DENOSA appalled by reports of government’s intention to cut thousands of jobs...

Media statement

Tuesday, 14 August 2018 

The Democratic Nursing Organisation of South Africa (DENOSA) registers its annoyance at media-reports that government is planning to cut as much as 30 000 jobs in the public service at the time when quality of public service is deteriorating due to gross shortage of public servants. 

While government has publicly denied these reports by media, however, this move would be in line with previous intentions as announced by Treasury in its Budget Speeches, which we had warned against.  For instance, current Finance Minister, Nhlanhla Nene, made this intention clear in 2014 during his Mid-Term Budget Policy Statement when he said government was planning consolidate personnel numbers and that jobs which had been vacant for some time would cease to exist. 

Once again, DENOSA, would like to bring to the attention of the public that this move will not only result in poor and worse services rendered to communities, but will further drain the very same public funds that government believes it would be saving by cutting the jobs, due to high litigation rate as a result of shortage of public servant in areas like health. 

It is obvious that such a decision would have to be tabled at the collective bargaining platform, but the fact that government had made this intention clear previously makes us to believe the media reports. But organised labour will obviously reject this absurd thinking, simply because:

-          Government will still have to fill the hundreds of thousands of vacancies in the public sector; 

-           We can’t allow another Life Esidimeni phenomenon in public health because even the current vacancies are leading to high litigations against government; Government had to pay over R150 million for trying to save costs in the removal of mentally-ill patients in Gauteng. 

-          Citing the reskilling and retraining of public servants as a justification for job cuts because there are many nurses who have been retrained already and are being abused and made to work and as professional nurses on the salaries of enrolled nurses because vacancies are not being advertised.  

Therefore, despite government’s denial of this secret move, DENOSA believes that government will only be left with regrets if it forges ahead with this move, as it will spell disaster to the quality of public service. 

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

For more information and comment, contact:

Cassim Lekhoathi, DENOSA Acting General Secretary

Mobile: 082 328 9671

Or

Simon Hlungwani, DENOSA President

Mobile: 082 328 9635 

Website: www.denosa.org.za

Facebook: DENOSA National Page 

Twitter: @DENOSAORG

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DENOSA KZN disapproving of department’s non-compliance with staff establishments ...

Media statement

Monday, 13 August 2018

The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal would like to bring to the public attention that the Department of Health in the province continues not to comply with the approved staff establishments in many hospitals and clinics, owing to slow pace of service and exploitation of staff who are not remunerated for the extra work they do.

 

DENOSA has noticed that many health facilities and almost all Community Health Centres (CHCs) in the whole province have disregarded the approved staff establishments in terms of their service package and have added more health programmes in facilities without adding the number of workers and updating the staff establishments. 

This worsens the poor quality of health that community members are receiving at the points of service, because health workers are few while service packages have been increased. “Almost all CHCs now have additional programmes such as test-and-treat in the management of HIV/AIDS, and yet these were not in the approved package,” says DENOSA Provincial Secretary, Mandla Shabangu.

“That simply means both the pace of service for patients becomes slower every day, especially as more and health workers are not replaced when they leave that institution. It also means health workers have to stretch themselves to the breaking point and without any adjustment in their remuneration in line with the added tasks; and that is exploitation. And often it is the main reason for the resignation of health workers.”  

What worsens the situation is that, in terms of nursing services, lower category nurses such as enrolled nurses and nursing assistants are no longer hired or replaced upon retirement or resignation on claim that they are not critical positions. DENOSA asks the question: who is to do the work that was designated for the enrolled nurses when none gets replaced upon resignation or retirement?

DENOSA is making this known because the public is not made aware whenever these developments take place, and nurses are often the ones who are left to deal with the anger of patients and community members over the slow pace of service at service points. 

This is not the only problem with the Department, however. There are thousands of employees who have not progressed to the next grade, despite the fact that they had gone through training, due to lack of funding. It is a requirement to move from grade one to grade two, which must happen after ten years. 

These employees cannot have their performance remunerated accordingly due to the fact that PERSAL system is declining to process payment as their notches remain, which is not of their doing. “We have a long list of affected workers in this regard,” adds Shabangu. 

DENOSA demands that the Department first corrects the staff establishments and then correct the shortage of health workers, because the Department is talking about correcting the shortage based on the old structure which that does not have the new programmes. 

DENOSA will mobilise nurses not to comply if they are forced to work according to work on programmes that are not reflecting in the approved staff establishment.   

End 

Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal 

For more information and comment, contact:

Mandla Shabangu, DENOSA KZN Provincial Secretary

Mobile: 071 643 3369

Tel: 021 305 1417

 

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DENOSA warns of nurses’ unhappiness over prolonged non-payment of Uniform Allowance...

Media statement 

 

Tuesday, 07 August 2018 

 

 

The Democratic Nursing Organisation of South Africa (DENOSA) would like to warn both government in many provinces and the public about the looming chaos in hospitals and clinics if many provinces continue to prolong the non-payment of Uniform Allowance to nurses, which should have been paid in April this year already.

 

DENOSA would particularly like to remind the Gauteng Department of Health that it is not long ago that chaos erupted at Charlotte Maxeke Academic Hospital over non-payment of bonuses. It looks like the unrest at the hospital has not been a lesson to the department, just as Life Esidimeni disaster was never a lesson for them to have learnt from.

 

Uniform Allowance was long agreed upon and is a collective bargaining agreement. Each year, however, government continues to drag its feet in implementing this on the 1st of April until nurses either come to work wearing pyjamas or embark on a protest action because they are tired of wearing torn uniform.

 

DENOSA raised this issue sharply at the South African Human Rights Commission dialogue on balancing the rights or health workers to strike with the right of patients to healthcare that was held early in July, and warned that failure to disrespect this collective agreement by the employer is often the cause of chaos and strikes in many facilities. DENOSA made an example of the current delayed non-payment of Uniform Allowance and warned that this will see nurses pitching to work wearing pyjamas or staging protests if it is not addressed soon. 

 

DENOSA would like to applaud provinces such as KwaZulu-Natal, Eastern Cape, and Western Cape for having paid the Uniform Allowance, because nurses in these provinces previously had to embark on a protest. It looks like previous experience has taught them a lesson. 

 

Because nurses are classified as essential service workers, beside the fact that government does not show this as the employer in its actions, they are required to wear uniform. Up to date, nurses uniform has not been provided,  let alone as a pilot, despite the country’s Nursing Strategy of 2011-2017 having promised that this would be done by now.   

 

Furthermore, DENOSA reported to the SAHRC that the employer is still reluctant to sign the Minimum Service Level Agreement which will regulate the minimum staffing levels in wards for nurses in times of strike when their right to collective bargaining, like timeous payment of Uniform Allowance, is undermined by the employer. 

 

It’s not even that this allowance pays for the full ‘uniform’ of nurses, because it is a fraction of what government should actually be paying towards nurses’ real, full complement and quality uniform.  

 

End 

 

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

 

For more information and comment, contact:

 

Cassim Lekhoathi, DENOSA Acting General Secretary

Mobile: 082 328 9671

 

Or

 

Simon Hlungwani, DENOSA President

Mobile: 082 328 9635 

 

Website: www.denosa.org.za

Facebook: DENOSA National Page 

Twitter: @DENOSAORG

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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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Publications

Nursing Update

         
January 2018

Nursing Update is jointly published by the Democratic Nursing Organisation of South Afr... More.

Curationis

         
January

Curationis provides a forum for cutting-edge theories and research models related to th... More

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