Opening Statement to the Joint Committee on Health Protection and Support for Frontline Healthcare Workers - 9th February 2021
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Opening Statement to the
Joint Committee on Health
Protection and Support for
Frontline Healthcare
Workers
9th February 20211.0 Executive Summary
1.1 The INMO has experienced difficulties in protecting frontline healthcare workers since the
pandemic began. In particular, it is critical of:
- Slow, reluctant decision making processes in the HSE and wider Government.
- Failure to classify COVID-19 as a workplace biological agent until required to do so by the
EU.
- Delays in rolling out universal facemasks and higher standard masks.
- Unclear communications on occupational health policy changes.
- Vaccine rollouts without clear guidance or regional prioritisation.
- Poor reporting on vaccine rollouts.
- No policy of regular testing of asymptomatic healthcare workers.
- Last-minute decision making on student nurses and midwives.
- Long-standing problems with workforce planning, health service underinvestment, and
privitisation in the nursing home sector.
1.2 The INMO is calling for the above problems to be acted upon, along with other key
recommendations (set out in more detail in the final section). They include:
Enforcement of the requirements in the Code of Practice for Biological Agents Category 3 in
every health care facility and workplace.
An independent expert investigation into healthcare worker infection.
High prioritisation of vaccination rollout for healthcare workers with clear reporting on the
progress.
HSA inspections into sites with clusters/outbreaks.
Increased breaks for staff due to PPE burdens.
End the derogation policy allowing staff return before end of self-isolation.
Staffing requirements set by scientific need, including a legal basis for minimum staffing.
Increase in undergraduate nursing and midwifery places.
Annual workforce plans.
Mental health supports for frontline staff.
Childcare provision for frontline staff.
Employment protections and pay for students and interns.
Compensation for frontline healthcare workers, for all they have done during this pandemic.
2.0 Introduction
2.1 The Irish Nurses and Midwives Organisation (INMO) wishes to thank the Oireachtas Health
Committee, for this opportunity to submit on the important matter of protection and support for
frontline healthcare workers.
2.2 It is important at the outset that we acknowledge and thank the nurses and midwives of
Ireland for their dedication and commitment demonstrated throughout this pandemic. They have
been at the forefront of the fight against the virus and have gone above and beyond in responding
to the population's health needs. Their effort, dedication, commitment, professionalism,
expertise and excellence must be recognised.
2.3 The COVID-19 pandemic has exposed failings over many years to invest in capacity and staffing
adequately. Governments and the HSE over the last number of years have many reports indicating the
1staffing and capacity pressures of the health service. Unfortunately, these were ignored. As well as
dealing with the current challenges arising from nurse and midwife staffing, protection for frontline
nurses and midwives must be achieved through long term workforce planning, investing in public
health provision of services as set out in Sláintecare, appropriate recruitment and retention policies
and implementing fully the Framework for Safe Nurse Staffing and Skill Mix.
2.4 The essential role that nurses and midwives play in the Irish health services has come into sharp
focus during the COVID-19 pandemic. Nurses and midwives have faced unprecedented challenges and
pressures during the pandemic, the effects of which will be felt for a long time to come. Now in the
third wave of the pandemic, faced with new variants and high levels of community infection, nurses
and midwives must be protected and supported in their roles to deliver high quality, safe patient care
in the COVID and non-COVID environments.
2.5 Ireland has one of the highest incidence rates in Europe, and the third wave of COVID is having a
severe impact on the Irish health service. High levels of community transmission equate to high illness
levels within the health care setting. The pressure which the hospitals are under during this surge has
come at a much faster pace. According to the HSE, the decline will be slower. Therefore, the impact
on patients, healthcare workers and the hospital system will continue for several weeks to come.
2.6 We present issues under three main categories:
Data on infection rates and aetiology.
Health and safety protections - commentary on limitations.
Long term effects on the nursing and midwifery professions.
3.0 Data on Infection rates and aetiology
Healthcare worker infection rates
3.1 Since the start of the pandemic, the INMO has continuously negotiated and campaigned for the
rights of nurses and midwives to be protected in their workplace. To date, each stage has been met
with a very slow or reactive response from the Government and the HSE, which ultimately is putting
nurses and midwives at risk daily.
3.2 The INMO sought the amendment of the health and safety legislation to include COVID-19 as a
reportable occupational hazard in April 2020. Under the 2016 Regulation 2241, diseases, occupational
illnesses, or any mental condition impairment were removed from the reportable incidents
requirement of employers to the Health and Safety Authority (HSA).
3.3 Initially, the Government did not amend the Safety Health and Welfare Regulations. In November
2020 the European Biological Agent Directive recognised Sars2-CV2 as a biological agent and subject
to those regulations Irish health and safety legislation was amended. Before the European legal
developments, the Government had relied on the "loophole" in the 2016 regulations which allowed
employers to avoid reporting COVID-19 clusters to the HSA. HSE and other health care employers had
no obligation to report to the HSA, and there was no independent scrutiny of the approach taken
toward worker safety. HSPC has recorded 11 healthcare worker deaths, but the HSA has not reported
any healthcare worker deaths.
1
Code of Practice for the Safety, Health and Welfare at Work (Biological Agents) Regulations 2013 and 2020.
The Code of Practice along with the Safety, Health and Welfare at Work (Biological Agents) Regulations 2020
(S.I. No. 539 of 2020) transpose requirements in Commission Directive (EU) 2019/1833 of 24 October 2019 and
Commission Directive (EU) 2020/739 of 3 June 2020. Directive 2020/739 specifically addresses SARS-CoV-2 (the
causative agent of COVID-19) and classifies it as a risk group 3 human pathogen.
23.4 In our view, this lack of routine testing and monitoring exposed nurses, midwives and other
frontline workers to a greater risk of infection. Put simply – if we cannot see a problem, then we cannot
deal with it. Significant risks result from a lack of independent statutory data collated to improve
workers' protections. This, in our view, was an eminently avoidable error. Amending the health and
safety regulation was an option open to Government. The INMO and ICTU requested this be done
early in the pandemic. However, the Government chose not to take any action until legally required2.
3.5 It is well documented that healthcare workers are the cohort of workers most exposed to the risk
of the virus. According to the Prevalence of Antibodies to SARS-CoV-2 in Irish Healthcare Workers
Phase 1 Interim Report (2021), within this cohort, nurses, midwives and healthcare assistants have
been identified as being most at risk. According to the United Nations, "across every sphere, from
health to the economy, security to social protection, the impacts of COVID-19 are exacerbated for
women and girls simply by virtue of their sex" (UN, 2020). In Ireland, 4 out of 5 healthcare workers are
women (NWCI, 2020). There is a disproportionately higher infection rate among women if they work
in the health services: "the number of female cases is disproportionally high (76.9%) among HCW
COVID cases compared to non-HCW cases (49.6%), most likely due to some HCW specialities e.g.
nursing being female dominated" (HPSC, 2021).
3.6 In the UK, research indicates that Black Asian and Minority Ethnic (BAME) workers may be at a
higher risk to COVID-19 (Public Health England, 2020; Cook et al. 2020). The HSE has recently issued
guidance to pregnant workers from the BAME community. Considering that 43% (1,731) of all
registrations to the Nursing and Midwifery Board of Ireland (NMBI) in 2019 were from outside the EU
– with the overwhelming majority of these likely to fall into the BAME category – there is a need for
specific health and safety advice and measures for this healthcare worker group.
3.7 The INMO consistently raises the issue of COVID-19 infection rates amongst health care workers,
including the very high rates identified for nurses and midwives. We previously raised this issue at
this committee, and the situation has not changed. Information from the International Council of
Nurses (ICN) again confirms that Ireland's healthcare worker infection rates, as a proportion of the
overall infection, remains the highest figure they have seen internationally. Recently, ICN CEO Howard
Catton wrote:
"ICN believes that, on average around 10% of all confirmed COVID-19 infections are among HCWs. In
Ireland, data shows that the HCW infection rate (total no. of HCW COVID-19 cases/ total no. of COVID-
19 cases) now stands at 12.4% meaning that whilst the HCW infection rate in Ireland has declined it
remains significantly higher than the average global HCW infection rate in the ICN dataset".
3.8 The number of COVID-19 cases amongst healthcare workers continues to rise. Over the last
number of weeks, the statistics show a gravely concerning situation and threatens healthcare service's
ability to provide essential care. As of the 2nd February, there were 24,730 detected cases of COVID-
19 in healthcare workers. However, the antibody studies conducted in several Irish hospitals clearly
show that this is a conservative figure, and the number of infections was higher. The number of nursing
and midwifery cases between week 48, 2020 and week 4, 2021, was 3,144 or 25% (n=12,348) of all
infected healthcare workers (HPSC, 2021). According to the HSE, there were 4,800 (approx.)
healthcare workers unavailable for work (week of 1st February) including:
2,800 – acute sector
2 The period between 11th March 2020 and 24th November 2020.
3 800 – community sector
3.9 In a briefing for the Cabinet Committee on COVID-19-19, HSE Chief Executive Paul Reid said rising
numbers of outbreaks in care facilities had caused significant staffing shortages across the health
service. Significant staff numbers are currently deployed to the residential care sector, presenting a
considerable challenge for the HSE. There are currently approximately 2,000 staff unavailable for work
in nursing homes (HSE Briefing, 4th February 2021).
3.10 The introduction of the Biological Hazard Directive into Irish health and safety legislation requires
the HSA to play a central role in inspections and reporting of infections among healthcare workers
who acquired COVID-19 at work. Healthcare settings, being places of work, are no exception and the
HSA must investigate these settings to determine causative factors and examine the risk assessment
undertaken, particularly the measures to reduce the risk for staff employed in these workplaces. This
is vital considering the high incidents of clusters/outbreaks outlined above, and to identify what
additional elimination or mitigation measures are required.
3.11 Despite the exceptionally high infection level among healthcare workers, the Health Service ranks
among the lowest in terms of COVID workplace inspections. We have asked the HSE for evidence of
inspections by the HSA, and they have not confirmed that any such inspections have happened in the
Public Health Service. A minimum of 24,730 health care workers detected as infected requires
Independent statutory examination.
3.12 The reaction to an ever-changing situation, which includes new, more infectious variants of the
virus, is exceptionally slow. The systems currently in place are too complex and involves many
different agencies including NPHET, HPSC and the HSE. The healthcare worker is all too often
secondary in the decision-making process. This teamed with long delays in policy updates and adopted
inevitably exposes frontline healthcare workers and patients to infection. The state and employer
must adopt the precautionary principle of maximum protection until the evidence and science catch
up with this new virus.
4.0 Health and safety protections - commentary
Vaccinations
4.1 The INMO was critical of the rollout of vaccinations for healthcare workers as it commenced. Many
frontline nurses working in COVID wards and ICUs still have not received the first dose yet non-
frontline staff received the vaccination.
4.2 There is clear data available showing where the virus is spreading – both geographically and in
terms of the healthcare workforce. However, it appears this data was not used for planning the
vaccination strategy and as a result, distribution did not strictly follow the virus's trajectory. Instead,
the rollout commenced in a haphazard manner, not focused on the locations or workplaces with the
highest infections or geographically bordering areas with high community infection. Put simply, the
vaccines' initial distribution seemed to be based on the HSE's administrative areas, rather than by
where the virus was most prevalent.
4.3 The IT system purchased by the HSE to support vaccination rollout, introduced on the 28th
December 2020, up to last week was not working correctly. The HSE has advised the INMO that it
expects it to be fully functioning this week. This has created difficulty for vaccination teams as they
swap between manual and electronic systems.
4.4 The INMO raised this issue of a lack of planning and sequencing of vaccination distribution with
HSE management and on the 12th January and again on the 19th January sequencing documents were
4issued to all managers in the HSE. The length of time it took to get the now-published HSE's Sequencing
of COVID-19 Vaccination of Frontline Healthcare Workers document shows insufficient focus on the
protections, required by law for nurses, midwives, and health care workers exposed to COVID-19.
4.5 There must be adequate governance, transparency and accountability around the vaccination
rollout for healthcare workers. This must include regular and consistent reporting of the vaccination
process as it progresses. There is a statutory obligation considering the HSE's requirement as an
employer to provide a safe place of work in the context of the biological agent that is COVID-19. The
agreed priority list, which prioritises frontline patient-facing healthcare workers must not be altered
or changed.
Personal Protective Equipment (PPE)
4.6 Along with the rollout out of the vaccine, it is critically important to ensure the most appropriate
PPE levels and other infection prevention and control (IPC) precautions are in place consistently across
the health service, including primary, community, voluntary and private settings.
4.7 This is an area that the INMO has advocated strongly for our members. At the start of the
pandemic, nurses and midwives were reprimanded by managers for wearing masks. The INMO was
forced to start a public campaign for basic facemasks to be introduced across healthcare workplaces.
Ultimately this campaign was successful, but our members reported frustration that it took a public
campaign to secure this policy change.
4.8 During the recent surge of the virus, we had to battle again for the right for nurses and midwives
to have access to FFP2 respiratory masks - the masks deemed most appropriate by many frontline
healthcare professionals. Once this was agreed, it took a further month for policy changes to provide
access to these masks for staff.
4.9 In the INMO's view, this is part of a regular lethargic decision-making pattern and slow
implementation in the HSE. The HSE was too slow in applying the precautionary principle, and unless
it is pressured into doing so, worker safety is delayed. International evidence from this, and previous,
epidemics and pandemics are clear – where employers fail to follow the precautionary principle and
instead insist on scientific certainty to guide workers' protection, the outcome has always been the
same – workers are at greater risk and are harmed.
4.10 A system-wide approach to the health service must be taken if the reduction in transmission
levels are to be achieved. The results of the Prevalence of Antibodies study (2021) show that it was
likely that healthcare workers were working during periods of infections. It goes on to state that this
situation has the "potential for onwards transmission to patients and other staff members if proper
use of PPE and adherence to IPC measures are not strictly adhered to".
4.11 Within the healthcare setting, early detection is central to preventing the transmission of hospital
acquired infection of COVID. Clinical care and clear, open communications are also essential to reduce
the levels of infection.
4.12 The virus's current surge has also led to a sharp increase in hospital acquired infection. According
to the HPSC, between week 32 and week 3, 4,168 (30%), healthcare workers have contracted the virus
within a healthcare setting. In week 3 (17-23/01/2021), there were 20 new acute hospital outbreaks
reported, and from the 22/11/2020 to week 3,139 outbreaks reported.
4.13 Currently, there is a high rate of open clusters in the long term residential care setting. As of the
4th February, there were 560 open outbreaks (428 in residential care, and 132 in acute). This is a major
challenge, particularly in terms of transfer of care from the acute hospital system. Like the acute
5setting, there has been a rapid increase in infection rates in the nursing home sector since December.
On 11th January, this number was only 20%, by the 27th January, it was 30%. There are also 203
outbreaks in disability, mental health and addiction services. 317 nursing homes are requiring
intensive supports form the HSE. The HSE should be reporting the number of patients with COVID-19
in all settings as currently they only provide figures for the acute sector. COVID patients' care in non
acute settings is a major challenge with many services under severe pressure.
4.14 Supplies of PPE must be maintained and available to all nurses, midwives and healthcare workers,
and the Government must seek to ensure these supplies do not reduce. Close attention must be given
to new variants and any further surges of the virus to ensure that guidance is adapted appropriately
to ensure the highest possible standard of protection. As guidance is updated, clear communication
must be provided to ensure access to the most appropriate PPE is not compromised. There cannot be
situations where nurses and midwives are put at risk due to a lack of PPE, outdated policy positions
relating to requirements. The precautionary principle must apply in this novel and developing
situation.
Infection Prevention and Control (IPC)
4.15 PPE is only one aspect of IPC. Along with the availability of PPE, the other IPC precautions must
be in place across the health services and implemented consistently.
4.16 There must be a robust, national testing and tracing system in place, one that can withstand any
future surges in all health care settings. The lack of routine testing in acute hospitals has been a major
failure on the part of the HSE and must be addressed. In the last two weeks, the HSE conducted serial
PCR testing in only 3 acute hospitals. It is impossible to determine how to mitigate the risk when not
testing the potential asymptomatic population. The Prevalence of Antibodies study (2021) recorded
16% of participants with positive antibodies who reported never having symptoms. The authors state
that 39% of infections were undiagnosed, and therefore, it is likely that these healthcare workers were
working during an infectious period. Again the INMO has repeatedly called for serial testing across the
acute and non – long stay community services.
4.17 There must be a review of the occupational health supports required. This must include removing
the "derogation policy", which allows managers to call staff back to work before the end of their self-
isolation period, even if they are a close contact. This policy is likely reimporting the virus into hospitals
and healthcare settings.
4.18 The INMO believes other measures need to be put in place, including increasing the distance
between beds from one to two metres. A safety review must occur in each hospital and healthcare
setting to reduce footfall and improve decontamination practices.
4.19 Safety Representatives and COVID Lead Worker Representatives of frontline workers must be
given specific time to carry out their representative duties including risk assessments, staff surveys
and access to decision-making managers who can address without delay the safety concerns of staff.
5.0 Long term effects on the nursing and midwifery professions.
Psychological Impact
5.1 Nurses and midwives' health and wellbeing are essential to the quality of care they can provide
for people and communities, affecting their compassion, professionalism, and effectiveness. Nurses
and midwives work in a pressurised setting every day. However, the pandemic has placed
extraordinary demands on staff.
65.2 The experience of nurses and midwives during the pandemic has been described by the ICN as
"mass traumatisation of nurses worldwide" (ICN, 2021). In their report, the ICN identify this emerging
phenomenon as complex and involves several key issues including persistently high workloads,
increased patient dependency and mortality, occupational burnout, inadequate personal protective
equipment and the fear of spreading the virus to families and relatives.
5.3 The INMO has undertaken several surveys of its members during the pandemic. All have shown
members under immense pressure, concerned for their mental health. A preliminary survey identified
that 81.29% of respondents felt that working in the health service had somewhat or substantially
negatively affected their mental health.
5.4 The INMO sought to investigate the impact on members further and surveyed the psychological
impact of COVID-19 on members in August 2020. There were 2,642 responses, and the key results
were as follows:
82% of respondents indicated that the experience of COVID-19 had a negative impact on their
mental health.
95% felt that COVID-19 had a negative psychological impact on their nursing/midwifery
colleagues.
91% described feeling mentally exhausted when off duty since the pandemic commenced and
more than 90% of nurses and midwives reported being mentally exhausted, a core component
of burnout.
90% believe that routine COVID-19 testing of staff should occur at their workplace.
61% stated that their working experience during the pandemic caused them to consider
leaving the profession.
Mental health and wellbeing
5.5 In addressing the mental health and wellbeing of staff, the recommendations of the recent King's
Fund document, The courage of compassion Supporting nurses and midwives to deliver high-quality
care (2020), should be used to future proof nursing and midwifery professions. The report focuses on
the importance of ensuring a better workplace for nurses and midwives instead of finding ways to
cope with poor working environments. It identifies three core workplace needs - belonging, autonomy
and contribution to ensure wellbeing, motivation and a less stressful workplace. It also identifies eight
recommendations designed to facilitate the core needs described. These are:
1. Authority, empowerment and influence.
2. Justice and fairness.
3. Work conditions and working schedules.
4. Teamworking.
5. Culture and leadership.
6. Workload.
7. Management and supervision.
8. Learning, education and development.
These recommendations should be kept at the core of the workplace to ensure high quality,
compassionate patient care, and equally to care for the nursing and midwifery workforce.
7Long Covid
5.6 Long Covid refers to symptoms lasting for protracted periods due to a COVID infection. Evidence
around the impact of long covid is only emerging. This area will require further research, and there is
much to be learned about this phenomenon. According to a study in the UK, approximately, 1 in 5
respondents testing positive for COVID-19 exhibit symptoms for a period of 5 weeks or longer and 1
in 10 respondents testing positive for COVID-19 exhibit symptoms for a period of 12 weeks or longer
(Office of National Statistics, 2020). The International Council of Nurses (ICN) in their recent report
(2021) warns that the potential long-term impact of COVID-19, including PTSD and long covid is
currently unknown but potentially extremely significant. A recent survey of INMO members also
identified that almost three-quarters of respondents who had contracted COVID-19 were experiencing
long-term physical effects.
5.7 Protection against COVID-19 must prioritise patients, nurses, midwives and other healthcare
workers. Irrespective of the variant of COVID, it is essential that nurses and midwives are provided
with the most appropriate care, support and assistance during their illness and recovery, however
long this takes. There is currently no established clinical pathway for the healthcare worker post
infection, which we have been waiting for since October 2020.
5.8 A recent study in the UK identified the complexities of dealing with a novel condition for healthcare
workers. The study found that this was compounded by "by pre-existing confirmatory biases and an
absence of guidelines or care pathways" The study also found that the "personal and professional
challenges of long covid were exacerbated by frustrations and callousness that participants
experienced in their encounters with the healthcare system" (Ladds, et al. p. 63). Occupational health
departments must be proactive in their approach, providing clear guidelines adhered to appropriate
care pathways for employees. The health and wellbeing of the employee must be kept at the centre
of care.
5.9 A national occupational health policy that strengthens worker protection, infection control advice,
and protocols provide necessary support and must be agreed upon. Occupational health and human
resource departments must work together to ensure maximum protections are provided to nurses
and midwives and other healthcare workers.
Student Nurses and Midwives
5.10 The pandemic has changed the clinical placement experience for student nurses and midwives.
Increased risks, costs, loss of alternative income sources, taking on necessary work responsibilities due
to staff absences, and now due to suspension of placements uncertainty about their academic term.
5.11 The agreement reached with the Department of Health in March 2020, did attempt to address
some of the workplace-related risks and issues and the need to provide a safe place of work with the
protections afforded to those work colleagues taking the same extraordinary risks. The INMO has
consistently pointed out that without a contract of employment, basic employment rights are not
available to unpaid students.
5.12 Unfortunately, there is a clear absence of due care for students' health and safety. Information
and consultation protocols require consultation and negotiation on these essential issues, and this has
been absent to date in our engagement with the Department of Health. While there are education
policy issues relating to the payment of wages, this is a pandemic and exceptions can and should be
made. This is an exceptional time, and concerns about long-term policy implications cannot take
precedent over basic health and safety considerations.
85.13 The oversight group have failed to provide any alternative to address the educational needs and
instead have advocated a disorderly, haphazard return to placement which will divide classes and
disadvantage those whose placements cannot be facilitated due to COVID collateral damage. Thus,
nursing and midwifery students alone will be penalised in their educational programme.
Nursing Home Sector
5.14 The Expert Review Group on Nursing Homes made several recommendations in its
comprehensive review of the situation last year. It is now essential that these are implemented
including:
a review into the privatisation of the nursing homes sector and in particular its impact on
nurse staffing levels - The substitution of registered nurses as a cost-saving measure within
the sector must cease. This practice is contrary to the evidence on nurse-led care and staffing,
previously outlined.
COVID-19 must also become a notifiable disease under the health and safety regulations
implemented by the HSA.
The development of robust testing and tracing capabilities which will allow for 24-hour
turnaround time and facilitate ongoing uninterrupted serial testing in congregated settings.
5.15 Recruitment and retention problems within the private nursing home sector are linked with pay,
conditions and welfare at work. Nurses and midwives working in private nursing homes must be
afforded the right to collective bargaining. The human right to join a union and bargain collectively for
fair pay and fair employment conditions is critical to a more equitable workplace.
Workforce Planning
5.16 A shortage of nurses and midwives was a feature of the Irish health system before the COVID-19
crisis. The health service pre-COVID experienced increased activity and high demands on the public
health service. Over the last number of years, the reality has been a busier and more acute service
with fewer staff to deliver it. The recruitment pause/freeze in place placed immense pressure on an
already struggling workforce. The continued lack of clarity and the lack of a funded workforce plan to
meet the health service's needs and its patients continued to contribute to problems already evident
due to the baseline shortage. This, combined with challenges associated with an ageing population,
increasing incidences of co-morbidities and an ageing workforce, was undermining patient care and
safety and creating intolerable working environments for nurses and midwives.
5.17 The Framework for Safe Nurse Staffing and Skill Mix must be rolled out across the health service.
Phase 2 must be completed in the emergency departments, followed by phase 3 in the community
and care of the older person settings. Simultaneously, the maternity strategy must be implemented
in full and work must be progressed in developing staffing ratios for children's health services.
5.18 The world faces a severe shortage of nurses and midwives. For two decades Ireland has relied
heavily on international recruitment, and those recruited have made an incredible contribution to the
Irish health service. However, the facility to recruit valuable nurses and midwives internationally is
likely to be weakened, given the current travel restrictions. Ireland will face strong competition
internationally to recruit. There can also be ethical issues with recruiting large numbers of staff from
countries experiencing their own nurse or midwife shortages. Given the current emergency involving
necessary travel restrictions, it is likely that nurses and midwives' migration will reduce somewhat.
Therefore, we have to increase retention and work harder at recruiting those not employed at present.
5.19 There must be clear and deliverable funded recruitment and retention strategies across the
acute, primary and community settings established and must:
9 Address the current staffing challenges and appropriately plan and fund in the medium and
long term.
Provide defined clinical and managerial career opportunities for nurses and midwives
Provide accessible ongoing continuing education and professional development
opportunities.
Ensure decision-making around recruitment is devolved to the Directors of Nursing and
Midwifery.
Reduce the bureaucracies experienced in the recruitment process.
Support all grades of nurses and midwives.
Provide flexible working options.
5.20 Along with staffing requirements, it is essential that capacity across healthcare settings can
respond to the population's health care needs. Again, there must be a long-term approach to planning
around capacity. This should necessarily include an increase in the number of undergraduate nursing
and midwifery spaces.
5.21 Several countries have instituted legal minimums for safe staffing levels. Ireland should consider
doing the same, using scientific safe staffing calculations, rather than a crude "X nurses per patient"
approach.
6.0 Recommendations
Rigid enforcement of the requirements in the Code of Practice for Biolocical Agents Category
3 in every health care facility and workplace.
An independent expert investigation as to why so many healthcare workers in the Irish health
care system have contracted the COVID-19 virus.
High prioritisation of vaccination rollout for healthcare workers with clear reporting on the
progress.
Immediate health and safety inspections into outbreaks and clusters in hospitals and
healthcare settings - worker protection is a legal requirement.
Recruitment must ensure staffing levels can protect staff by providing regular and frequent
breaks from wearing PPE and exposure to COVID-19 environments. This will require the
employment of additional staff.
Examine the role and function of occupational health in relation to staff protections and safety
during this pandemic to date.
Remove the policy which allows derogation for close contacts of COVID-19 positive healthcare
workers to attend work.
Additional staffing requirements must be based on scientifically determined staffing needs,
using principles contained within the Framework for Safe Nurse Staffing and Skill Mix in
General and Specialist Medical and Surgical Care Settings.
There must be a long-term commitment to a funded workforce plan for nursing and midwifery
employment, to allow for the safe opening of the required additional health capacity across
the health service. Legal limits of safe staffing levels based on the framework findings must be
introduced.
Improve the supply of nurses and midwives by increasing undergraduate places and
postgraduate places for specific disciplines in short supply.
10 Develop clear and deliverable funded recruitment and retention strategies to ensure nurses
and midwives can continue to improve patient outcomes, patient safety and high standards
of care.
Develop a robust and effective workforce strategy which will produce annual funded
workforce plans to ensure nurses and midwives can continue to improve patient outcomes,
patient safety and high standards of care.
Protect nurses and midwives in training from exploitation as unpaid workers during this
pandemic.
Compensate the most exposed group of workers for their contribution and bravery in
meeting the challenges posed by this virus head-on.
Acknowledge the role of frontline female workers for the outstanding contributions they have
made, by implementing real measures of support in the area of childcare provision and
assistance with the costs associated with same during this pandemic.
Provide state-funded and sourced mental health supports, planning ahead now for the
predicted needs for such supports that will arise among our frontline health care workforce.
117.0 References
Allen, N. et al. (2021) Prevalence of Antibodies to SARS-CoV-2 in Irish Healthcare Workers Phase 1
Interim Report Phase 1 October 2020. Available at: https://www.hpsc.ie/a-
z/respiratory/coronavirus/novelcoronavirus/research/precise/PRECISE%20Study%20Phase%201%20
Interim%20Report%20January%202021.pdf Accessed 5th February 2021
Cook, T et al. (2020) Exclusive: deaths of NHS staff from covid-19 analysed. Heath Service Journal.
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