axed, according to a shock report by a Canadian consultant.

And it is feared that fully-trained nurses could be replaced by lesser-qualified nursing assistants in a bid to cut soaring health costs.

Also on the consultant's hit-list are the maternity and paediatrics departments -- it is suggested the two be combined because of "low patient numbers.'' The Monahan & Associates report also suggested that "a potential saving of 27.9 full time employees could be made with management and adjustment of allocated nursing resources''.

Top jobs set to disappear include 13 assistant unit coordinator posts and two assistant director of nursing positions. They are expected to be phased out within the next 18 months.

The report admitted: "The future directions for the hospital will directly impact nursing and challenge this group to be active participants in the development of solutions for the future.

"To this end it is important that the department be organised and managed in a manner which ensures the effective use of nursing resources.'' And it added: "Certain areas such as paediatrics and obstetrics lack sufficient patient volume to staff for workload alone. Thus consolidation has been recommended.'' The Director of Nursing and Patient Services should establish a task group to examine and make recommendations concerning the enhanced utilisation of auxiliary staff.

"The Executive Director, in Consultation with the service teams and facilities planning, examine the demand for and the needs of an amalgamated unit for the services of paediatrics and maternity.'' According to one insider morale at the hospital has plummeted since the proposals were announced.

And staff have also blasted union bosses for not protecting jobs. "If the assistants are to be offered other jobs they have to retain current salary,'' the insider said.

"So where is the saving? The Hospital Board can ruin the careers of Bermudians for the sake of efficiency but what efficiency? Prove how that can be achieved and at what moral, ethical and practical expense.

"What effect will this decision have on Bermudians entering the nursing profession when 11 promotions have been eliminated? How will efficiency be increased when 18 senior and middle nursing professional jobs have been eliminated? This is akin to eliminating the 12 Chief Inspectors from the Police Service.

"There have been no discussions -- staff were just told what was going to happen -- and morale is at rock bottom. The Bermuda Public Service Association never took the initiative.'' Last night a hospital spokeswoman said it was too early to tell how many, if any nursing staff faced the sack.

"We are re-structuring and that means that our current structure is not accomplishing what it should,'' the spokeswoman said.

"Health care is changing and there is now more focus on home care. We are moving in that direction and we need people to fill those jobs.

"There are some departments that are over staffed and these people need to be identified and cross trained.

"To say that we can chop 27 people doesn't make sense because we are only now working on how, where and why we are going to deploy those people.'' Hospital managers will be meeting with nursing staff to discuss the recommendation in the next two weeks.