Our standards of training for nurses are very high — all you have to do is look at how our nurses get poached by other countries to know that. And whether trained in the public sector or private sector, when they get into their new positions overseas, they stand out.”
Dr Sipho Mkhize is more than qualified to talk about training nurses. He trained as one, then did a degree in nursing education. He’s taught at a nursing college, worked on the Nursing Council, been Principal of Excelsius Nursing College in the North West for 11 years, and is national chairperson of College Principals and Academic Staff (CPAS). The training of nurses in South Africa stands at a crossroads at present.
In 2008, the National Department of Health commissioned a consultancy to audit all facilities where nurses are trained. At the same time, from next year, there are proposed new qualifications in play for nursing. These qualifications must be aligned with the National Qualifications Framework Act of 2008.
Dr Mkhize says that the nursing colleges hold a special place in his heart, and indeed are vital if the country is to provide the nurse practitioners needed. At this time of reassessment and change, he will be bringing a special plea to the National Nursing Summit: Declare the nursing colleges institutions of higher learning. This would put them on a level footing with the universities and facilitate the consolidation of the college diplomas and the university degrees into one qualification, a Bachelor degree in nursing.
“The universities fall under the Department of Education and thus are higher education institutions, but the colleges do not, and so they are not classified as such. But they could be: according to Section 21 of the Higher Education Act, a college can be declared a higher education institution.”
The removal of difference between the two qualifications, he says, is a key issue: “It affects how the public views nurses, as well as how they are treated by their employers.” And let us remember, he says, that this feeds into conditions of service — one of the vital factors that trigger professional migration.
Consolidation makes perfect sense: “Both the university-qualified nurse and the nursing college student do four years of basic training and study. When they graduate, both are called professional nurses.” In the future, the public colleges should also be allowed to generate and retain their own revenue. This facility would help them cope with day-to-day expenses, but it would also enable them to seek grants and other funding.
Upgrade facilities
As a college principal, Dr Mkhize is passionate about the colleges, which are able to handle not just basic nurse training, producing the ‘foot soldiers’ of nursing (staff, professional and midwife nurses), but also specialisation thereafter. Once they’ve have been declared institutions of higher education, says Dr Mkhize, the next priority is to speed up the revitalisation of the colleges — always bearing in mind that this will require funding.
One way of making sure this happens, he says, is to declare the colleges a national competency rather than a provincial one. At present, the colleges are unevenly funded because of disparities between the provinces — yet, as Dr Mkhize points out, the colleges are all supposed to be supplying a national need and meeting the same standards. “We really need a clear, unambiguous funding model for public nursing colleges.”
There should be no differences between the kind of training a student receives anywhere in the country — it should all meet a National Clinical Teaching model of work-integrated training that is uniform and teaches the same competencies across the board. In practice it doesn’t always work like this: Dr Mkhize says each university trains nurses according to their own idea of what is needed, while in some provinces there’s no university for the local colleges to work with (for example, the Northern Cape).
“A critical issue is upscaling the training of nurse educators,” he says. “In some provinces, they are trained through distance education, but is that proper training to be a nurse educator, who should be trained in practice as well as theory?” He calls for the reintroduction of clinical receptors and mentors to assist students during work-integrated training, too. “We need extra manpower to accompany the students as support.”
The status of a student nurse urgently needs to be clarified: is she a worker and student, or a senior student? A declaration of students’ status would ensure that funding was the same for all students — and that would help to avert strikes.
Dr Mkhize feels that there’s a missing link in the system: a nursing cluster at the National Department of Health. “This would provide a link between the Department of Health, the Nursing Council, those working in education, those in practice, and even organised labour.”
College successes
“With all their constraints,” says Dr Mkhize, “the nursing colleges have succeeded in producing nurses according to their mandate.”
He compares enrolment figures from 2001 with 2010:
Nursing auxiliaries: 273 — 898
Staff nurses: 1058 –2314
Sisters: 1634 — 2337
“I am very jealous of my colleges,” he says with a laugh. “Believe you me, the colleges are, and will remain very important!”