DENOSA Student Movement deeply concerned about the funding model of nursing education in South Africa...

Media statement 
26 February 2021 
 
DENOSA Student Movement notes the clarification by the Department of Higher Education and Training (DHET) regarding funding for nursing education by the National Student Financial Aid Scheme (NSFAS). However we still believe that there should be a tangible, effective and specific solution to the funding model of nursing education since the structure of the course itself is unique.
 
The 2020 academic year marked the year of the last group that was on the persal system and the first group of graduates from the bursary funding. Meaning that it has been four years that the bursary system has been implemented in all provinces. Since then we have faced many issues regarding the clinical practice and access to funding for nursing education to a point where the funding is discontinued in some parts of the country. Removing the BCUR course from the National Student Financial Aid Scheme (NSFAS) funding list was going to further deny young South Africans the opportunity to study nursing. The past four years after the implementation of the bursary system have been challenging for access to nursing education.
 
Since the implementation of the bursary system in nursing many students in universities had NSFAS as an alternative funding model since there is no certainty in the government bursary, the dependence on NSFAS by nursing students in universities increased when the government bursary was randomly discontinued. Only nursing colleges benefited from the nursing bursary and that in itself signals the inequality in the funding model of nursing education.
 
The department of higher education and training and the department of health need to be very careful when it comes to the funding model of nursing education and the transition of nursing education in general. Since we are talking about the transition of nursing into higher education, the department must be careful not to inherit a mess created by the department of health.To avoid this situation the Persal system must be brought back as it was a working funding model of nursing education which was never supposed to be removed in the first place. With the persal system in place, the NSFAS will have relief because nursing students will have a funding option specific to them. The only focus will be to avoid dual funding.  
 
MORE ELABORATION ON THE FUNDING MODEL OF NURSING EDUCATION.
 
It has been years since the question of the funding model for nursing education existed; however some went to an extent of manipulating the confusion that rises within the debate to benefit their functions. For some it remains a lost victory stolen away from them, and for students it is unfairness as they are left with nothing. By that we mean nothing at all because all the replacements that were put in place are taken away from them. Students who receive a salary are regarded as ‘employees’ protected by labour law. This leads to several challenges: difficulty to terminate their training when they do not meet the academic standards; over reliance of the employing institutions on their services; potential abuse of privileges by the incumbent and failure of the employer to create learning opportunities and meet students’ learning needs. On the other hand, students with supernumerary status enter the workplace to ‘observe’ nursing care in the clinical situation which also does not provide sufficient preparation for students to take up their role as qualified professional nurses on completion of training. (Strategic Plan for Nurse Education, Training and Practice 2012/13 – 2016/17,pg 22).
 
What is quoted above does not begin to give a perspective of the student. The first point itself speaks about the difficulty to terminate training when the student fails to meet requirements, this is as if they’ve never successfully terminated training of any student during the previous funding model.no need to mention the student leaders targeted and perished in such processes. Instead of taking out the whole model and limiting the reason surely someone could’ve mentioned that student academic rules and regulations can inform the contracts for the persal system on when a student can face termination. 
 
The second point boldly admits to the over reliance of the employing institutions on students services as if that is not the case currently with a full student status.to be honest students go to the clinical practice area to work, clinical accompaniment is still limited and what happens during the rest of the 12 hour shift is just duties of a nurse. The nursing strategy speaks on a potential abuse of privileges by the incumbent as if the privileges are not well deserved because of the service provided in the absence of clinical accompaniment. Maybe we must ask the question why that gathering was so jealous of the individual benefits of the student from the little compensation they got.
 
The failure of the employer to create learning opportunities and meet student needs was surely not compromised by the previous funding model because if that was the case the situation would be different by now. Instead we are seeing funding being withdrawn just as seen in Gauteng where for three consecutive years students have not received any bursaries from the department of health. 
 
If we are asked to provide evidence we will refer you to the nursing students sleeping in libraries with only one meal per day (excluding breakfast before work) trying to save the little R500 from home to use for transport to “work” and rising trends of absenteeism.
 
Student needs include transport, food and accommodation to an extent of safety, not forgetting the provision of uniform, practice equipment, study material and even the social psychological wellbeing. You will be amazed how some students are calling home asking for money to buy uniform and equipment. Well it is entirely not true that students enter the wards to observe nursing care, instead we are part of those routines done in the clinical area. 
 
When planning is done, students are included in the plan, hence our appearance in the delegation of duties.
 
Difference between the persal and bursary system:
 
The bursary offered (which was not all provided as expected):
• Tuition fee 
• University/nursing college registration fee 
• Transport fee 
• Accommodation 
• Uniform 
• Books
• Meals 
 
Persal offered (which served as employment of young people):
 
• Salary
• Uniform allowance
• Housing allowance
• Medical aid subsidy
• Remuneration for working on public holidays, Sundays and night duty
• Incentive bonus
• Pay progression
• Pension subsidy
• Service bonus
 
It is expected that one would view this system as costly but my response would be a question on whether there is a significant cost difference between the two models.it may appear that the nursing students are spoilt or given a huge responsibility at a young age, however when one says that they must not overlook the opportunity of securing future financial savings through pension funds and current benefits in terms of medical aid subsidy due to the dangerous nature of the exposure in the work place. The benefit really doesn’t go to the student because it clearly goes towards tuition fees and all student needs. 
 
This doesn’t only teach the young nurse responsibility but also a lesson of financial education and management. It addresses the high number of unemployment in the country and at least when managed properly relieves certain families from the burden of poverty. Why was there an impression that the young people of South Africa do not deserve such opportunities? If ever there is a view that some of the students came into the profession because of the money what is the difference because even today they come into the profession because there are bursaries? Let the education, practice and the profession itself judge who came for the right reasons. At least there we won’t have speculations.
 
Fix the funding model of nursing education now!!
 
Issued by DENOSA Student Movement.
 
For more information, contact:
Nathaniel Mabelebele, National Chairperson
Mobile: 071 684 1646

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DENOSA response to the budget by Finance Minister which has relegated health expenditure ...

Media statement  
Thursday, 25 February 2021
 
The Democratic Nursing Organisation of South Africa (DENOSA) notes the budget that was presented by Finance Minister, although we are utterly disappointed that Health has dropped to the 4th position on the list of priority spending by the government at the time it should have been given priority in the face of the COVID-19 pandemic. 
 
The budget allocation of R248.8 billion to health is well behind that of education (R402.9 billion), Social Development (R335.9 billion) and Debt Service cost (R269.7 billion). 
 
While we commend the allocation of the more than R10 billion for the country's vaccination programme for a two-year period, we are disappointed, however,  that the same commitment is not made towards both human and material resources for the healthcare sector. 
 
Our main concern is that the country will not stop dealing with the pandemic until we reach 67% herd immunity in our population by end of the year if things go according to plans. In the meantime, this means healthcare workers would still be cornered by the heavy work, when they have not had their salaries adjusted since April last year. Many healthcare workers are still sitting at home because they have not been absorbed by government due budget cuts in provinces.
 
On the issue of salary increase for public servants, the minister continues to duck and dive and pass the buck onto the minister of Public Service and Administration as if he is the one to make a final decision on salary increment.  
 
Moreover, the Minister of Finance is talking of potential negotiations for yet another multi-term, when they are disputing the last leg of the current multi-term agreement. He must table that ridiculous multi-term agreement proposal at the bargaining council when he has proven that he cannot be trusted with the multi-term agreements. For our part, as DENOSA we are fixated on the single-term agreement. 
 
Minister Mboweni repeated the same line that he read in his previous Budget Speech and during the Mid-Term Budget Policy Statement late last year that Minister Mchunu is in talks with stakeholders in labour regarding the salary increment, when he knows that the matter is now with the Constitutional Court, over an agreement that the legal representatives of the Department of Public Service and Administration believe is legal while legal representatives of the National Treasury believe it is illegal. 
 
If Minister Mboweni has any proposal to make, he knows that the bargaining council is the relevant platform that was created for that purpose. 
 
End 
 
Issued by the Democratic Nursing Organisation of South Africa (DENOSA).
 
For more information, contact:
 
Cassim Lekhoathi, DENOSA Acting General Secretary.
Mobile: 082 328 9671
 
Simon Hlungwani, DENOSA President
Mobile: 082 328 9635 
 
Tel: 012 343 2315 
Website: www.denosa.org.za 
 
Facebook: DENOSA National Page 
 
Twitter: @DENOSAORG 

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DENOSA solidarity statement with Lesotho Nurses Association on oppression of nurses at Tsepong ...

Media statement 

Tuesday, 23 February 2021

The Democratic Nursing Organisation of South Africa (DENOSA) stands firmly with its sister organisation in the SADC region, the Lesotho Nurses Association (LNA), in its fight for equality of nurses at Tsepong.

LNA has brought to our attention that the remuneration structure for nurses and assistant nurses is not equal and is not in line with the one applied by the Department of Health in that country. 

Enclosed is the statement from LNA. 

Our solidarity with LNA is on the basis that this behaviour also implicates entities that are from South Africa. 

Nurses in the continent have done their utmost best to shield the nations from the invisible enemy, often at the expense of their own lives due to poor protection in the workplace. 

As our neighbouring country, what happens in Lesotho has a way of affecting us in South Africa, and vice versa. 

We wish great strength to LNA in fighting this justified cause on behalf of nurses of Lesotho.

End 

Issued by the Democratic Nursing Organisation of South Africa (DENOSA) 

For more information, contact:

Simon Hlungwani, DENOSA President 

Mobile: 082 328 9635

Cassim Lekhoathi, DENOSA Acting General Secretary 

Mobile: 082 328 9671 

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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.

REFERENCES

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


 

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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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WHY DO WE SAY NURSING IS A CALLING? ...

 
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   
End

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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