Outcomes of DENOSA National Executive Committee Meeting...

Media statement 
Monday, 25 April 2016   
The Democratic Nursing Organisation of South Africa (DENOSA) held its first three-day National Executive Committee (NEC) meeting this year from Wednesday 20 April to Friday 22 April 2016 at the DENOSA head office in Pretoria to deliberate on the state of nursing in the country and the current challenges that the health fraternity faces. 
On the lack of safety in the workplace
The NEC notes with great concern the continuing lack of safety of healthcare workers in the workplace as a result of poor security deployment by the state. Over the past few months already, nurses have been at the receiving end of attacks from patients and community members. In all provinces, there have been cases of attacks of nurses in the workplace. 
After thorough deliberations and reports from provinces on the attacks of nurses, the NEC resolved that DENOSA has issued enough stern warnings to the employer that security must be beefed up in facilities, and we have noticed that security is only beefed up in facilities after incidents have occurred despite our calls for overall tightening of security in our facilities. The NEC has resolved that one more attack on a nurse or any healthcare worker in any of the country’s facilities will be enough for DENOSA to withdraw members from all facilities whose security has not been tightened. 
The most obvious dangerous areas for health workers in many health facilities are the following:
·  Psychiatric hospitals;  
·  Psychiatric wards in other hospitals; 
·  Outpatient Departments (OPD) in facilities, which are entry points for all patients before any diagnosis; and  
·  CHCs that have no security 
On non-payment of Danger Allowance to nurses and contravention of collective agreement 
Given the risky environment that nurses work under, DENOSA calls for total implementation of the relevant resolutions to ensure fairness on the side of the employer to pay nurses and healthcare workers in psychiatric wards in hospitals, outpatient departments and prison clinics with a danger allowance. 
New Danger Allowance dispensation was part of the agreement between labour and employer in the public sector negotiations that were concluded for the 2015-17 period and the agreement was that different sectors will discuss those categories in which employees face danger in their daily working conditions, so that these are discussed and resolved on in the Public Service Coordinating Bargaining Council (PSCBC). Our position is that these areas for nurses are the most important and need urgent attention.   
On non-payment of danger allowance by Western Cape government since 2007 
While payment of Danger Allowance to different categories of government employees, such as nurses who work in psychiatric facilities, is Resolution 1 of 2007 which in the case of nurses stipulates that nurses working with psychiatric patients must be paid Danger Allowance, DENOSA is taking the Western Cape Department of Health to arbitration for failing to pay Danger Allowance to nurses working with psychiatric patients, thus defying this agreement. 
We demand that those nurses who have been in the employment of the Department of Health in the Western Cape since 2007 be backdated their rural allowances and those who have been in the employment of the Department after 2007 be backdated from the date of their commencement of employment.    
DENOSA regards this as a sheer undermining of nurses by the Western Cape government, and it cannot be tolerated any further. 
On Occupation-Specific Dispensation (OSD) and Rural Allowance reviews 
DENOSA is saddened that there remains no will on the side of the employer to review Occupation-Specific Dispensation (OSD), which was supposed to be reviewed in 2012 already. The NEC calls for seriousness from the employer to review OSD, which has been a pain for many healthcare workers as it has often been improperly implemented and wrongly interpreted. Government negotiators at the bargaining chamber have been citing that they have not been given a mandate by their principals to kick-start the process negotiating on the review of OSD. 
Equally, Rural Allowance is another matter that needs urgent review as the landscape has changed drastically since this agreement was signed. DENOSA calls for lower category nurses to be included in the Rural Allowance band. Because of the severe shortage of nurses especially in rural areas, many of lower category nurses are in charge of CHC facilities which, while it is not accepted as it poses a danger to their careers, they ought to be properly remunerated. Many enrolled nurses (ENs) and enrolled nursing assistants (ENAs) are greatly needed in rural areas, just as professional nurses are, and this is the basis for their qualification for rural allowance. Or else, rural health facilities will remain without nurses of all categories forever.  
On National Health Insurance (NHI) and procurement pain 
The NEC notes the release of the White Paper on National Health Insurance (NHI) by the Department of Health late last year. DENOSA is in a process of finalizing inputs into the white paper. As great supporters of NHI as a concept of achieving Universal Health Coverage for all citizens regardless of their socio-economic standing, DENOSA remains concerned that there continues to be little progress on the supply of tools of trade for nurses in many facilities that are situated around NHI pilot districts country-wide, despite the supply of a comprehensive list of all required equipment that all facilities must buy. 
We call upon government to ensure standards of emergency medical services is adhered to such as provision of life support apparatus.
As NHI will be a key vehicle that will contribute greatly in achieving the dream of access to quality health care services, DENOSA is more convinced that, given the current ongoing challenges in facilities, it has become a non-negotiable that health facilities, districts and provincial departments are led and headed by people with health background. 
The NEC is calling on all provincial departments to assist the national department in laying the ground for effective implementation of NHI and ensure the following are put in place as a matter of urgency:
·  The establishment of proper nursing directorates and staffing of provincial chief nursing officers in all provinces as a matter of urgency, just as the national department already has; 
·  Improvement in the supply chain processes;  
·  Filling of vacant positions as a matter of urgency.
·  Delegation of power to procure and repair medical equipment and medication to heads of hospitals from the Department of Public Works. 
Poor HR planning and budgeting has been letting the departments down considerably. While there is a severe shortage of healthcare workers, at the beginning of each year many provinces are still unable to employ nurses who have just completed their studies to do community service for a year because HR Departments continuously fail to take plan for this period. Even after community service nurses have finished their community service, they are not absorbed into facilities by January each year because of poor HR Planning in the main. They only get absorbed after April of each year in many instances.
This must come to an end, and the way of assisting it is to establish nursing directorates and chief nursing officers in provinces. 
On the Competition Tribunal’s Inquiry into the private health sector  
The NEC notes the Competition Tribunal on the pricing of private healthcare in the country, headed by former Chief Justice Sandile Ngcobo. DENOSA is also in line to make a presentation to the Tribunal on the private healthcare pricing in the country, which excludes the majority citizens.   
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact: 
Simon Hlungwani, DENOSA President
Mobile: 079 501 4922
Sibongiseni Delihlazo, DENOSA Communications Manager 
Mobile: 079 875 2663   
Facebook: DENOSA National Page

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DENOSA calls for urgent tightening of security at health facilities, or else nurses will boycott the wards ...

Media statement 
17 April 2016
The Democratic Nursing Organisation of South Africa (DENOSA) is calling for urgency in both political and administrative will to tighten security in the country’s health facilities and especially in certain sections and that a nurse must not be attacked or die first before security is beefed up.
If this issue is not addressed urgently, it is our duty as a union to protect nurses by withdrawing them from all unsafe wards and sections in our facilities as their safety and livelihood are not ensured by the employer. 
Our call follows the tragic death of a nurse who was strangled by a mental patient at the prisoner’s ward of Hayani Psychiatric Hospital in the Vhembe district in Limpopo on Thursday, 14 May 2016. We send our heartfeltcondolences to the family.
While security at our psychiatric facilities should be a non-negotiable, it is disappointing that nurses are still exposed to dangers of death while executing their duty in these hospitals and sections, despite our numerous calls for tightened security.
As sad as this incident is, it is not an isolated one as very often nurses are the subject of attacks not only in psychiatric facilities, but also in casualty areas as the entry point of health facilities. Last month, a nurse was also attacked in one of the facilities in Pietermaritzburg; and nurses were attacked at Ramokonopi Clinic in Gauteng in March this year.
Furthermore, we call on the Department of Health to ensure a fair and safe gender balance when allocating both nurses and security personnel in psychiatric sections and ensure that there are male security guards and nurses in wards which are dominated by male patients as they often overpower nurses. 
Nurses in most facilities work under unsafe environment, which is a misery that adds to the staff shortages. For the past two weeks, DENOSA has been paying surprise visits at night in health facilities in Mpumalanga and noted that in most facilities, especially Community Health Centres (CHCs), only one nurse or two are on duty, which is totally unacceptable.  
On a visit at Siyathemba CHC in Balfour on Wednesday evening, we found only two nurses at night with no support staff like a clerk and no lights in front of the facility. At Tweefontein D Community Clinic in KwaMhlanga on Thursday morning, we found only one nurse on duty at a facility that is overshadowed by weed and long grass.  At Paulina Murapedi CHC in Embalenhle near Secunda, we found nurses working far beyond their scope of practice and doing clerical work as there are no clerks at the facility, and thus queues of patients getting longer as a result, which ends up frustrating communities.
Many provinces have cut security personnel in facilities drastically, and death and physical attacks of defenseless nurses are a direct result of this negligence on the part of the employer. 
DENOSA calls for empathy of the Department and the will to address these issues such as tools of trade and to provide a conducive environment.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Simon Hlungwani, DENOSA President. 
Mobile: 079 501 4922
Madithapo Masemola, DENOSA Acting General Secretary
Mobile: 082 551 6041
Facebook: DENOSA National Page 


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DENOSA Western Cape to lead a nurses’ march to the provincial legislature in Cape Town on 16 March demand...

The Democratic Nursing Organisation of South Africa (DENOSA) in Western Cape will be leading a nurses’ march from various health facilities in the province to hand over a memorandum of demands for the improvement of their working conditions at the Provincial Legislature on Wednesday 16 March 2016. 
Nurses will be raising various challenges that nurses encounter in facilities daily, ranging from:
-          Severe shortage of nurses, support staff and extraordinarily long queues in health facilities in the province;
-          Shortage of medication, broken and non-repaired equipment; 
-          Lack of resources (both financial and human); 
-          Lack of safety in the workplace; 
-          Non-payment of health workers; and  
-          Lack of support and continuous professional development opportunities for nurses due to severe shortages.   
Led by provincial, regional and local leaders, nurses will gather at Kaizergracht Street (westerly direction), down Darling Street, south on Adderley, west on Wale Street and stop on Wale Street at the provincial legislature.  
Members of the media are cordially invited to attend and report. For more information, contact: DENOSA Provincial Secretary, Danver Roman on 082 775 7739
The details of the march are the following: 
Date Wednesday 16 March 2016 
Meeting Venue: Kaizergracht Street in Cape Town 
Time: 10h00 
Contact person: Danver Roman, DENOSA Provincial Secretary 
Mobile: 082 775 7739

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National changes in nursing training: South African perspectives 2015...

Dr. Respect Mondli Miya,(D.Lit et Phil)

Senior Lecturer: Psychiatry at Durban University of Technology, Department of Nursing Science


Nursing is a career of love rooted in rich and fertile soil governed by caring ideologies and philosophies. Individuals within the profession have strong and inexplicable desires to serve and preserve humanity at all cost. The nursing profession drives the health care system and is forever in the forefront of preventing, promoting and management of various diseases.  Nurses have always been there and have survived trials and tribulations. Nursing demands not only the brain for cognitive purposes but a humble heart, selflessness in daily duty execution. An individual without passion for the sick will never survive a minute of nursing’s demanding tasks.

Nursing novices are professionally socialized and groomed on their first day of training. Noble traditions of nursing are gradually unpacked and monitored up to graduation to enhance relevance and dignity of nursing profession. Nursing demands the utmost respect for humanity even after death itself. Most professions have minimum set of working hours yet nursing philosophy calls and promotes dedication beyond duty. Nursing is a way of living not just mere qualification written on papers but lived and experienced charisma. 

Historically, nursing was viewed as a religious vocation and was predominantly religious in nature which explains chapels, and meditation designated facilities utilized for prayers before commencing daily duties in old hospitals. Nursing training in South Africa before 1976 was hospital-based hence the notion of viewing nursing as a “hands-on” career has been accepted nationally and acknowledged by most prolific nursing scholars who remain sceptical to have nursing pitched at a degree level and offered in higher training of education in South Africa.   

Such training exposed and subjected nurses to poor recognition as a career.  Nurses were abused and viewed as medical officers’ hand maids who were good for nothing but to offer a bed pan, bathing the sick, and carry orders as prescribed without being objective. The training at that time was strict and limiting, even the scope of practice was limited and nobody could imagine a degree in nursing or university based nursing teaching and learning. Hospitals mostly trained nurses in general nursing and later midwifery.

Around 1987, nursing in South Africa was gradually introduced in tertiary education system and scope of practice and curriculum were amended. Nursing graduates were introduced to a 4-year degree obtaining general, psychiatry, midwifery and community health nursing. That made older nurses to feel bitter and never fully accepted university graduates as satisfactorily trained. Even medical officers were threatened and witness role change from nurses as hand maids into fully recognized members of the multidisciplinary health team with independent roles and functionality. These changes failed to bridge the gap of scope of practice and remuneration packages. Even to this date, the university and hospital trained nurses earn the same salary and follow same stream of training regulated by the same nursing Act 50 of 1978 as amended with specification stipulated in Regulation 425 (R.425).

The nursing act 33 of 2005 introduced community service of one year post- training for both hospital- and university-trained individuals. Errors still exist within the nursing education such as same recognition of a hospital and university trained graduate have similar scope of practice, universities are allowed to implement R425 differently. For example, some South African universities train students for six months in midwifery while others dedicate two full years for midwifery and three years for community health nursing which is offered for six months in colleges and some universities. The problem in South Africa is that there is one R.425 and implemented differently from one university to the other.

The current health ministry is proposing nursing training restructurization. In the proposal dated 23 July 2015, it recommends reintroduction of the old nursing training system with a hope of extending the nursing training duration and to phase out the R.425 of Act 50 (1978). The current proposal overlooks scope of practice and remuneration packages of such graduates irrespective of their qualification which is an error not even Occupational Specific Dispensation (OSD) could resolve in 2007. OSD failed to address issues of salaries in the nursing fraternity; an obvious error is that a nursing lecturer is graded as a nursing specialist.

The unresolved question here is: Who teaches the other? And why do they earn same salary if the other is a teacher? Up to the very same date, the public health system continues to fail to distinguish university graduates from hospital nursing graduates yet continues to differentiate auxiliary social worker from a University graduate Social Worker, and experienced Medical Officer from a Master of Medicine graduate. Why not with nursing in South Africa? 

The proposed training changes are as follows: general nursing and midwifery be done in a college over a period of four years without indicating whether that shall be Bachelor of nursing offered in a college which can never materialize as colleges do not offer degrees but universities do. If agreed upon, this will mean degrading the dignity of nursing as a profession over medicine which continues to be offered in the university without interruptions.

According to the proposed plan, nursing training is extended to 9 years (four year of midwifery and general, 18 months of psychiatry and one year of community health) which is unnecessary waste of time for an undergraduate qualification yet medicines years of training have been reduced to 5 years (MBCHB).


There is absolutely no need for such drastic changes in the nursing education.  It is alarming to witness MBCHB years of training have been reduced to five years and get paid a satisfactory remuneration package compared to Bachelor of Nursing graduates with stagnant remuneration. The introduction of Masters Degree in Medicines in South Africa is preparing sound clinical researchers and such projects (thesis and dissertations) are evaluated by nursing professors who in turn receive less recognition and degrading salaries compared to MMed graduates.

The South African health system requires the following:

1.     Strong and vocal task team of nursing professors who shall preserve the image and dignity of nursing as a profession and strongly oppose plans to change nursing training.

2.     No college shall be allowed to offer a bachelor of nursing, strictly universities only.

3.     Salary packages to be reviewed and sort clear distinction of a university graduate over a hospital trained graduate.

4.     Revised scope of practice, degree holders be given more opportunity to execute complex clinical procedures and be given better remuneration packages.

5.     Chief Nursing Officer to be more vocal and avoid external influences to disorganise nursing training.

6.     Hospitals to create portfolios and acceptable remuneration packages for all nursing qualifications from a diploma to PHD level.

7.     All South African universities to adopt and implement similar training structure  that is two years of midwifery, two years of psychiatry and two years of community health nursing

8.     Develop a Nursing Ministry by nurses with nurses and for nurses.

9.     MBCHB degree be afforded same status as B.Cur degree thereafter if need be.

10.  South African nursing council to be headed by prolific PHD holders and nursing qualifications be regulated and registered up to PHD level.

11.  Any qualification obtained outside university be regarded as either associate professional nurse and associated medical office until related exam has been endorsed by the regulating body.

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We are professionals, and let us fight to be recognised as such… 
Vuyolwethu Mashamayite - 20150728_073623
By Vuyolwethu Mashamaite 
Ever since I joined nursing in 2005 I have heard nurses say nursing is a ‘calling’ and it's not about money. I couldn't understand why they said so and I still don't.   
I believe that everyone is called by God to be in the profession or job they are doing, unless nurses consider themselves in the same umbrella as ‘Sangomas’ and ‘Preachers’. Those are the people who will leave their profession or jobs and focus on their calling or do both, regardless of whether they are paid or not. 
Perhaps this could be the reason why nurses are under-paid and left to work in extreme unfavourablecircumstances ...because it’s a "Calling".
Don't get me wrong; I have passion and great respect for human life as a nurse. But I cannot keep quiet. Nurses are the most abused professionals by the employer because they consider themselves "called" instead of being employed professionals.
Nurses you are jack of all trades doing everyone's jobs from a cleaner to a doctor but come pay day you are the ones who cry the most because you are underpaid while doing everyone's jobs. I guess it's the consequences of having been “called" instead of being professional.
We feel so comfortable working out of our scope of practice to an extent that we run a risk of performing tasks that we are not equipped to do. When told it's not your scope of practice you tell us of how long you've been doing this and you didn't kill anyone. But the South African Nursing Counci (SANC) is out there nailing nurses and not considering your "calling" but rather your profession and scope of practice.
What hurts the most is the fact that you studied for four years and someone from another discipline who studied the same years is treated and paid better than you. I guess they are professionals and you are in a "calling". 
Nurses, let's STOP hiding behind "CALLING" and start taking our profession seriously. If you don't do it, no one will do it for you. Like it or not we are professionals and let us fight to be recognised as such. 
Vuyolwethu is a nurse based in Kimberley, Northern Cape   

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From Ntandane Nyebe, a nurse in Cape Town. 

As the backbone of any healthcare system in the world, it is my honest opinion that nurses deserve proper compensation for the hard work they put in in improving the health of South Africans. After all, nurses are the proverbial Alpha and Omega. The following 10 points are the reasons.    

1. We are short staffed- one person does a work that should have been done by 4 people.

2. We have gone through formal education, we have got degrees etc, we are accountable to a nurses' board, we got to be paid decent salaries like Pharmacists and doctors- YES.

3. The health institutions do not have enough of the unskilled workers e.g. porters and cleaners- Nurses are then forced to work as unkilled workers-on top of their scope of practice, when the need arises.

4. There are many instances where doctors go & do shopping at the malls when they are on call, or simply some institutions have shortage of doctors- when an emergency situation arises- a nurse does a work that was supposed to be done by the doctor to save the client. Same case when there no social workers- nurses must run around doing what was supposed to be done by a social worker.

5. We do a risky job - I've heard of many nurses & docs who died from contagious diseases- especially trauma staff.

6. The governing party admitted in 2011 that there is a dire shortage of nurses in SA, which means nursing is a scarce skill in SA and the last time I checked professionals with scarce skills were getting paid higher salaries in SA.

7. We work under bad conditions- institutions with no proper security, lack of proper equipment etc. But we always try and do our best to improvise for the benefit of the clients.

8. Nurses who go & work overseas they don't go there just for fun or to experience different culture- they leave because they feel they are being overlooked by Government in terms of salary- meanwhile SA loses specialised nurses with experience - Government who cares about its people would try and keep nurses by raising salaries.

9. We deserve better. Our Government can afford to increase our salaries by 100%. There is money in SA- we have seen structural developments in SA & they have been built by companies who have been paid millions and billions.

10. ANC Government promised to increase salary of Nurses when they were in Mangaung in 2012/13. 

I Thank You


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January 2016

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About us

The Democratic Nursing Organisation of South Africa (DENOSA) in its current form was established on 5 December 1996.

The organisation was formed through political consensus after the transition to democracy and was mandated by its membership to represent them and unite the nursing profession. Prior to this, the South African Nursing Council (SANC) and the South African Nurses Association (SANA) were statutory bodies which all nurses had to join. It was also important after the transition to democracy to incorp... Read more