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DENOSA KZN aggrieved by R17 billion overspending on litigations while nurses’ shortage is not addressed ...
Friday, 21 September 2018
The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal is highly aggrieved by overspending by the provincial Department of Health, which is cited to be R17 billion, mostly on litigations and general mismanagement while the persistent gross shortage of nurses in many facility is the main cause of litigations.
DENOSA raised a warning flag from as early as the previous financial year (2016/17), when overspending had reached R10 billion then. We raised the matter and pointed it out that much of the money that is drained from the Department through litigations would not have left the department if it had filled the vacant positions in many health facilities.
The shortage of midwives is worse, and that is the answer to why most litigations occur in maternity sections. In many facilities, maternity units are allocated two midwives per shift, for example, when it should be four midwives.
Furthermore, as DENOSA we are equally unhappy that it has been uncovered that 66 senior managers within the department are pushing business interests with the department by getting tenders to render services. This raises many suspicions, justifiably so, over the inflation of prices for services.
DENOSA calls on the department to address the gross shortage of health workers in the province speedily, or else litigation costs will sky-rocket even more.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal
For more information, contact:
Mandla Shabangu, Provincial Secretary
Mobile: 071 643 3369
Tel: 031 305 1417
DENOSA Gauteng statement on the upcoming COSATU National Congress...
Thursday, 13 September 2018
The Democratic Nursing Organization of South Africa (DENOSA) in Gauteng is looking forward to the upcoming national congress of Cosatu, which will start from 17 to 20 September.
We view this congress as an opportunity for workers to renew the mandate of the federation but also it will be a festival of ideas to respond to all the challenges faced by workers on a daily basis.
We regard the congress, which will be made up of majority the delegates, as an opportunity to create history in the alliance. DENOSA in Gauteng fully supports Zingiswa Losi to take over Cosatu. We long said this as far back as the 18th of April 2018, as was published in the Sowetan, that we think she is ready and we committed to canvass this view.
We are calling on delegates to exercise their rights by applying their minds and prioritising Cosatu in all discussions as this is the opportunity to revive Cosatu. We are aware that the nomination process has been closed and we want to strongly caution the leadership of Cosatu that it is illegal to close nominations before congress starts as this is a congress competency. We want the nominations not to be closed as we are working tirelessly to ensure that we nominate capable leaders and also want 50-50 gender representation in leadership. It is our firm view that there should be a woman in one of the deputy president positions. Our last view is that there should be a vibrant and capable woman or man to replace both the current treasurer and the General Secretary and we will reveal the names in the congress as we are still selling these views.
The current competitive environment does not need a passive leadership in the federation when workers continue to be enslaved. We want a leadership that will revive Cosatu and fight for workers without any fear or favour. Those who have ambitions of going to Parliament next year must please not waste workers’ time by availing themselves to contest and use Cosatu to advance their ambitions.
Lastly, DENOSA Gauteng would like to send a word of appreciation to the Cosatu national spokesperson, Cde Sizwe Pamla, for filling the vacuum that was created and for representing Cosatu views without any fear or favour at all times and we call for a special recognition of him in the National congress.
For more information call
Simphiwe Gada, 072 563 1923
DENOSA Gauteng Student Movement supports student nurses’ protest over non-payment of Uniform Allowance at B...
Thursday, 13 September 2018
The Democratic Nursing Organisation of South Africa (DENOSA) Gauteng Student Movement is putting all its weight behind student nurses’ protest at Chris Hani Baragwanath Nursing College over non-payment of uniform allowance to many students at the college and calls on all other student nurses in other institutions to also support the student in their march tomorrow morning.
We are dismayed that there are students who have not yet received their uniform allowances and if one has received it is half of what is expected. In total number of students who have not received the allowance at all is 305 between 3rd and 4thyear students.
In collaboration with college SRC, engagements have been held with the issue of standardisation of uniform allowance raised in both the health portfolio committee, SRC/MEC and senior management meetings. Unions, more especially DENOSA raised this issue further. In response to our submissions, the nursing directorate team announced in a recent SRC and senior management meeting that students will receive the same amount of uniform allowance that permanent staff receive. This undertaking was welcomed by student population.
After the successful #UniformChallenge by nurses in Gauteng, students did not receive what was promised to them.
For this reason, we are in full support of Chris Hani Baragwanath Nursing College Students in intensifying the #UniformChallenge. We call on all students in Gauteng nursing colleges and universities to continue with this protest of not wearing their uniform until they are listened to and paid what is due to them. We are also in support of the march on Friday 14 September to the college to submit a memorandum of demands. We will not leave the premises until we are addressed by the college principal, Registrar and HR manager.
“It is sad that in some institutions the bursary students were not provided with uniform that was promised to them when they were signing those application forms,” says Chairperson of DENOSA Student Movement in Gauteng, Nathaniel Mabelebele.
“We need to remain in solidarity and maintain high discipline as the future of this profession. We cannot continue to allow the Department of Health to use us as their workforce without any proper compensation. They continue to undermine the importance of this profession even with the newly introduced funding model that is failing us. Let us continue to organise and mobilize mass support as students.”
The GDoH better prepare themselves as we (GPSM) will soon visit them as student movement on many other issues including the uniform allowance. The profession's future is in our hands as young nurses and we are here to ensure that the future is bright.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) Student Movement in Gauteng
For more information, contact: Nathaniel Mabelebele (Acting Provincial Chairperson, Student Movement)
Mobile: 082 767 7064
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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