The nursing profession is facing many challenges and problems. Nurses in South Africa are confronted by unsafe working conditions, burn-out and inadequate resources in the workplace.
South Africa has a total of 3 816 public healthcare institutions. The Office of Health Standards Compliance (OHSC) conducted inspections at 969 (25%) of the healthcare institutions across South Africa for the period 2016-2017 to determine whether they complied with basic health standards. The results for only 852 institutions were released (reason unknown). Only seven (1%) of the institutions complied with health standards with a score of more than 80%, and 32 (4%) institutions complied with health standards with a score of 70 – 79%. A further 87 (10%) conditionally complied with standards, while 194 conditionally complied but with serious reservations, and 308 (36%) did not comply with basic health standards with results of 40 – 49% in the assessment. 224 (26%) institutions were critically inadequate with regard to health standards, with scores below 40%. A total of 62.4% (532) of healthcare institutions therefore did not comply with the basic measurements of health standards.
The issue of poor working conditions has reached the stage where the Department of Labour in 2016 issued a section 7 notice to the Department of Health concerning occupational health and safety violations. Virtually no feedback in this regard has been received from the Department of Health.
Enrolled nurses provide limited nursing care, while enrolled nursing assistants perform basic procedures and general care of patients. These two types of nurses should be supervised by registered nurses, who also have their own duties.
The following aspects are highlighted with regard to the poor working conditions of nurses:
- Problems with management, accountability and lack of decision-making.
- Financial shortages and bad policy.
- Serious staff shortages (in particular specialist nursing staff) and resources.
- Increasing work loads, resulting in inexperienced staff often having to perform medical procedures that should have been performed by a more senior staff member.
- Concerns about nursing training and nursing skills. Poorly trained colleagues.
- High levels of responsibility.
- Infrastructure and equipment that sometimes are in a critically bad condition.
- Constant shortages of supplies and medication.
- Physical health and safety.
- The perception that their work is not appreciated.
- Poor remuneration.
It is common knowledge that nurses are earning low salaries. Lower categories of nursing staff are poorly paid and have to work very long hours in often demanding and inadequate working conditions. This is the case especially in the public sector and also in rural areas.
Professional nurses with a degree qualification may expect a starting salary of approximately R18 000. They are required to make decisions on life and death and to work 12-hour shifts over a period of seven days. The result is that many nurses have to “moonlight” and work shifts in the private and the public sector to augment their income.
*This article is an adaptation of Solidarity Research Institute’s report on the shortage of nurses in South Africa by Nicolien Welthagen.