This International Nurses Day is bittersweet for many nurses working in South Africa’s public healthcare system. With the devastating shortage of nurses, ongoing wage battles,  unsafe working conditions, and lack of resources, nurses say there is very little to celebrate.

International Nurses Day celebrates and honours nurses for their role in saving millions of lives, The theme for this year is “Our Nurses, Our Future.” The National Department of Health says this is a call by the International Council of Nurses to countries to address global health challenges.

Health-e News Service spoke to three nurses working in district hospitals and primary health care clinics about how they feel on this day.

Demoralised, losing patients, feeling like a failure

*Ntombi Msimelelo is a Professional Nurse at a North West hospital. She asked to remain anonymous to avoid victimisation. A nurse for nine years, she says challenging working conditions destroyed her passion and the fulfilment saving lives gave her.

“The overwhelming shortage of nurses in our hospital means that the overall quality of care that we provide is deteriorating. Patients are not attended to as soon as they should be, medication is not distributed properly or on time, and many of us have overworked the overtime hours and are still expected to work.”

Msimelelo cares for more than 25 patients on a daily basis. She says the situation worsened over the years, with less and less time for rest, and more risk of burnout.

“In a setting of a casualty for the emergency unit – patients are not helped in the time that they are supposed to be assisted. There are not enough of us.”

She says she feels her community sees her as a failure for not providing decent quality care. 

“I carry the guilt of knowing that I can’t do my best for patients in some situations because I just don’t have the resources, assistance, medication, or support to do so. Families direct their frustration toward me every day, they don’t know that I also feel a deep pain when I lose a patient. Community members scream at us and swear at us for our attitude, seeing us like nurses who don’t do their jobs – but they don’t know about our working conditions.”

Msimelelo is now considering leaving nursing. “I am supposed to be fulfilled by saving lives and helping people, but I can’t do that with no staff or support, what is the use of me being a nurse in the public health system?”.

No mental health support in 17 years

Sivuyile Mange started his career 17 years ago. Today he is a professional nurse in a tertiary hospital in the Eastern Cape. His passion to heal also called him to be a nurse. But over the years, he says this passion has been sucked out of him and now he battles feeling demotivated.

“The environment we work in is very challenging and stressful because of the lack of human resources – some of us are even forced to quit or look for greener pastures in the private sector or overseas.”

He says his hospital often does not have the basic tools nurses need to do their jobs. 

“We use old machines for examining the patients, this also leads to litigation and problems because you find that we don’t meet the set standards of quality care because of the lack of resources.”

Mange adds that rural patients are also compromised due to the shaky referral system.

“Facilities in rural areas are struggling to take care of their patients because they don’t have resources like oxygen or ventilators,  and when they try to refer them to a regional, district, or tertiary hospital for better services. This takes time and leads to the increased burden on the hospitals and nurses because they need even more resources to tend to the referred patients.” 

Mange works in the hospital’s intensive care unit (ICU) and although he should be caring for one patient on a daily basis, he is usually seeing four people. 

Mange chuckles bitterly when asked about the availability of mental health support for nurses. “I have never received or been offered such support in my years as a nurse.” 

“We have been crying for counselling. Even after COVID-19, this was not implemented for us at all. When we see relatives and patients and feel that we could’ve done more than what we have done, but we know that we can’t because of the resources it hurts psychologically. You go home mentally exhausted and come back the next day, with the same feeling,” he says. 

Working with old infrastructure 

Old and unmaintained infrastructure demotivates Sabata Thekiso, a nurse for 12 years. He is stationed at a Gauteng district hospital.

“The deterioration is fast and ongoing because there is no maintenance. In the wards we work in, the paint is always peeling off the walls, and there is no hot water. Buildings are dilapidated.”

He says a shortage of cleaners means that more often than not the hospital is filthy. Nurses often have to double up on cleaning work as well. Thekiso says his ward treats between 120 to 150 patients a week. Seven years ago they would see between 10 and 15 patients in the ward a week.

“The health centres are unable to keep up with the quality of care while the burden of diseases is growing and it is because of the infrastructure. It is not up to standard. We also simply don’t have enough hands for the number of patients,” he says. 

He says the impact of the high cost of living on people is evident in the number of patients who default on medication. People can’t afford to buy food and they have to eat before taking medication. This leads to more patients seeking care at clinics and hospitals, while the workforce remains unable to keep up. 

“Looking at our working conditions, the decline of our salaries, the lack of training opportunities, diminished education, – there is nothing to celebrate. The picture is gloomy but we will still go and attend these government-organised events with the same hope we had last year – that things will change.”  – Health-e News