Nurses' union says: 'No bed, no surgery'

The nurses' union has instructed its members to turn away patients awaiting surgery if no beds are available in wards, claiming that numerous patients are also being operated upon without first signing a consent form.

"We appeal to patients to call the hospital's customer care unit on the day of their scheduled surgery to ask whether a bed is available. Nurses will not accept them in wards otherwise," Malta Union of Midwives and Nurses Paul Pace said.

He did not exclude that the wide-ranging "instructions" issued to nurses would lead to a slowdown in hospital services.

At the moment, some 40 patients who go to hospital for scheduled operations every day are not given a bed before surgery.

The union instructed nurses in a number of wards not to take patients to operating theatres unless a consent form was signed since there could be legal implications. "Patients have a right to know exactly what to expect from their operation and afterwards," he said.

The instructions, which come into force tomorrow, also call on theatre nurses not to be first assistant to surgeons since they are not trained for this. The first assistant holds the retractor, which keeps wounds open during surgery.

Overstretched anaesthetic nurses have been instructed not to accept post-operative patients in the recovery room unless the established nurse-to-patient-ratio is respected. Although there should be two nurses for every three patients, Mr Pace said one nurse often had to take care of five patients. "Unless there are enough nurses, patients will remain in the operating theatre with the anaesthetist."

He said nurses were under extreme stress to ensure patients were safe, adding it was only because nurses went over and above their call of duty that tragedies did not happen.

"The authorities are playing Russian roulette with patients' lives."

Mr Pace said patients were being treated solely as numbers by the health authorities, and what was important for Health Parliamentary Secretary Joe Cassar were the figures he could give in Parliament.

This was vehemently denied by Dr Cassar: "I will let the Maltese people judge me."

Dr Cassar admitted he was taken aback by the union's instructions especially when discussions were under way to change current work practices.

"Patients will suffer. To stress what point? We know that a lot of nurses go beyond the call of duty and it is commendable," he said, adding that asking them to go by the book at a time when attempts were being made to improve the situation was not right. He pointed out that there was a major problem of lack of human resources.

Dr Cassar said he was unaware that consent forms were not being signed, although there were times when nurses were being asked to take care of them.

The union has instructed nurses to stop changing the dressing of patients who were not in their ward and refuse to take blood tests ordered in the private sector.

"We are seeing a number of patients who see a consultant privately but are sent to wards for blood tests," Mr Pace said. Patients who had been discharged from hospital should go to health centres to have their dressing changed, he added. He said the instructions - which were not directives - had been issued to safeguard the health and safety of both patients and nurses.

"These measures should already be followed in hospital. If we had a serious health division it would have already issued a circular with these instructions."

Ward nurses are also being instructed to inform the bed manager of empty beds, not to pressure discharged patients to go to the waiting area until they are picked up and not to do any non-nursing clerical work. Nurses in the Ophthalmic Ward are being called on not to give assistance to emergency patients who should be seen in the Emergency Department and only take care of day cases if there was enough staff.

Anaesthetic nurses working in the recovery area will start taking their morning break at 8 a.m. Nurses are being asked to take their break together to avoid intimidation.