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Many healthcare facilities are lacking in the necessary resources and equipment that nursing staff require to provide quality care to patients, rendering them inadequate to perform their duties, writes Hester Klooper.
Nurses, who form the largest part of the healthcare workforce globally, play a crucial role in providing healthcare services, from basic nursing care to advanced and specialised care to critically ill patients, managing chronic conditions, and educating patients, families and communities about healthcare issues.
Nurses work in a variety of settings, varying from clinical, including hospitals, clinics, to the community, including schools, and homes, and their dedication and expertise are essential for maintaining the health and well-being of individuals, families, and communities.
Friday, 12 May, marked the birth anniversary of Florence Nightingale, who is widely regarded as the founder of modern nursing. On this day we also celebrate International Nurses Day. The day provides an opportunity to show appreciation for the hard work and dedication of nurses and to raise awareness about the challenges they face in their profession. It is also a time to recognise the contributions of nurses to the healthcare system and to society as a whole, as they advocate for the importance of investing in the nursing workforce to improve the quality of healthcare services for everyone. It is, therefore, fitting that the theme for 2023 is "Our Nurses. Our Future".
Nurse shortage
South Africa faces a shortage of between 26 000 and 62 000 nurses across the different categories, from nursing assistants to specialist and advanced practice nursing professionals, in both the public and private healthcare sectors, with the gap expected to grow to between 131 000 and 166 000 by 2030, according to Netcare.
Exacerbating this shortage are a myriad of challenges facing our country's nurses. More recently, it was reported that just over 21 000 nurses deregistered after failing to pay annual fees to the professional regulating body, prohibiting them from practising, and this amid the nursing shortage crisis highlighted during and after the Covid-19 pandemic.
Well-trained nursing professionals are critical, and when capping on numbers of students either by the professional body or by the limited placement opportunities in the clinical settings, ensuring adequate training of nurses becomes another common challenge. This can lead to a lack of confidence due to inadequate knowledge and poor competency levels to deliver quality care.
Studies conducted in several countries across the globe provide evidence that the better a nurse is trained, the better the patient outcomes. There is a direct correlation between more degree nurses in practice and less adverse events for patients being reported. In addition, the serious shortage of specialist clinicians in Trauma, Intensive Care, Neonatal ICU, Cardiology, Pediatrics, Psychiatric and Mental Health practitioners should immediately be addressed by providing opportunities to professional nurses who wish to specialise.
Many healthcare facilities are lacking in the necessary resources and equipment that nursing staff require to provide quality care to patients, rendering them inadequate to perform their duties. The fact that almost 82% of South Africans rely on public healthcare that is already underfunded and under-resourced places a disproportionate burden on nurses.
Long-term planning
These challenges seem insurmountable because one organisation or advocacy group or university can’t solve them all in isolation. To make progress in solving the nursing crisis, it is important to address these underlying factors and work towards comprehensive, long-term solutions that support the nursing profession and improve patient outcomes. This will require a multi-stakeholder approach involving government, the private sector, healthcare organisations, universities, nursing colleges, NGOs and professional associations.
In some instances, there may be a lack of political will to invest in healthcare and address the underlying issues contributing to the nursing crisis, perhaps because these challenges aren't prioritised given that we are struggling to find solutions to other societal problems such as poverty, unemployment, load shedding, failing infrastructure, corruption, joblessness, and crime.
Solving the nursing crisis requires long-term planning and investment and addressing it is essential for three reasons. Firstly, nurses are at the forefront of patient care, and their expertise and skills are essential to ensuring the delivery of quality care. Without enough adequately trained nurses, patients may experience longer wait times, delayed treatment, and reduced access to care, all resulting in negative patient outcomes.
Secondly, addressing the nursing crisis is crucial for the sustainability of the healthcare system. The shortage of nurses puts strain on the total system and can lead to compassion fatigue, moral distress, burnout and a high turnover rate, which can exacerbate the problem and make it difficult to retain experienced nurses. This, in turn, can lead to a cycle of negative staff outcomes like shortages that further strain the healthcare system.
Finally, addressing the nursing crisis is a matter of social justice. Nurses often work in challenging environments, and the lack of investment in their profession can lead to poor working conditions and low salaries. This often results in vulnerable communities and low-income individuals, especially those in rural areas, who cannot afford alternative healthcare options being deprived of the quality healthcare they so desperately need. Quality accessible healthcare is a basic human right.
There are, however, some immediate actions that can be taken to address the challenges the profession and nurses face.
Salaries and working conditions
Salaries and working conditions must be improved to make the profession more attractive and to retain existing nurses. We need to invest in the training and education for all categories of nurses to improve the quality of care they provide as well as boost their knowledge, confidence and competence. We also need serious investment to expand the number of degree-prepared nursing professionals, as well as the various clinical nursing specialists.
Healthcare facilities can increase resources, including equipment, supplies, and staffing, to provide quality care to patients. The government can address health inequalities by investing in healthcare infrastructure and programmes that reach marginalised communities. Nursing organisations and advocacy groups can raise awareness about the challenges facing nurses and campaign for policies and programmes that support the nursing profession and improve patient outcomes.
From a higher education perspective, I believe that through education, training, research, innovation, clinical practice, and advocacy, tertiary institutions play a critical role in supporting nurses in delivering high-quality care. Universities should establish and support nurse-led research programmes that provide solutions to improved patient outcomes as well as positive staff and organisational outcomes.
Addressing the nursing crisis in South Africa is essential for ensuring the delivery of quality healthcare, the sustainability of the healthcare system, and social justice. By investing in the nursing profession and advocating for policy changes that support it, as well as improving working conditions and resources, we can work towards a healthcare system that provides equitable, safe and accessible healthcare for all.
- Prof Hester Klopper is Deputy Vice-Chancellor of Strategy, Global and Corporate Affairs and a Professor in the Faculty of Medicine and Health Sciences at the Stellenbosch University.
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