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DENOSA fully supports COSATU National Strike and says ‘Hands off nurses’ pension money!’ ...
Monday, 18 September 2017
The Democratic Nursing Organisation of South Africa (DENOSA) fully supports the COSATU CEC decision to embark on a National Strike against State Capture, corruption and job losses on 27 September and would like to urge public servants to take part in the strike to protect their pension money which is becoming a target.
DENOSA is embarking on a mobilization programme in various facilities across the country, building up support for the Strike for those nurses who will be available to take part in the strike. The strike has been granted to COSATU by NEDLAC and Section 77 certificate has been granted, which protects workers who take part in the strike.
In the health sector where DENOSA organises, critical clinical positions in various departments have remained vacant and frozen for far too long. This is largely because of lack of funding, which compromises the quality healthcare service while millions of Rands go up in smoke mysteriously. Many State-Owned Enterprises (SOEs) are begging for bailouts in the tune of billions largely because of mismanagement of funds. Currently, the Department of Health in Gauteng is under serious financial constraints that even threaten to disrupt the functionality of the department.
Part of the total shut down on 27 September is that a Commission of Inquiry on State Capture be established as a matter of urgency, so that the funds that get siphoned from public coffers could remain and used for public good. In health, there is a gross shortage of nurses and support staff and equipment. Vacancies remain unfilled for longer periods, thus putting too much strain on few health workers who are in facilities and who are expected to perform miracles.
State Capture and Corruption also threaten to delay the implementation of National Health Insurance (NHI), which is South Africa’s Universal Health Coverage (UHC) where all community members have access to quality healthcare service regardless of their socio-economic status.
In the sector, State Capture and corruption also threaten to prolong delays in the payments of Performance bonuses to health workers who continue to work tirelessly, as well as payment of Rural and Danger allowances as well as pay progression for those who are deserving.
In the public sector, out of 1.3 million public servants a whopping 900 000 workers do not have houses, and monies leaving government through corruption and state capture could also assist in narrowing this gap by actualizing Government Employees Housing Scheme.
Nurses are worried that even auditors, who ordinarily should be the last line of defense against misuse of funds, are also made to overlook serious crime being committed in government entities. The latest KPMG concession is a case in point and begs the questions: how many other wrongs in government or SOEs have been overlooked by auditors? How deeply rooted is the problem of State Capture.
DENOSA strongly feels that it is in the interest of every South African who contributes to South Africa’s well-being in one way or the other to take part and be counted on this important day so that there are consequences for those who are spearheading the misuse and diversion of public funds.
DENOSA urges all its shop stewards and nurses in general to demand transparency especially in the way their pension money is managed in government. It looks obvious that the R1.8 trillion government employees pension money under the management of PIC remains the only appealing last resort for those who are drying public coffers for their own interest. Nurses are not even well-paid, and their pension money is often their only hope. DENOSA says ‘Hands-Off nurses pension money!”
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Oscar Phaka, DENOSA General Secretary.
Mobile: 082 328 9771
Sibongiseni Delihlazo, DENOSA Communications Manager
Mobile: 072 584 4175
Tel: 012 343 2315
Facebook: DENOSA National Page
DENOSA Limpopo hopes Lebowakgomo Hospital management will take responsibility for Monday’s shutdown by nurs...
Friday 01 September 2017
The Democratic Nursing of South Africa (DENOSA) in Limpopo says management at Lebowakgomo Hospital must accept responsibility for Monday’s planned shutdown of that hospital due to anger of nurses caused by parachuting of an ordinary qualified general nurse with midwifery to act as a Nursing Manager for the second time when there are better qualified assistant managers at the hospital.
Nurses at the hospital have vowed to shut down operations if the political decision of the management is not rescinded immediately. Today, Acting District Executive Manager, Mrs Dlamini, came to convey the decision to organized labour that the same junior nurse who had acted from June to end of November last year was again being given another opportunity. Organised labour and nursing population is against this political decision.
But Mrs Dlamini has just proceeded to hand over the appointment letter to the said individual despite visible unhappiness, citing that she is under pressure from the powers above to ensure the letter is delivered despite overwhelming disapproval by nurses.
As a result, nurses at the facility will shut down the institution in anger for being undermined.
Nurses are demanding that politics be put aside and quality nursing be respected, and that adequately qualified nurses with at least additional nursing education, administration and management qualifications as part of their experience be given an opportunity to assist as the institution is blessed with those nurses currently. But they are being overlooked for mere political beneficiation other than efficient rendering of quality nursing care to patients.
DENOSA and nurses are demanding this fairness because the institution is an academic institution and, for the sake of its reputation, it must be led by health professionals with the necessary consummate skills and experience.
We warn that nursing care will be severely affected at the hospital and thousands of people will be affected if this decision is not reversed as nurses are revolting against it, fairly so. The feeling of nurses is that politics and political connections are being considered and rewarded with positions ahead of the interest of quality nursing care at the institution.
DENOSA says nursing service has suffered enough negative reputation and it is time nursing management function is allocated to relevant individuals with the required expertise. There are operational managers and assistant managers at the facility who would almost automatically qualify to lead the nursing function of the hospital smoothly.
“Why is a junior nurse being reappointed when there are many adequately qualified nurses with nurse education and management qualifications who are able to run the nursing management function smoothly at the hospital?” asked DENOSA Limpopo Provincial Organiser, Jacob Molepo.
DENOSA calls on the management at the institution to start doing things fairly, and for the provincial department to intervene if the institution refuses to acknowledge the crisis it is bringing to the institution because of this poor, unfair and partisan decision.
“We are raising the red flag because this affects nursing, and we need to advocate for quality patient care at that institution, and for proper support of all nursing personnel at the facility so that nursing is not in the bad news unnecessarily.”
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in Limpopo
For more information, contact:
Jacob Molepo, DENOSA Limpopo Provincial Organiser
Mobile: 072 587 0684
Facebook: DENOSA Limpopo
DENOSA’s response to the freezing of nursing positions in government as exposed by South African Health Rev...
Thursday, 24 August 2017
The Democratic Nursing Organisation of South Africa (DENOSA) notes the South African Health Review 2017 Study by Health Systems Trust that was released yesterday which, among others, paints a bleak picture of potential compromise of quality healthcare service due to unfilled critical clinical positions in provincial departments of health.
DENOSA’s interest and take about the study is from a perspective of advocating for the welfare of the population in as far as adequate healthcare service provision to the vulnerable, majority of whom are indigent and rely of public healthcare.
The Study confirmed what we have always been saying that there is a silent moratorium in provincial departments on the appointment of even nurses despite assurances that critical clinical categories were exempted from such. While we understand the current financial situation the country and government find themselves in as after-effects of the 2008 financial meltdown, DENOSA is of the strong view that the shortage of staff in health facilities is becoming a ticking time-bomb that has the potential to regress the country’s achievement of positive health outcomes in the years behind us. This is owing to the increase in the disease burden in the country, and the increasing South African population figures.
DENOSA is happy that the Study also makes this point clearly and we would like to add that the population of immigrants into South Africa also needs to be accounted for so that budgetary planning for health is informed by relevant numbers. We already know, thanks to the study, that our health budgets have often underestimated the population growth. What adds salt to the wound for us as nurses is that despite the underestimation of population figures in the budget processes, the austerity measures in relation to control of personnel figures wades off even the few nurses that are qualified and sitting at home while they are greatly needed by facilities. Vacancy rates are a serious challenge that create new norms in different critical units in our health facilities.
Speedy implementation of acceptable staffing norms in the country is a matter that should be given priority by government before we see ourselves back to where we were 10 years ago.
The study also touches on another critical area for us as nurses, that of neglected capital infrastructure spending (i.e. building and reconstruction of clinics and hospitals) which has been shelved off as a way to save costs. This, too, is equal to merely delaying your day of reckoning because more and more infrastructure in our health facilities is decaying and falling on top of patients and health workers. Maintenance of the existing old infrastructure, which was said to be the substitute for capital infrastructure spending, is not being carried out. The one fresh example of this was the sudden collapse of the ceiling at the maternity section at Tembisa Hospital last month. The roof fell on top of nurses and patients. There are more examples like this.
“DENOSA believes that efficiency is the key word that government is looking for as a way to address the current crisis,” says DENOSA General Secretary, Oscar Phaka.
“This means proper prioritization in the form of employing relevant personnel. It is well-known that nursing is the backbone of healthcare, and even Minister of Health acknowledges that. To have nurses sitting at home when there are vacancies that are not filled is counter-productive to the very goals SA seeks to achieve in the end.”
Occupation-Specific Dispensation for nurses, which is cited in the study as having had a great impact in driving costs towards remuneration, was a staff retention strategy used by government at the time when the country was experiencing mass exodus of experienced and specialized nurses who were leaving the country for greener pastures like the UK, Australia, UAE and others.
When OSD was implemented in July 2007, by December of the same year, not less than 10 000 nurses had returned back to South Africa to render quality healthcare services to South Africans. And this brought about 80% drop in job application by South African nurses to the UK alone a year later. While this OSD strategy should have been reviewed by 2012 already, it has not yet been reviewed five years later. Nurses are becoming edgy and some have, once again, already taken their flights for greener pastures in the developing countries where working conditions are far better off than they are locally.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
DENOSA General Secretary, Oscar Phaka.
Mobile: 082 328 9771
DENOSA Communications Manager, Sibongiseni Delihlazo
Mobile: 072 584 4175
Facebook: DENOSA National Page
Trauma Nursing Matters...
Evidence based practice: Is cricoid pressure effective in preventing gastric aspiration during rapid sequence intubation in the emergency department?
By Ntombifuthi Jennet Ngiba (BN) (UKZN).
There is on-going change within trauma nursing due to increased research in the area. Practices have been routinely adopted as the norm, but subsequently on further examination proven to be useless and more of a risk to the patient (Moore & Lexington, 2012). Research has brought into question practices or techniques such as the application of cricoid pressure during rapid sequence tracheal intubation. This practise was goaled at preventing the regurgitation of gastric content into the pharynx and subsequent aspiration into the pulmonary tree, but now questioned.
Cricoid pressure was briefly defined by Sellick in 1961 as a method used to reduce the risk of aspiration during the induction phase of anaesthesia. Sellick`s technique was to apply backwards pressure to the cricoid cartilage, compressing the oesophagus against the underlying vertebral body (Ellis, Harris & Zideman 2007; Priebe 2005). In this application of pressure the oesophageal lumen is occluded, preventing the passage of regurgitated gastric content into the pharynx and subsequent aspiration into the pulmonary tree (Stewart et al, 2014). Cricoid pressure is incorporated into the overall approach in reducing the chances of aspiration through rapid sequence induction of anaesthesia (Ellis et al., 2007; Priebe 2005). Over the years rapid sequence induction has been adapted by emergency physicians to allow ventilation as required to prevent hypoxia and subsequently termed “rapid sequence tracheal intubation”. Rapid sequence tracheal intubation (RSTI) is now the most widely used technique for tracheal intubation in the emergency department (ED) and cricoid pressure is taught as a standard component of emergency airway management (Ellis et al., 2007).
Despite inadequate scientific evaluation of the risks and benefits of cricoid pressure it is adopted as an integral component of rapid sequence intubation in EDs. No randomised controlled trials have shown any benefit of its use during rapid sequence intubation (Trethewy, Burrows, Clausen & Doherty, 2012). Furthermore, the application of cricoid pressure may be linked to increased risks to the patient such as impeding airway management, prolonging intubation time by concealing laryngeal view, inducing nausea/vomiting and oesophageal rupture with excessive force (Ellis et al., 2007; Priebe 2005;Trethewy, et al, 2012). Paradoxically, cricoid pressure may promote aspiration by relaxing the lower part of the oesophagus (Ellis et al., 2007). Some case reports note that tracheal intubation was impeded by cricoid pressure and regurgitation occurred despite application of cricoid pressure, possibly due to its improper application (Trethewy, et al, 2012). According to Bhatia, Bhagat and Sen (2014) the application of cricoid pressure increases the incidence of lateral displacement of the oesophagus from 53% to 91%.
However despite this evidence and the outcome of Trethwy’s (2012) RCT the judicial system appears guided in its judgement by outdated practises. A judge in UK ruled against an anaesthesiologist for failing to apply cricoid pressure to a patient with irreducible hernia who had regurgitated and aspirated. The judge argued that “We cannot assert that cricoid pressure is not effective until trials have been performed, especially as it is an integral part of anaesthetic technique that has been associated with a reduced maternal death rate from aspiration since the 1960's” (Bhatia et al. 2014). Therefore one may say that despite cricoid pressure entering medical practice on limited evidence and only supported by common sense, it somehow remains the practice of choice (Bhatia et al., 2014).
Thus it is about time nurses and doctors embrace evidence-based practice within the emergency department and let go of traditional practice that are proven to do more harm than good. There is still a great need for further evidence-based practice within the emergency department, to investigate the validity of the notion that cricoid pressure prevents regurgitation.
Ntombifuthi Jennet Ngiba is a Professional Nurse at Greytown Hospital.
Bhatia N, Bhagat H & Sen I. (2014). Cricoid pressure: Where do we stand? J Anaesthesiol Clin Pharmacol, Vol 30 pp 3 – 6.
Ellis D.Y, Harris T & Zideman D. (2007). Cricoid pressure in the emergency department rapid sequence tracheal intubations: a risk-benefit analysis. American College of emergency physicians.Vol 50, pp 653 – 665.
Moore K & Lexington K.Y (2012). Evidence-based practise guidelines for trauma care. Journal of emergency nursing. Vol 38, pp 401-402.
Priebe H.J, (2005). Cricoid pressure: an alternative view. Elsevier. Germany.
Stewart J.C, Bhananker S, & Ramaiah R. (2014). Rapid-sequence intubation and cricoid pressure. J Crit Illn Inj Sci, Vol 4, pp 42 - 49.
Trethewy C.E, Burrows J.M, Clausen D & Doherty S.R. (2012). Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial. BioMedCentral. Australia. Retrieved 04 August 2016: http://www.trialsjournal.com/content/13/1/17
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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