Marathon talks at the Labour Court have failed to reach an agreement which would avoid tomorrow's nurses strike.
The INMO, the HSE and government officials spent eight hours at the negotiations, which ended shortly before 1am this morning.
The Labour Court heard lengthy presentations from both sides and is to make contact with them again today.
Tomorrow's strike is set to go ahead, with 37,000 nurses staging 24-hour industrial action, in a row over pay and conditions.
Speaking on her way out of the talks, General Secretary of the INMO, Phil Ní Sheaghdha, says the Labour Court will reflect on the dispute.
"The Labour Court are in no doubt as to what it will take. They spent a lot of time exploring that with us and we appreciate that time," said Ms Ní Sheaghdha.
"They have said that they have some reflection to do themselves. This is a big dispute and it's due to start in 24 hours.
"So as far as we're concerned that's where it sits right now. We'll see what tomorrow brings."
Even if the strike is averted at this late stage, a significant number of patient services face disruption on Wednesday. The HSE has already cancelled all outpatient appointments, including adult, maternity (non-urgent) and paediatric, and local injury units will remain closed.
Inpatient surgery, with the exception of urgent cancer surgery, is also cancelled, as are day-case procedures. Chemotherapy and radiotherapy appointments will take place as normal, as will dialysis, palliative care and colposcopy services.
In the community, the HSE has advised that all public day centres for older people or people with disabilities, where nurses are employed, will close and all routine community nursing services where nurses participate will be cancelled.
The country’s 29 EDs will remain open but emergency medicine consultants have warned of the risk of “genuine harm” to patients if nurse staffing levels are too low. The Irish Association of Emergency Medicine (IAEM) has written to the INMO and to the HSE warning that Christmas day levels of staffing are required “as an absolute minimum”, should the strike go ahead.
The INMO is set to hold a series of strikes over the next number of weeks in a dispute over pay, which they say is linked to the recruitment and retention crisis. If unresolved, there will be further 24-hour strikes on February 5, 7, 12, 13 and 14.
The Psychiatric Nurses Association (PNA) which represents 6,000 psychiatric nurses, is also planning extended industrial action, beginning with an overtime ban on Thursday. The ban will continue into Friday, and will also operate on February 5,6, and 7 before all out-strike on February 12, 13 and 14. The PNA dispute is also linked to recruitment and retention.
Separately, the PNA’s ambulance personnel branch, the National Ambulance Service Representative Association, has decided on a further two consecutive days of strike action in the coming weeks, dates yet to be confirmed, in a row with the HSE over union recognition.
Last week 500 PNA ambulance personnel members held a one-day national strike - a significant escalation of their dispute which began with an overtime ban last November.
