Patiala, March 30 -- The Punjab government on Sunday issued a final warning to striking nurses across three government medical colleges, directing them to immediately resume duties or face strict action under the East Punjab Essential Services (Maintenance) Act, 1947. In a letter, the director of research and medical education (DRME) said that despite enforcement of ESMA from March 25, members of the United Nurses Association of Punjab have continued to abstain from duties, severely disrupting essential healthcare services. The ongoing strike has affected critical hospital operations, including intensive care units (ICUs), neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), operation theatres, wards and emergency services. Terming the agitation "illegal and unlawful," the government warned that failure to comply would compel it to initiate strict action. "The government hereby issues a final warning to all members of the Nursing Association to immediately call off the strike and resume their duties forthwith, failing which the government shall be constrained to initiate strict action," the DRME said in its communication. The strike has impacted three major institutions - Rajindra Medical College and Hospital, Patiala, Government Medical College, Amritsar, and Dr BR Ambedkar State Institute of Medical Sciences, Mohali, - where officials estimate that 40 to 50% of the nursing workforce has joined the agitation, affecting patient care. Officials expressed concern over the strain on healthcare delivery, noting that nursing staff form the backbone of the system. While contingency measures are being explored, the shortage of trained nurses has proven difficult to offset. The protest centres on a long-standing pay anomaly affecting nurses recruited on or after July 17, 2020. Union leaders claim that nearly 1,500 nurses in these institutions are being paid around Rs.29,000 per month under a Rs.2,800 grade pay. They are demanding an upgrade to Rs.4,600 grade pay, which would raise salaries to approximately Rs.44,900 per month, along with reclassification of their posts from Grade C to Grade B. The association has argued that the existing pay structure is discriminatory and does not reflect the workload and responsibilities of nurses in tertiary care hospitals. However, the DRME stated that the demand for Rs.4,600 grade pay is currently sub judice before a competent court and cannot be decided at the administrative level. The letter also underlined that continuing the strike despite ESMA enforcement constitutes a violation of statutory provisions. Meanwhile, the nurses' union has remained firm, stating that the agitation will continue until their demands are met. Union leaders described their demands as legitimate and criticised the government's move to invoke ESMA, calling it an attempt to suppress employees' voices and curb democratic rights. Jujhar Singh, Patron, United Nurses Association of Punjab, said: "We will continue our strike until our demands are met. We will not bow down to such warnings from the state government." He added that nursing students - who are not legally permitted to administer injectable medications, perform invasive procedures, or independently manage emergency and critical care cases - are being deployed on such duties, raising serious concerns about patient care. He warned that assigning such duties without proper supervision not only violates professional and ethical standards but also exposes institutions to legal liability in case of adverse outcomes....