From Mr J. Sharples

Reference is made to a letter titled “Nurses should not be doing clerical work” by Paul Borg (TMIS, 18 February). The letter contains a number of 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 have miserable conditions”. Admittedly, there are areas due to overcrowding where the situation is difficult both for the staff, particularly the nurses, and patients, but this is definitely not the situation in all the wards.

It is debatable to state that 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 be the major component of the work schedule. However, one cannot claim that, as the title of the article states, “nurses should not be doing clerical work”. How are nurses to document their planning and implementation of care? How are they 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 fallacious thinking. On the other hand, I agree that nurses at Outpatients should be doing less clerical work and more clinical work in order to focus on the real core of what nursing is all about. Mr Borg’s view of what nursing is all about is rather limited. Nursing is not only delivered at the bedside but also in clinics, health centres, the community – in the family or at school, in the work place and so on. Apart from the usual traditional roles, there are other roles nurses are taking on that can still 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 at national and international level. Most of the work done in these fields involves clerical duties, which for nurses are 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 in order for the patient or client to obtain maximum benefits from such provision of care. One cannot substitute such employees working at a strategic level with clerks just as much as one would not substitute all doctors working in the health division in the spheres of administration, policy, planning and regulation and so on in the its directorates with clerks.

Another factual error is the allegation of pay discrimination between those nurses who work at Outpatients and those nurses 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 are a very small number of nurses who occasionally work approximately four hours, for example once a week, overtime in the wards in the afternoon. These do not represent most of the hundred or so nurses who work at Outpatients.

The last sweeping statement in the letter tied to 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 in the course of their work. While one may find demotivated nurses working in some of the wards (including Outpatients as well), one also finds nurses who do deliver a sterling service to the patients who are recovering in the wards in spite of all difficult circumstances, and these are definitely in 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.

The least one expects from readers of newspapers is that letters expressing an opinion are as factual as possible. It is unfortunate that this was not the case with this letter. If one is really interested in the nature of work done at our Nursing Services Department, one can access this information by clicking on: http://www.sahha.gov.mt/pages.aspx?page=37

Jesmond Sharples

Director Nursing Services (Health Division)