Mr Paul Borg's letter (The Sunday Times, February 25) contained several factual inaccuracies that need to be clarified.

It is incorrect and unjust to label all wards in St Luke's Hospital as being in a "precarious situation" and with "miserable conditions". Admittedly there are areas due to overcrowding where the situation is difficult both for the staff, particularly the nurses, and the patients, but this is definitely not the situation in all the wards.

I agree that nurses are not clerks, but it is debatable whether nurses should not be doing clerical work. Clerical work is part and parcel of most professional work. The closer one is to the patient in the clinical environment, clerical work should not form the major component of the work schedule. However, nurses need to document their planning and implementation of care.

They also need to communicate with health care professionals and other stakeholders.

To detach this clerical component (including the use of IT) from the scope of practice and assign it to a clerk is incorrect. On the other hand, I agree that nurses at Outpatients should be doing less clerical work, and more clinical work to focus on the real core of what nursing is all about.

Nursing is not only delivered at the bedside, but also at clinics, health centres, the community - in the family or school setting, at the work setting, etc.

Apart from the usual traditional roles, there are other roles that nurses are going into and which still can be described as being an integral part of the scope of professional nursing practice.

I am referring particularly to nurses in management, education (schools and university), research and scholarship, policy-making, particularly in the health fields, regulation and legislation, both of a national and international dimension. Most of the work done in these fields involves clerical duties which are for nurses only a means to an end or function.

It is within this context that the nurses employed at the Directorate Nursing Services operate, not as clerks as wrongly stated by Mr Borg, but as nurses who work to establish standards of nursing services so that the patient or client maximally benefits from such provision of care.

One cannot substitute such employees working at a strategic level with clerks as much as one would substitute all doctors working in the health division in the spheres of administration, policy, planning and regulation within the its directorates with clerks.

Another factual error is the allegation of pay discrimination between those nurses who work at Outpatients and those who work in the wards. It is not true that they have the same salary package. In fact, ward nurses have a higher salary than their counterparts at Outpatients due to a number of allowances and other incentives.

It is also incorrect to state that most of the nurses who work at Outpatients work overtime in wards in the afternoon. There is a very small number of nurses who work overtime occasionally in the wards in the afternoon for approximately four hours, e.g. once a week. These do not constitute most of the 100-odd nurses who work at Outpatients.

The last sweeping statement in Mr Borg's letter regarded the ratio of clerks/nursing aides to nurses at outpatients is misleading and untrue. There is no correlation whatsoever between the ratios mentioned and motivation of nurses working in wards.

Local studies have shown that nurses' satisfaction and motivation at work, including those in the wards, is not low. This does not mean that these nurses do not experience difficulties or frustration during the course of their work.

While one may find demotivated nurses working in some of the wards (including outpatients), one also finds nurses who, in spite of all difficult circumstances, deliver sterling service to the patients who are recovering in the wards, and these definitely constitute the majority.

Evidence-based research shows that motivation is very often dependent on factors related to the intrinsic nature of the job rather than on extrinsic factors such as pay and the social and physical environment.

For more information about the Nursing Services Department, visit http://www.sahha.gov.mt/pages.aspx?page=37