The number of nurses graduating last year was the lowest in a decade, with only 83 qualifying in the much-needed profession compared to 149 the previous year, according to data obtained from the University of Malta.

According to Paul Pace, from the Malta Union of Midwives and Nurses, fewer than half of the new graduates moved on to work with the government, where there is a chronic staff shortage. About 20 went on to study medicine.

“Things are bleak. We are highly dependent on third country nationals,” he said, adding he was informed that the government’s call for foreign nurses, issued in September, was not attracting as many as hoped.

He said this was mainly due to the penalty that foreign healthcare workers must pay on leaving their private employer before their contract expires as well as delays in processing paperwork.

Things are bleak. We are highly dependent on third-country nationals- Paul Pace, head, MUMN

The nurses’ union has repeatedly drawn the attention of the authorities to the shortage of staff that was leading to burnout and resignations. Annual resignations in 2019 and 2020 hovered around 50 and doubled in 2021 and 2022. The hospital often tries to make up for shortages by recruiting foreign nurses. In 2021, there was an exodus of foreign nurses as many who were trained in Malta opted to leave for better opportunities in the UK, Germany and other European countries.

Figures provided by the university showed that the number of nursing graduates remained steady since 2013, fluctuating bet­ween 126 and 180 graduates a year. However, 2023 saw the number drop to just 83.

Still, when it comes to doctors graduating, the numbers are on the increase, rising from 86 in 2013 to 128 last year, and 156 are expected to graduate this year. Out of the 1,446 doctors who graduated since 2013, 779 were women and 666 men, with one identified as ‘gender X’.

When it comes to nurses, however, women far outnumber men, with 1,184 out of the 1,558 graduates being women and 374 men.

Godfrey Baldacchino, a sociology professor at the University of Malta, says Malta is experiencing new shifts in its labour markets, reflecting similar shifts in other labour-importing economies including small ones like Cyprus and Luxembourg.

“Over time, a jostling of preferences occurs, and the tendency is for local employees to migrate away from jobs that are considered unattractive, for various reasons such as high risk and danger, shift work and unfriendly hours, hard manual work, low social status, and, sometimes, but not always, including relatively low pay. The nursing and paramedical sector is experiencing this transition… As a result, employers have a choice between either a replacement of labour with capital investment (such as robotisation, telemedicine) or recruiting immigrant workers,” he said.

The labour shortage problem, Baldacchino added, was compounded by the fact that various nursing and paramedical staff considered Malta to be a transit destination and stayed enough to secure enough qualifications and experience required to proceed to better paying locations, such as the UK.

Nurses who spoke to Times of Malta, and preferred not to be named, said there was no respect for the nursing profession.

“Nurses are burnt out because they need to stay after hours because there is no one to change them at the end of a shift. This is every day, not a once in a blue moon situation,” one nurse said.

Another agreed, saying the salary did not make up for this.

Lack of space remains Mater Dei’s main problem

The shortage of nurses and other staff is one of the main issues plaguing the State hospital. The biggest issue, however, remains a lack of space.

Earlier this month, Health Minister Jo Etienne Abela said Malta needs a second national hospital to keep up with its growing population. Abela believes the Guardamangia area, which includes the dilapidated St Luke’s and Karin Grech hospitals, is ideally placed to serve that function.

His idea is to shift all non-clini­cal services, including the medical school, away from Mater Dei Hospital to the Guardamangia “health village”. That would allow “every nook and cranny of Mater Dei to be used for clinical purposes”, he said.

But staff who currently work at Mater Dei questioned how a second hospital would be manned given that staffing one hospital was a challenge.

Malta Medical Association chief Martin Balzan said that space was always an issue at Mater Dei, and this was now compounded by the growth in population and an increased life expectancy, which has resulted in high numbers of elderly medical cases.

“We need more operating theatres, more wards and more space in emergency,” he said, adding that infrastructure for acute medical admissions was a priority.

Mater Dei has long been facing a chronic bed shortage as it operates beyond its bed capacity with patients placed in “makeshift wards” ‒ areas of the hospital that are not originally designed to host patients.

These include the Endoscopy Unit, the Catheterisation Suite, ITU6 as well as foyer areas of wards. Apart from these, there are the Major Incident Units (MIUs) opened in the past to cater for overcrowding: the former library, now called MIU4, and a former corridor turned into a ward called MIU1. The former staff canteen, now called MIU6, was refurbished to take in patients.

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