'Nurses sick of being exploited and are taking a stand... anyone who thinks there's not a crisis in the health service is fooling themselves'
NI's top nurse representative tells Lisa Smyth of her love for the job, but also the pressures that forced a ballot for industrial action
Pat Cullen (55) took up the post of Director of the Royal College of Nursing in Northern Ireland in May. She lives in south Belfast with her husband Enda. The couple have two children, Shane (28) and Teresa (23).
Q. You're married to Enda and have two children. Can you tell me a bit more about your family?
A. I've been married to Enda for 30 years. He's 59 and a GP on Botanic Avenue in south Belfast.
Everyone says he thinks and behaves like a nurse, but then he's had no choice living with me all these years.
I tried very hard to get my children to become nurses, but Shane followed his dad and is doing his surgical training in Dublin.
Teresa is an interesting character, I would describe her as a free spirit.
She spent two years at Liverpool University doing primary teaching but then left to become a full-time sponsored kite surfer.
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She also bought a van and fitted it out herself and I went travelling with her in it to Sicily recently - it was the most wonderful fun.
Q. Did you have a happy childhood?
A. I grew up in Carrickmore in Co Tyrone. I'm the youngest of six girls and one boy, so it's fair to say my mum had her hands full.
Coming from a family of girls and being the youngest, I had at least four mothers and I definitely felt very well looked after, and I was actually very happy to play the young child - it had many benefits for me.
My oldest sibling is 73 and I'm 55, so there was a bit of gap between us, but we were and still are a very close family.
In fact, there's only a year-and-a-half between myself and my next sister Petra, who is also a nurse.
Because we lived out in the country we were best friends, and still are to this day.
I would say that growing up she wasn't just my sister and best friend, she looked after me very well.
Q. It sounds like you have a very close bond with Petra. Tell me a bit more about your relationship.
A. I went to St Teresa's Primary School in Loughmacrory, which is a very small village about a mile-and-a-half outside Carrickmore.
They were the most wonderful, happy days of my life, which were all the better because Petra was close in age to me.
She always looked after me, I was a bit of a tomboy, I would have done things like deliberately forget my school bag and she would make sure I had absolutely everything I needed for school and make sure I got on the bus.
I only got an A in my 11-plus because Petra would sit down with me every night and do practice papers with me.
She was in the year above me and she did all her papers in pencil so she could rub out the answers and do them with me. She was so desperate for me to follow her to Loreto Convent in Omagh, and we were so close that when I was there the nuns used to go to her and get her to talk to me when I misbehaved.
If I'm being truthful with you, I enjoyed my time there, but I'm sure my family would tell you they struggled to get me to concentrate on school work.
I would always have found a reason not to do it, like going out to play with Petra and my friends.
I did find the regime in the convent difficult, there was a streak in me that wanted to challenge the system and I remember one particular time when I was a little bit rebellious about the school dinners.
I started a bit of a petition in the school, and of course the mother superior wasn't at all happy about it, so she immediately went to Petra who came to talk to me.
I always knew I was in trouble if I saw Petra waiting for me outside the classroom.
She would take me for a walk and tell me I didn't want the school to write to our mum and I wanted to please her and my mum, so she was always able to influence me.
She has always been such an important part of my life, and, in fact, she was ill with cancer recently which has been very, very difficult because she means so much to me.
Q. That must have been very tough given how close you both are. Do you think it was made even harder because of your medical training?
A. Without a doubt. I would have described myself as someone who has very resilient, good coping skills, but for the first time in my life I felt totally out of control in terms of not being able to help Petra.
I really struggled from the time of her diagnosis to now and that's because I could see that the health service was under so much pressure.
I was so desperate to make sure she got the best care and attention that she required, and she did get that at Craigavon, I absolutely couldn't sing the praises of all the staff at the hospital enough.
Thankfully she is in remission now. It's still early stages, but she is doing very well.
Q. So, how did you get into nursing?
A. Well, like I said, I was one of six girls and four of us ended up becoming nurses, so I was surrounded by nurses from a very early age.
One of my earliest memories was that I always wanted to be a nurse, probably because I looked up to my older sisters.
I remember Petra and me looking forward to our older sisters coming home and telling us their stories of looking after people.
I was also fascinated by their uniforms because in those days they wore such beautiful uniforms, and I distinctly remember them getting their white shoes ready.
I remember my eldest sister actually trying to convince our brother to become a nurse, but he wasn't having any of it.
When I talk to him about it now, he would say a big factor was that it wasn't something that men did - don't forget we're going back to the Sixties and Seventies. Of course things have changed since then, and changed for the better.
There's still work to do to encourage more men into nursing but there's definitely been significant progress made.
When it came to school, I didn't actually pass my GCSEs to be able to stay on and do my A-levels, so I went to Dean Maguirc College in Carrickmore and without doubt they were really happy years.
It was the first time I actually enjoyed school and studying, and from there I went on to become a trainee nurse
I left home when I was 17-and-a-half and went to live with one of my sisters who was a ward sister in Antrim.
It was a very exciting time but also a very sad time as I was leaving my mum and Petra.
Then my mum died very suddenly when I was 18 which had a huge impact on me and still does to this day.
Q. Tell me a bit about your career.
A. I was always adamant that I was going to be a mental health nurse because I have a sister with learning disabilities and that really influenced my decision after watching my mum looking after her.
I can honestly say that I loved every day of working in mental health, I can't imagine any other career that would have fulfilled me professionally or personally as much. I started out working in hospital before moving into the community, which was just mind-blowing and a privilege to look after people in their own homes.
I was a community psychiatric nurse in Twinbrook and Poleglass during the Troubles and the impact of the violence on mental health was shocking.
I look back now and wonder how I coped, although there was a real sense of team and we all looked out for each other.
I remember our nurse manager getting us special jackets to carry our equipment and medication in because there were so many hijackings in those days that you couldn't carry your stuff around in bags.
I never felt under threat, however, because there was a real sense of belonging to the community.
Q. The Royal College of Nursing has recently decided to ballot its members for the first time on possible strike action over pay and conditions. What led to this decision?
A. Our members aren't coming to us complaining because they aren't being paid fairly, even though they aren't, they're telling us they need something done because they can't care for their patients.
I took a call from a young nurse last week and her opening words were: 'I don't know how I kept any of my patients alive last night'.
She was driving home from a night shift, she had worked two hours past her finishing time, and I had to tell her to pull over because she was so upset.
She qualified two years ago and she told me she'd been looking after 10 elderly patients, the youngest was 82.
She had one nursing assistant to help her, who was also helping another nurse who was looking after another 10 elderly patients in the opposite bay - it was utterly heartbreaking.
Q. Are you surprised nurses are considering industrial action?
A. No, because nurses are being exploited and actually the RCN has come in for criticism from some who have said we should have taken a stand before now.
They're the first to be hit with the stroke of a pen and taken out of the system and they can't understand why they aren't being treated like the assets they are.
Employers are also denying nurses their contractual rights to overtime, so they're at a financial disadvantage, so nurses are being forced to join agencies and banks because they're not getting what they're entitled to.
Nurses have now made it very clear they are not willing to continue on without the resources they need to look after patients.
Q. What would you say to people who claim the health service in Northern Ireland isn't in crisis?
A. There are 2,600 unfilled nursing posts in Northern Ireland - that's 2,600 nurses not available every day to provide care in our hospitals, in the community, in residential facilities.
Nurses say to me that as soon as they get home their manager is on the phone asking them to come back in to fill vacant shifts.
They never get a break, but the managers have to do it just to keep the service going.
Look at the waiting times for appointments - Department of Health statistics are telling us how bad it is, how can anyone argue with the figures?
The RCN is very clear the health service in Northern Ireland is in crisis and if anyone claims there isn't a crisis in the health service, I'm not sure what their definition of a crisis is.
Q. Do you think the permanent secretary would be persuaded to act if he met nurses and listened to them describe their working conditions?
A. My answer to that is that the permanent secretary is welcome to come to the RCN and hear from our members any day of the week.
We get harrowing calls from our members every day and I do think personal accounts have an impact.
I know that the call I took from the young nurse last week was very difficult - I haven't been able to get her out of my head.
It really didn't rest easy with me and I've been asking myself what more we can do to try and support nurses who are out on the ground.
That's why we're balloting our members - we aren't just listening to what they're telling us, we're trying to do something about it.
Q. Finally, is it likely that nurses' concerns will be adequately resolved in time to stop industrial action?
A. I'd like to be optimistic about this, but I have to say I'm not hopeful.
I never believed the time would come where nurses would be pushed into this position, but our members have given us a clear message that the Department of Health has run out of road.