Professional nurses and midwives are often referred to as the backbone of the health system and it is well documented that there is a global shortage of these medical practioners and primary healthcare professionals in South Africa.
In the Western Cape there are 9 500 nursing posts, of which about 1 700 are unfilled. This is grossly untenable as patient care is compromised. When the government implemented the occupation specific dispensation (OSD) salary increase system, whereby nurses and midwives in specialist areas such as critical care receive higher increases than their managers, a can of worms was opened. The new system encourages nurse and midwife specialists to stay in their clinical fields but their social standing and skills recognition have not been addressed.
It is now time for government to support nursing and midwifery specialists by offering them registrar and consultancy posts in the clinical facilities, similar to doctors who start postgraduate studies but stay in their clinical facilities. These doctors are taught while they become specialists and the same should hold for nurses and midwives who want to advance their careers.
This advancement should take the form of a two-year registrarship for nurses or midwives who stay in their job but do a master’s or advanced specialist diploma. There should be a four-year registarship for a nurse or midwifery specialist undertaking a PhD. On the completion of these qualifications, they should be recognised in the clinical field as specialist consultants. The provision of specialist consultants will enhance the quality of care in rural areas and could lead to a reduction of maternal and neonatal morbidity and the mortality rate.
There are only a handful of advanced practitioners in the midwifery obstetric units (MOU) or primary healthcare (PHC) facilities’ clinical settings. It is recommended that each MOU and PHC facility has at least two lead clinical specialists (advanced graduate) and one nurse consultant (PhD graduate) on duty per shift to ensure quality and safe care to the public.
There are few nurse specialists (advanced qualifications) or nurse consultants (PhDs) in hospitals and clinics.
As the scope of a consultant is broader than that of a junior midwife, he or she would be in a position to care for the emergencies that surface in these units. The importance of acknowledging these specialists will enable them to use their critical and analytical skills and competencies to deliver quality care to their patients. There should be no distinction between the social status of the nurse or midwife consultant and the medical consultant. Both should deliver care to the patient and decisions regarding the patient’s health should be made in consultation (team decision) and not in isolation (doctor’s decision only).
The implementation of lead clinical specialists or consultants at all levels in a clinical setting will allow for a recognition of the distinguished value that nurses and midwives contribute to nursing and midwifery science and will retain nurses in the clinical settings.
To faciliate the postgraduate studies of nurses and midwives, traditional classroom teaching has to be transformed to meet the needs of rural students. Innovative technology-driven methods need to be implemented and curricula must accommodate the agenda for the global community (such as HIV) without jeopardising the specific needs and aspirations of the rural and urban groupings (such as alcohol foetal syndrome).
The provision of postgraduate programmes that address the realities and complexities of the global marketplace and the specific rural area is long overdue.
Nursing institutions need to adopt an andragogical (engaging adult learners in the structure of the learning experience) approach to teaching so that we can meet the demands of the mature adult learner. There is evidence that the development of appropriate content, teaching methods, modalities and context can impact on the knowledge, skills and care provided by health professionals.
A blended range of educational products (text-based materials and activities on WebCT, DVD and interactive telematic education satellitebased platforms) need to be implemented to attract and recruit a higher volume of student nurses from a broader social, geographic and academic base to engage in advancing their careers. The anticipated implementation of continuous professional development before nurses can re-register is important in that they continue to advance their career. To practise evidence-based nursing the nurse needs to stay abreast with her knowledge and skills.
The days of the bedside “nursie” are gone. Nurses need to be transformed from the image of a traditional “bedside nurse worker” into a “lead clinical nurse consultant” through blended teaching methodologies. Furthermore, to enable nurse academics to train clinical nurse consultants we have to transform the current “traditional nurse academic” into an “internationally renowned consummate nursing professional scholar and researcher”.
Dr Cheryl Nikodem has accepted a post as professor of nursing in the division of nursing at Stellenbosch University’s Tygerberg campus. She is one of a handful of National Research Foundationrated nurse/midwife researchers in the country