Nurses and midwives have given the government until Wednesday to start tackling the staff shortage "crisis" or face industrial action in all hospitals and care centres.
As he announced the ultimatum, the president of the Malta Union of Midwives and Nurses (MUMN), Paul Pace, listed measures he expected the government to take to relieve its members of the workload that is stretching their 46-hour week to 60 or even 80 hours.
Mr Pace would not say what sort of industrial action the union would be calling should the demands not be met but said that "at this stage we are not excluding anything".
The union called on the government to shed its "bureaucratic attitude" and start implementing their October 2007 agreement which deals precisely with staff increases.
He said the union was left with no option but to give an ultimatum following several unproductive meetings with the authorities.
The agreement also includes training and measures to encourage retired nurses to stay on. Recently, he added, 20 nurses graduated but the government was dragging its feet on employing them, despite there being about 187 pending vacancies at Mater Dei Hospital.
"This (nurse shortage) is a problem that the government should be tackling... In Malta, as in other countries, we have a shortage of nurses but the government is not fully utilising our potential workforce," Mr Pace said.
Every day, nurses have to make "sacrifices" to cope with the overwhelming workload that often does not allow them to take leave, he said, stressing that while staff try to keep up a good service there are times when patients end up paying the price for overworked nurses.
He pointed to a case in which a nurse is facing disciplinary proceedings for failing to administer treatment to a man when several patients were demanding her attention at the same time and she was alone in a ward.
Among its list of requirements to be met by Wednesday, the MUMN is asking the government to accept its proposals to change the nurses and midwifery course, as from next year, through a number of measures. These include: Reducing the diploma course from four years to three, eliminating the student-number limit of courses, lowering the age for mature students, giving final-year students a minimum wage allowance and sending them on supervised shifts, and opening the course twice a year.
The union is also calling on the government to draw up a manpower plan that studies the number of nurses and midwives needed over the next five years and where their services will be required most. The plan had been suggested by the union at the beginning of this legislature but nothing had been done, Mr Pace said.
He also criticised the government for employing foreign nurses instead of tackling the staff shortage.
In the October 2007 agreement the union had agreed to the employment of 100 foreigners but this was meant to be a temporary measure, he said.