INMO Director of Industrial Relations, Tony Fitzpatrick, said it is the largest strike in the history of the health service “No nurse or midwife wants to go on strike, but we have been forced into this position by a government that just isn’t listening.”

Pickets were mounted at hospitals across the country on 30 January 2019 from 8am to 4pm including Connolly Hospital in the Taoiseach’s constituency in Blanchardstown.

It came as Mr Varadkar brushed aside opposition calls to make an 11th hour direct intervention to stop the strike.

The strike by 40,000 nurses was set to go ahead as a last ditch attempt by the Labour Court to avert the 24-hour stoppage has failed.

The Labour Court concluded that "an intervention at this time holds no prospect of impacting the dispute planned for tomorrow".

It had been trying to determine if there is a basis to formally intervene in the dispute.

The court had met with the Irish Nurses and Midwives Organisation, the Irish Congress of Trade Unions health service management.

“The court has a full understanding of the dispute and parties’ positions at this time,” it said in a statement.

“The court has reflected on the situation and has concluded that an intervention at this time holds no prospect of impacting the dispute planned for tomorrow.

“The court has therefore decided not to formally intervene in the dispute.”

It said it will remain focused on the matter in the coming days as it continues to assess what assistance it might provide “at the appropriate time”.

A spokesperson for the Irish Nurses and Midwives Organisation said it was “disappointed” and strike preparations will continue.

This will only be the second time in the union’s 100 year history that its members will go on a national strike.

In a statement, the INMO said the Government did not table any realistic proposals that could have ended the dispute.

INMO Director of Industrial Relations, Tony Fitzpatrick, said the largest strike in the history of the health service is looming and the Government has “nothing to say”.

“We are deeply disappointed that the Government still have no serious proposals to resolve this dispute,” he said.

“No nurse or midwife wants to go on strike, but we have been forced into this position by a government that just isn’t listening.”

He said the union is “always open for talks” and to receive realistic proposals to end the dispute.

“We are immensely grateful for the outpouring of public support for Ireland’s nurses and midwives, and for the solidarity events by Irish nurses working overseas,” he said.

Fears

There are fears for patient safety in high-risk areas such as A&E departments amid the strike action.

Hospitals have cancelled planned surgeries as they prepare to scale down to just an emergency service.

But A&E consultants expressed serious concerns about the impact on patient safety if the strike goes ahead.

Dr Emily O'Conor, in a letter to the HSE, warned that the level of A&E cover by nurses, which was set out in contingency strike plans, was inadequate.

She warned that the A&E doctors were making an "earnest plea" and that "genuine harm could occur".

Patients coming through A&E could have life or limb-threatening conditions, she cautioned.

The nurses, as part of their plan, refused to include their regular triage of patients which would prioritise those in most urgent need of medical attention.

This task could be carried out by a doctor, but understaffed A&E departments will struggle to free up medics for this duty. It could heighten the risk of some patients slipping through the cracks and not getting attention on time.

The deterioration in the weather and plummeting temperatures also increase the risk to vulnerable patients, particularly those with respiratory illnesses.

The nurses said if there was a serious emergency, they would leave the picket line and return to the hospital.

Pay

Nurses are demanding a 12pc pay rise to put their wages on a par with other healthcare professionals.

Sources said they may explore the option of setting up a body to examine their pay - although this may not report until after the current wage deal ends.

During angry Dáil exchanges today Mr Varadkar heard several key opposition TDs strongly advocate meeting the nurses’ 12pc pay claim.

People Before Profit TD, Brid Smith, pointed to the huge gap between the Taoiseach’s own pay and that of an individual nurse.

“You’re worth six nurses – or are you?” Ms Smith asked.  She accused the Taoiseach of using the Brexit crisis “as a stick to beat the nurses.”

Mr Varadkar issued an appeal to the nursing unions to delay their first of several 24-hour strikes.  And he urged their leadership to use the country's industrial relations mechanisms to resolve their dispute.

“I have to be the Taoiseach for the whole country,” Mr Varadkar stressed.

The Taoiseach pointed to warnings from the Finance Department and Irish Central Bank that a no-deal Brexit would cost Irish jobs. “This isn’t made up  - and it’s not about blaming anyone,” he insisted.

Fianna Fáil leader, Micheál Martin, said the nurses were in a very difficult situation suffering low morale, poor pay and bad working conditions.

Mr Martin, a former Health Minister from 2000 until 2004, said up to €1.4m per week was being spent on agency nursing services to plug staffing gaps.

Mr Martin said “whole cohorts” of young nursing graduates were emigrating to places like UK, Canada, Australia and elsewhere.  At the same time large sums of money was being spent on recruiting nurses overseas for the Irish health services.

The Dáil also heard a strong statement of support for nurses from Sinn Féin leader, Mary Lou McDonald.

Finance Minister Paschal Donohoe said the nursing unions are seeking a significant increase in pay over and above all of the benefits of the current wage agreement, which they signed up to.

He said he had no doubt that conceding the nurses’ pay claim would generate leapfrogging claims from the rest of the public service workforce.

He said these could come from sections of the workforce where there were “already other well aired pay grievances”.

“The nursing unions are seeking a significant increase in pay over and above all of the benefits of the current Agreement seeking parity with other health professionals,” he warned.

“Concession of this pay claim, even if possible, would have serious consequences for the public finances and for public pay policy generally with estimated costs of €300m annually based on a 12pc claim in pay.

“However, it would not end there. It would, I have no doubt, generate knock-on or ‘leapfrogging’ claims from the rest of the public service workforce, where there already other well aired pay grievances”.

Mr Donohoe said the Labour Court is an independent and expert body and he respected its judgement.

“Their decision undoubtedly reflects the fundamental issues at dispute between the parties on the claim by nurses who wish to generate additional pay increases over and above those provided under the terms of the Public Service Stability Agreement to which they have subscribed,” he added.

Earlier the General Secretary of the Irish Congress of Trade Unions, Patricia King, said the dispute was very complex and clearly concerning.

"The trade union movement is trying its best to find a solution to what is a very difficult set of circumstances," she said.

"We’re obviously very concerned about the outturn of this for users of the health service, for the nurses who are working in the health service and indeed for all the other grades who will be affected by the dispute."