Hundreds of appointments and procedures at hospitals across Northern Ireland were postponed or cancelled as nurses took part in strike action.
On the picket lines in Belfast nurses spoke of an effective pay cut over the last decade and their concern for the next generation of nurses.
The Royal College of Nursing (RCN) strike was the second in three years in the region, and the first involving nursing staff from England and Wales.
Nurses braved freezing conditions to gather at picket lines outside hospitals across Northern Ireland from 8am on Thursday to 8pm in the 12-hour action.
A second strike is planned for next Tuesday.
A number of areas, including emergency departments, are exempt from the RCN walkout.
I am absolutely clear that no member of nursing staff wants to be in this position but we have been left with no choice but to take action— Rita Devlin, RCN
Michael Rooney, a nurse of 27 years, works in the acute mental health inpatient centre at Belfast City Hospital.
His son, Michael, who recently graduated, is also a mental health nurse.
Mr Rooney Snr, who was on the picket line outside the hospital on Thursday, told the PA news agency he worries for the next generation of nurses.
“I’m relatively lucky. I’ve had a very good career over 27 years,” he said.
“But my son, Michael, who’s also a mental health nurse, he’s just qualified two years, but he was one of the students who the Government asked to come out of their training and to facilitate help on the ward during Covid.
“Now he’s a brand new staff nurse and he’s currently on £25,600, not the £32,000 that the Government says new nurses are on.
“He and a lot of his colleagues came out early of their training to work on the wards to protect the public from Covid and he’s now going to be on strike today for a fair pay award.”
Mr Rooney said nurses’ pay has been cut in real terms by 20% over the last decade while the salaries of some Government officials have increased by 20% over the same period.
“We are the people who everyone clapped for and yet the Government is forcing us on to the picket line today,” he said.
“The minister, Steve Barclay, won’t even meet and discuss pay with our RCN leader, Pat Cullen, and the Government has forced us on to the picket line today in the cold in the month of December.”
Thursday’s action comes after health workers from three of Northern Ireland’s largest trade unions: Unison, Nipsa and GMB, took part in a 24-hour strike on Monday in the fight for better pay and conditions.
The RCN said they took part in the industrial action “with heavy hearts”, but insisted they feel they have been “left with no choice”.
There were picket lines outside every hospital in Northern Ireland.
The Department of Health warned that the action would inevitably have an impact on an already fragile health service.
Health trusts across Northern Ireland announced the postponement of hundreds of appointments, including 587 outpatient appointments at the Western Trust where eight planned inpatient and day case procedures were also cancelled.
The Belfast Trust said 588 outpatients appointments were cancelled, as well as 54 inpatient day cases cancelled.
The Northern Trust said 155 appointments were postponed, and the South Eastern Trust said 774 outpatient appointments were postponed and 38 day-case, surgical procedures and endoscopy investigations were postponed.
The Southern Trust said 183 outpatient appointments were cancelled on Thursday, as well as a number of other services impacted.
The RCN said its members voted unanimously to take action earlier this year in response to an inadequate pay award that is well below inflation.
Rita Devlin, director of the RCN in Northern Ireland, said none of their members wants to be in this position.
“I am absolutely clear that no member of nursing staff wants to be in this position but we have been left with no choice but to take action,” she said.
“As we have seen this week, all areas of health care are under enormous pressure.
“Those working in the service are the same staff that have just carried us through a pandemic and are now being expected to deal with unsafe staffing levels, leaving them unable to provide the care for patients that they want to.
“We simply cannot continue like this for much longer.”
Ms Devlin said the pay situation was a “key factor” in workforce vacancies, saying there are almost 3,000 unfilled nursing posts in the HSC (health and social care) sector across Northern Ireland.
The Department of Health said it “fully understands the frustration and deep concern of staff”.
The department said intensive work is ongoing to mitigate the impact on patients where possible.
“There has been constructive partnership working between the RCN and the chief nursing officer and HSC trust directors of nursing on patient safety issues, including derogations from strike action to maintain critical services,” a spokesperson said.
“However, as the department has previously stated, already fragile services will inevitably be further impaired by industrial action.”
The department voiced “particular concern” at the cumulative impact of repeated strike days, at a time when it described the health service as “facing what many regard as the most challenging winter in its history”.
“The industrial dispute is a national dispute which is only resolvable at national level.
“Northern Ireland has a policy of pay parity with England for nurses and other HSC workers covered by the Agenda for Change framework,” the spokesperson said.
“The Department of Health remains extremely concerned at the scale of the current pressures on health and social care services – and the impact this is having on patients, service users, carers and staff.
“The challenges being faced here are mirrored in neighbouring jurisdictions.
“It is the reality that there are no quick or simple solutions.”
