SA’s pipeline for training specialist nurses has been virtually throttled by the government’s botched transition to new qualifications, data published by its key regulatory agency for nurses reveals.
The situation heralds a deepening crisis for public and private hospitals, which have for more than a decade battled to recruit specialist nurses in areas such as intensive and emergency care and oncology.
The situation is so grave that the government has sought to bolster numbers by including specialist nurses on its scarce skills list, a mechanism intended to smooth the way for employers to hire foreign nationals.
Universities and public nursing colleges have been given the go-ahead to train only 70 nurses seeking postgraduate qualifications in emergency care this year, along with 80 for oncology, fewer than 200 for critical care, and just 265 for midwifery, according to SA Nursing Council (SANC) data.
This is despite SA’s massive trauma burden and high maternal and infant mortality rates. Only 15 places are available to train nurses who want to specialise in critical care for children, 46 for nephrology and 80 for mental health. No nurses at all will receive specialist postgraduate training in the Eastern Cape this year.
These low numbers come after a two-year hiatus in the training of specialist nurses under the new qualifications, a plan that was supposed to kick off in 2020.
“We have a shortage of up to 62,000 nurses in all categories, and 50% of these shortages are in the professional nursing category. If the capacity to train is not increased, we will produce less than half the shortfall by 2030,” said Wits professor of nursing Judith Bruce, citing data from a report commissioned by the health department from the Hospital Association of SA and McKinsey.
She warned that the number of specialist nurses produced by nursing education institutions would be less than the number of approved places for 2023, as not all spots are taken up and the attrition rate can be as high as 20%. “This crisis will be felt for years to come if not addressed decisively and urgently.”
The government’s decision to introduce new qualifications in 2020 meant nursing education institutions had to acquire fresh accreditation from multiple bodies — the department of higher education & training, the Council for Higher Education, the SA Qualifications Authority and the SANC — before they could begin training specialist nurses on the new curriculum.
But red tape stymied their plans to such an extent that no new students could begin specialist nursing training in 2020 and 2021, according to Nursing Education CEO Nelouise Geyer.
Education for nurses is provided by universities, public colleges run by provinces, and private colleges such as those operated by JSE-listed hospital groups Netcare, Life Healthcare and Mediclinic. However, only universities and public colleges have been permitted to offer postgraduate qualifications in specialist nursing fields.
In addition to the higher education & training department’s delays in declaring public nursing colleges higher education institutions, the health department promulgated the regulations required by nursing education institutions to develop their curricula for the new specialist qualifications only in June 2020, six months after they were supposed to begin teaching, said Geyer.
Nursing education institutions had to obtain approval first from SANC and then from the Council for Higher Education.
“In spite of the commitments made by these two regulatory authorities to work together to speed up the accreditation process on many occasions, this has not happened,” said Geyer.
Asked why so few postgraduate specialist nursing training places had been approved by the SANC, its acting CEO, Jeanette Nxumalo, said the figures were based not only on the number of spots applied for by nursing education institutions but also on the availability of clinical facilities and mentors required to give students practical experience.
SA’s shortage of nurses is steadily getting worse, with the pool of health-care workers per capita shrinking even as the demand for services grows.
Population growth, an ageing population and a growing burden of disease are all putting more pressure on resources.
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