Healthcare a pillar of society
Nurses are a valuable resource,” says Department of Health Director General Precious Matsoso. “They are a pillar of healthcare. If we are to get on top of our healthcare goals, we cannot do so without the nurses.”
A National Nursing Summit will be held on 5 to 7 April this year in Sandton, with the stated aim of “reconstructing and revitalising the nursing profession”.
The DG explains how the Department of Health is tackling a broad range of issues that affect the nursing profession, from training to practice to research to infrastructure. The nurse practitioner around the world has experienced a decline in image and respect.
This is true in South Africa as well: over the last few years, bitter labour actions have red-flagged working conditions of the profession; and an audit of nursing colleges presented last year offered food for thought about training, as well as the status of the profession. So the Department of Health planned a series of face-to-face consultations with nurses in every province.
“We thought it would be good to hear the nurses’ voices; after all, if we are going to address the problems within the profession, we must first find out what they are and acknowledge that they exist,” says Ms Matsoso. Over a couple of months early this year, the Department listened to the concerns of about 1 800 nurses across the country.
“We found that the nurses had a number of common problems.” The way the Occupation Specific Dispensation had been implemented came up frequently during consultations. There was unhappiness about the practice of moonlighting (where nurses in the public sector take on additional shifts in the private sector to earn more money); this was seen to be detrimental to patient care.
Adequate resources were not always available, not only in terms of equipment and supplies, but also staffing and the proper mix of skills in a facility. Disparities between institutions of learning have raised a lot of concerns, as has the lack of oversight which has seen some students taken for a ride by ‘fly-by-night’ private schools.
The themes seemed to be about recognition (not just in terms of remuneration), respect, resources and training.
“Our overall aim as a department is to improve the quality of healthcare for South Africans,” says the DG. “Quality is a culture, a way of life, but it needs a champion. We see the nurse as an important player in this, one with huge potential to turn things around. So we have to urgently address these problems.”
Through the Office of Health Standard Compliance quality of health provision at facility level will be enhanced. Nursing training has, historically, focused heavily on a caring ethos. “If we bring back the patient-centred value system, we can reduce the burden of disease and reach our other goals, such as providing effective primary healthcare.”
The first part of call is a human resources strategy, she says. “This is a very labour-intensive sector and therefore it needs adequate numbers of qualified and properly trained nurses—at all levels. We need the staff nurse, but we cannot do without the specialised nurses, like the midwifery nurse.”
Training is, of course, central to providing the qualified and accountable personnel. The DG says that the Department wants to see undergraduate training incorporate principles of social accountability, and is working with the World Health Organisation on this. But training new nurses is not the only approach to ensuring adequate staffing.
South Africa has long produced an outstanding calibre of nurse, but we have lost a significant number to jobs in other countries—a common plaint in the healthcare sector around the world, as the DG points out: in every country where the teaching turns out good healthcare practitioners, there is a problem with migration to other countries.
“By reconstructing and revitalising the profession in South Africa, we believe we can attract nurses back to the country,” says the DG. “In addition, there are a number of retired nurses whom we can draw on as a resource to support up and coming nurses.”
Boosting nursing’s image
Public confidence in the nursing profession has suffered damage, not only due to unfortunate incidents during strikes, but also due to a lack of recognition of the nurse’s knowledge and skills. “Nurses actually do up to 10 years of training,” says Ms Matsoso.
“Their first four years—whether at college or university—are followed by a number of years where they study to collect ‘bars’ which represent training in a particular speciality—community health, ICU or psychiatry, for example. Nurses want recognition of the extent and depth of their basic training, but also of the breadth of the qualifications gained after basic training, which should be recognised at the same level as other post-graduate training.”
Another related factor that has impacted on the profession’s image is the overloading of nurses which has occurred in recent years. “Any policy that has been developed, we’ve tended to say, OK, nurses can do it,” says the DG.
“But what does it mean if we constantly add to their role without changing their scope of practice, without incorporating such changes into training, without consultation, without recognition?”
The result, she says, is an overburdened and under-recognised nurse. “It’s essential to design support into the system whenever we consider adding to their roles.” That’s why the upcoming National Nursing Summit will be thrashing out a scope of practice for nurses.
The nurse in primary healthcare
Primary healthcare (PHC) has long been a national goal—if it can be offered widely, it is an effective form of healthcare, one which also helps to meet budgets by avoiding overdependence on expensive tertiary healthcare institutions. The nurse is seen by the Department as absolutely key to this goal, and in fact is the healthcare practitioner who has always been integral to PHC.
“Historically, nurses have done community health services—for example, it was nurse-led teams who would do follow-up visits to new mothers at home. It was nurses who did the contact tracing when a new tuberculosis patient was diagnosed—they would be the ones getting the whole family to come in and be checked for infection.
It was nurses who went into schools to check ears, eyes and teeth, picking up problems before they became illness. This is the concept we will be bringing back. And the nurse will be right at the very centre of it.”
Ms Matsoso says the National Nursing Summit is a first step down the road to revitalisation. This important meeting will see stakeholders come up with a road map for the next steps, and, she says, action must and will result.
“This must be for real; we will start to take the actions we decide on from the day the summit ends.” The end result, she hopes, will be a proud profession re-energised. “I would like learners at school to see nursing as THE career of choice.”