As the date for the completion of Mater Dei Hospital creeps closer, new Malta Union of Midwives and Nurses president Paul Pace says he would rather wait until the needed support staff have been employed before the migration takes place.

Waiting an extra month or so before opening Mater Dei Hospital would be a small price to pay, Mr Pace believes, adding that this should lead to better services on offer once the new hospital does start operating.

Mr Pace, who was elected president last month, pointed out that the authorities had shown commitment to employ the needed support staff, but it was unclear whether these would be in place when the hospital opened.

"The process to employ them could have started much earlier. After all, this hospital has been in the pipeline for years."

The hospital is expected to be finished by July 1, but it is still unclear when medical services will move to Mater Dei Hospital and how long the migration will take.

Although the union has not been given an indication of when the hospital will be fully operational, Mr Pace expressed concern that the big debate on its opening date could lead to this being hurried rather than waiting for the right time.

"Having support staff in place would make everybody more confident."

Support staff, including nursing aides and ward clerks, would enable nurses to focus on their nursing duties by helping in other jobs, like administrative work and accompanying patients to hospital appointments.

Mr Pace said many hours are wasted taking patients to out-patient appointments or to have tests carried out. "There have been cases when a nurse spent seven or eight hours waiting with a patient at casualty."

He also asked why the hospital does not have a porter system, whereby theatre staff take patients for surgery themselves rather than this task being done by ward nurses.

He said talks with the union about the migration to the new hospital started a couple of weeks ago, adding that these had been left for quite late in the day. However, he believes that the migration could be carried out effectively and its effects minimised.

It is understood that for a short period of time when migration is taking place the two hospitals will be operating in tandem. Mr Pace said the union was concerned that dual services would put added pressure on the staff.

One concern is whether there will be enough nurses to take care of the "social cases" who will be left behind at St Luke's, where the Zammit Clapp rehabilitation services will move temporarily. "There are around 60 nurses at Zammit Clapp and unless a number of nurses decide to join the service in the very near future we might have problems."

He stressed the importance of recruiting more nurses across the board to be able to give a better service.

In a recent interview with The Times, the director of nursing services in the Health Division, Jesmond Sharples, said an additional 300 nurses would be needed to run the upcoming expansions in the local health system.

Mr Pace said it was essential to entice more young people to take up a career in nursing, adding that the current intake for both the degree and diploma courses was very low. In fact, the annual intake of the Bachelor of Science degree is only between 20 and 25 students while that for the diploma stands at around 30. He highlighted the need to increase the university stipend for those reading for a degree in nursing, which currently stands at Lm36 a month.

Another way to increase the number of nurses would be by offering better conditions to those who are returning to the job, and the union was trying to reach an agreement with the government so that returning nurses do not have to start from scratch.

It has long been argued that nurses have one of the most stressful jobs. A survey carried out by the union in 2003 showed that 95 per cent of nurses and midwives working in the public sector believe their work is physically and mentally stressful while 62 per cent said they were suffering from burnout.

"Nurses are constantly seeing people suffering and dying. The shift system means that their private life is heavily disrupted.

"Then there is the shortage of nurses which is taking its toll on the staff. We are overburdening nurses with the large number of patients."

He pointed out that St Vincent de Paul residence has seen an increase of four to eight patients in every ward, but the number of nurses remained the same.

"Nurses working at the residence for the elderly cannot take their own leave unless they find a colleague who is willing to work overtime for them. This is causing great stress and tension."

He pointed out that when nurses are overburdened with work, it is the patient that suffers at the end of the day. "What hits us will reflect on our job. A nurse on a one-to-four ratio is able to give much better care than one who has to take care of 10 patients."

Moreover, overcrowding could lead to cross infections. "We preach the importance of washing hands before moving from one patient to another, but I am sure that when there is so much burden nurses become too busy to do this."

All this boils down to increasing the number of nurses, and Mr Pace said a way forward could be offering nurses a package which includes the possibility of early retirement.

The union has looked at a number of European models and feels that the package could also include the possibility of nurses who have been loyal to their employer for a number of years benefiting from longer leave and allowances.

"We would like to see relief pools, but for now this seems to be only a dream," he said.

He pointed towards the need for investment in community care, expressing hope that this would be considered a priority in the near future. "Just focusing primary health care on health centres is something of the past. There are not enough support services in the community. Unless we have the proper support in the community, hospitals will continue to be overloaded with social cases."

Mr Pace has also vowed to continue in his predecessor's footsteps and push for nurses to be given a warrant. "A warrant means that we have a licence to work on our own, something that we are already doing," he said.

He looks at his four-year term as president with excitement, mentioning the signing of the public service collective agreement and a sectoral one as well as the opening of two new hospitals apart from Mater Dei - the move of the oncology hospital to Zammit Clapp and the building of a new rehabilitation hospital.

The icing on the cake will probably be the International Council of Nurses conference that Malta will be hosting in 2011.