South Africa has more than 400 000 registered nurses according to the South African Nursing Council’s latest published figures. As the country combats the coronavirus outbreak, nurses play a critical role in keeping the healthcare system functioning.  

Over the past few weeks, nursing unions have spoken out about the need for nurses to be paid better and for improved working conditions, with supplies, such as personal protective equipment (PPE), to be prioritised in an effort to protect health workers from being infected with Covid-19.  

Earlier in the month, Minister of Health Zweli Mkhize announced that more than 500 health workers have been infected with Covid-19, and that some have succumbed to the virus. 

Unions have also expressed their disappointment in government not giving healthcare workers tax relief for the next six months, as they are stationed on the frontlines of fighting Covid-19 and are also under immense financial strain. 

 Different nursing motivations  

Health-e News spoke to three nurses about their passion and what change they would like to see in their working environments. 

A paediatric nurse, who would like to be known as Tish, she says that her love for her patients and having great support from her colleagues motivates her.  

“Working with children is absolutely special they are honest, loving, realistic and truly amazing little humans. Working in a paediatric haematology and oncology unit teaches you the value of life, and to treasure every moment of life. The wisdom in children with a terminal illness is a very humble experience.” 

Oageng Tidikwe says that the continuous learning that comes with nursing fuels his love for the profession. 

“In nursing, there is ongoing education. You can never feel like you know every condition, yes, you may know it in theory, but it may take years to be confronted by that condition. But what is more exciting about nursing is that as a nurse you’re a provider of holistic care. You’re the first person to facilitate the birth of a human being and you’re in many circumstances the first person to witness the death of a human being.” 

 Noko Morakaladi is a clinical nurse practitioner in the South African Military Health Services. He graduated cum laude twice in his nursing qualifications. He says that his love for his profession grows when he sees his patients. 

“The knowledge and the skills that we possess as nurses are very important for our society’s day–to–day living and most of all, the impact that we make in our communities. I love that I am a change agent and I am a mouth, eyes and ears of the vulnerable and the defenceless. Bringing the sick back to life and putting a smile on a grieving client is what makes my light shine brighter in this profession.” 

Skill and knowledge must be compensated 

 A 2016 study published in African Journals Online surveyed 875 nurses in South Africa. The results revealed that 86% of nurses experienced personal stress-related to financial strain. Over 500 of the participants experienced high levels of work stress related to staff issues, while 60% had poor general health-related anxiety and insomnia. Almost 600 nurses said that they have low job satisfaction related to pay.  

 Tish says that not enough is being done to recognise the work of nurses. She says that resource shortages – from staff to stock and supplies – pose a challenge to her work.  

But she also cites that nurses need attractive remuneration packages. She adds to this, saying that the government should show their appreciation for nurses by “investing in staff, by educating and doing more training to increase excellence across all levels.” 

Tidikwe also says that the primary challenge is that nurses face is that they are “hugely underpaid”. He adds that many nurses work in dilapidated facilities and are forced to deal with a shortage of resources such as medication, equipment and, at times, facilities have poor sanitation. He thinks that the government and society can make their work easier by appreciating their efforts. 

“I think the government can appreciate us by adjusting our salaries because it’s disheartening to find a specialist nurse earning just above R370 000 per annum. Our communities can appreciate us by not hailing insults at us when they get to facilities and then at times don’t get treatment for their condition because no nurse gets excited by the lack or non-availability of medication,” he adds. 

Morakaladi echoes the same sentiments as Tish and Tidikwe. He adds that there are unsafe staffing ratios in some institutions, which leads to nurses becoming overwhelmed with working conditions and end up facing litigations and burnout. He says that the lack of resources leads to poor nursing care and “nurses always have to learn the art of improvising”. 

 He also says that the nursing salary needs to reflect the work that they do. 

“Government must pay nurses better salaries. It can’t be right that a newly qualified pharmacist with just four years of study earns more than a nurse specialist with more than five years of study and a lot of experience. Government must recognise the knowledge and skills embedded in this profession. Our hard work must also be evident in the paycheque.” 

Nursing Covid-19 

As the department of health prepares for the virus to peak, provinces like Gauteng went on a drive to hire unemployed nurses – of all categories, including retired nurses – in case there is a need for a greater workforce to tackle Covid-19. 

But the government has also been accused by unions of not providing adequate PPE for healthcare workers, in a bid to decrease their chances of contracting Covid-19.  

Tish fears that her institution may run out of PPE if they do not get enough supplies. 

“We have PPE, it makes you feel protected. PPE is not adequate for the long term. [We are] hoping more supplies will come to prevent a shortage,” she says. 

But for her little patients, the protective gear is not friendly. 

“[We are] definitely feeling the strain as we have to do social distancing. Children are wary of a stranger in so much gear; the visor is intimidating. I miss hugging my patients and parents,” she says. 

Tidikwe says that government needs to make PPEs their top priority. 

“There’s a limited number of PPE where I work. At this moment, health professionals have lost their lives due to Covid-19,” he says. 

But their fear of the virus is not limited to the workplace. 

“My fears as a health professional is to see not only my patients especially those with co-morbidities or the elderly and my family members losing lives due to coronavirus. My overall assessment is that many people are not taking social distancing and proper handwashing advice seriously,” Tidikwe expresses. 

Meanwhile, the personal cost of being on the frontlines of the fight against coronavirus is higher than ever. When Tish arrives home from work, she must distance herself from her family – no hugging, no touching – and rushes to clean herself prior to any interaction with her family. 

“I have minimal interaction with family when working. I cannot cook, the kitchen is off-limits. My children’s rooms are off-limit. I am limited to my bedroom.” – Health-e News