Direct Request (CEACR) - adopted 2025, published 114th ILC session (2026)

Nursing Personnel Convention, 1977 (No. 149) - Malta (Ratification: 1990)

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Government indicates notes that the People Management Department within the Ministry for Health (MFH) conducted a research study on the positive integration, assimilation, and retention of foreign workers, given Malta’s reliance on healthcare professionals from abroad. As a follow-up to the “Attraction, Recruitment, and Retention of Nurses” study, the Nursing Services Directorate (NSD), in collaboration with relevant stakeholders, including employee representatives, intends to implement the recommendations from the NSD report. This collaboration is expected to result in targeted action plans and interventions to address challenges in attracting, recruiting, and retaining healthcare workers and nurses. These initiatives may include strengthening recruitment strategies, improving working conditions, enhancing training and career development opportunities, addressing remuneration and benefits, and fostering a supportive and inclusive workplace culture. Furthermore, regarding career opportunities for nurses, the Government states that nursing positions within the MFH are regularly advertised in accordance with criteria established in the sectoral agreement between the institutions and the Malta Union of Midwives and Nurses (MUMN), with frequent calls for various posts. The Government also highlights that each nurse is entitled to a Continuing Professional Development (CPD) allowance annually, can apply for paid study leave, and can access a variety of CPD courses offered by institutions such as the University of Malta (UOM), the Malta College of Arts, Science, and Technology (MCAST), and private educational bodies. Additionally, the Government reports on measures involving nurses during the COVID-19 pandemic. The Government indicates that a range of strategies, initiatives, and updated policies were implemented to mitigate the pandemic’s impact on all healthcare workers, including nurses. Specific measures by the Superintendent of Public Health included providing personal protective equipment (PPE), infection prevention and control training, paid quarantine leave for nursing personnel, vaccination opportunities, and monitoring the increased workload and potential burnout among staff. The Government also provided support for nurses through mental health services, access to testing and healthcare, alternative accommodation, and childcare services.

The Committee takes due note of this information of the measures taken by the country to face the challenges in the nursing sector, including staff shortages due to nurses seeking better opportunities abroad, leading to increased workloads. It further notes with interest that, in 2022, Malta has launched its first-ever national health workforce strategy 2022–2030 to address the shortage of health workers and improve their training, retention, and professional development. The strategy emphasizes training nurses, including language skills, and recruiting cultural mediators. It also aims to enhance mental health support for health workers, addressing stress and burnout. The Committee notes that the strategy aligns with WHO and EU’s recommendations and includes strategic planning and sustainable investment and could represent a good comparative example for countries facing similar challenges. The Committee requests the Government to provide detailed updated information on the implementation of the new strategy and how it has allowed to improve the working conditions, career opportunities and professional competencies of nursing personnel. Noting that the nursing workforce in Malta is predominantly female, the Committee requests the Government to provide information on whether the new national health workforce strategy 2022–2030 includes specific gender-sensitive measures. In particular, please provide information on measures taken or envisaged to: (i) address the gender pay gap in the health sector, if any; (ii) ensure work–life balance arrangements that take into account the disproportionate care burden often borne by women workers; and (iii) promote women’s access to senior and managerial positions within the nursing service. The Committee further requests the Government to provide information on the consultations carried out with the social partners to develop policies concerning nursing services and personnel.

Article 3(1). Nursing education and training. The Committee notes the information submitted by the Government concerning undergraduate and postgraduate nursing programs offered by the UOM, the MCAST, and other accredited institutions. These include the UOM’s Bachelor of Science (BSc) in Nursing and BSc in Mental Health, Continuing Professional Development (CPD), and MSc programs for nurses. The Committee also notes the courses offered to nurses coming from other countries in order for their qualifications to meet the EU Directive standards. The Committee notes the NSD’s role in establishing the competencies required for various nursing specialities and identifying changes required in the legislation pertaining to nurse and midwife specializations. The Committee notes that the information compiled by the NSD was then submitted to the Specialist Accreditation Committee (SAC), which is responsible for reviewing and evaluating the proposed updates to ensure they meet the necessary standards and criteria for officially recognizing nursing specializations. The Committee notes the Government’s indication that the MFH’s issuance of a call for the post of Advanced Practice Nurse (APN) demonstrates the recognition and importance of advanced nursing roles in the healthcare system. The Committee further notes the setting up of a Postgraduate Training Centre for nurses, midwives, allied health professionals, pharmacists and environmental health professionals, which will offer various postgraduate training opportunities to these professionals to enhance their knowledge, skills, and expertise in their respective fields. The Committee requests the Government to continue providing updated detailed information on the content and impact of the measures adopted to ensure that nursing personnel are provided with education and training appropriate to exercise their functions. It also requests the Government to provide information on the measures and programs concerning nurses and midwives adopted in the framework of the Postgraduate Training Centre for nurses, midwives, allied health professionals, pharmacists and environmental health professionals.

Articles 5(2) and 6. Collective bargaining concerning employment and working conditions of nursing personnel. The Government indicates that the existing collective agreement for the public sector will expire in 2024 and that social partners, mainly major trade unions representing the employees working with the Public Service together with the Government, will negotiate a new collective agreement. The Government further indicates that throughout the past year, the MFH, the Industrial Relation Union (at the Office of the Prime Minister) and the MUMN held various meetings to negotiate a new sectoral agreement for nurses and midwives and that during the negotiation process, the MUMN registered disputes. The Government adds that the Sectoral Agreement expired on 31 December 2022, but negotiations started before the agreement expired and since the new agreement is not yet signed, one cannot divulge any information on the new clauses. While noting that the Government has not provided information concerning nurses in the private sector, the Committee requests the Government to continue to provide updated detailed information on the content and impact of collective and sectoral agreements concluded concerning the working conditions (including remuneration and training opportunities) of nursing personnel in public and private hospitals, nursing homes and medical centres. It further requests the Government to provide copies of such agreements in its next report.

Article 5(3). Procedures for the settlement of disputes arising in connection with the determination of terms and conditions of employment. The Committee notes that the Department of Industrial and Employment Relations takes a proactive approach towards the settlement of trade disputes and that officials of this department make a special effort to mediate and conciliate litigants in order to bring them to amicable settlements and avoid strikes or other forms of industrial action. The Government reports that where a trade dispute exists or is apprehended, the parties to the dispute may agree to refer the dispute to the Director of Employment and Industrial Relations (DEIR) or to a conciliator chosen by the parties or, in case of disagreement, by the director from among the conciliation panel appointed under the EIRA (Employment and Industrial Relations Act). Where a trade dispute exists or is apprehended and the parties fail to nominate or to agree on the appointment of a conciliator in terms of the above, or where an appointed conciliator reports a deadlock, the DEIR refers the matter to the minister responsible for Industrial and Employment Relations and copy such referral to the parties to the dispute. The minister may appoint a court of inquiry to inquire into and establish the causes and circumstances of the dispute. On an application by both parties to the dispute, the ministry may also refer such trade dispute to the Industrial Tribunal. The Committee requests the Government to continue to provide information on the procedures for the settlement of disputes arising in connection with the determination of terms and conditions of employment of nursing personnel.

Article 6(g). Social security. The Committee notes that following the budgetary measure implemented by the Government, nurses with the status of public officers can apply to continue work till age 65 with their current grade due to the current lack of nursing staff. The Committee notes also that nurses in a non-management position are entitled to continue working on a full or part-time basis until the age of 70. Regarding its impact on the agreement with MUMN, the Government indicates that the current agreement caters to this. Regarding whether nursing personnel enjoy conditions with regard to social security that are at least equivalent to those of other workers, the Government indicates that nursing staff have the same conditions regarding social security as other employees. The Committee understands that these are non-binding measures which do not have negative repercussions on the pension and other social security rights of the nursing staff and asks the Government whether there are incentives in terms of accrued social security rights put in place to promote nursing personnel’s staying longer on the labour market to compensate for the lack of staff. The Government is requested to continue to provide detailed information on the manner in which it is guaranteed, in law and in practice, that nursing personnel (both in the public and private sectors) enjoy working conditions that are at least equivalent to those of other workers, including conditions with regard to social security.

Article 7. Occupational safety and health of nursing personnel. The Government indicates that the safety of all healthcare professionals (not only nurses) was paramount during the COVID-19 pandemic. As a result, the Infection Control Dept at Mater Dei Hospital constantly adopted all the relevant health and safety policies to ensure adequate staff protection. The Government explains that these evidence-based policies – developed by a multidisciplinary team including infection control nurses – were congruent with those issued by the European Centre for Disease Control and the World Health Organization. The Committee notes that in some instances the local policies were more proactive than WHO or ECDC policies (e.g. standard use of N95 masks for all contact with known COVID-19 patients) and that, as a result, Malta had one of the lowest rates of COVID-19 transmission in Europe and did not lose a single healthcare professional to the infection. The Government explains that the key to these results was an exhaustive protocol of screening, isolation and contact tracing, as well as efficient procurement of the necessary PPEs. The Committee requests the Government to continue to provide updated information on all the safety measures taken or envisaged with a view to protecting the health and well-being of nurses, including adequate rest breaks during their shifts, measures to prevent and reduce psychosocial risks, including burnout, violence and harassment, in addition to preventing the risk of long-term repercussions on nurses’ well-being. It further requests the Government to indicate whether nurses and/ or their representatives were consulted or participated in formulating and implementing such measures.

Application in practice. The Committee observes that, according to the European Commission 2023 Country Health Profile on Malta, the number of nurses per 1,000 population has increased in the last years but is still just below the EU average. The Committee notes the statistical information submitted by the Government for the period 2018–2022. The Committee notes that the number of students enrolled for the Nursing and Mental Health Degree Courses appears to show an increasing tendency, with 189 students registered in 2022. The Committee notes with satisfaction that the number of nurses recruited in the Ministry for Health in the period 2018–2022 was 895, while the number of nurses who resigned for the same period was 450. The Committee noted in its previous observation that the nursing workforce increasingly relies on migrant workers, posing challenges for recruitment and retention. The Committee requests the Government to continue to provide updated detailed information on the application of the Convention in practice, including statistics disaggregated by sex, age and region, on the ratio of nursing personnel to the population, the number of persons enrolled in nursing schools, the number of men and women nurses who enter and leave the profession each year, the organization and the operation of all institutions in the public and the private sector which provide healthcare. It also requests the Government to provide any official studies, surveys and reports addressing health workforce issues in the health sector.