At the heart of the South African healthcare system is the nursing paradox, where the profession is simultaneously experiencing a shortage in personnel and a glut in unemployed nurses.
It is harming the industry, and it has been around for decades. The resolution will arrive through cooperation, better planning and time spent listening to nurses.
In a panel discussion at the Hospital Association of South Africa Conference in Cape Town, Professor Laetitia Rispel of the University of the Witwatersrand explained what was causing the paradox. There is a misalignment between planning and policy bureaucracy in the public sector.
Currently, there are 271,047 registered nurses in South Africa, and while this number has grown over the last decade, there is a predicted shortage of up to 162,000 nurses by 2030. South Africa also has 10,000 frozen nursing vacancies.
But both Rispel and fellow panellist Professor Hester Klopper, the Deputy Vice-Chancellor at the University of Stellenbosch, said more data was critical to understand the problem better.
An example of the nursing paradox, said Rispel, is seen with the funding of community nurses in the different provinces, which depends on the provincial health department having to negotiate with their treasury to get the money for additional posts. If this is not successful, those posts will be unfilled.
“So it means then, that you cannot absorb those young people, once they finish their community service, because they have to make ways for the next group,” Rispel explained.
One way of addressing the surplus of unemployed nurses, according to Klopper, is to look at new models of care.
“Taking nurse-led care to the communities, using qualified nurses in those spaces and allowing them to set up private practices,” she explained. The problem, Klopper added, is that the cracks in the healthcare system are showing after decades of attempted reform.
“The answer will be in strong leadership coming together, getting the data, looking at all aspects around the system, working together, both with our legislation and the government. But that will need a concerted effort,” she said.
Rispel said it is time for organisations like HASA and the trade union The Democratic Nursing Organisation of South Africa (Denosa) to apply pressure.
“The kind of pressure to implement solutions that we know already exist. Because we don’t need another study, that is just the typical South African syndrome,” said Rispel. These solutions could be in the form of a scaleable pilot study.
Both professors believed in lifting restrictions limiting the number of trainee nurses at institutions. Another issue plaguing the nursing profession is the flight from the industry, as many either head overseas or leave. It is a problem, said Klopper, related to nurses wanting a better work-life balance and pay.
“So I believe that the retention strategies will have to involve good leadership, it is about the work environment, it is about failures to the value of what they bring to the table.”
A solution is looking at different models where nurses may work shorter shifts, argued Klopper.