The head of the Irish Nurses' Organisation has warned that planned admissions to hospitals will have to be deferred on a regular basis if the accident and emergency crisis is to be resolved. Liam Doran said that hard choices would have to be made by hospital managers about the admission and discharge of patients. It is the second day of nurses' industrial action in hospitals around the country.

Planned admissions in all the major hospitals in Dublin were affected today. In Galway, elective admissions were cancelled in University Hospital Galway to free up beds for emergency admissions. SIPTU and the INO go to the Labour Relations Commission tomorrow.

Mr Doran said that the nurses in A&E; wanted managers to assertively manage their admission and discharge policies to ensure beds were consistently freed up to reduce overcrowding.

He warned that hard choices will have to be made by hospital managements to resolve this crisis. He said it was more preferable that elective admissions were put back by hospitals than patients remain on trolleys.

But management sources were adamant that admission and discharge policies were already in operation in most of the country's hospitals, with senior managers available to ensure patients were discharged, including out of hours and weekends.

Vascular surgeon Dr Kevin O'Malley, who said that he sympathised with the frustration of nurses working in difficult conditions, warned that if this work to rule continued the already serious difficulties that urgent surgical cases face in getting beds would be exacerbated.

He warned that patients needing cancer surgery, vascular and major reconstructive surgery as a matter of urgency were now facing further delays. He said that if their admission was pushed back it would affect their long-term outlook.

Nurses are on an indefinite work to rule, refusing to do clerical. administrative, or portering duties, as well as extended nursing duties. Earlier today, the main Dublin hospitals called on the nursing unions to postpone their action.