"While this is a great compliment for our nursing professionals and also for our public and private healthcare system it is also one of the important reasons for the grave nursing shortage currently experienced within our country,” says Brannigan.
However, just how great is the nursing shortage and in what specific area is the shortage most prevalent? This subject has been under considerable scrutiny in recent times - so much so that there are at present great moves afoot to re-evaluate the current nursing status within the country. As part of the process, worldwide trends have been carefully studied. One particularly interesting international phenomenon, known as ‘task shifting', has caught the attention of the public sector and hospital groups such as Netcare and is now being explored by way of joint initiatives between the public sector and private hospital groups.
Brannigan explains that because of considerable advances in technology there are many tasks that were previously undertaken by registered nurses that can safely and easily be undertaken by less qualified staff members. “This will free up our registered nurses so that they can spend more time caring for unstable and complicated patients in need of specialised attention and, very importantly, utilise their critical thinking and team leadership skills to supervise the lower categories of nurses.
Typical examples of such tasks include operating electrocardiograph and blood gas machines, as well as routine interventions and treatment. Because of the very sophisticated nature of machinery and equipment these are becoming easier than ever to operate. Even a task such as ‘taking blood' is more technique-based than anything else. Many fairly time-consuming tasks can therefore successfully be delegated in the interest of greater efficiency and productivity.”
Brannigan says that the Department of Health (DOH) and the private sector have set up a joint task team - initiated by Dr Percy Mahlathi deputy director general of DOH to explore the more efficient use of nurses and revisit the nursing staffing ratios of registered nurses to the other categories. “A task team has already completed a highly successful pilot workshop in Gauteng during which the concept of ‘task shifting' was thoroughly explored.”
“As part of our pilot study we engaged with nurses asking them to evaluate all the nursing tasks and activities, in the light of the new draft regulations regarding the scopes of practice of the various categories of nurses. They were asked to provide us with an indication of what they believe the lowest level of competency would be for those particular tasks. A total of 80 registered and 80 enrolled nurses - in both the private and public sectors - were involved in the pilot study,” says Brannigan.
Initial indications from these two groups are that staff nurses could in fact complete many tasks that were previously thought to be strictly within the domain of the registered nurse. As a result of these workshops and their immense success the DOH, and more specifically Dr Percy Mahlathi, has agreed that the workshops should be conducted nationwide.
Within Netcare the ‘task shifting' nursing workshops have already been run with nearly 500 unit managers and senior nursing managers. “Our findings totally corroborated those of the initial workshops,” says Brannigan. “Some eleven odd years ago when Netcare first started out we agreed that our nursing ratios in the medical, surgical, and paediatric wards should be 30% registered nurses, 25% enrolled nurses and 45% nursing assistants, while in the intensive care units it should be 90% registered nurses, no enrolled nurses and 10% nursing assistants. However, over time the ratio of registered nurses has dropped due to factors such as emigration, closure of training colleges and retirement of nurses, and so, for example, we currently cannot meet these ratios.
“As you know we have been very concerned about the apparent shortage of registered nurses in our hospitals. However, since running the workshops we have in fact ascertained that perhaps the shortage of registered nurses is not as severe as we thought, provided we can train more enrolled nurses. In terms of the outcomes of the Netcare workshops it seems that at general ward level we may only need 20% registered nurses 40% enrolled nurses and 40% nursing assistants. In our ICU's we may only need 50% registered nurses 40% enrolled nurses and 10% nursing assistants, provided the various members of the team are competent. This was quite a revelation!”
“Having gone through the process and having studied trends throughout the world, we now have the situation where the perceived shortage of registered nurses is possibly not as significant as we had believed. We do, however, have a great shortage of the mid-level nurse, known as enrolled nurse at present but to be replaced by the more intensely trained staff nurse.”
“Going forward we are embarking on a comprehensive evaluation process to determine exactly what our shortages really are and what our training needs would be to reduce these shortages. My gut feeling is that we need to train a great many more staff nurses. Instead of encouraging them all to go on and train as registered nurses, they could achieve great job satisfaction by being enabled to specialise in their individual areas of interest as a staff nurse while remaining in South Africa.”
“Statistics compiled and released by the Nursing Council at the end of 2007 indicated that more than 42,000 of our current 107,000 registered nurses were over the age of 50 at that stage. We will therefore always be needing and always be training registered nurses, but a really viable solution is to also train and retain many more of these very important staff nurses,” says Brannigan.
The Nursing Council recently published draft regulations for the new scopes of practice for registered nurses, staff nurses and nursing auxiliaries within South Africa. This gives a clear indication that staff nurses or middle nursing staff should be given greater autonomy when it comes to the care of stable and uncomplicated cases.
Brannigan is in full agreement with this. “Netcare will be reviewing its training needs for 2010 in June this year. We will change our training model appropriately at that time. For now the intention is to continue with assisting to run the ‘task shifting' workshops countrywide and to extend these to non-governmental areas, for example old age homes, and primary care organisations such as government clinics.
“These winds of change are welcomed by the nursing profession in South Africa and will certainly assist with efficient, competent service delivery. Let's give our nursing professionals the space and time to deal with the "science and art" of nursing - this new model will allow them to grow in their profession, to spend more time with their patients and competently deliver the care our communities so desperately need and deserve,” implores Brannigan.
