a) A total of 72 posts are attached to both the Maternity Ward and the Neo Natal Ward, allocated per category type as follows: There are 45 Professional Nurses (PNs) of which 27 are assigned to the Maternity ward, this number includes 2 PNs already issued with job offers and are expected to resume duty on the 1st of August 2020. There are also 17 Enrolled Nurses (ENs) and 8 Enrolled Nursing Assistants (ENAs), of which 8 ENs and 5 ENAs are allocated for the Maternity ward. Currently there are no vacant posts that exist in the maternity Ward.
The Hospital fills replacement /vacant posts within 30 days when they became vacant, especially in the Medical and Nursing(clinical) departments. The Hospital also utilises the service of a Nursing Agency to provide nursing personnel to alleviate pressure in critical areas.
However, it needs to be mentioned that the Hospital was a day hospital, that has since been upgraded recently to a Regional Hospital. A new Organisational Structure has been finalised and approved for the package of care for a Regional Hospital, and a phased-in approach for filling of the posts is being pursued dependent on the available budget. This has not been realised currently, and the Hospitalcontinues to operate with an inadequate structure for the level of care to which it is upgraded.
b) (i) (ii) (iii)
CORRECT DESCRIPTION OF NURSING CATEGORIES IN SOUTH AFRICA
There are three categories of nurses as follows:
- Professional nurses /midwives (also called nursing sisters)
- Enrolled Nurses
- Enrolled Nurse Assistants
PRODUCTION OF NURSES
The training of midwives has been ongoing. Since 1986, all nurses doing the Bachelor degree programme in nursing, offered at universities, as well as the 4-year diploma programme in nursing, offered at nursing colleges, completed their training with a qualification as a midwife. The trend in output of both these nursing programmes, which produced professional nurses (with a midwifery qualification) is as follows:
- 3 528 in 2016,
- 3 322 in 2017 and,
- 3 564 in 2018.
It is envisaged, that this trend will continue in the following years until the teach-out period is reached in 2024.
Additional numbers of professional nurses were produced through the 2-year Bridging programme. These nurses could go on to do the 1-year diploma in Midwifery, which was offered.
In addition, the Department of Health prioritised midwifery by accrediting five provincial nursing colleges to take an additional intake in the second half of 2019 in order to increase the production of 4-year Diploma programme nurses (who will have midwifery as a qualification) and prevent shortages during the transition to higher education in 2020.
Production of enrolled nursing auxiliaries and enrolled nurses were through the old legacy of both one year and two-year programme, respectively. An overproduction of these categories resulted in many of these nurses not being employed over the last ten years. According to a survey by the South African Nursing Council, up to 60% of these nurses were not employed after completion of their studies.
The abovementioned basic nursing programmes, will be phased out by 2024 and replaced by the new nursing programmes as follows:
- Bachelors degree Nursing & Midwifery National Qualification Framework (NQF) level 8 started 2020
- Advanced midwifery NQF level 7 which will be phased in from 2021
- Diploma in Nursing NQF 6
- Higher Certificate nursing NQF 5
The above information shows that the shortage of nurses is not due to a lack of production of nurses.
OFFSETING OF SHORTAGES
On an Annual basis, a minimum of 3500 Community Services Professional Nurses joins the Public Health Sector, distributed across Provinces, mainly in rural and underserved areas where it is difficult to recruit.
During the period, January 2020 to 30 June 2020, 7393 Nurses were added to the Public Health Sector, which reduces the vacancy rate in the Nursing field with 27%. This is a giant step taken by the Public Health Sector to reduce the number of unemployed nurses to assist in managing, amongst others the Covid-19 pandemic.
The challenges observed amongst others include:
The lengthy time span it takes to fill vacant posts.
The non-appointment of community service nurses post their community service training due to budget constraints.
RESPONSE TO ALLEVIATE THE CHALLENGES
The Minister of Health, Dr ZweliMkhize, issued a directive in April 2020, instructing that the recruitment process should be shortened by advertising a post and effecting appointments within a period of a week, on condition that an appointment may be set aside depending on the outcome of personnel suitability checks and verification processes.
Since 2019, Province are expected to develop their Annual Human Resources Plan that includes recruitment plans making provision for the continued appointment of community services nurses post their community service training period. Since Covid-19 surge, a National Data Base System has also been created at the National Department where all unemployed health professionals including nurses are capture. Province have been given rights to access the database when required.