The Minister of Health, Dr Aaron Motsoaledi, has emphasised that the nursing profession should work towards restoring the ethical standards for nursing that were taken for granted and applied assiduously by nurses three and more decades ago, but have since been eroded and are rarely applied nowadays.
Catherine Makwakwa, a retired nurse, former principal of the Garankuwa Nursing College near Pretoria and former international health liaison director in the department of health, was assigned the task of collating information from various sources, as well as input from nurses around the country, for the purpose of establishing guidelines as to how this goal might be achieved.
“It is a very tricky and complicated problem and will not be quickly or easily solved,” she says. “It is a common cry in this country that nurses are not as caring as they used to be. The ethics and values of nurses are very key to correct caring. When you care, you must care with compassion, commitment, love and respect for human dignity. You must also have ordinary good manners.
“There are many reasons why nurses have lost these qualities. But nurses can’t be dealt with in isolation; they are a product of the society. There is a general concern about moral degeneration in the country, which has led to poor service delivery in general.
“One of the misconceptions that many people have is the human rights approach, where responsibilities are not linked with these rights. In the nursing profession the patient’s rights are key, and the problem is how to balance those with the rights of the nurses.”
Makwakwa is among those who believe that nurses’ ethics can be re-instated into the profession so that they again become part and parcel of the way nurses conduct themselves in the course of their work. But there are stumbling blocks to be overcome in achieving this.
As part of the search to find answers, the Nursing Summit’s organising committee conducted a series of consultations with nurses in all nine provinces of South Africa during February and early-March this year.
“We had a one-day consultation in each province, meeting around 200 nurses each time, covering all categories of nurses, including organised labour and retired nurses,” Makwakwa explains. “The outcome of this is that nurses contend that their rights are overridden by patients’ rights and community rights. Patients’ rights are exhibited on notices on hospital walls, but those of nurses are not.
“They also point out that due to widespread unemployment many people enrol as nurses because they need the money and not because they have any personal commitment to nursing. “Also, they talk about the fact that the image of the nurse in the community is not very good. They suggest that nurses’ uniforms should be the same across the country so that nurses are more easily recognised and identified as such, which would contribute towards them gaining more respect from the general public.
“A further problem they point out is that many nurses do moonlighting to earn more money and so come to work exhausted, resulting in them having a less positive attitude and neglecting their duties. It affects teamwork because the other nurses have to carry the load.
“The trade unions emphasise the need for service level agreements to be signed between employers and the trade unions throughout the country to ensure that strikes are properly managed. In the old days nurses couldn’t strike. Now it’s a constitutional right, so it needs to be managed to ensure that patient care isn’t undermined during the strike. Presently, service level agreements apply in some provinces but not in others.”
Further causes of the erosion of nurses’ ethics during the last two to three decades, Makwakwa says, include the fact that nurses are often not sufficiently recognised for their skills and not remunerated well enough, they are frequently overworked due to shortages of staff and in many instances the level of support to enable them to carry out their duties properly is lacking.
“These factors all combine towards lowering their morale,” she comments. She concludes: “We are going to address the key moral and ethical issues of the nurse and the nursing profession today. This will be in line the human rights approach, encompassing both patients’ rights and nurses’ rights and responsibilities.
“We will come out with a nursing compact in line with the resolutions we will be agreeing upon at the Nursing Summit and then set out an action plan.”