Huge workloads endanger patients
Gwagwa says cases of misconduct against nurses, particularly those working in midwifery and intensive care, have escalated over the past few years.
‘Individual nurses are always blamed, but if patients are to be protected, something must be done about nurses’ conditions of service. Their work loads are huge, many lack basic equipment and drugs and their salaries are not OK,’ says Gwagwa.
‘We are beginning to wonder if nurses are not valued because they simply see us as a bunch of women.’
A professional nurse with a four-year university degree has a gross monthly starting salary of R5657.25, while a staff nurse with two years’ training starts on R3 291.50. A nursing assistant with a year’s training earns R2 865.75 a month.
‘Imagine, you are a professional with a four-year degree and 20 years’ experience, but you cannot afford even the cheapest little car,’ says Gwagwa.
‘Many professional nurses have opted to work outside the country to earn more money. What will make 52-year-old woman leave her family and go to the UK to work? This is really painful.’
Denosa, a Cosatu affiliate, acknowledges that government improved the starting salaries of professional nurses in 1996, when it hiked their salaries by 42%.
But, says Gwagwa, nothing was done for those who already had many years’ service as a professional nurse.
In addition, after agreeing in 1997 to a promotion system for nurses based on years of service, this agreement was removed in 2001.
Denosa’s chief negotiator, Thembu Mngomezulu explains: ‘Now that the employer has removed the mechanism of pay progression, the only way that a nurse can progress to the next salary level is by applying for another post. There is no recognition for years of service.’
Mngomezulu believes that the government got cold feet about the pay progression system because of the ‘sheer numbers’ of nurses ‘ about 100 000 in the public sector.
‘But there is a global shortage of nurses,’ she warns. ‘Our nurses can work anywhere in the world. Developed countries can afford to poach staff from developing countries.
‘In Australia, 50% of posts in the health sector are filled by foreigners. New Zealand’s going to become the next hot spot for our nurses because nurses there have just negotiated a 20-30% pay hike.
‘So if you are a developing country, you would think that you would try to do what you can to keep our nurses. But by the time the health department is willing to talk to us, there will be no nurses left in this country.’
The rural and scarce skills allowances introduced in 2004 to try to retain health professionals in rural and specialised areas are also a sore point for Denosa. Initially, says Gwagwa, nurses were not included in the allowances.
After representation from Denosa, some nurses were included but there has been a lot of unhappiness from those excluded.
A professional nurse can get an additional 8% to 12% of her salary if she works in a rural area (the amount depends on the area) but staff nurses, who usually run rural clinics, are not included.
In addition, only nurses who have qualifications in oncology, theatre or intensive care are in line for the scarce skills allowance, which could also add 10% to their pay packets.
‘We don’t know how they came up with those three categories. We wanted this allowance to encourage the nurses running the primary healthcare clinics. They have a huge workload and are crucial in ensuring that the hospitals are not overcrowded. But government decided there were too many of them so they were sidelined,’ says Mngomezulu.
Nurses who had been working in the three areas for years but lacked the formal qualifications felt bitter at being excluded.
‘We did a survey of staff at the three biggest hospitals in every province after the introduction of the scarce skills allowance and found that it had made matters worse as it had caused conflict between nurses.
‘Those who had been working in theatre for years but didn’t have the formal qualification said they weren’t going to work in theatre any more.
‘Some actually wanted to go on study leave to get the necessary qualifications but couldn’t because of the shortage of staff. So there is a vicious cycle,’ says Gwagwa.
Denosa has yet to be consulted on government’s plan to introduce a year’s community service for nurses, which it wanted to introduce in January but lacked the legal framework to do so.
‘We don’t know what this community service trying to address. Nurses are trained on the job. You can’t take a newly qualified person and dump her in a rural area without supervision,’ says Gwagwa.
In addition, the organisation has not seen the national human resources plan that the Health Minister promised to release to stakeholders by the end of March.
Gwagwa says she has heard that government wants to introduce a category of ‘assistant doctors’, but that the upgrading of professional nurses ‘ many of whom do the work doctors do in developed countries ‘ does not seem to be on the table.
In addition, there are proposals to upgrade the community health workers ‘ but this is encroaching on work done by staff nurse assistants.
‘It is not a solution to create more categories of health workers. This will cause unnecessary conflict.
‘What we need is more nurses. In 1994/5, there was rationalisation and many nursing colleges were closed. But now there is a shortage. There are lots of matriculants lingering around. Why can’t we increase the intake and train more nurses?’
E-mail Kerry Cullinan
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