LAST UPDATE | 4 May 2023

MOIRA WYNNE HAS been an emergency department nurse in Dublin for fourteen years. In her own words she can “cope with a lot”, but she reached a breaking point when a man punched her in the face while she was on duty. 

“It wasn’t the patient’s fault,” Wynne explained. 

“I want to be able to go into work and provide an environment for patients where they are looked after, and I am not concerned about being able to keep them safe. 

“There’s been many times when someone comes in who is experiencing mental health issues, and they are waiting in a hall where it is noisy, bright lights are on constantly, it’s crowded, doctors are coming in and out, ambulances are arriving. 

“For vulnerable people that is the worst situation to be in. We should have quiet spaces where they are able to be assessed, and staff are there to do that, and we do have one of those spaces, but sometimes three or four other people should have a safe space as well. That is what really gets to me,” Wynne said. 

“I am usually very calm, but when I got punched I went and sat down in an office and cried. My colleague came in and said ‘Oh my God, you never cry!’, but that day I couldn’t hope,” she added. 

The Clinical Manager said that she believes that there is no real “appetite” for industrial action amongst the Irish Nurses and Midwives Organisation (INMO) member’s at the conference this week, but that “it might be the only way to see changes made, but I hope not”. 

“When we talk about the safe staffing framework, it is not some made up plan. It is facts-based. We want to see it implemented with some weight behind it. That means that if, as part of the framework, there needs to be four nurses in your team, there are. When one person leaves, no one is able to turn around and say ‘Well maybe you will be okay with three,’ and then not replace them,” Wynne added. 

INMO has voted in favour of holding a national ballot on industrial action if sufficient progress is not made on a safe staffing framework that is underpinned by legislation.

This move comes despite Health Minister Stephen Donnelly promising an extra 25 million in funding for 854 additional nurses in acute hospitals across the country. 

“Where is he going to get them from? We’ve heard promises like this before, but we know that the recruitment process is unnecessarily slow, and we have approved positions that are vacant in the health service,” Wynne said. 

“Migrant nurses are being made to come here and pay to do a test that isn’t like anything I did when I got my qualifications – and if they fail it twice, by even getting one station out of fourteen wrong, they are out. 

“For people looking to move to practice in other parts of the country, you’d think that that would be fairly simple, but it isn’t, it can take six or nine months and you need to go through all of the paperwork again, including garda vetting,” she added.

The Dublin-based nurse said that she believes the lack of investment in older people’s services is contributing in a serious way to the backlog for discharges and transfers in acute settings, and has a knock on effect on the entire health system. 

“It is like we are on a hamster wheel.

Older people go through deconditioning, and they are able to be discharged, but there is no availability for homecare hours to make sure that they will be looked after at home, they can’t even get twelve hours a week. 

“Families try to do it, and we see them exhausted, but in many cases they cannot do it all by themselves. So one thing knocks into another. That patient continues to stay in an acute bed, we end up with overcrowding, the staff cannot cope with the demand, and non-urgent surgeries get cancelled. 

“That means that by the time a patient who is pushed back on a waiting list comes to us, they are sicker, and they are then also in hospital for longer. 

“In some cases, an older person can come in for something like a chest infection, and because they can’t get homecare hours, they end up going into a private nursing home. We are paying a very large amount of money to these private facilities, when we should be invested in helping people to get back home,” Wynne said. 

Being redeployed to other wards that are short staffed is an issue that is affecting emergency department nurses up and down the country – a motion was passed calling for the practice to end within the health service at INMO’s conference. 

“It is not like a site manager would redeploy us just for the sake of annoying someone. They come into the ED and think things look under control, and then people get asked to go to other areas. 

“The thing is, things can look under control one minute, and there can be a very urgent situation, like patients coming in after a car crash, the next. 

“It also affects us retaining staff. Some nurses have gone on to complete postgraduate study specifically in emergency department work, and they don’t feel they can do that to the best of their ability when they are redeployed, or we have patients coming into us who should be able to get seen by a GP,” Wynne said. 

Bernard Gloster, the CEO of the HSE, made a number of promises on changes to critical care planning, and changes to the structure of the HSE, which should see more senior managers reporting directly to him. 

Wynne, who has attended many INMO conferences, said that listening to Gloster she felt some “hope that things will change”, because he “recognised the problems we are facing, and spoke about solutions and deadlines”. 

“We are so used to being told that we are so hardworking, that we are the cornerstone of the health service. We are tired of that. It seemed to me that he is someone who wants to confront the reality of the situation. 

“I like what he said about scrapping the winter plans, because they are a joke. We follow them each year when in reality, we go back after Christmas and it is just as bad, and the situation isn’t getting better during the rest of the year either. Then we are meant to act surprised that people are in unsuitable conditions. 

“I love what I do. I feel very honoured that peoplFe trust me to look after their relatives. I’m proud to make a difference and to work with such an amazing team. I just want to be able to do my job well,” Wynne said. 

“We also need to end the disconnect between the people making the plans, and the people working on the frontline. Look at what has happened with the new Limerick ED. My colleagues are working there and it is like a war zone, but it was meant to be a solution at the time. We need to bring together the interested parties and have an honest conversation about the way forward in order to future proof our hospitals,” she added. 

Minister Donnelly is set to address the INMO conference tomorrow.