SA has a critical shortage of qualified nurses, the backbone of healthcare
The Covid-19 pandemic has laid bare the faultlines in nursing — a critical shortage of nursing staff, a low number of nurses with degree qualifications, too few nurses with advanced degrees such as intensive care specialists, and too few nursing academics for training and research.
When the World Health Organization (WHO) designated 2020 the Year of the Nurse and Midwife to acknowledge their vital role in healthcare, nobody could foresee exactly how prophetic — or ironic — this would be.
We did not know at the time that 2020 would be the year in which the world came to a sudden and shocking halt due to the pandemic. As frontline workers, nurses were at the coalface, day and night.
As we honour nurses on International Nurses Day, 12 May (the anniversary of Florence Nightingale’s birth), we are again confronted with the myriad challenges the pandemic has laid bare over the past two years — particularly the critical shortage of nurses in South Africa, on the continent and globally.
Importantly, we need to acknowledge the void of adequately qualified nurses and the vital role they play in providing scientific-based nursing care and specialist services when needed.
In reflecting on the impact of the pandemic on nursing staff, Dr Matlou Molepo, chairperson of the South African Nursing Council (SANC), wrote in the council’s latest report: “The healthcare system has been challenged severely by the Covid-19 pandemic, with nurses at the forefront of the fight against the virus. Nursing is a noble profession which requires the highest degree of professionalism, dedication and care.
“This pandemic has highlighted that the healthcare system cannot function without nursing as its backbone.”
Cracks in the system
Also, we need to recognise that this pandemic has further emphasised existing cracks in the South African healthcare system. It has certainly confirmed that there is a critical shortage of nurses at all levels in SA. Yet, earlier this year, nursing was not included in the critical skills list of the Department of Home Affairs.
But even more so, South Africa needs nurses with degree qualifications with expert clinical competencies and skills.
Multinational studies indicate that patient outcomes are better when the nursing staff is better qualified. Although healthcare systems have introduced interventions and innovations during the pandemic, it is unclear whether nursing managers and staff were adequately equipped for this demanding and emotionally taxing situation.
Were they receiving the necessary support, or were they set up for failure?
According to estimates by the World Bank (the latest available numbers are from 2017), South Africa only has about 1.3 nurses and midwives for every 1,000 people. The international average at the time was 3.8.
More recent statistics published by the SANC indicate that in 2021, at least 276,819 nurses (from all the different categories) were registered, which results in a population-per-qualified-nurse figure of about 218:1.
Covid-19 exacerbated the shortage of staff when nurses either became sick, had to isolate after testing positive or even died.
Also contributing to the crisis is the “great attrition”, as a 2021 McKinsey report calls it. The report found that since the start of the pandemic, American nurses are increasingly looking at other career opportunities outside the healthcare system — their main reason being their vulnerability in direct patient care amid uncertainties about the virus. This is also true of the South African situation.
In March, Health Minister Joe Phaahla said in Parliament that public hospitals have more than 10,000 vacancies for nurses, but general budget cuts introduced by the National Treasury could affect the cost of employment negatively.
However, as the minister then replied to a question, the “total number of nurses who were confirmed as having met the requirements of completing their degrees in December 2021 — that made them eligible for community service for January 2022 — are 3,196”.
With 10,000 vacancies and only 3,196 degreed nurses produced, it is clear what the core problem is: South Africa has a critical shortage of nurses with adequate qualifications.
Although some hospitals, especially private ones, may have enough nurses, they do not necessarily have degree qualifications. A degree not only provides nurses with in-depth knowledge and the related competence and skills, but also prepares them to fulfil broader roles within nursing practice and management, and in the healthcare system at large.
While nurses in practice remain critical, we also need them in academia, providing tertiary training and producing research.
The world of medicine is changing at a rapid pace, and expert researchers in nursing science must be at the forefront of exploring new avenues in nursing practice.
The development of nursing science and the generation of new scientific knowledge in relation to medical sciences will best serve the population of South Africa.
This prepares nursing professionals to provide expert primary care as the first point of care — and often the only point — in communities. If this development does not materialise, the nursing profession will regress even further.
There is, therefore, a multilayered challenge to address: a critical shortage of nursing staff in the healthcare systems, a low number of nurses with degree qualifications, too few nurses with advanced degrees such as intensive care specialists and too few nursing academics for training and research.
This year, the theme of International Nurses Day is, “Nurses: A voice to lead — Invest in nursing and respect rights to secure global health.”
If we aim to address the multi-layered challenge, we most certainly need greater investment in nursing from the private sector and government.
But greater investment will not help if we do not create interest in nursing as a career option.
Within the broader context of unemployment in South Africa, recruitment strategies must be devised to ensure that our universities are able to attract the best possible candidates who will build careers in nursing practice, teaching, research and in health policy.
Investment in nursing training in higher education is our fundamental means of, on the one hand, creating an outcome that supports our healthcare system with adequately qualified nurses that can provide patients, families and communities with the best care possible.
On the other hand, we can strengthen the nursing profession by providing training and doing research that makes an impact on the future of healthcare globally. DM
Prof Hester Klopper is Deputy Vice-Chancellor: Strategy, Global and Corporate Affairs at Stellenbosch University, professor in Global Health, a fellow of the Academy of Nursing of South Africa (FANSA), and a fellow of the American Academy of Nursing (FAAN).