Nursing in crisis

Nursing is in crisis, with huge shortages, declining interest in the profession, lack of a caring ethos and an apparent disjuncture between nurses' needs and those of the communities they serve.

This is according to Wits University's Professors Laetitia Rispel and Judith Bruce writing in the SA Health Review released last night. While 133 127 professional nurses are registered with the SA Nursing Council nationally, only slightly more than half (68 105) work in public health.

Yet nurses are the backbone of the public health system. By 2010, the Health Department estimated that the country was short of over 44 700 nurses yet we are only training around 3 500 new nurses a year.

The shortage has resulted in a rise nursing agencies to provide temporary nurses, which the authors describe as a worrying "casualisation" of the workforce.

Between 2005 and 2010, provinces spent R1.5-billion on agency nurses to supplement shortages. Yet hospital managers reported that agency nurses often provided sub-optimal care to patients, were uncooperative, had poor relationships with doctors and were "reluctant to perform certain nursing interventions".

The acute shortage of skilled intensive care unit (ICU) nurses meant that these nurses are much more likely to "moonlight" for other institutions than any other category of nurses. In a survey of over 3 700 nurses, over a quarter (28 percent) reported that they had "moonlighted" in the past year, with 70 percent saying that they did so because they needed more money.

Over half reported being "too tired to work", while almost a third - mostly women aged 25 to 34 - planned to quit their jobs within a year. Over four in 10 (43.7 percent) nurses are over the age of 50, and younger women are less inclined to become nurses.

In addition, as primary healthcare has been prioritised, more nurses are required to work in clinics rather than hospitals yet many report sub-standard working conditions. Nursing managers at the clinics said staff shortages was one of their biggest problems and it resulted in long waits by patients.

This was followed by delayed emergency medical services for patients, and poor infection control linked to interrupted water supply. In addition, "several layers of bureaucracy" involving the clinic supervisor, area manager and district manager meant that clinic managers did not have decision-making powers.

This "stifled their work environment" and contributed to "a great deal of personal distress". The fact that South African Nursing Council "is largely dysfunctional" as a regulatory body and provides "sub-optimal leadership in policy development and implementation", does not help the plight of nurses.

The authors conclude that revitalising nursing requires concerted efforts by government and key stakeholders to improve and modernise resources for a positive work environment.

Health-e News Service, 21 October 2015