A profession in need of a cure

Chronic staff shortages, bad working conditions, inadequate training, lack of professional ethics — no one is in any doubt that matters are critical in the nursing profession.

The current estimate of the staff shortage in the public health sector is around 40 000 vacancies. Private hospitals fare better, but things are not rosy.

What is being done to improve conditions in hospitals to help nurses render a more professional service? After all, nursing is a profession. Yet many witnesses can attest to a general apathy and, in some cases, a total lack of professionalism.

Mpumalanga’s health and social development MEC, Dikeledi Mahlangu, spent her Easter weekend visiting hospitals around the province posing as a patient. She discovered that nurses, porters and others do not meet professional standards and the state of healthcare provision is in dire need of an overhaul.

Tshwane District Hospital, visited by the Mail & Guardian in March, echoed this general don’t-care attitude. Nurses were rude and unhelpful, bleeding patients were left unattended, their blood dripping on the floor. In general any answer directed at staff was rudely answered often with a shoulder shrug.

Nurses work long hours. This has always been the case. But in conditions that leave a lot to be desired, such as not having the correct equipment (or not being able to use clean equipment), these long hours take an extra toll.

And when too many patients line up for too few beds, the challenges can seem insurmountable.
Then, of course, the wage issue becomes more important as nurses feel that facing these challenging conditions should be better rewarded.

According to the department of health, 27 priority hospitals were identified as needing help in particular areas to develop improvement plans.

The department provided support to these hospitals to help them turn bad conditions around in the short term. The results of these actions are yet to be seen.

Nurses who have had their fill of local conditions can work anywhere in the world. Some nurses spend a few months working in the United Kingdom and then return to South Africa to rest before going back to work overseas.

KwaZulu-Natal heal th MEC Sibongiseni Dhlomo said recently that there is a global crisis in the health workforce caused by the ‘poaching” of health workers by developed countries. He said that health professionals play a critical role in improving access to quality healthcare for the majority of people, who depend on public healthcare.

Democratic Nursing Organisation of South Africa (Denosa) spokesperson Asanda Fongqo said that the latest figures show a decline in the number of nurses leaving to work overseas.

‘We cannot become complacent, though,” he said. ‘We need a sustainable solution to our problems, of which the staff shortages, which lead to unmanageable workloads, with a lack of resources and poor remuneration, are key.”

Fongqo called for the reopening of nursing colleges that were closed. ‘We need more nurses than the system is training into the workforce.” He said that Denosa is taking very seriously the latest reports of the deterioration of professionalism in the nursing sector.

‘Professionalism is one of the most important components of nursing and our executive has decided to call for research to determine the factors playing a role in this regard and devise sustainable answers to this problem.”

Denosa is also in the process of reestablishing the Denosa Professional Institute to train and retrain nurses in this area. It is a programme being rolled out countrywide.

Addressing problems
From the government, the South African Nursing Council and the Health Professions Council to the private hospital sector, attention is being paid to the existing problems. Of these, low remuneration and poor working conditions top the list.

But issues associated with the nursing workforce are dynamic and complex because multiple stakeholders are involved. Each of them support the overall objectives, but the roads to the eventual outcome are varied.

State of training
The nursing profession is under siege by many fraudulent characters. Adjunct to this is the proliferation of illegal nursing training institutions giving training that is not recognised by the Nursing Act (1978) or the South African Qualifications Authority Act (1995), the two legislative pieces governing the nursing profession.

The South African Nursing Council warns that both nurses and employers should verify the status of the institution(s) providing training by checking with the council. Both the institution and the individual courses should be approved — sometimes the institution is approved but the courses offered are not.

In January there were 394 active approved nursing education institutions providing a total of 1 285 approved programmes.

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