Senior nurse and midwifery managers (Directors of Nursing/Midwifery and Assistant Directors of Nursing/Midwifery) and their linked grades (Advanced Nurse/Midwife Practitioners and Nurse/Midwife Tutors) will begin industrial action in the form of a work-to-rule over the non-implementation of proposals to modernise pay and grading structures on September 29th.
The dispute involves approximately 3,500 nursing and midwifery managers and their linked grades, represented by the Irish Nurses and Midwives Organisation (INMO), Psychiatric Nurses Association (PNA) and SIPTU. The grades involved work across a wide range of healthcare settings, including psychiatry, community services, public health nursing, maternity services, paediatric services, general hospital services, long-term care and palliative care.
The issue of the outdated system used to determine the pay of senior nursing and midwifery managers has been outstanding for many years. This issue was first identified in the Public Service Commission in 2018.
Following the nursing and midwifery dispute in 2019, the Labour Court recommended the establishment of an Expert Review Body on Nursing and Midwifery. The review was tasked with examining a range of issues affecting the professions, including long-standing claims relating to nursing and midwifery managers.
The Expert Review Body subsequently recommended that the existing hospital banding system be discontinued and replaced with a new approach to determining the grading of Directors and Assistant Directors of Nursing and Midwifery, taking account of their revised roles, scope and responsibilities in the context of Sláintecare and the reform of the health service. The Department of Health have failed to implement these recommendations.
INMO Deputy General Secretary, Edward Mathews said:
Nursing and midwifery managers have waited years for this issue to be resolved. They participated in an extensive expert review process and engaged in the implementation process in good faith.
A new structure was determined in February 2025 to replace a banding system which is based on activity levels from 1999. Yet, more than 18 months later, that structure has still not been implemented in full.
The health service of 2026 bears little similarity to the health service of 1999. Services have expanded, responsibilities have increased and the complexity of healthcare delivery has changed enormously.
These are senior professionals carrying enormous responsibility for the delivery of safe patient care and for the management of increasingly complex services. They have statutory and professional responsibilities in relation to standards and quality, including responsibilities connected to HIQA and the Nursing and Midwifery Board of Ireland, as well as significant responsibilities to their employer for service delivery.
At the same time, we have a situation where nursing and midwifery managers are responsible for staffing and for the risks associated with staffing levels, but increasingly do not have the authority to recruit the staff required to mitigate those risks.
Psychiatric Nurses’ Association Deputy General Secretary, Michael Hayes said:
Our members working in mental health services are managing increasingly complex services and supporting patients with increasingly complex needs, often in the context of significant pressure on staffing and resources. Yet the pay and grading structure for the managers responsible for these services remains rooted in a model dating back to 1999. It does not reflect the scale, complexity or level of responsibility involved in managing modern mental health services.
SIPTU Health Sector Organiser Damien Ginley added:
The recommendations arising from the expert review process must be implemented in full. Our members have engaged constructively throughout this process, but continued delays and attempts to introduce additional conditions are unacceptable. These managers carry significant responsibility for the delivery of health services and their pay structure must reflect the jobs they actually do.