Updated Sunday 11.10am with MUMN statement

Nurses’ union directives were “carefully designed” to bring Mater Dei to a halt in the midst of a pandemic, the hospital’s clinical chairman of the emergency department has warned.

Stopping or severely hindering admissions or discharges of patients to and from hospital would have a negative effect on emergency operations, Michael Spiteri said on Saturday.

The directives, which were interrupted by a temporary court order on Wednesday, were ordered over a failure in discussions between the Malta Union of Midwives and Nurses (MUMN) and the government over financial packages.

The case is expected to be decided in court in the coming days.

Spiteri told Times of Malta that standard safety practices dictate that a verbal handover is given between professionals during patient treatment.

“This goes hand in hand with the written documentation. Therefore, wards receiving patients may not have been aware of patients’ issues, what treatment they had, what investigations were pending, and any other relevant information in a timely manner.”

Among the measures, nurses were directed not to transfer patients between areas and to not report any faults that may occur within a ward.

Coordination and communication between the hospital bed management unit and wards was prohibited.

Consequently, patients were left at the emergency department for extended periods of time with wards even sending patients back to the emergency department.

Coordination between hospital bed management unit and the wards prohibited

Times of Malta is informed that one of the most problematic directives was the instruction to nurses not to give a handover between wards. This meant wards receiving patients were not made aware of the issues of patients they were receiving, what treatment they had, what investigations were pending, and any other relevant information crucial to ensuring proper care.

Sources said patients, including COVID-19 patients and those with serious illnesses including cancer, were directly impacted by the measures, which the union said lasted for four days before the temporary court order was imposed.

Patients left in emergency room

Times of Malta is also informed there were patients who were left in the emergency room for extended periods of time due to wards refusing admissions. Sources said that at one point, this also included a newly diagnosed leukaemia patient who needed urgent admission for chemotherapy.

Other patients were not inputted into the hospital’s system, resulting in medics on call being unaware where newly admitted patients were. These doctors were forced to search for patients ward by ward and “hope to find them”.

The hospital’s management would not confirm the claims involving individual patients.

Spiteri said the smooth running of the hospital operations rely to a large extent on the internal transfer of patients. This is done to optimise patient care and to clear acute admission beds for further admissions.

“The fact that this process was halted meant that a backlog of several hours was created at the emergency department admissions stream. This obviously had a negative effect on patient care.”

Moreover, the directives resulted in overcrowding at the emergency department and thus the implementation of hospital infection control practices became more difficult with potential risk to vulnerable patients.

But union chief Paul Pace refuted claims that patients suffered as a result of the harsh directives. He said delays in the emergency room occur even when there are no directives in place and were not as a result of the union’s action.

On claims that COVID-19 patients had been mixing with other patients who were not infected, Pace said the nurses were only ordered to not carry out additional duties, which they should not have been doing in the first place. The nurses never turned away anyone from wards, he said. 

“The directive was to not coordinate transfers. That is because there are others who should be doing this and not the nurses. The problem is that nurses handle so many additional duties that when they stop doing the extra work, the impact is felt by everyone,” Pace said.

Describing the action as a “success”, Pace said he will await the sitting on Wednesday before divulging what the union might do if the courts uphold the government’s request to stop further industrial action.

“There are so many issues nurses are dealing with. It is no longer just about shortages. Nurses are now overworked, tired and there’s yet to be an end in sight. The least we expect is to be given the opportunity to share these concerns with the Prime Minister,” Pace said.

He said that at no point were patients left uncared for and the nurses simply stopped doing work which should be done by other professionals.

'Bizarre' comments

Reacting, the nurses’ union described Spiteri’s comments as “bizarre”. 

Directives would not affect the emergency department, the MUMN said, as it was aware of the department’s sensitivity. 

The union also insisted that written hand-overs given between doctors and nurses superseded verbal ones, which nurses have been instructed not to provide as part of union directives. 

It accused the government of trying to influence the courts by getting Spiteri to “comment on false pretences”. 

“MUMN expects a fair play attitude by all and not trying to blame all the wrongdoing at MDH on MUMN,” the union said.