The General Secretary of the Irish Nurses and Midwives Organisation has said that next week's national strike will not be deferred unless "real and substantive measures" are delivered by management. 

Talks aimed at averting the strike took place at the Workplace Relations Commission today, and will resume at 1.30pm tomorrow.

Speaking when arriving for the talks, Phil Ní Sheaghdha said any measures must ensure that the crisis in nursing since 2007 is completely and utterly dealt with.

She said that without them, the country would face a widespread strike by nurses and midwives.

Following today's talks, Ms Ní Sheaghdha said there was a full and frank exchange of views on both sides and the WRC had asked the parties to reflect overnight.

The dispute centres on pay and staffing shortages, which Ms Ní Sheaghdha said can be resolved, if the Government engages with the unions.

The INMO and the Psychiatric Nurses Association will progressively withdraw their labour over the coming weeks, with significant disruption for patients.

Ms Ní Sheaghdha acknowledged the strike would certainly be widespread cancellations of elective procedures, but said that requests for exemptions for services, including cancer services, had been "positively responded to". 

She said the HSE had indicated that of the 2,000 workers they intend to employ next year, only 300 will be in nursing and midwifery grades at a time when there are more than 2,000 nursing vacancies. 

Ms Ní Sheaghdha said this demonstrated the lack of urgency that health management was attaching to addressing the fundamental difficulties that were triggering longer waiting lists, longer waits in emergency departments, and longer waits to implement a strategy on increasing capacity.

HSE National Director of Human Resources Rosarii Mannion stressed that in approaching the nurses' dispute, the management side was confined to the terms of the Public Service Stability Agreement.

Ms Mannion said that if they could reach agreement within the confines of the agreement, she was hopeful that progress could be made, and that there would be less impact on the public and service users.

Asked whether the HSE accepted the nurses' claim that their pay demands to address recruitment and retention problems could be addressed within the PSSA without triggering knock on claims, Ms Mannion said that remained to be seen.

On the subject of potential disruption for patients, she said the HSE would be doing everything in its power to find a resolution and ensure the strike does not proceed.

Meanwhile, PNA General Secretary Peter Hughes said he was hoping health management would come with realistic proposals to address the recruitment and retention crisis in nursing.

He noted that over the last year, vacancies in mental health services had increased by 40%, which was having a detrimental effect on patient care.

Asked about yesterday's ambulance strike by his paramedic members, Mr Hughes said the PNA position is that it is not in breach of the Public Service Stability Agreement because the issues in contention in the dispute have absolutely nothing to do with the agreement.

As to whether future ambulance strikes could happen in tandem with stoppages by nurses, Mr Hughes said they would be meeting their ambulance personnel branch NASRA in the coming days to review yesterday's strike.

Unions argue that only a 12% across the board pay rise will be sufficient to incentivise nurses to join and stay in the profession. 

They say there is a mechanism in the current pay agreement that would permit this without triggering knock-on claims.

However, the Government says the claim would cost an unaffordable €300 million and would breach the current public service pay agreement. 

Even ahead of a nurses' deal, other unions including Fórsa have warned that if the nurses get any special award, their members will seek similar gains.

Local health service management is expected to start cancelling appointments for thousands of patients around the country.

Meanwhile, a leading consultant in emergency medicine has pleaded with both sides in the dispute to make Emergency Departments exempt from strike action.

Dr Fergal Hickey said Emergency Department nurses cannot be replaced by doctors or paramedics who "don't have the training or expertise to do what our expert nurses do".

Speaking on RTÉ's Drivetime, he said that Emergency Departments need to be exempted due to the nature of their work.

Dr Hickey said that while elective and out-patient procedures can be deferred from strike days, emergencies cannot be deferred.