June 2017, Modern Medicine.
South Africa has a dire shortage of registered nurses, yet those wanting to enter the profession are now finding a closed door. 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. To add fuel to the fire, working conditions discourage retention.
The looming crisis
The looming crisis began with a sweep of nursing college closures and mergers in the late 1990s, according to Health Systems Trust training unit technical advisor Dr Joan Dippenaar. This led to significantly fewer nurses being trained in State facilities.
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 old curriculum continues in public training facilities until 2019. 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 points out in her paper here: “The new curricula are yet to be approved.” Until SANC, together with government, finalises and publishes updated scopes of practice, the new qualifications can’t be offered.
The situation, according to Moneyweb, 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. Hospersa has raised the staff shortage issue with the DoH on numerous occasions “with little response.”
South Africa also has an ageing nursing population. Approximately half of all licenced nurses are 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.
Then there are the working conditions – believed to explain why an estimated 18% of SA’s registered nurses don’t practice. 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.
Thousands more nurses needed
In her paper, Matlakala noted that the health system was short of 20 815 nurses in 2015. There is clearly an urgent need for changes to the current situation regarding training, accreditation and licensing. Creating a favourable workplace environment would also go a long way towards keeping professional nurses in their posts.