The pipeline of registered nurses in South Africa has ‘paused’ – and hospitals and students are being affected by legislative bungles halting the flow of skills into the sector. And, says a Moneyweb report, to add fuel to the fire, working conditions discourage retention.
The report says the sequence of events is startling, especially for a country where, according to calculations and South African Nursing Council (SANC) statistics, there were only 5.14 nurses per 1 000 people in 2016. Dr Wilmot James, DA shadow minister of health, is quoted in the report as saying: “Having a critical mass of professional nurses in hospitals reduces the risk of patients dying by 8%. It also significantly cuts the incidence of patients acquiring additional health problems while in hospital.”
The report notes that according to Health Systems Trust training unit technical advisor Dr Joan Dippenaar, looming crisis began with a sweep of nursing college closures and mergers in the late 1990s. This led to significantly fewer nurses being trained in state facilities.
It says until now, private hospitals with their own colleges filled the gap – but this pipeline has been plugged. Nursing education now falls under the Department of Higher Education, rather than the Department of Health (DoH). The Strategic Plan for Nursing Education, Training and Practice (2013) came into effect that year and introduced new qualifications. Nursing education programmes approved by SANC prior to the promulgation of the National Qualifications Act, 2008 were terminated in June 2015.
As a result, private training facilities discontinued all programmes in 2016, and have not taken on any new students since then.
The report says the old curriculum continues in public training facilities until 2019. But many private nursing education institutions have yet to be accredited. And those that have received accreditation face another challenge, and this one is insurmountable. As Unisa lecturer Professor Mokgadi Matlakala says in the report that the new curricula are yet to be approved and until SANC, together with government, finalises and publishes updated scopes of practice, the new qualifications can’t be offered.
The report says the situation is being further aggravated by the fact that thousands of posts in state hospitals have been frozen. The hiring freeze isn’t just keeping qualified health care workers from securing work in state hospitals – it has led to a licensing hold-up. A one-year practical training stint in the public sector is a mandatory requirement of professional nurse training. There are not enough posts in the public sector for students who complete their studies, says Professor Laetitia Rispel, head of the School of Public Health at the University of the Witwatersrand.
In a May statement, Hospital Personnel Association of SA (Hospersa) general secretary Noel Desfontaines said it is alarming that the DoH is not filling these vacant posts. The report says Hospersa has raised the staff shortage issue with the DoH on numerous occasions “with little response.”
South Africa also has an ageing nursing population with approximately half of all licenced nurses over 50, with only 5% under 30. “There will be a critical shortage of nurses in the near future when all the skilled professionals, teachers, managers and clinical specialists retire,” says Dippenaar in the report.
Then there are the working conditions – believed to explain why an estimated 18% of South Africa’s registered nurses don’t practice. The report says working conditions were found to be so poor at public health facilities that the Department of Labour issued the DoH with a Section 7 notice over Occupational Health and Safety contraventions late last year. “The report showed dismal results from the first round of inspection where the overall compliance for the country was rated at 22%,” Hospersa says.
Dippenaar says the challenges facing the profession are further influenced by the shortage and uneven distribution of doctors between sectors, provinces and urban rural areas, compounded by a shortage of resources.
The report says at the end of 2016, SANC had 21,339 student nurses and 287,458 registered nurses – the latter up from 203,948 in 2007 (46%). In the same period, the population grew from 47,850m to 55,909m (16%). The ratios have improved – but with only 5.14 nurses per thousand people in 2016, South Africa is still well below global averages.
The report says there is clearly an urgent need for changes to the current situation regard training, accreditation and licensing. Creating a favourable workplace environment would also go a long way towards keeping professional nurses in their posts.
SANC was given an opportunity comment and hadn’t by publication, report says.
The Eastern Cape Department of Health is, meanwhile, in the process of training more than 350 nurses at the Lilitha College of Nursing. Health-e News reports that the college has campuses in Mtata, East London, Port Elizabeth and Lisikisiki at Ngquza local municipality where hundreds of Lilitha Nursing College students graduated last year.
Provincial spokesperson Sizwe Kupelo said the department was hoping to improve the quality of healthcare in the province. “We are trying to ensure that we produce nurses of high quality. We are faced with severe shortages and are pleased that Lilitha produces more qualified nurses every year than any other training facility.”
Kupelo said training was done all over so that province could produce well trained, disciplined nurses passionate about helping their patients. He said the Lilitha College of Nursing has been allocated R307m for training.