Ms Geraldine Talty:

I will address the question about risk forms and the filling out of incident forms when one finds one's self without adequate numbers of staff to provide safe care. The difficulty is that in many hospitals, when one fills out the risk or incident form, which is for a near miss, sets out that A, B and C are going to happen if one is not provided with another nurse, health care assistant or member of staff and sends it to the risk manager, business managers and other people, while the director of nursing may endeavour to get more staff in view of all the international evidence about staffing numbers, one must go through hoops, roundabouts and unbelievable paperwork to get somebody who is not a nurse to make a decision on behalf of the nursing profession about whether the risk form is adequate or not. Many people are filling out forms - some of us are better at filling them out than others - but those of us who fill out a lot of them do so because we see the difficulty at ward level. The people making the decisions about staffing numbers are not nurses, which is why we need to have directors of nursing making decisions about nursing, staffing levels and patient safety.

We cannot get away from the fact that everybody and anybody will tell one that it is nurses who are the glue holding the health service together at present and in the past. The Minister agreed with us on that and said that the people who keep the health service going are the nursing staff. To answer Senator Burke's query, the difficulty lies with the budget. When we qualify and train, all we are ever taught, and all that is engendered in my bloodstream as a registered nurse, is patient safety and putting the patient and quality first. Unfortunately, the people in charge at the moment put the budget first. One cannot put the budget first if one is trying to put patient safety first. To answer the question about how we might save money, all the evidence in Ireland, from the RN4CAST and internationally for years and years is that when nursing numbers are cut, as they have been in Ireland, with a view to saving money because of budgetary constraints, the patient impact is so great that there is definitely an increase in the number of patients who fall and get pneumonia and urinary tract infections. After a fall, a patient may not be able to go back to live in his or her own home. It can cost a fortune in respect of having fractured femurs fixed and requirements to go to the operating theatre. There is also the question of the general impact on them and their re-entry into society, because the majority of people who fall are over 70. The difficulty is that antibiotics must be used for pneumonia and urinary tract infections. There is also an increase in the number of pressure ulcers if there is a reduced nursing staff.

If one increases the number of nursing staff to the levels we are asking for, guided by international best practice, one will save a fortune. Things are extremely unsafe at the moment due to the numbers with which we are working. We are working with one hand tied behind our back, which is impossible in nursing because it is very labour-intensive. We are not being recognised for the job we do on a daily basis. The consequences for patients are detrimental. It is definitely dangerous; I cannot use another word. What we and the patients are being put through every day is dangerous and not right. We are responsible and accountable, unlike other people who are not in the nursing profession and who are making decisions about those incident forms. These people cannot be struck off the register of nurses tomorrow morning because they made a mistake. Yet we are being prevented as registered nurses and midwives from doing our job, which is to ensure patient safety, care and quality. A fall-----