repeatedly warned that Irish hospitals are already chronically understaffed in relation to nursing rosters.

An INMO study last year revealed that no Irish maternity hospital reached international best practice in terms of midwife to patient ratios.”

Finally – A step back in time!

Woman’s Way (January 13) featured a number of photos from the 80s including one of our former president, Bridget Butler. The caption read “Bridget Butler, leader of the Irish Nurses Organisation, with nurses from all over the country as they march to Dáil Éireann to protest against proposed health cuts, 28 May 1986.” If you would like a copy contact the INMO Media Department by email: lisamoyles@inmo.ie Ann Keating is the INMO media relations officer, email: annkeating@inmo.ie

No 1 February 2015

and in fairness some of it is happening, is an expansion of the health service both in terms of bed capacity, in terms of community services. Mr Doran said the biggest problem the health sector is experiencing is staffing, because the supply has been ‘turned off’ over the last five years.”

The story was also carried in the Irish Daily Mirror (January 15) – Work to rule gathers pace as shortages hit new low.

“The Irish Nurses and Midwives Organisation said members at Naas General Hospital voted 97% in favour of the industrial action. It will begin on February 4 and follows planned work-to-rules in Beaumont beginning on January 27, and Galway and Limerick and the Mid-West on February 3. The union has warned nurses will only engage in direct clinical care of patients.”

The Sunday Independent (January 11) states that one of the issues causing the crisis is bed closures – “According to the Department of Health briefing documents, the country needs an additional 1,000 beds every year between now and 2021 to cope with the ageing population.

According to the nursing union, the INMO, more than 2,000 hospital beds have been closed since the recession. It says most are “decommissioned” but that 532 beds around the country could re-open immediately if additional staff were appointed.”

The Irish News (January 9) ran a headline – Union vows to resist extra bed proposal. Liam Doran, in response to Minister Varadkar’s proposal to place one or two additional beds in non-emergency wards, warned that “it would only push the problem ‘up the house’ and would not alleviate ED overcrowding.”

NMBI The Irish Examiner ( January 19) reported on the NMBI dispute – Minister intervenes in nurses’ dispute. Nurses’ representatives have welcomed the call

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This year certainly started with a bang in terms of INMO media coverage. The perennial A&E crisis deepened and peaked on January 6 when a record 601 patients were waiting on trolleys for a hospital bed. The story received widespread coverage in all media outlets with members and officials giving numerous interviews.

RTE’s Morning Ireland interviewed four of our industrial relations officers – Mary Fogarty, Lorraine Monaghan, Derek Reilly and Tony Fitzpatrick on the show regarding the crisis in their areas. Having four officials on this programme, one after the other, was certainly a first for us. Valerie Cox interviewed three of our Executive Council Members – Anne Burke, Moira Wynne and Theresa Dixon, as well as IRO Joe Hoolan and general secretary, Liam Doran for the Today with Sean O’Rourke show on the same issue. Again, it was fantastic to have five of our people on the show on the one day. Liam Doran also appeared on the inaugural UTV Ireland Live at 10 show to discuss the crisis.

The station also interviewed members and officials around the country during its first days on air. In addition, ED nurse Karen McGowan participated in The Diary of an Emergency Department Nurse, also aired on UTV Ireland, where she spoke about her experiences.

Put this issue to bed – Nurses urge Leo to open 2,000 beds to end crisis was a headline in the Irish Daily Mail (January 15). Liam Doran, general secretary said “the overcrowding issue needed more action and less talk. More staff, more beds, more community services are needed to address the problem…We don’t need more high-level strategies, we need actions on the ground, which means funding, which means resources, so HSE and government are going to have to start making decisions. What’s required now,

MIDWIFERY MATTERS 49

Supporting hypnobirthing Brenda Harkin looks at the role of midwives in hypnobirthing However a Hypnobirthing woman can refocus her awareness quickly and fully at any time should the need arise.

Hypnobirthing mothers will request to avoid the topic of pain with the inherent understanding that they know that they may request pain relief at any time. Hypnobirthing aims to engage in soft non-threatening language so for example contractions are referred to as surges or tightenings and membranes release instead of rupture. In the second stage of labour women are taught to use special ‘J breathing’ to ‘breathe their baby down’ instead of pushing. J breathing is favoured as it does not require holding of the breath and there is no interruption of oxygen supply to the baby.7 Discussions on the complications of labour are avoided unless they arise. In the event of special circumstances, hypnobirthing mums are trained to keep calm by using breathing techniques and to trust in the expertise of the professionals when birthing takes an unexpected turn.

Special circumstances While it is important to read and follow the birth plan where possible, the care of a Hypnobirthing woman is the same as that of any women in normal labour and is ultimately determined by the NICE Guidelines Of Intrapartum care.2 Couples are aware that in special circumstances, ie. where there is concern for either mother or baby, this plan will have to be modified or abandoned and that their full co-operation will be expected.

In conclusion, deep relaxation, the loving support of a partner and a calm environment are among the measures that can enhance normal physiological labour.

Perhaps as midwives we should watch and listen more and be less willing to intervene. As Dr Michel Odent, a renowned advocate of gentle birthing, said,“One cannot help a physiological process. The point is not to hinder it”.

Brenda Harkin is a practising midwife and a hypnobirthing practitioner References on request from nursing@medmedia.ie (Quote: Harkin, WIN 2015 (23):1; 49)

No 1 February 2015

are also stimulated by laughter and touch and promoted in a calm loving environment. Oxytocin the ‘love hormone’ is promoted by touch and sexual contact.

It stimulates the release of endorphins and provides a natural euphoria. It is also responsible for milk flow and the promotion of bonding. Melatonin works in synergy with oxytocin and is necessary for effective contractions, expulsion of the placenta and uninhibited milk flow. It is released in dark, quiet settings. Bright lights are known to stimulate adrenaline production.

Basic needs The basic needs of a woman in labour are therefore to feel safe and supported, in darkness or low light, in warmth and silence that can leave the thinking brain switched off, to not feel surveyed and to be stress free. Maintaining a calm, relaxed birthing environment can therefore play a crucial role in successful birthing. In a modern labour ward with high levels of technology, maintaining an optimal environment can be difficult. Simple measures such as dimming lights, controlling room temperature and protecting a couple’s privacy are vital.

In Hypnobirthing there is a shift in emphasis away from healthcare workers and towards the family unit. The woman’s partner is encouraged to engage with healthcare providers and to participate fully in the birthing process while helping make informed choices. The couple learn Hypnobirthing techniques together and practice at home. They will have a comprehensive birth plan that they have formulated in advance, based on best practice and minimal intervention.

As labour advances the woman may chose to focus her attention inward, rather than engaging in conversation. Her partner may use techniques such as physical anchors, message and verbal prompts.

He is aware of her desires and may become her spokesperson. Evidence suggests that such support can enhance the effectiveness of hypnobirthing techniques.

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Hypnobirthing is based on the hypothesis that uncomplicated physiological birth has a natural rhythm and flow, and that mother’s and baby’s bodies are perfectly designed to achieve natural birth.

When a woman is relaxed, when she trusts in her ability to give birth and when fear is absent, the muscles of the uterus, like all other muscle groups of the body, work in perfect synchrony and pain is diminished or even absent.1 The National Institute for Clinical Excellence (NICE) in the UK states that women who choose to use hypnosis during childbirth should be supported in doing so as the evidence shows a reduction of pain without adverse effects to mother or baby.2 Hypnobirthing has been around for centuries.3,4,5 A Cochrane review consisting of five randomised controlled trials involving 749 women, found that hypnosis during childbirth decreases the need for pharmacological pain relief, including use of epidural: reduces augmentation of labour and increases spontaneous vaginal birth.5 Fear factor Fear or worry, whether perceived or actual, activates the body’s primal fight or flight, causing the production of stress hormones catecholamines. Tension in the mother’s body, creates resistance in the uterine muscles leading to pain and inhibiting labour’s progress. The phenomenon was first identified as ‘fear tension pain syndrome’ in 1946 by prominent obstetrician Dr Dick Reid. Stress also effects the foetus as catecholamines enter the foetal bloodstream via the placenta profoundly altering the distribution of foetal blood flow and causing foetal distress.7 Re l a x a t i o n s u p p o r t s t h e n o r m a l physiology of labour by inhibiting the fight or flight response and promoting the woman’s own production of hormones, principally endorphins. Endorphins, are natural tranquillisers and so enhance relaxation, they are powerful analgesics, they have an amnesiac effect and crucially they inhibit adrenaline production. They

50 eHEALTH

Winds of change

Vol 23

No 1 February 2015

We must be prepared for change if we are to successfully negotiate the uncharted waters of eHealth Ireland, writes Pamela Hussey Something new is happening in healthcare, Europe is in the midst of a financial crisis, escalating service costs and population demographics indicate that existing models of care are no longer sustainable or fit for purpose.1,2 European Policy Analysts, preoccupied in finding ways to balance budgets and restrain spending, are currently investing hundreds of millions of Euros in research and development funds on ‘health demographic change and wellbeing’. The aim of this is to support citizens in Europe with personalised healthcare plans. Future models of healthcare delivery will be developed in partnership with individuals and carers and will be collaborative, holistic, integrated and co-ordinated.

Ireland, as is the case in most EU member states, now calls for modernisation of health and social care records using information and communications technology. Fragmentation with associated tribal values still prevails, although new governance and management processes are now being implemented. There is an imperative for substantial input from clinical staff to ensure that the planned transformation is implemented in a clinically pragmatic way.

Nursing as a profession has a critical role to play in contributing to this transformational programme migrating from the existing care delivery service models to the new models of healthcare as defined in the eHealth Ireland national strategy documentation.3 Key requirement I n fo r m a t i o n a n d c o m m u n i c a t i o n technology (ICT) is identified as a key requirement for the delivery of a more efficient and effective service plan promising timely access to information for clinical decision making. Often perceived as an enabling resource ICT is recognised as tackling service costs in other industries such as finance and travel. Healthcare, unlike finance, is however not a streamlined set of care processes that can be easily defined; rather it is a continuous set of dynamic interventions set against a background of complex demand driven needs, and ICT infrastructures will need to be able to address and support this complex environment.

Taking time to consider what the nursing role is in the midst of this transformation, particularly in regard to the ICT agenda, is therefore both timely and critical. Advancing practice at the coalface of health

service delivery, nurses and midwives are required to provide safe and compassionate care with less staff and increasing service demands. In times of austerity the profession is often recognised as a temperature gauge in determining the quality and safety of care. Given the scale of the anticipated investment and planned growth in eHealth Ireland, there is no doubt that nursing and midwifery will engage with critical factors impacting on the evolving health service transformation. To achieve optimum impact on investments the professional contribution will need to be underpinned with both innovation and strong leadership Defining nursing innovation and leadership for 21st century healthcare can however be a complicated task raising within the profession a number of key questions that must be carefully considered. For example, where are the similarities or differences (if any) with traditional models of client care? Is there a need for focused reflection on practice development initiatives on eHealth, such as smart and sensor technologies? How will nursing integrate emerging technologies in community and practice settings in an ethically sensitive way, and what kind

eHealth 51

Nursing is well situated to inform, develop and evaluate such programmes, ensuring that they are ‘fit for purpose’.

With established informatics competencies nurses will be well placed to support next generation health service delivery plans across multiple platforms and dimensions. Understanding complexity of need and ensuring that eHealth initiatives, such as electronic health records, accurately capture the individual’s health issues to identify care requirements assists in planning targeted interventions for optimum patient outcomes.

Projected service plan investment on ICT now underway requires proactive – as opposed to reactive – engagement assisting in the effective use of limited resources. Nurses as team players within health and social care delivery possess core attributes to deliver next generation healthcare in Ireland.

As a profession, nursing needs to protect its unique contribution and, where appropriate, advance and adapt models of care to ensure traditional values are protected for optimum health service delivery.

While the profession may be navigating through uncharted waters assimilation and use of informatics competencies will complement existing leadership and innovation skills within practice development to adjust the sails to reach our destination for optimum health and wellbeing for citizens in Irish society.

Further information on nursing informatics in Ireland is available from www.hisinm.ie Pamela Hussey is a lecturer in nursing informatics at the School of Nursing and Human Sciences, DCU References 1.Napier D, Holmes D. Cultivating the role of culture in health. The Lancet 2014; 384 (9954): 1568 Online Resource Available from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61937-1/abstract Accessed December 1, 2014 2. The Economist Intelligence Unit. The Future of Healthcare in Europe Geneva Online Resource Available from http://www.janssen-emea.com/sites/default/files/ The-Future-Of-Healthcare-In-Europe.pdf 2011 Accessed December 1, 2014 3. Department of Health and Children, eHealth Strategy for Ireland Online Resource Available from http://health. gov.ie/blog/publications/ehealth-strategy-for-ireland/ Accessed April 2, 2014 4.Gladwell M. The Tipping Point: How Little Things can make a Big Difference Little Brown 2000 5. Nagle L, Crosby K, Frisch N, Borycki E, Donelle L, Hannah K, Harris A, Jetté S, Shaben T. 2014 Developing Entry-toPractice Nursing Informatics Competencies for Registered Nurses Studies in Health Technology and Informatics Ebook Volume 201: Nursing Informatics 2014 Online Resource Available from http://ebooks.iospress.nl/publication/36615 Accessed January 4, 2015 6. Adovasio JM, Soffer O, Page J. The Invisible Sex; The true roles of women in prehistory. New York Smithsonian 2007 7. Larsen P, Lubkin I. Chronic Illness impact and interventions 7th ed, Sudbury MA: Jones & Bartlett, New York 2009

No 1 February 2015

third will expand within contemporary nursing practice to include new infrastructure, including electronic health records in addition to smart, mobile and sensor technology deployment.

Nurses as cultural leaders Second role: Re c o g n i t i o n t h a t culture is an integral part of the transformation equation is important. As the largest stakeholder group in Irish healthcare, nurses are cultural experts, they set the pace and set the boundaries of the context of care and management of care processes. In 2013 the Royal College of Nursing report ‘Positioning Nursing in a Digital World’ on eHealth transition, indicated that 78% of nurses had little or no influence on eHealth use in their workplace. Failure to address the role of culture or ignoring cultural systems of value as an integral part of a change management programme can have a direct impact on quality of care.2 There is therefore a need for strong leadership in nursing practice development on cultural systems for contemporary nursing and midwifery practice to underpin recent strategy agendas such as those outlined in eHealth Ireland .

Nurses as researchers Third role: Traditionally, nursing practice theory can be described as evolving organically, adapting to the multiple situations, and advancing to meet the needs of complex changing environments. 6 Transformational research on eHealth is a key requirement in realising anticipated benefits and building on established nursing theory. Current examples may include chronic illness and the uptake and use of smart technologies.

Described by Larsen and Lubkin as core nursing territory, chronic illness is one area that is increasingly under review.

Specifically, there is a need to define nursing sensitive concepts that measure the impact on patient outcomes.7 A measured approach engaging with and designing next generation integrated health systems will ensure that core nursing territory is supported in future healthcare models. One focus may be the inclusion of concepts that adequately capture the therapeutic relationships that exist between nurses and individual clients.

Looking forward The profession of nursing has a key role in supporting eHealth Ireland. For modernisation of health and social care appropriate education and training programmes will be required at different times and in various sectors within the domain of healthcare.

Vol 23

of resources will be required to ensure delivery of anticipated benefits?

This article briefly explores some of these issues. From an informatics perspective, this feature identifies aspects of the role of nursing and how it can engage with eHealth Ireland. The intention is to encourage some discourse that may inform some practical applications and, perhaps, answer some of the questions raised.

There is a saying that we cannot change the direction of the wind but we can adjust the sails to always reach our destination.

Briefly identified in the following section are three roles for future professional innovation and creative initiatives. The three roles, while not new to practice development, should be considered for adaptation using informatics to address the eHealth digital agenda.

Nurses as change facilitators First role: The role of the profession in change management initiatives is well described in the evidence base. From a business perspective the definition of the ‘maverick role’ is identified by Gladwell as those individuals with insider information who operate within the social sphere providing critical content on context and, without whom, most business or ground-breaking ideas might be lost due to inaction.4 This article suggests nurses are ‘mavericks’ in future healthcare transformation in Ireland. Core areas for nursing engagement include providing a bridgehead between the service user, the family and the healthcare system in evolving new roles where ICT is in use. They will need to manage the existing fragmentation within current health services and foster shared values to facilitate future integrated care models. Delivering downstream training to educate and train formal and informal carers on health and wellbeing strategies, such as symptom management on self care management programmes, will also be important.

Drawing on evidence in Canadian publications, informatics skills that nurses will engage with include the following broad competencies: an ability to use relevant information and knowledge to support the delivery of evidence-informed, patient or client-based care; an ability to use ICT in accordance with professional and regulatory standards and workplace policies; and an ability to use ICT in the delivery of patient/client care.5 While the first and second competency above are reasonably embedded in Irish nursing practice, the

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Time to breathe easy Ongoing education supports nurses implementing palliative care for patients with COPD, writes Ann Cronin of anxiety and depression with poorer prognosis than patients with non-small cell lung cancer.7 A review of palliative care in advanced COPD in Canada identified spiritual concerns such as searching for meaning, strengthening of relationships, loss of meaning and fear of death as being common among patients.8 Also, airflow limitation, hyperinflation and inflammatory mediators associated with COPD may initiate or worsen co-morbidities such as ischaemic heart disease, heart failure, osteoporosis, normocytic anaemia, diabetes, metabolic syndrome and depression.9 Therefore, the management of COPD requires a multidisciplinary approach that includes physiotherapists, nurses, physicians, dieticians, social workers, pharmacists and counsellors. It also requires participation of community-based health professionals, liaising and providing care in conjunction with hospital-based professionals.5 Nurses and palliative care Nurses have a key role as regards the provision of palliative care for patients with COPD.4,10 The need for appropriate training and support for healthcare staff was also identified.

No 1 February 2015

COPD, and has developed a national program entitled ‘Palliative Care for All’.5 The World Health Organisation defines a palliative care approach for patients with COPD as reducing suffering by means of holistic early identification, assessment and treatment of symptoms that include physical, psychosocial and spiritual symptoms.6 Palliative care needs of patients with COPD The nature of advancing chronic illness including COPD, is that the ‘organ system failure’ trajectory can be unpredictable, ie. declining function punctuated by acute exacerbations.

The ‘Palliative Care for All’ programme highlighted that people with advanced COPD experience symptoms which include severe breathlessness on minimum exer tion, cough and excess sputum production.

Other symptoms include poor sleep, fatigue, loss of appetite, pain, depression, increasing inability to carry out the functions of daily living, social isolation and anxiety.5 Patients with advanced stage COPD have low levels of self-efficacy, disability, poor quality of life and high levels

Vol 23

Chronic obstructive pulmonary disease (COPD) is charac terised by air flow obstruction that is usually progressive and not fully reversible. 1 Currently in Ireland there is no national respiratory database, therefore figures of patients with COPD remain unclear. However more than 400,000 people in Ireland have COPD.2 Palliative care for patients with COPD and other non-cancer conditions is increasingly been recognised.3 Palliative care for patients with COPD has been endorsed for symptom management and as a means to reduce unnecessary acute hospital admissions. In Ireland patients with COPD occupy 122,263 beds annually and remain in hospital for a mean of 9.2 days.4 Despite the burden of COPD on the health system and the palliative care needs of patients with the condition, 19% of Irish specialist palliative care services report that they restrict their services to people with cancer, MND and HIV/AIDS.4 The Irish Hospice Foundation has recognised the need for a change in attitude and knowledge towards palliative care for chronic conditions including

Vol 23

No 1 February 2015

54 CLINICAL

A lack of knowledge regarding palliative care services, may impede the ability of healthcare professionals to have an informed discussion with patients regarding palliative care services.5 With regards to nurses’ attitudes towards palliative care, the Irish Hospice Foundation’s end of life forum report (2009) highlighted how clinicians may not take palliative care seriously (‘just an extra bit of TLC’). It also identified a perception that referral to palliative care signifies a failure on the part of the healthcare professional.11 Study rationale A qualitative study was conducted in 2013 with the aim of exploring nurses’ attitudes to and knowledge of palliative care for patients with COPD. Palliative care for COPD is a relatively new concept. Qualitative descriptive research was conducted using semi-structured questions. The semi-structured questions were based on the literature and two established questionnaires. 12,13 A sample of 10 nurses caring for patients with COPD was used.

Study findings Nurse attitudes to COPD All 10 nurses identified with the chronic, debilitating nature of COPD as a condition. However, the need to individualise patient care was also identified as nurses appreciated the difficulties patients had with symptom management. This view of emotional care as an essential element of patient care is in keeping with guidelines for the management of COPD.3 The stress of observing and nursing a patient struggling’ to breathe, with frequent re-admissions and exacerbations, is something in the current study that nurses did mention with regards attitudes to COPD. The impact of these emotions on those providing support for patients with COPD needs to be considered at ward level.

Nurse attitudes to palliative care for COPD Nurses in the current study supported the need for palliative care for patients with COPD. It is increasingly accepted in the literature that the principals of palliative care should be available to all patients. 6,14 Recent national and international guidelines and research recommend palliative care for patients with COPD.3,5,9,15 Another new finding of significance is the impact of nurses’ attitude on the transition to palliative care for all

patients with chronic illness. Nurses in the current study felt that, with societal and cultural recognition of the role of palliative care for patients with COPD, late referral of patients had decreased.

Nurses also described how palliative care is now more available for patients with chronic illness, at an earlier stage, with more involvement from all members of the multidisciplinary team.

Nurse attitudes to end of life care for COPD The need to individualise patient care was a strong theme within the study.16 Similar to previous studies, nurses found it difficult to identify when to involve palliative care for patients with COPD.17 However nurses did recognise a patient’s age, stage of diagnosis, frequency of exacerbation, frequency of admissions to the acute hospital system and support structure as influencing factors on referral to palliative care services.

Research suggests the initial discussion regarding palliative care should occur before the cessation of curative treatment.18 Some nurses in this study believed early palliative care was appropriate.

Others felt early palliative care would unnecessarily frighten patients. However, the majority of nurses supported palliative care involvement when symptoms became unmanageable for the individual patient.

This holistic individualised approach to end of life care is in contrast to the intensive medical approach often highlighted within current literature.19,20 The need for ongoing support for nurses to aid the transition of care to palliative care for all was identified in this study.

Nurse knowledge of COPD Nurses felt competent in caring for patients with COPD. However, nurses identified patients with COPD as having different needs from patients with other respiratory conditions and specialised patient education is required

for this group. This is consistent with previous research.21 Recent changes in service delivery have allowed patients with COPD access to all members of the multidisciplinary team.

Nurses in this study found that with specialised education, multidisciplinary support and improved service provision, they could improve patients’ knowledge and ability to cope with COPD as a condition.

Nurses knowledge regarding palliative care Nurses’ identified the value of holistic care. However knowledge of the principles of palliative care varied in the current study from symptom relief, support and education of families, psychological support, pain management and improving quality of life to end of life nursing care.

Research has found that nurses’ knowledge influences ‘crisis-point’ care. 22,23 Nurses within the current study felt that, with the appropriate knowledge regarding palliative care for patients with COPD, ‘crisis-point’ care involving late referrals to palliative care services was reduced.

The study found that the duration of clinical nursing experience was a factor in the recognition of patients’ signs and symptoms that required palliative care services.24 Clinical experience was highlighted as a factor that could ease nurses ‘fear’ regarding palliative care. Type of nursing experience was also relevant. Nurses cited the change from a surgical to medical ward environment as an influencing factor on nurses’ knowledge of palliative care for patients with COPD. Time constraints were also mentioned, in this category, as impacting on nurses’ knowledge of palliative care. A valuable resource is the clinical nurse specialist who has time to discuss palliation with patients with COPD. Time restrictions were highlighted as a barrier to nurses in providing palliative care for patients. This is supported by findings in the literature.7 The future Insight into nurses’ attitudes, eg. support for the ‘stress’ of nursing chronic illnesses and the emotional difficulty of providing palliative care, will aid the implementation of the highest standards of nursing practice for patients with COPD. If access to palliative care for patients with COPD is to improve, nurses must strive to understand the impact

CLINICAL 55

nurses can have on the provision of palliative care.

With specialised education, multidisciplinary support and improved service provision for patients with COPD, nurses within this study felt they could improve patient’s knowledge and their ability to cope with COPD. National and international guidelines are needed to ensure holistic palliative care is available for patients with COPD. Nurses, whether practice nurses, respiratory nurse specialists or hospital nurses, need to continue to be proactive in highlighting the role of palliative care services in the care of patients with COPD. This in time may have a positive effect on the care of patients with COPD. Ann Cronin is a registered nurse. This research was conducted under the supervision of Dr Margaret Landers and in conjunction with the Bon Secours Hospital Cork and University College Cork References: 1. National Institute for Health and Clinical Excellence.

Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care. National Institute for Health and Clinical Excellence. London, 2010 2. Houston M. First European audit on COPD compares care models. Irish Times 2012; Aug 21 3. American Thoracic Society and the European Res-

piratory Society. Standards for the Diagnosis and Management of Patients with COPD. American Thoracic Society and European Respiratory Society. New York and Switzerland, 2004 4. Irish Thoracic Society, Health Service Executive and Irish College of General Practitioners. The National Draft Respiratory COPD Framework. Irish Thoracic Society, Health Service Executive and Irish College of General Practitioners. Dublin, 2008 5. The Irish Hospice Foundation and Health Service Executive. Palliative care for All Integrating Palliative Care into Disease Management Frameworks. Irish Hospice Foundation. Dublin, 2008 6. World Health Organisation. WHO Definition of Palliative Care. World Health Organisation, Geneva, 2002.

Available from: www.who.int/cancer/palliative/definition/en/ [accessed Aug 11, 2014] 7. Yohannes AM. Palliative care provision for patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes 2007; 5(17): 1-6 8. Michaud-Young J, Rocker G. Facilitating Palliative Care in Advanced COPD: A Unique Leadership Opportunity for Respiratory Therapists. Can J Resp Ther 2009; 45(4): 27-29 9. Global Initiative for Chronic Obstructive Lung Disease.

Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease.

Oregan: US, 2013 10. Irish Hospice Foundation, The Irish College of General Practitioners and The Health Service Executive. Primary Palliative Care in Ireland. Irish Hospice Foundation, The Irish College of General Practitioners and The Health Service Executive. Dublin, 2011 11. Hospice Foundation. Perspectives on the end of Life Report of Forum on the End of Life. Irish Hospice Foundation. Dublin, 2009 12. McDonnell MM, McGuigan E, McElhinney J, McTeggart M, McClure D. An analysis of the palliative care education needs of RGNs and HCAs in nursing homes in Ireland. Int J Pall Nurs 2009; 15(9): 448-455 13. McLoughlin KE. Identifying and changing attitudes

towards palliative care: an exploratory study. Maynooth: Department of Psychology, 2012 14. Murray MA. Crossing over: transforming palliative care nursing services for the 21st century. Int J Pall Care Nurs 2007; 13(8): 366-376 15. National Institute for Health and Clinical Excellence.

Chronic obstructive pulmonary disease-management of chronic obstructive pulmonary disease in adults in primary and secondary care. National Institute for Health and Clinical Excellence. London, 2004 16. Giacomini M, DeJean D, Simeonov D, Smith A. Experiences of living and dying with COPD: a systematic review and synthesis of the qualitative empirical literature.

Ontario: Ontario Health Technology Assessment Series, 2012 17. Thoonsen B, Groot M, Engels Y et al. Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial. Family Practice 2011; 12(123): 1-7 18. Jefford M, Jefford M, Milne D, Aranda S, Scholfield P. Further considerations regarding discussions around the transition to palliative care. Palliative Medicine 2007; 21(7): 651 19. Goodridge D, Duggleby W, Gjevre J, Rennie D. Exploring the quality of dying of patients with chronic obstructive pulmonary disease in the intensive care unit: a mixed methods study. Nurs Crit Care 2009; 14(2): 51-60 20. Connors AF et al. A Controlled trail to Improve Care for Seriously Ill Hospitalized Patients, The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (Support). JAMA 1995; 274(20): 1591-1598 21. Yawn BP, Wollan PC. Knowledge and attitudes of family physicians coming to COPD continuing medical education. Int J COPD 2008; 3(2): 311-317 22. Dowell L. Multi-professional palliative care in a general hospital: education and training needs. Int J Palliative Nurs 2002; 8(6): 294-303 23. Spence A, Hasson F, Waldron M et al. Professionals Delivering Palliative care to People with COPD. Qualitative Study Pall Med 2009; 23(2) 126-131

UPDATE 57

Nurses align to tackle incontinence Launch of All-Ireland Branch of the Association for Continence Advice In late 2014 the National Nurses Continence Advisors Forum (NNCAF) Ireland played host to the launch of the All Ireland branch of the Association for Continence Advice (ACA).

Nurses from various HSE areas who worked within or who have an interest in bladder and bowel care in the Republic of Ireland founded the NNCAF in 2003.

The original aims of the group were to support the education of nurses working in continence management, and to develop national guidelines for continence promotion and the management of incontinence. Develop and deliver the core essential and specialist aspects of a quality continence service.

It had been recognised for some time that the NNCAF should amalgamate with a reputable international body on continence to ensure that continence care had a greater profile and a stronger voice when lobbying for changes in practice.

Following an overall consensus from the members of both groups, a decision was made to amalgamate to form an All-Ireland branch. The amalgamation of both groups facilitates closer cross-border working for

Pictured at the launch day for the All Ireland Branch of the ACA were: (front row l-r) Patricia Finnerty, chairperson NNCAF, Janice Reid, chairperson ACA; Jane Smith, chairperson, NI branch ACA. (back row): Frances Mc Ginley, continence advisor, Donegal; Margaret Tiernan, continence advisor, Roscommon and joint secretary, NNCAF; Patricia Dever, continence advisor Mayo, and joint secretary, NNCAF; Breda Moore, continence advisor, Kilkenny, and treasurer NNCAF; Patricia McDermott, membership secretary ACA; and Bernadette Charles, CNS, Cavan

staff in HSE and NHS NI and ensures greater standardisation of continence practices.

Delegates attended the launch day from both sides of the border and the UK, representing various disciplines from hospital voluntary and community settings, including continence, urology, physiotherapy and midwifery. In addition various companies provided display stands for

INMO recruitment draws

UCD award for chief nurse

No 1 February 2015

Prof Andrew Deeks, president of UCD, presents Dr Siobhan O’Halloran, chief nursing officer at the Department of Health, with the inaugural UCD alumnus award for nursing and midwifery. Dr O’Halloran was selected for the award in recognition of her leadership of the professions over many years and her contribution to significant developments in education, research and policy that have had a lasting impact on the professional formation and development of nurses and midwives, and on the quality of patient care. Pictured at the ceremony late last year were (l-r): Prof Andrew Deeks; Dr Siobhan O’Halloran; and Dr Martin McNamara, dean of nursing, UCD

WIN Vol 23

At the INMO Special Delegate Conference it was announced that a competition would be held for a special draw with a prize of €300 for new members who joined the INMO from October to December 2014 and a second draw of €300 for recruiters of new members. The draws took place at the January Executive Council meeting and the lucky winners were Biby Andrews, staff nurse, St James’s Hospital for new member, and Toni Howard, Cork University Hospital as a recruiter. Pictured at the draw were (l-r): Claire Mahon, INMO president, Albert Murphy, IRO and organiser; and Liam Doran, general secretary. On being informed of her success, the winning recruiter, Toni Howard said: “What a nice surprise for me to win the draw and … just after Christmas is a treat! I try to enforce in my workplace that it is vital to be a member of INMO”

attendees to visit throughout the day.

Commenting on the launch, Janice Reid, ACA chairperson, said: “The formation of this new branch is an exciting and positive development and I know, with the commitment and motivation of the people involved, it will go from strength to strength and provide a platform for influencing continence care policies in the entire island of Ireland.”

UPDATE 59

Low breastfeeding rate persists - report Future policy needs to understand factors that influence mothers The latest Growing up in Ireland (GUI) report on ‘Maternal health Behaviours and Child Growth in Infancy’ has found that Ireland’s low rate of breastfeeding persists despite a breastfeeding strategy being in place since 2005. The most recent figures from the National Perinatal Reporting System (NPRS), representing births in 2011, show that only 55% of women leaving hospital following birth were breastfeeding, and only 47% were doing so exclusively. While this proportion has increased over time Irish breastfeeding rates are still much lower than the UK (76%) and Sweden (over 90%).

The absence of a system to monitor breastfeeding in Ireland means that there are no national figures on the pattern of breastfeeding after discharge from hospital. Growing Up in Ireland data includes detailed information on patterns of breastfeeding, including data on the duration of breastfeeding. This data represents a landmark in the study of breastfeeding in Ireland and should contribute to the development of policies in the area.

The Report states that policy development in this area largely depends on understanding the factors that influence patterns of breastfeeding in Ireland and finding those that are amenable to policy intervention.

Current understanding of breastfeeding trends in Ireland is based on data from the NPRS which collects and processes data generated at the birth of a child. Births are registered and notified on a standard birth notification form, completed by the

hospital or the attending midwife. The NPRS system records whether the child was being breastfed at discharge from hospital and whether this was exclusive or complementary. From 2000 to 2009 the data show a general upward trend, with those mothers implementing ‘any breastfeeding’ increasing from 38 to 46%.

Mothers who reported that they did not breastfeed were asked to choose among a set of 15 reasons as to why. The feedback shows that almost half stated that formula feeding was ‘preferable’, while 17% chose ‘inconvenience/fatigue’ and 8% ‘difficulty with breastfeeding techniques’ as reasons for not breastfeeding.

Of the 4,417 women who answered this question, 84% chose just one explanation while 10.4% chose two and 2.5% chose three or more.

According to the report, the choice by half of the non-breastfeeding mothers of formula feeding being ‘preferable’ did not shed light on the underlying reasons for this preference. Although the proportions selecting the other reasons were quite small, their choices varied by maternal age. Older women (35 or older) were significantly more likely to choose difficulty with breastfeeding techniques as the reason compared to women under 30 (10.8% versus 6.3%). Conversely, younger women (under 25) were more likely to report embarrassment and stigma as the reason for not breastfeeding – 9.7% compared with 3.4% among women aged 35 or older.

GUI found that a smaller proportion of women stated that they did not

breastfeed due to embarrassment compared to previous studies.

They stated that this may be due to women opting for the ‘formula feeding preferable’ option even when embarrassment was a primary reason or it may reflect differences in the sample designs.

Of those who initiated breastfeeding, the proportion doing any breastfeeding fell to 70% at one month and to 50% by three months. By six months, the proportion still providing any breastfeeding fell to just over a quarter of those who had initiated it and the figure for those exclusively breastfeeding was down to 6%.

The GUI data show that Baby-Friendly Hospital Initiative-accredited hospitals are more effective at promoting breastfeeding initiation than non-accredited, although this advantage is not sustained once women leave hospital. Also, within hospitals, women who have a Caesarean section are 50% less likely to breastfeed, adjusting for other factors. According to GUI, given that over one-quarter of births are sections this is an important issue that deserves policy attention at both government and hospital levels.

Future waves of the GUI study will provide data on child outcomes that can be related to the pattern of breastfeeding that the child experienced.

WIN Vol 23 No 1 February 2015

Retired Section on the road for Christmas: Retired Nurses and Midwives Section on the road: For its Christmas dinner this year the ever-active Retired Section decided to take an overnight break in Athlone and just have an informal lunch in Toddy’s, which was declared a huge success by those who participated. While in Athlone, some opted to take a guided trip to Clonmacnoise, while others choose to shop, visit galleries and relax. A number of midland members joined the group for dinner both evenings . In 2015, the Section has plans for a tour of Sligo in spring time, a day out to the Royal Hospital and a Paddywagon tour to Belfast, that takes in Stormont Castle

REVIEW 61

Irish guide to pregnancy Nancy Murphy, a nurse and midwife from Roscommon, has followed up her 1993 book entitled Self Preparation for Childbirth with a new publication Preparation for Pregnancy, Birth and Motherhood – Recommended Reading for Prospective Parents.

Her decision to write the book was influenced by the changing characteristics of women’s lives and their expectations of pregnancy. Women’s lives are busier and more complicated than ever before and in her book Nancy aims to provide them with high-quality information that is clearly presented and easily understood in today’s climate of ethnic and social diversity.

According to the book, although pregnancy and birth is a perfectly natural process it is seldom naturally perfect! The author believes that inadequate preparation for pregnancy and birth is a major factor in the cause of complications that could be modified by preparation or, indeed, aggravated by lack of preparation. An unhealthy diet, stress, anorexia, bulimia, obesity, lack of exercise, sexually transmitted infections, effects of alcohol, smoking, drug abuse and overuse of over-the-counter drugs for example,

she says cause wear and tear on the body’s resources, adversely affect health and impact on fertility and pregnancy outcomes.

Many women feel well and believe themselves to be in perfect health, yet may have a lifestyle that has the potential to make them less well or even cause

them to become ill. According to Nancy, knowledge is power and prevention is heightened by awareness. It is questionable, she writes, how much healthier our babies would be if all prospective parents aimed for optimal preconceptive health.

Preparation for Pregnancy, Birth and Motherhood is a health educational book and addresses these issues.

The book is packed with useful information and advice. For example, all aspects of breastfeeding are discussed in detail but not to the detriment of formula feeding, the management of which is covered thoroughly.

The book is laid out in a very easyto-read manner, peppered with useful diagrams and divided into clear chapters that follow the pregnancy journey from preconceptive care to the care of the newborn infant. As many pregnancy books fail to cover the post-partum period adequately, the last few chapters in particular will be welcome to new mothers.

– Alison Moore Preparation for Pregnancy, Birth and Motherhood Recommended Reading for Prospective Parents by Nancy Murphy has a RRP of €20. ISBN: 9780952257813

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Crossword Competition 2

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1. Keeping a trickster pouring drinks (10) 6. Is in debt (4) 10. Subsequently (5) 11. Can you see Da bearing such material? (9) 12. Young female horses (7) 15. Scene of America’s infamous witch trials (5) 17. County nicknamed ‘The Garden of England’ (4) 18. Mathematical line (4) 19. You can steal no less than this (5) 21. Deliberately inflict pain (7) 23. A grouping – of grapes, perhaps (5) 24. Challenge, venture (4) 25. Attest that there’s an avenue to the right (4) 26. An easily taken goal, or the result of a faucet installation? (3-2) 28. Saul is confused about headgear for a bone! (7) 33. Tyrannises, subdues (9) 34. Aristocratic (5) 35. Organs of hearing (4) 36. Such prettiness has dogged meaning (10)

Down 1. Young cow (4) 2. T he goodness of food – you might run into it (9) 3. Sign up (5) 4. Fashion (5) 5. Parts of pens (4) 7. Spin, gyrate (5) 8. Father’s new wife may make a hem protest (10) 9. Grapple (7) 13. The villain in ‘Othello’ (4) 14. Might the rest ask to become denizens of the rink? (7) 16. Alice’s entrance to Wonderland (6-4) 20. At one’s disposal (9) 21. Expressed gratitude (7) 22. The capital city of Latvia (4) 27. On which we write (5) 29. Overheads involved in surrounding the street with lettuce (5) 30. Yearns for conifers (5) 31. Small island (4) 32. Warmth (4)

The prize will go to the first all correct entry opened.

Closing date: Friday, February 20, 2015 Post your entry to: Crossword Competition, WIN, MedMedia Publications, 17 Adelaide Street, Dun Laoghaire, Co Dublin

Solutions to December/January crossword: Across: 1. Low 3. Gerrymander 8. Viable 9. Dispense 10. Lupin 11. Event 15. Tigress 16. Admirer 20. Swoon 21. Snows 23. Linen 24. Angelica 25. Abbess 26. Hydrophobia 27. Rod Down 1. Love letters 2. Wrapping paper 3. Galen 4. Rudolph the red-nosed reindeer 5. Apple 6. Dancer 7. Rue 13. Poses 14. Radon 18. Volcano 19. Jogged 22. Salvo 23. Libra 24. Ash

The winner of the December/January crossword is: Bernie Golden Mullingar

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MATTERS

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€FINANCE €63 €

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Dermot Wells advises readers not to give up on health insurance without careful consideration could use their savings to fund the cost of private care if needed, but this gamble may not pay off. For example, if you require a private room in a public hospital, then this could cost approximately €1,000 per night and then you may also be faced with consultants’ fees as well, making this an expensive option.

How do waiting periods affect cover?

If you cancel your health cover now and re-join in 12 months time, you will be treated as a new member regardless of how long you held insurance cover previously. This means that if you are under 55, you will have to wait six months before any new conditions will be covered under your new policy, but more importantly, any existing medical condition will not be covered for a period of five years. For those over 65, this increases to 10 years.

So, while everyone must be charged the same premium by law regardless of their age, gender and medical history, different waiting periods apply depending on age, so consumers need to be very careful.

What other benefits can private health insurance provide?

There are other benefits associated with private health insurance cover that shouldn’t be ignored. Many consumers have now opted for corporate plan cover and many of these plans give guaranteed

€ € € €

€

€

refunds on a whole range of routine medical expenses such as GP, physiotherapy, specialist visits and many more with no excess to pay first.

On the majority of plans, it is now possible to get both MRI and CT scans carried out privately at no cost to the consumer.

These could cost between €200 and €500 if paying privately with no insurance cover.

Most plans include a certain level of cover for emergency treatment received while on a temporary stay abroad, while one insurer includes free travel cover on some of its plans.

In summary, having health insurance cover has never been more important.

As more people cancel their cover, this puts added pressure on an already over-crowded public system, which will inevitably lead to longer waiting times for elective and other treatments. Many consumers are happy to rely on the public system, which is perfectly understandable, however, for those who want to be able to make choices as to where they are treated, when, and by whom, private health cover is essential.

Our message is simply, don’t cancel your cover without shopping around – you might be surprised at what you find.

If you’re confused, Cornmarket can offer you a free health insurance comparison service. We compare all four health insurers on the market to find you the best plan to suit your needs.

Call us at Tel: 01- 408 6212.

Dermot Wells is general manager at Cornmarket Group Financial Services Ltd, Health Division

No 1 February 2015

1. Based on Laya Future Protect Plan.

2. Based on Aviva Select Plus Plan.

All figures sourced from www.hia.ie All prices quoted are correct from 1 January, 2015. The information is only intended as a general guide and has no legal standing. Cornmarket Group Financial Services Ltd is regulated by the Central Bank of Ireland. A member of the Irish Life Group Ltd. Telephone calls may be recorded for quality control and training purposes.

WIN Vol 23

The upward pressure on health insurance premiums continues unabated. With reductions in tax relief, increased levies and higher charges for health insurance members accessing public hospitals, it is little wonder premiums continue to rise.

This couldn’t come at a worse time as 45% of the population are due to renew their cover in the first quarter of 2015, with almost 500,000 customers due to renew in January alone.

Key reasons to keep health insurance Recent surveys from the Health Insurance Authority found that approximately 59% of respondents believe that health insurance is a ‘necessity’.

The key drivers for having cover in place remain the same, ie. the high cost of accessing treatment and the ‘perception of public services’.

Having quality private cover in place puts you in control of your treatment. Depending on the plan held, you can decide which hospital you want to attend; what accommodation type you’d prefer (private/semi-private) and when it suits you best to have your treatment carried out. If you’re faced with lengthy waiting lists accessing your treatment via the public system, you have the option of going privately using your cover.

If I cancel my private health insurance and go through the public service, how much will it cost?

Many people thinking of cancelling their cover believe that public treatment is free, which is absolutely not the case. Unless you hold a medical card, you will be charged €75 per night in a public ward up to €750 in any 12-month period. This also applies to young children.

Given that health insurance can be purchased for €495 per adult1 and €140 2 per child, one could end up paying more as a public patient with no health cover.

Many consumers also believe that they

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64 DIARY

February Saturday 7 CNM CMM Fitness to Practise Workshop INMO HQ 10am.

Booking is essential. Contact: helen@inmo.ie

Thursday 16 Retired Nurses Section meeting.

Saturday 7 Midwives Section meeting.

CUMH. AGM and section meeting.

Contact: jean@inmo.ie or Tel: 01 6640648 for further details

Tuesday 21 National Care of the Older Person Section Annual Conference.

Sheraton Hotel, Athlone. Go to www.inmoprofessional.ie – sign in, and register for the conference to avail of a 10% discount or alternatively contact the INMO directly to book your place.

Saturday 7 International Nurses Section meeting. INMO Head Office: 11am-1pm. Contact: jean@inmo. ie or Tel: 01 6640648 for further details Wednesday 25 Assistant Directors Section meeting. 11am. INMO head office. Contact: jean@inmo.ie or Tel: 01 6640648 for further details

March Wednesday 11 RNID Section conference ‘Future Proofing Disability Services – The Role of the RNID’. Crowne Plaza Hotel, Santry, Dublin 9. Go to www.inmoprofessional.ie – sign in, and register for the conference to avail of a 10% discount.

Alternatively, contact the INMO directly to book your place.

Friday 20-Saturday 21 ODN Section Conference ‘Continuing to Care’. Limerick Strand Hotel, Limerick City. Go to www.inmoprofessional.ie – sign in, and register for the conference to avail of a 10% discount.

Alternatively, contact the INMO directly to book your place.

Retired Section v T he INMO Retired Nurses Section is organising a fiveday McGinley Coach Tour holiday to Sligo. Members will be staying in the stunning four-star Glasshouse Hotel in Sligo Town for four nights from April 19.

No 1 February 2015

vC ost is €275pp sharing (€10

WIN Vol 23

April

per night single supplement).

Maximum of 15 single rooms available, so please book early if you require a single room.

v T our will depart from Parnell Square, Dublin returning Wednesday April 22

v T o book phone Annette McGinley Tel: 074 9135201

INMO head office at 11am.

Contact: jean@inmo.ie or Tel: 01 6640648 for further details

May Wednesday 20 OHN Section Conference.

Maryborough House Hotel, Cork.

Go to www.inmoprofessional. ie – sign in, and register for the conference to avail of a 10% discount. Alternatively, contact the INMO directly to book

Library Opening Hours February

Monday-Thursday: 8.30am-5pm Friday: 8.30am-4.30pm

For further information on the library and its services, please contact: Tel: 01-6640-625/614 Fax: 01-01 661 0466 Email: library@inmo.ie

INMO Membership Fees 2015 A Registered nurse (Including temporary nurses in prolonged employment)

B Short-time/Relief €228 This fee applies only to nurses who provide very short term relief duties (ie. holiday or sick duty relief) C Private nursing homes €228 DA ffiliate members Working (employed in universities & IT institutes)

Deepest sympathies to Paula Dunne on the very sudden death of her dear husband Joseph (Joe) Lennon. From all her colleagues and friends in the Assistant Directors Section, and the staff of the INMO

Condolence Sincere condolences from all her INMO colleagues to Jean O’Connell of CUH on the death of her father John O’Connell

Condolence Sincere condolences from all her INMO colleagues to Sinead Loy on the recent death of her mother Ann Kinahan

Condolence Sincere condolences from all her INMO colleagues to Ann Higgins of the Emergency Nurses Section and CUH on the death of her mother Margaret Higgins

Condolence The INMO extends sincere condolences to past president and colleague Sheila Dickson on the death of her mother Bridie O’Shea

€116

EA ssociate members Not working

€75

F Retired associate members G Student nurse members

Condolence

€299

€25 No Fee

Register now for ICN conference 2015 Registration is open for the International Council of Nurses’ (ICN) international conference ‘Global Citizen, Global Nursing’ to be held on June 19-23, 2015 at the Coex Convention and Exhibition Centre in Seoul, Republic of Korea. Members of nursing associations, other health professionals, and members of the public may register online at the ICN Conference website: www.icn2015.com.

Participants can register for the spectacular opening ceremony, the popular biennial fundraising luncheon for the Florence Nightingale International Foundation, a wide range of concurrent sessions including dynamic papers accepted through a highly competitive abstract selection process; and a host of options to learn about nursing practice and healthcare in Korea. This international gathering of thousands of nurses will explore the importance of cross-cultural understanding and global co-operation in nursing and provide opportunities for nurses to build relationships and to disseminate nursing knowledge across specialties, cultures and countries.

Visit www.icn2015.com to view the full programme and list of confirmed speakers. The early-bird discount price for registration closes on March 13, 2015.

Lactation consultants meeting vM embers Only Spring Study Day for the Association of Lactation Consultants in Ireland will take place on Saturday, February 28, 2015 in the Nurses Home of Galway University Hospital.

v Registration and membership renewal is available at: www.alcireland.ie/join-alci/

Third IHFD meeting v Irish Hip Fracture Meeting, Friday, March 6, 2015, 9am-4.30pm v RCSI, Cheyne Lecture Theatre v To register go to www.noca.ie