At least 50,000 patients have had medical appointments cancelled across the Republic of Ireland on Tuesday due to the nurses’ strike.
Strike action resumes at 8am with the number of patients affected up from 25,000 on the first strike day last Wednesday.
Action is being taken in a dispute over pay and staff shortages.
The number of health units affected has risen as fewer exemptions are being granted.
Nursing union the Irish Nurses and Midwives’ Organisation (INMO) is now including respite centres for the elderly and people with disabilities.
The 24-hour stoppage by 37,000 members of the INMO will see pickets at 240 locations – up from the 82 facilities affected during the first strike.
All outpatient, inpatient and day surgery appointments on Tuesday are cancelled and injury units will also be closed.
Emergency departments will be open but with reduced nursing staff cover – so the Health Service Executive has asked that people only attend them if absolutely essential.
Thousands more patients will be affected if the next six days of planned industrial action proceed.
The Psychiatric Nurses Association (PNA) will also be staging an overtime ban in mental health facilities over the next three days.
On Monday, the Government offered to go back to talks on workplace issues relevant to nurses – but categorically ruled out any discussions on pay.
However, both the INMO and the PNA dismissed the overture as cynical, saying that talks without pay would not resolve the recruitment and retention crisis.