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The nurses stepped up their sanctions yesterday, when four nurses walked out of two internal medicine wards at Sheba Medical Center in Tel Hashomer, leaving them staffed with only two nurses each.

The walkout was part of a work-to-rule policy under which the number of nurses on a given ward would be limited to the number of official staffing positions rather than the number actually needed to care for the patients. This is the first time the policy has been carried out.

The hospital said that "activity on the wards continued as usual, with no disruptions."

The nurses' union said walkouts at other hospitals with badly understaffed internal medicine wards will follow. Eight hospitals - Sheba, Poriya in Tiberias, Soroka in Be'er Sheva, Assaf Harofeh in Tzrifin, Wolfson in Holon, Meir in Kfar Sava, Bnei Zion in Haifa and Western Galilee in Nahariya - are in this category.

The union resumed its sanctions last week because the 190 additional staff positions for nurses that were approved in January have not yet been filled. If these positions are not filled quickly, nurses are threatening to move to an alternative version of the work-to-rule policy, under which they would enforce the official standard of 0.85 nurses per hospital bed by leaving beds in understaffed internal medicine wards empty. That means patients would either remain in the emergency room or be put in other wards.

The Health Ministry said it considered the nurses' struggle justified and demanded that hospitals fill their allotted positions for nurses "immediately."

Meanwhile, the state yesterday appealed last week's decision by the Tel Aviv Labor Court not to issue back-to-work orders in the three-month-old doctors' strike. The National Labor Court will hear the appeal tomorrow.

The state is seeking to prevent the physicians from beginning their own work-to-rule policy on Friday, under which only the number of doctors specified in official staffing agreements - last updated in 1977 - would be allowed on the ward. Doctors say this could cause entire wards to shut down.

Today, doctors will strike outpatients clinics in all hospitals from Tel Aviv southward.