Directives to the Nurses working in the E/A Department:

1. No ED nurse is to work in Area 3 if the following allocation is not met: 4 nurses in team A, 4 nurses in team B, 3 nurses in Resus, 2 nurses in triage, 2 nurses in the control room, 5 nurses pre-hospital during the day shift (3 nurses in RRVs, one nurse Mosta, one nurse Paola) and 4 during the night shift (3 nurses in RRVs, one nurse from ED), a minimum of 1 nurse allocated for training and lastly, 2 nurses in team C. If area 3 is not manned and the workload of ESI-1 and 2 patients is not high, ED nurses may participate in the care of ESI-3 patients, however, the priority of the ED nurse should always be given to the more acute ESI-1 and 2 patients.

2. Code Orange and Code Red calls should be responded to with an MDH Ambulance not a private contractor ambulance. If no MDH ambulance is available at the time of the call, a private contractor ambulance should still be used, however, MDH ambulances should always take priority in these call categories as they are better equipped, and the nurse can provide the patient with much better care.

3. No Emergency Dept carer should be placed on elevated supervision duties. When the SNMs office does not provide a carer for this, the patient should be taken to Cubicle 24 and a security guard is to be requested by the nurse-in-charge. We need the department’s carers to care for the masses of patients present in the department and cannot be allocated to just one patient.

4. Fully independent patients tracked for a normal bed who is not transferred to a ward within 30 mins of being ready to be transferred out of the ED, should be transferred to the ex ED2 waiting area. Upon doing so, the ED nurse-in-charge should be informed to inform the SNMs office. This excludes patients on elevated supervision, fully dependent patients, patients requiring opiate pain relief, and patients with unstable parameters. The priority of the ED nurse is to take care of acutely ill patients who need rapid emergency assessment, care, and diagnosis, not patients who are ready to be transferred to a ward.

5. ED nurses are only to perform patient transfers of ESI-1 patients, patients needing sedation, transfers to ITU and Cath Lab and transfers of clinically unstable patients.

Nurses working in MOT (MDH):

1. Pillar 1, 2 and 3 – Do not participate in any elective operation except those operations related to oncology patients, paediatric cases, and life-threatening cases. These operations are to be dealt by 2pm. After 2pm no new operations are to commence. Those major operations which commenced before 2pm are to continue. Any major complex surgery which does not start before 11am, will not be assisted by the nurses.

2. Pillar Four, being the Pillar where all emergency operations take place is not to be affected by the Directives. So, such Pillar is exempted from the directives. Any surgery which will be cancelled by Pillar 1,2 and 3 will not be assisted by the nurses in theatre from all Pillars.

Nurses in the Primary Care Department including bereg:

1. All bloodletting excluding INR is to be stopped.

2. All wound care is to be done from 10am to 2pm

Nurses and Midwives working in MDH including Maternity Wards:

1. All washing of patients by nurses/midwives is to be stopped immediately. This directive is exempted at ITU, NPICU, and HDUs and patients with several indwelling devices. Dressing of wounds is still to be done by nurses/midwives.

2. No booking shall be done without an appointment.

3. Nurses/Midwives are not to go out of the ward for any errands, transfers, or theatre except to highly critical areas and where there is a life-threatening situation.

4. No work whatsoever related to procurement.

5. Charge Nurses/Midwives or ward nurses not to sign for anything that is delivered at the ward such as food trolley, supplies, pharmacy, disposables, etc.

6. No clerical work.

Nurses working at MDH Out-Patients Department:

1. Do not answer any phone calls.

2. Do not take any messages from the clerks and other supporting staff.

3. Do not call any patients from the waiting rooms.

Nurses working at Karen Grech Hospital:

1. All washing of patients by nurses is to be stopped immediately. This directive is exempted to patients with several indwelling devices. Dressing of wounds is still to be done by nurses/midwives.

2. Bed-state to be reduced to 22 patients per ward.

Nurses working at Gozo General Hospital:

1. All washing of patients by nurses is to be stopped immediately. This directive is exempted at ITU/CCU and patients with several indwelling devices. Dressing of wounds are still to be done by nurses/midwives.

2. Not to go out to do any errands and transfer of patients.

3. Charge Nurses or ward nurses are not to sign for anything that is delivered to the ward such as food trolley, supplies, pharmacy, disposables etc.

4. Charge Nurses are not to attend the SNMs office periodically to do any Senior Nursing Manager duties.

5. No clerical work

Nurses working in mental community care:

1. Not to accompany doctors during patient reviews

2. No to attend meetings with management.

3. Not to send daily absence forms.

4. No intake assessments on new referrals.

5. Not to answer telephones after 2.00 pm.

6. Not to collect or send any data for statistical purposes.

Nurses working at Old SVP:

As there is an existing agreement not to wash patients, nurses are to follow these Directives –

1. Not to answer to any phone calls.

2. Not to go out to do any errands and transfer of patients.

3. Charge Nurses or ward nurses are not to sign for anything that is delivered to the ward such as food trolleys, supplies, pharmacy, disposables, etc.

4. No clerical work

Nurses working in Elderly Homes:

1. Nursing report is to be written only when a change in patients’ condition has occurred.

2. Nurses are not to wash, ambulate or take parameters since all such duties can be done by auxiliary staff.

3. Nurses are not to fill any care plans to cope with the sheer number of patients on your ward.

4. The only paperwork to be done is to stock the ward with supplies or pharmacy.

5. Nurses are only to phone relatives if there is deteriorated in the condition of the resident or the resident is taken to MDH.

6. Nurses are not to make use of phones even if called by the ward clerk, concentrate our duties on the patients.

7. Head counts are not to be done. That is a security duty besides head counts are not in the job description of the nurse.

Nurses working at Community Care Unit:

1. Nurses are not to do any outside visits.

Endoscopy Unit at MDH:

1. Nurses are only to assist with 50 endoscopic procedures per day.

Nurses working at Mt. Carmel Hospital:

1. All washing of patients by nurses is to be stopped immediately. This directive is exempted on patients with several indwelling devices. Dressing of wounds are still to be done by nurses.

2. Not to go out to do any errands and transfer of patients.

3. Charge Nurses or ward nurses are not to sign for anything that is delivered to the
ward such as food trolley, supplies, pharmacy, disposables etc.

4. No clerical work.

5. SNO’s office is not to process any paperwork related to the Mental Health Act.

6. Not to open the ward doors.

7. No IOS for maintenance works.

8. If a patient returns from short-term leave but their bed has been filled due to a lack of space, then they are not to be allowed in the ward. Instead, they are to be directed to the transit ward so that the medical profession has to find a bed for the patient.

9. No ward is to accept the introduction of additional beds.

10. All nursing management (both night management and day management) are to refrain to do any work related to bed management.

SAMOC Hospital is excluded from Industrial Directives pertaining to the New Sectoral Agreement.

Senior Nursing Managers are to adhere with the Directives of their respective hospitals and support their Nurses/Midwives.

Practice Nurses/Midwives, Senior, and Advanced Practice Nurses/Midwives:

1. Not perform any duties that are not directly related to PN/SPN role.

2. No job shadowing (clinical shadowing) of nurses with practice nurses

3. Not see outpatients without an appointment (excluding SAMOC)

4. No participation in the development of new or updating of existing guideline documents.

5. Stop providing clinical practice audit reports.

6. Not answering any calls from landline telephones

7. No swabbing for MRSA and COVID-19 by Practice Nurses

8. No booking of blood tests or swabs by Practice Nurses

9. No booking of transport for patients

It is important to note that if any intimidation is conveyed to you, please report immediately to MUMN Office at 21448542 or send an email to [email protected]

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