Nursing unions will meet the Health Service Executive and the Department of Health tomorrow in a bid to avert a series of strikes over pay and staff shortages.
Sources voiced pessimism as to whether tomorrow's meeting can deliver any substantial progress, but as yet it is unclear when the HSE will start to cancel outpatient and hospital appointments ahead of the stoppages.
Even though the unions have pledged to maintain emergency cover during the strikes, cancellations will not only cause inconvenience to patients, but will also lead to longer waiting lists.
Meanwhile, the 6,000 members of the Psychiatric Nurses Association (PNA) will refuse to do overtime on 31 January and the 1, 5, 6 and 7 February - escalating to strike action in tandem with the INMO on 12, 13 and 14 February.
Sources noted that the Department of Public Expenditure and Reform, which oversees public sector pay and whose authorisation would be required to allocate a pay rise, will not be present at tomorrow's management/union meeting.
The nursing unions insist that inadequate pay is causing a recruitment and retention crisis and are seeking a general pay rise of around 12% to bring them into line with therapy grades like physiotherapists.
They claim that a special award could be made to nurses without triggering knock-on claims elsewhere in the public service, though that view is disputed by the Government.
It is understood that the department is anxious to avoid anything that could undermine the current Public Service Stability Agreement on public sector pay and industrial relations.
The department believes that the €300m estimated cost of the nurses' claim would trigger knock-on claims across the public service, as happened when a €50m award to gardaí in 2016 led to an additional €120m in payments to other public servants.
Department sources stress that the current Public Service Stability Agreement rules out cost increasing claims and industrial action, and that breaches of the agreement (for example, by going on strike) will result in penalties.
They also highlight that pay restoration under the current pay agreement, a shorter incremental scale, a €20m package of allowances targeted allowances recommended by the Public Service Pay Commission, combined with pay equality measures for new entrants would give many nurses substantial increases.
Other public service unions including Fórsa have already warned that if any group is awarded a special pay rise, they will seek increases for their members.
SIPTU, which represents 4,000 nurses, is not taking industrial action, and has pledged to pursue higher pay for members through procedures consistent with the Public Service Stability Agreement and the Public Service Pay Commission.
The Public Service Pay Commission was precluded by its terms of reference from considering a general pay rise for nurses, but raised the possibility of a review through a separate process.
It remains to be seen if nurses, who backed strike action by 95%, would be prepared to settle for another process - rather than immediate cash on the table.
The Government is keen to keep the brakes on public expenditure, when it is facing challenges from Brexit and the housing crisis.
But it may ultimately be forced to make a political decision, on whether it can afford to let a nurses' strike proceed, ahead of local and European elections in May.