DENOSA Limpopo statement on the severe shortage of nurses to deal with the resurgence in the province ...

Media Statement
Monday, 11 January 2021
 
The Democratic Nursing Organisation of South Africa (DENOSA) in Limpopo notes the increasing numbers of COVID-19 new infections in the province, especially in Capricorn, and Vhembe districts. 
 
We further take note of Limpopo Health Department's efforts to strengthen capacity in the fight against the pandemic by establishing additional Covid-19 beds to accommodate many patients who need in-patient care. We believe that these additional beds will not save the lives of community members due to shortage of nurses who are required to take care of patients admitted in the hospitals.
 
The available nurses are already overstretched, exhausted and frustrated due to the overwhelmed health system in the province. 
 
DENOSA Limpopo is worried about the Department of Health's poor preparations in a fight against the resurgence where shortage of Healthcare Workers is mainly caused by failure to fill vacant nursing posts left by nurses who went on pension, transfered or lost their lives. The situation is exacerbated by the impact of Covid-19 which confined more than hundred nurses either on self- quarantine or isolation. 
 
DENOSA is seriously disturbed by Department of Health's decision to dismiss more than 350 newly qualified Professional Nurses who are due to complete their Community service on the 31st of January 2021. These nurses were recruited and trained by Limpopo Health Department for a period of four years after identifying the need for additional Professional Nurses in the province. 
 
The clinics couldn't provide 24 hours services due to shortage of nurses, which denies our communities access to health services 
 
Limpopo Department of Health is now serving as a training agent for other provinces such as Western Cape, Eastern Cape, Gauteng and private healthcare institutions which are benefiting from professional nurses trained and dumped on the streets despite severe shortage in the public hospitals and clinics. Limpopo Health Department trained and dumped about 700 professional nurses who were recruited by other provinces and private healthcare institutions. 
 
DENOSA Limpopo calls on the Department of Health to resolve shortage of nurses and other Healthcare Workers through:
 
1. Absorbtion of 368 professional nurses
     who were issued with letters to terminate their contract at the end of January 2021.
 
2. Location and appointment of Post-Community Service Professional Nurses who were trained and dumped by Limpopo Department of Health in 2019 and 2020.
 
3. Implementation of Circular 39 of 2020 by appointing 1362 Professional nurses, 167 Staff Nurses and 102 Nursin Assistants as advertised. 
 
We believe that additional beds are required to strengthen the province's capacity to deal with the resurgence. 
 
END
 
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in Limpopo. 
 
For more information, contact:
 
Jacob Molepo, Provincial Secretary 
Mobile: 0725764979
 
Lesiba Monyaki, Provincial Chairperson 
Mobile: 0725782753 

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DENOSA KZN statement on the second wave as well as its impact on health care workers....

Media statement  
Monday, 11 January 2021 
 
The Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal is disappointed by the DOH poor response to the second wave of COVID-19 in the province. 
 
The Department has been waiting for the second wave and reassuring the public that they are ready, only to discover during the resurgence that they are not ready.
 
DENOSA KwaZulu-Natal requested a resurgence plan and a meeting to discuss and give inputs on that plan before the resurgence. 
 
To date, DENOSA has not received that plan, which we believe it is irresponsible of the Department not to have a plan for such fatal wave and we condemn it vehemently. 
 
DENOSA visited different institutions to investigate the severity of problems that were reported by our members who are nurses in facilities. 
 
During this visit, DENOSA noted a number of challenges which included, amongst other: 
 
Gross shortage of staff due to infections and deaths due to COVID19;
 
Inadequate and poor PPE;
 
Overcrowding; 
 
Lack of psychological support to staff; and 
 
Forcing staff to sign their normal sick leave for COVID-19, which is against the DPSA circular 7 of 2020.
 
Based on its visits, DENOSA drafted a plan to be shared with the Department. 
 
This plan has recommendations to assist its members in dealing with the second wave. 
 
DENOSA made the following recommendations:
 
 *1. Urgent filling of all vacant posts caused by deaths due to COVID19 and other diseases before the end of March 2021 while the posts are still funded as well as establishment of a relief pool of staff in all districts to assist when nurses go for isolation and or quarantine.
 
*2. Urgent employment of Employee Assistance Programme (EAP) staff in all institutions to provide psychological support to staff. 
 
*3. Call on the department to issue full PPE to all staff irrespective of whether they are in a COVID ward or not to minimise transmissions.
 
*4. Urgently implement national guidelines on vulnerable employees by ensuring that all institutions have functional Institutional Risk Assessment Committees (IRAC) to ensure that guidelines are implemented in terms of vulnerable employees.
 
*5. Re-furbish all staff tea-rooms to allow for social distancing to minimise cross infection.
 
*6. Department to withdraw HRM circular 41 of 2020 on COVID leave to allow staff to get special leave for COVID 19 as per DPSA circular 7 of 2020*
 
DENOSA is of the view that if the Department can implement all these recommendations they can be able to deal with this pandemic successfully and be able to save lives.
 
DENOSA noted that there are institutions that force members to re-use masks.  Therefore, we would like to inform our members to refuse that irresponsible and illegal order and urge them to report to the shopstewards so that DENOSA can deal with those managers.
 
Lastly all members of Denosa are advised not to start work if there is no PPE or staff to assist them.
 
End 
 
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in KwaZulu-Natal 
 
For enquiries, contact:
 
Mandla Shabangu, Provincial Secretary 
 
Mobile: 071 643 3369  

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DENOSA Mpumalanga disturbed by increasing numbers of new COVID-19 infections in the province....

MEDIA STATEMENT
 
Tuesday, 05th January 2020
 
 
The Democratic Nursing Organisation of South Africa (DENOSA) in Mpumalanga has noted the increasing numbers of COVID-19 new infections, especially amongst our members and other professionals who are frontline workers within the health sector, specifically nurses.
 
We are disturbed by the continuous undermining attacks from our Government more specifically the Department of Health and the Minister of Health, Dr Zweli Mkhize. As frontline workers who are exposed to the virus on a daily basis, one would have expected the Department of Health to do a thorough consultative process with nurses and doctors on the vaccine of the COVID-19. 
 
“As nurses, we are also humans and need to be reassured on anything that could affect our safety and that of our loved ones. We will not allow the government to impose the vaccine on us or use us as testing tools, and it is within our right to reject this vaccine,” said the Provincial Secretary, Mzwandile Shongwe.
 
At the beginning of this pandemic, we requested a Tax break from Government and the Government remain silent. We further requested a Risk Allowance as we continuously risk our lives to save the lives of the public but instead the Government rejected all this and yet we are still expected to serve with open arms and hearts. 
 
DENOSA in Mpumalanga calls on the Department of Health and the Government at large to:
 
1.To continue and fill the gaps of nurses in all categories as this dire shortage is causing burnout on nurses. If nurses, who are the heart of the health sector, continue to be infected, the public will be left unattended.
 
2.The Mpumalanga Department of Health to continue and provide enough and quality PPE, and to advice managers in health facilities not to deprive our members of PPE as it is a nurse's right to work in a safe environment.
 
We call on our members to call our Shopstewards that are close to them if they have challenges with PPE. Our nurses must never allow to be used as sacrificial lambs of the department. 
 
We continue to say: NO PPE, NO WORK!
 
End
 
Issued by the Democratic Nursing Organisation of South Africa (DENOSA) in Mpumalanga.
 
For more information, contact: 
 
Mzwandile Shongwe, DENOSA Mpumalanga Provincial Secretary
Mobile: 072 564 0136

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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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August 2020

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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