A tAire,
Thank you for joining us here in the Kingdom and for your remarks on the vast contributions nurses and midwives make to society and each community across our island.
Before I respond to the Minister, I want to say thank you to the members of the INMO Executive Council who continue to go above and beyond to advocate for the continuous evolution and improvement of the nursing and midwifery professions.
Minister, nurses and midwives are the lifeblood of our health system. We are rostered in 24 hours, 365 days of the year, always there to ensure our patients are receiving high quality care that we have been trained to provide, despite trying circumstances.
Since we last met in Sligo, our members have really been through a difficult year. Minister, much of which could have been avoided, but we will touch more on that later.
As nurses and midwives, we are trained to deal with the knowns and unknowns. When the unknowns occur, each member of our profession feels it deeply.
I want to pay particular tribute to our members in Letterkenny University Hospital and all of the first responders on the scene i who responded so well to the absolute tragedy in Creeslough. As a Donegal native, I can say that you did our county so proud and showed the real difference we all make to our communities.
I want to acknowledge our members in the South East who are still dealing with the aftermath of the fire in Wexford General Hospital. I know that INMO members did everything possible to ensure the safety of their patients in their relocation. Our members in University Hospital Waterford are also facing sustained pressure following the incident in Wexford.
As working nurses and midwives, we offer our complete solidarity to all staff in the Mercy Hospital in Cork. When news broke of that event, it resonated with every nurse or midwife who has ever worked a night shift.
We salute all frontline workers and let’s stand now for a bualadh bos for our colleagues across the frontlines.
Safe Staffing – Making it Happen (Recruitment and Retention)
Since the last time you addressed this conference over 128,084 patients have been treated on trolleys or chairs while waiting for a hospital bed. 3,799 of those people were on trolleys in the local hospital here in University Hospital Kerry.
That is absolutely shocking and something that your Government should not be willing to stand over.
Our hospital system sleepwalked into a summer trolley crisis. During that time all signs were pointing toward a winter of chaos. We know that all too well because the INMO were the ones sounding the warning call.
Minister, why is it when the nursing profession is calling it for what it is that you, your colleagues in Government and the HSE are so slow to act? When we flag these issues we are not trying to be agitators or chasing a headline. We have a duty to provide safe care to patients and if we feel we cannot do that we are going to call it out.
The failure to act on our stark warnings led to a winter like no other in our health service. Nurses and midwives were walking into hospitals in December and January absolutely traumatised by the sheer level of overcrowding. Overcrowding is no longer a problem confined to our emergency departments; we are regularly seeing patients on trolleys in completely packed wards that are totally understaffed. Minister, our trauma when we walk into hospitals, pales when compared with our patients and their loved ones.
Minister, it is not just our nurses in ED that are facing extreme levels of stress stemming from the overcrowding in our hospitals, our public health nurses are feeling it, nurses who are working in the community are feeling it, those who work in care of the older person services are feeling it, those who are working in medical and surgical wards are feeling it, those who are working in ICUs and other critical care units are feeling it. When we hear rhetoric like “there’s never been more nurses in the system” it means very little to us when we are working in understaffed wards or when nurses and midwives in the community are not able to fulfil basic parts of their roles such as developmental checks on our youngest citizens. The turnover rates in our profession have now reached over 10%, Minister I know that you will agree that we cannot allow this number to increase.
As you know our population has increased and we are proudly now leading on services that previously didn’t exist. Simply put any expansion to existing services or developments on necessary new services requires more nursing and midwifery staff. That’s the reason employment of nurses and midwives has grown, the other is catch up from the disaster after effect of the moratorium on employment.
Minister, the findings of our recent Nursing and Midwifery Work and Wellbeing survey found that 97% believe that inadequate staffing levels in their workplace is putting patient safety at risk and 74% consider leaving their current work area, with most citing exhaustion, stress and staffing levels as reason. This needs to be a wake up call – making safe staffing happen must be as much of a priority for you as it is for us.
Acknowledgement of gains
Minister, it would be remiss of us to not acknowledge the hard fought for gains that we have achieved since we last met in Sligo.
The restoration of pre-2013 hours being one of the more significant gains. It cannot be denied that it was a very long road to get here but it is something that we can all look back on with great pride.
Many gathered in this room will know that getting back to the 37.5 hour week was something that was a top priority for me when I was first elected President of the INMO.
Minister, I want to acknowledge the cost-of-living related measures included in the renegotiated Building Momentum Agreement. However, it is not good enough that every other part of the public service gets to enjoy the hard-won gains before nurses, midwives and our colleagues across the HSE. The constant delaying of implementing agreements is not acceptable to us, especially when we are facing the same cost of living increases as everyone else.
Minister, the next round of public sector pay talks are to commence shortly, and we will be closely watching the reaction of your Government colleagues, particularly in the backdrop of record taxation returns. This country has always undervalued caring professions, particularly nursing and midwifery. I you and your colleagues are serious about not just growing the profession but maintaining the staffing we have, then salaries must increase.
Housing and Cost of Living
Recruitment and retention strategies must now address the immense challenges nurses and midwives face in dealing with the cost-of-living crisis and specifically the issue of housing, or lack thereof.
The rising costs of rent are not keeping pace with the salaries of nurses and midwives. For instance, if a newly qualified nurse or midwife living in Dublin or Cork is paying up to €1800 on rent, that means over 77% of their take-home pay each month is going towards rent. This is not sustainable in the long-term.
Speak to any of Director of Nursing or Midwifery and they will tell you that housing is now one of the most cited barriers to not just recruiting staff but retaining them. A motion carried at last year’s conference on bringing forward a weighting allowance for nurses and midwives working in city hospitals must be made a reality if we want to see roles filled in hospitals across our major cities. We can see the everyday result of delaying to acknowledge the effect rent and availability of housing is having on our ability to retain staff.
Louise, a new graduate midwife and an INMO member, who up until recently worked in one of the maternity hospitals in our capital city after she studied in UCD made the really tough decision to move back to her parents in the west of Ireland after her landlord hiked the rent to something completely unaffordable. She loved the hospital she was working in in Dublin as there were amazing learning opportunities, but it seemed like most of her wages were going into paying rent and bills. It was becoming impossible to have a balance of being able to work and enjoy time off. She will soon join many of her classmates in moving to London. She really wants to come back to Dublin one day but only if house prices come down.
Louise is not alone, Minister nor is her case an isolated incident. Hundreds of nurses are coming to Ireland every year and we are so grateful for them, but Minister the State should hang its head in shame at the accommodation that our new colleagues are being placed in by agencies who are receiving state money. We know of nurses who have been forced to share rooms with strangers after a shift in overcrowded hospitals. Midwives who have been put up in AirBNBs over 30KM from their workplace. That is not the cead mile fáilte that we should be willing to stand for.
Affordable accommodation in close proximity to healthcare settings should not be a pipe dream for nurses and midwives who work long hours. We are calling for immediate provisions to be made to enable these essential workers to live within a reasonable distance of their place of work, have suitable accommodation to allow them work safely during long nights and days.
Minister, we work long shifts, compounded by hours of commuting and the risks to exhausted nurses/midwives driving long distances home after their shifts, which has tragically been proven catastrophic for some of our members over the years. The public expect and our statutory regulations mandates that we provided a safe level of care to our patients, our living conditions must be suitable to allow rest and sleep in daytime to prepare for night duty, rest and recuperation when off duty.
Provision of housing assistance, subsidisation, and zoned areas in any planning for hospital builds such as the new National Children’s Hospital or the proposed new elective hospital in Cork City should be a pre-requisite provision for such sites. Government should not be contemplating opening more beds without a plan to house those who will staff them.
Celebrating Diversity in our Health Service
Minister, I would like to also acknowledge the huge contribution of our nursing and midwifery colleagues from overseas. They uproot their lives and move across the world for the betterment of our people. The very least the State can do for healthcare professionals who choose to make Ireland their home is to ensure that they can apply for visas for themselves and their families in the most seamless way possible.
As a union, we are proud to stand against the hateful rhetoric directed at those who have chosen to make Ireland their home. No nurse or midwife should face vile, racist abuse while going to or from work or indeed while they are caring for patients.
Hate and division has no place in our hospitals or in our local communities.
Women’s Health and Midwifery
Minister, you join us here today on International Day of the Midwife, a day where we celebrate everything our amazing midwives do.
Maternity care in Ireland remains heavily reliant on consultant-led, hospital delivered care. Despite the countless recommendations to expand choice for women as realised by the National Maternity Strategy, the pace of implementation has been extraordinarily slow. All political parties are quick to pledge their support for implementation of the strategy, but progress is not evident, and funding for additional midwifery staff and midwifery-led units remains insufficient.
Minister, we are facing a major crisis when it comes to midwifery staffing. In December 2020, there were 1,486 Whole-Time-Equivalent staff midwives employed by the HSE, in February 2023 there were 1,425 – a reduction rather than an increase. The shortage of midwifery staff is not just something that is being felt in our large maternity hospitals in Dublin, it is being acutely felt in our regional maternity hospitals too.
Investment in increased undergraduate and postgraduate training is a clear requirement. We cannot continue to under resource and under value this profession.
Why should the health system decide how women have their babies? The views and choices of women are not taken into account. The implementation of a community midwifery service that provides home birth options must be fully realised. The INMO request that the review on waterbirths in Ireland be published. This service needs to be offered as an option for labour, either at home or in hospitals. The fact that women are not supported with sufficient choice of access in their supported pathway of maternity care goes against the essence of the National Maternity Strategy. We know you agree with us Minister. Women must have a choice.
Minister it would not be right for me to stand here today and talk about women’s health and not mention Vicky Phelan. Minister since we last met, I have begun a new role as an ANP in Gynaecology. My biggest inspiration to transfer to this role was Vicky Phelan. She is my hero and I want her legacy to live on through all of us gynaecology nurses. Vicky was a force to be reckoned with and saved many lives as she campaigned for all the women of Ireland. I think of her when I feel overwhelmed, and this drives me forward.
Minister, I know that women’s health is something you are taking very seriously. The work you and our Chief Nurse, Rachel Kenna, have done to enhance services for women going through menopause has been fantastic. With an overwhelmingly female workforce, the health service should be a leader in promoting workplace wellbeing for people experiencing menopause. Development of workplace policies is an employer responsibility for fostering equality and is vital for retaining skilled staff in their professions.
The Future of our Profession
Minister, when President Joe Biden addressed you and your colleagues in Dáil Éireann last month, he said that as a nation we do not focus enough on the “promise of our future”. I think the young nurses and midwives who are leaving Ireland for pastures new in their droves would echo President Biden’s sentiment.
When we met last year Minister, the INMO called on you to spearhead an innovative Bring Them Home campaign to entice Irish nurses’ home but now we are asking for you to give our young nurses and midwives a reason to stay.
Measures need to be implemented to ensure safer staffing across the health service and better supports for students and intern, or else we’re looking at a long term skills shortage in the health service that will have a direct impact on patient care.
The survey results here show us that student nurses and midwives need to be made to feel valued throughout their training, as well as seeing improvements in the working conditions for their qualified colleagues.
In closing, the challenges facing our health service are significant, but we are not without hope. As nurses and midwives, we are committed to providing the highest standards of care to our patients. Minister, I want to make it clear to you in no uncertain terms that we will not work another year like we just have. Something has to give because it is not sustainable. We are hungry for change at all levels in the health service. We need the support of our government and those who rely on us to provide care to help us make the changes that are necessary to ensure that our health service is fit for purpose and able to meet the needs of our patients now and in the future.
Minister, we are strong advocates of the Framework on Safe Nurse Staffing, but it cannot just be an aspiration.
Unfortunately the policy has not been enough, we must legislate for safe-staffing. You heard from our midwives yesterday, you know the challenges they are facing when it comes to staffing. Patient safety is proven to be directly linked to nursing and midwifery staffing. We know that you want to be the Minister who changes the face of patient safety.
We are more than happy to work with you to make it a reality and to make it work for Ireland. Minister, you don’t want your legacy to be the Minister who presided over the worst hospital overcrowding crisis. You want your legacy to be the Minister who presided over the most positive change to the nursing and midwifery professions in the history of the State.
Make safe-staffing a reality, like they have in California, like they have in New South Wales, where hundreds of Irish nurses are working in Sydney. Be the leader for change, you’ll have the full support of the nursing and midwifery professions.