asked the Minister for Health the steps which he is taking to ensure substantial improvements in all hospitals in the conditions of service for nurses.
Ceisteanna—Questions. Oral Answers. - Conditions of Service of Hospital Nurses.
33.
Mr. O'Malley
The Deputy will be aware that I am most anxious to improve the conditions of nurses employed in hospitals. Yesterday I addressed the annual general meeting of the Irish Nurses Organisation and I indicated the steps I am taking to bring about such improvements. The statement is detailed and comprehensive and, with your permission, a Cheann Comhairle, I propose to include it in the Official Report.
Following is the statement:
I am very glad to have this opportunity to address you here this morning, and am grateful to your Executive Committee for their invitation to me to do so.
The annual general meeting is always an important occasion for an organisation such as yours. It provides your members with an opportunity to discuss matters of concern to your profession and to decide the future policy of the Organisation. It is, too, the occasion on which your officers render an account of their stewardship for the preceding twelve months. Whatever they themselves may have to say on that score, I can assure you that they have been constantly "on my house", and with great politeness, but with irresistible firmness, have made their demands for better working conditions for your profession. I have, of course, no objection to being prodded in that way. A Minister of State must expect to be reminded from time to time of the needs and aspirations of persons whose daily lives can be influenced by his decisions. But where the nursing profession is concerned, I would like to assure you that it is not necessary for me to be convinced that there is a need for improvement in your conditions.
The Irish nurse has won and maintained a high and unchallenged status in the community because of her compassion, her patience and dedication to duty. The community must now ensure that she is granted conditions which match up to it. For we should consider ourselves in duty bound to show our gratitude to her, not merely by expressions of appreciation or speeches of approval, but in material ways as well.
I consider that, in particular, the working hours of hospital nurses should be improved. Other categories of workers have been seeking and obtaining shorter working hours during the last two or three years. You will appreciate, I am sure, how difficult it is for a Minister at this juncture to say anything that might appear to encourage a general reduction in working hours. Like every other member of the Government, I am deeply conscious of the need for restraint in this respect by the general body of workers. Nevertheless, I feel that the nature of nursing duties places nurses in a special category in the matter of working hours and that they are entitled to a reduction in the hours of duty which they have accepted so cheerfully down the years as a commonplace of their vocation. Accordingly, I propose to tell those bodies employing nurses over which I have any measure of control, that they should immediately put in hands an examination of their schedules with a view to ensuring that, as soon as possible, none of their nurses should be expected or required to devote more than 42½ hours a week or 85 hours a fortnight to the exacting duties of their profession.
It is hardly necessary for me to tell this audience that serious problems will arise in most hospitals in implementing this arrangement. I need not spell out what these problems are; but I promise you that formidable though they are, they will be resolved as speedily as I can arrange.
Before leaving the subject of hours of duty, I should also mention that nurses are one of the few professional groups whose calling demands that they must work on public holidays when most other members of the community are free to relax and enjoy themselves. Whether it be Christmas Day or St. Patrick's Day, patients require nursing attention. That the nurse should have to work on these days has been fully accepted by the profession. Working on these public holidays cannot be avoided; but it is only reasonable that a nurse who is required to attend for duty on such a day should be given a day off in lieu.
Again, I promise you that this overdue reform will be implemented as soon as I can arrange it.
I would hope to have associated with these improvements in hours of duty the introduction of a new category of hospital auxiliary worker who will relieve the nurse of such non-nursing duties as she still performs. This should make it possible for the nurse to devote more time to the highly skilled duties for which she has been trained. I am not in a position yet to say what the exact nature of the qualifications or duties of this auxiliary worker will be. That is a matter now under examination in my Department with the valued assistance of your organisation.
A matter which I know has been of concern, particularly to senior nurses, for some time past is the absence of a satisfactory superannuation scheme for those employed in voluntary hospitals. Some of these hospitals, as you know, have reasonably satisfactory schemes as regards the benefits payable, but they have the serious disadvantage that a nurse who transfers to another hospital, voluntary or local authority, cannot carry with her credit for her past service in respect of pension benefits. Some voluntary hospitals have no provision at all for superannuation, and some have schemes which are inadequate by any reasonable standard. A Committee which was appointed by my predecessor, Mr. MacEntee, examined this question and, having recently considered their report, I accept the principle of a superannuation scheme for the staffs of the public voluntary hospitals to which grants are payable out of the Hospitals Trust Fund in recoupment of revenue deficits. The terms of this scheme will compare favourably with those provided in the local government superannuation code for corresponding staffs of health authorities, and it will apply to voluntary hospital staffs generally, and also to the district nurses employed by voluntary agencies.
You will appreciate that superannuation schemes are complicated, and that the details must be worked out before the scheme is put into effect. This, however, is being done and the result will be to end the disadvantages which nurses in some voluntary hospitals suffer as compared with their counterparts in local authority hospitals in regard to provision for their retirement. It will also lead to more efficient hospital services since it will facilitate interchange of staffs between the voluntary and local authority hospital services.
There is one other matter which is receiving my attention. Normally a nurse spends three years in training, but in some hospitals a nurse who is fully qualified has to spend a fourth year in the hospital during which she does the full duties of a staff nurse, but does not get the full salary of a staff nurse. A qualified nurse should be paid as a qualified nurse, and I intend to arrange at an early date that student nurses, on completion of their three years' training, who have passed their qualifying examinations and who are doing the full duties of a staff nurse, will be paid accordingly.
As well as considering the manner in which the conditions of nurses generally might be improved, I have, in recent months, given particular attention to the conditions of student nurses. I felt that since the student is a very young person, lacking the freedom of the qualified nurse, her position merited special consideration with a view to bringing the conditions governing her working and leisure hours more into line with those of other young people of comparable position. It was clear to me that certain improvements were called for, and some weeks ago I had a number of recommendations sent to the authorities of all training hospitals, both voluntary and local authority.
These recommendations include the reduction of the students working hours, such hours to include time spent undergoing instruction as well as ward duties. I have suggested that lectures should in future be organised on what is called the "block" system, whereby the student will spend continuous periods of one or several weeks receiving tuition and be freed from ward duties. I consider that this arrangement should make it easier for the student to assimilate the formal instruction she is receiving and at the same time avoid the disruption of nursing services which arises when she has to switch back and forth between lectures and ward work.
I have also recommended that a student nurse should not have to do night duty during her first six months as a student, and that during the remainder of her studentship she should not have to spend more than two months a year on such duty. I have asked, too, that students be not required to undertake night work for at least a month before their examinations.
I have urged the training hospitals to increase, where necessary, their tutorial staffs so as to provide a ratio of one tutor to every 30 students.
I have recommended the replacement of traditional type uniforms by simpler uniforms of modern design, and this I propose to recommend for qualified nurses as well.
The question of restrictions on students during their off-duty hours was one to which I gave particularly serious consideration. I am fully conscious of the fact that nurse administrators in training hospitals are in loco parentis where the students are concerned, and for that reason a considerable amount of discretion must be left to them in the matter of regulating off-duty hours. However, I have informed the training hospitals that I feel that student nurses should be allowed maximum freedom consistent, of course, with their ages, the expressed wishes of their parents and the need for adequate rest to preserve their health. In particular, I consider that the hours at which they are required to return to the nurses' home after being off duty should be realistically re-examined in the light of the prevailing local standards for girls of corresponding age and status.
I have also recommended that greater importance be attached to good communications in the training schools, and in this regard I have urged regular consultation between students and management on matters of general interest. I propose to make a similar recommendation in regard to all nurses in all hospitals.
Finally, I should say that the improvements I have mentioned do not grant you everything I would like to see granted. But the reduction in working hours and other improvements to which I have referred cannot be provided cheaply. We are living in difficult times, economically speaking, and I know that you will appreciate that the national purse strings can be loosened only gradually for the present. What I have done, I regard only as the beginning, and with the co-operation of your organisation, I hope, as soon as I can, to continue to improve the working conditions of the nursing profession.
I hope your annual general meeting will be a success, and I would again like to express my gratitude for being given this opportunity to address you.
Could the Minister give us any indication whether they will get an increase in salary or a reduction in hours in the near future?
Mr. O'Malley
Yes, they are getting a reduction in hours. They have already got an increase in salary, so the Deputy must not be keeping in touch with the welfare of the nurses.
I was thinking of the welfare of the Minister's Party for the past month.
Mr. O'Malley
If in the general election we got over 50 per cent of the votes, we would get an extra 23 seats. The Deputy can think over that.
Next time .6 will not do you any good.
Mr. O'Malley
You can have 100 to 8 the next time if you want it.