The nurses’ union has insisted in court that the directives it was forced to suspend last week following legal action did not endanger patient care but were aimed at addressing a prolonged staff shortage that was in fact putting patients at risk and draining its members.

It said that contrary to what was claimed by the Health Ministry, the directives ensuring a proper staff-to-patient ratio was in the patients’ best interest.

The arguments were made by the Malta Union of Midwives and Nurses in written submissions to the court on Friday in reply to a request for an injunction filed by the Health Ministry to block its directives over what the union claims are serious staff shortages.

Mr Justice Ian Spiteri Bailey last week provisionally blocked the industrial action across the entire health service. He gave the union until last Friday to reply and will hear the merits of the case tomorrow morning.

Two weeks earlier, the union had issued a raft of directives in a dispute over shrinking staff numbers. The directives to nurses included taking a two-hour break each day at operating theatres, an order not to leave the ward to accompany patients unless the ratio is one nurse to five patients, and not admitting patients to particular hospital wards and at the government’s home for the elderly.

Tackling the directives individually, the union’s lawyer, Chris Cilia, explained that the one targeting the nurses’ breaktime was issued because nurses were being ordered to take their break at 7am, before they even started their working day and before consultants turned up in hospital. As a result, the nurses would end up working the rest of their day without taking a break.

On the staff-to-patient ratio, the union said the ratio should be one nurse for every four patients in each of the 65 wards at Mater Dei Hospital. However, the staff shortage had reduced this ratio to one to six, one to eight and sometimes even one to 12.  

The union argues this is affecting “in the most detrimental way” the primary objective of providing quality public health to the community.

Directives were chosen carefully and responsibly to ensure that patients would never be put at risk- Malta Union of Midwives and Nurses

It claims the shortage is also leading to criminal action being taken against nurses for not being there for patients. One example was a nurse jailed because a patient choked on chicken. Another was criminal action taken against a nurse because a patient self-harmed while the nurse was tending to another patient.

In a ward that usually holds 40 patients, the one-to-five ratio is the bare minimum, the union argued.

The government had appointed relievers to take over while the nurses were following the directives but once these were stopped, the relievers were withdrawn, it pointed out.

On the last directive regarding admissions, the union explained that the sole objective was not to exacerbate the present situation but it was ordered because the complement of nurses could not cope with more patients.   

It had chosen the directives carefully and responsibly to ensure that patients would never be put at risk, the union said.

It argued there was no reason at law for the injunction to be upheld permanently. As a union, it had a right to issue directives to its members and the injunction was impinging on this right protected by the country’s constitution. 

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