Government has brought Life Esidimeni findings upon itself!  ...

Media statement

Monday, 19 March 2018 

The Democratic Nursing Organisation of South Africa (DENOSA) notes the findings of the Life Esidimeni Arbitration which were delivered by Justice Dikgang Moseneke earlier today.  

DENOSA regard the findings, and especially the order for government to give victims’ families financial compensation as a deserved punishment for government’s deteriorating quality healthcare service as a result of its many ill-considered cost-cutting measures in health facilities across the country.   

The Gauteng Health Department’s inability to address its capacity challenges is proving to be costly in many ways. DENOSA is still adamant that human resource challenges, characterized by continuing shortage of staff and preoccupation with the costly outsourcing of services, are the main reasons behind the many legal woes faced by the Department.  

Simply put, the few workers employed by the department are being overloaded with work and there is no leadership foresight and boldness to address the problem at both national and provincial levels. Poor Human Capital Management and planning is what is bringing Gauteng public healthcare, which services 71% of its 13.4 million population, to its knees. 

The MEC of Health, Dr Gwen Ramokgopa, has acknowledged it herself that in 1998 the Department had 62 000 employees out of the then 7 million people in Gauteng. Today this population figure has almost doubled (to 13.4 million), and yet the department now has 68 000 employees! This is the route of the crisis! 

In addition to this, the Department is faced with a frustrated workforce whose work is not being appreciated. As a result, Gauteng Department has not paid the highly overworked workers performance bonuses for 2016/2017 and 2017/2018 financial years. The question is no longer about whether they should get paid what is due to them, but what kind of service are they expected to render when they are not happy? And their unhappiness, which has progressed into high stress levels, is not addressed in the workplace through interventions such as counselling or capacity and skills development.   

The order to pay victims hundreds of millions of Rands is likely to anger workers even more, as they are subordinates of senior managers who continue to plunge the Department into deeper financial woes because of their poor decisions, as their own little issue of compensation is being overlooked by them! 

The question will remain therefore: what kind of service are people of Gauteng (making 24% of South Africa’s population) going to get when further millions are to be paid to victims in damages by a department that has already hanged itself into debts? 

If nothing is done, the health system will just produce more victims that must be compensated in the end, just as it is happening in many maternity sections already! The healthcare quality is becoming dangerously poor by the day, and more health professionals are turning into victims of this poor system because the rules of the game are changing.      

Government has suffered a self-inflicted pain in this one. 

DENOSA appeals to President Cyril Ramaphosa to urgently look into this sector in all provinces, because the National Department of Health is overwhelmed due to lack of powers and nothing good is coming out of its presence at this stage. Or else, the troubles will go deeper.  


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 


Facebook: DENOSA National Page 

Twitter: @DENOSAORG   

Read more
DENOSA Gautent Student Movement urges all student nurses in the province to partake in tomorrow's march by uni...

Media statement
Thursday, 15 March 2018
DENOSA Gauteng Student Movement is urging all student nurses in Gauteng who will be off duty on friday the 16th of March to avail themselves for the march to the Gauteng Department of Health and Premier's office that has been organised by health trade unions. 
The march, which commence from Maryfitzgerald Square at 10h00, follows a meeting where the unions and the department of health could not find each other on PMDS of workers for both 2016/17 and 2017/18 financial years as well as a sit in from the very same day the 13/03/18 at 15:00 to the 14/07/08.  
We believe as Student Movement that this march is an opportunity for us nursing students in Gauteng to break our silence and speak out with a united voice against all the problems that we find ourselves in as student nurses due to the carelessness of the Gauteng department of health. These challenges vary from the implementation of the bursary system, the shortage of professional nurses and lecturers in nursing education institutions throughout the province, and the challenges with regards to community service posts after completion of R425, as well as the reduced intake of nursing students after all processes of selection are done.  And there are many other challenges. 
The department of Health in this province has continued to enjoy taking decisions that will greatly affect the workers as well as the nursing students alone in its office despite the advice and suggestion from labour and colleges' SRCs. Such decision like the bursary system implementation that was done overnight and as quick as possible without proper planning has proved to be a complete disaster and a threat to the already struggling and poor quality health care system in the province. The department was warned prio to the implementation of this system in many ways but decided to continue. 
Nursing education will never have a chance of being what it is desired to be even with the highly committed and passionate lecturers in all Nursing Education Institutions and Universities with the high shortage of lecturers and Professional Nurses who will be able to assist the process of theoretical and experiential learning. We need to remind this department that for the community to receive quality care, a quality trained nurse is a need and without adequate and immediate addressing of shortages of academic staff the status quo will remain. 
The 2018 academic year started in a bad note wherein this department had already decided that there will be no nursing intake for 2018 even when all selection processes have already been completed. This was not acceptable and action was necessary and it resulted in a reduced nursing intake. We need to warn the department and make them know that their poor management of funds has got nothing to do with nursing, and they need to find another source to cut cost with as we will not allow any further reduction of nursing students going forward and that those students who were successful in the selection process must just get admitted for 2019 without going through selection process again. 
Furthermore, the safety of nursing students must also be a priority; this includes having access to transport (moving to and from nurses homes to clinical practice areas) and safe residential areas.  When this was communicated to the department it didn't receive the attention it deserved especially for students at universities in between semesters when there are no campus buses and residences are closed. The department needs to respond to calls for mantained, clean and safe nurses residences for the safety of students training towards becoming nurses. 
We further need to call for absorption and translation of all Community Service Nurses  into Professional Nurses sooner without wasting anytime. All frozen posts in Hospitals must to 'defrosted' with immediate effect. 
Pay our PMDS now! 
It is us Nursing Students who can deliver all these challenges that we face and are ignored by the Department of Health that has better priorities than all its workers who deliver basic and significant services to the people of South Africa residing in Gauteng! When we are United we become a powerful force to be reckoned with! 
Don't be tempted to be with all those who will be marching only in spirit and in flesh. 
Issued by DENOSA Gauteng Provincial Student Movement
For Inquiries, contact:
Markos Khensani Ndlovu: 072 683 8460
Provincial Organiser: Nathaniel Mabelebele: 082 767 7064
Provincial Secretary: Nonhlanhla Blaauw:  078 748 7835

Read more
Gauteng health unions to march to the Premier and Gauteng health offices this Friday ...

Media statement


Wednesday, 14 March 2018


Friday’s march is first warning shot…


After the lengthy sit in the office of the health MEC the five unions, namely DENOSA, NEHAWU, PSA, HOSPERSA and NUPSAW, finally got the opportunity to hold long discussions with her yesterday around the outstanding performance bonuses for 2016/17 and 2017/18 financial years ending this month-end.


Unfortunately, after long discussions it became clear that we can't find each other on both items. The employer maintained that they don't have money to pay both and the decision no longer lies with the health department but with the Gauteng government led by the Premier.


Put simply, the employer is adamant that they are not going to pay PMDS for last year and this year.


As unions we condemn this stance taken by the employer and view it as an attack to collective bargaining agreement and exploitation of workers. 


The department of health finds itself in this financial mess because of corruption and mismanagement of funds and yet no heads are rolling and it is workers on the ground who are made to pay the price.


As a result of this, as the unions we will fire the first warning shot on Friday 16 March 2018 as we have agreed as organised labour to take to the streets this Friday (16/03/18) when we will be visiting the offices of the Premier and Gauteng Health to handover our memorandums of demand.


We are still discussing the possibility of marching to the ANC offices as the ruling party in the province to give direction to its deployees and its government to stop exploiting workers. If there's no movement after our first shot, we will do a total shutdown of the health system in the province. 


We therefore call on all workers to come out in their numbers this Friday and take the employer head on to address our demands.


The march will commence at 10h00 from Maryfitzgerald Square.


We say ‘No retreat, No surrender!’




Issued by organized labour in Gauteng Health sector.


For more information, contact:


Simphiwe Gada


Mobile: 072 563 1923

Read more
View More

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:


Read more

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.

Read more


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   

Read more
View More


Nursing Update

January 2018

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



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