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DENOSA response to the announcement by Health Minister to put the J&J vaccine rollout on hold. ...
DENOSA Limpopo statement on the outcomes of its PEC meeting....
Media statement – For immediate release
Monday, 12 April 2021
The Democratic Nursing Organisation of South Africa (DENOSA) in Limpopo held its Provincial Executive Committee (PEC) meeting from the 08th to the 09th April at Bolivia Lodge in Polokwane to deal with the number of issues affecting nurses in the province.
These issues include, among others, the withdrawal of circular 43 of 2020, Progress on Phase 1 Vaccine for Frontline Workers, budget cuts, shortage of staff especially professional nurses, suspension of employees in pursuant of Circular 43 of 2020, relocation of Mobile Clinics and training of nurses.
On the withdrawal of Circular 43 of 2020 on a new duty roster:
DENOSA welcomes the withdrawal of Circular 43 of 2020 following a lengthy battle between unions and the Department of Health in the province. The circular was not in the best interest of service delivery, but on saving costs which ends up denying our communities their basic human right of access to health service. It is our belief that the Department of Health has been saving costs by, deliberately, not filling vacant posts left by employees who went on pension deliberately, lost their lives or through resignations.
The Department further continued to save costs by appointing employees on Managerial positions on acting capacity for a long period without compensation, which contravenes DPSA policy on Acting. Failure to pay acting allowance to affected employees will leave the organization with no option other than to advice all nurses on acting positions to step down.
The PEC resolved that the item should be tabled at Limpopo Chamber demanding the filling of these vacant posts and payment of acting allowance to all nurses on acting positions in line with Public Service Regulation, Chapter 1Part VII, B.5.2 and DPSA Police on Acting.
The PEC further resolved on tabling the following agenda items at Limpopo Chamber: Overtime and Working hours to ensure that Department of Health develop Policy on Overtime and conclude Collective Agreement with Organized labour. The agreement will resolve our standoff with the Department on inclusion of Meal Interval and calculation of hours of employees performing 12-hour shifts in line with Section 11 of Basic Conditions of Employment Act 75 of 1997 as amended.
DENOSA further calls for the Department of Health to withdraw all suspension letters issued against employees in pursuant of withdrawal of Circular 43 of 2020.
On shortage of staff and further budget cuts by Treasury in the province leading to discontinuation of 24-hour service in most clinics:
DENOSA notes that the Department of Health has acknowledged the gross shortage of staff, particularly nurses, by appointing the 305 Post-community service nurses on a six month contract ending on the 31 July 2021. It is on that basis that DENOSA demands permanent appointment of the 305 Post-community service nurses.
The organization takes note of further budget cuts by Department of Treasury in the province with specific target on Compensation of Employees vote. Continuous budget cut for Department of Health denies our communities access to their basic human right to access health services. Most clinics are no longer providing 24-hours services due to shortage of personnel such as nurses and cleaners.
DENOSA calls for Limpopo Treasury to exempt the Department of Health from this continuous budget cut and to make provision for additional budget to cater for appointment of the newly qualified professional nurses on a permanent basis to strengthen human resource in the hospitals and clinics.
Appointment of additional nurses and cleaners will ensure that most of clinics provide 24-hour services to our communities, in particular rural areas.
On the progress of Phase 1 of Vaccine rollout on frontline workers:
The PEC noted the presentation made by the Department of Health during our Joint Committees meeting on the progress made on Phase 1 of Vaccine rollout targeting frontline workers, majority of whom are nurses. DENOSA was disappointed and concerned with the slow progress in implementing Phase 1, as the province has managed to vaccinate only 20285 frontline workers from both public and private health sector so far.
The number of employees vaccinated is not even half of the total number of healthcare workers in the Province. It is an open secret and not practical for the province to complete Phase 1 rollout by the end of April 2021 considering that most of nurses and other healthcare workers in the clinics are not vaccinated yet.
DENOSA demands completion of Phase1 of Vaccine Rollout to cover all Frontline workers to protect them before Rolling out Phase 2 as they will be expected to vaccinate our community members who have been waiting patiently.
On relocation of Mobile Clinics:
The PEC has learnt with serious concern the abuse of power by some of PHC Managers who are intending to disrupt mobile health services by forcing and bulldozing nurses to relocate to fixed clinics without following correct procedures. The relocation changes terms and conditions of these employees, which requires the employer to consult with union(s) in line with Section 64(4) of the Labour Relations Act 66 of 1996.
DENOSA calls on PHC Managers to stop tossing nurses around but to start consultation with union(s) in the Department of Health. Refusal by Managers to sign trip authorization forms to allow nurses to visit service point denies our poor communities access to health service, particularly the elderly and those on chronic medications which aggravates their health conditions.
On training of nurses:
The organisation welcome the extension of study leave for students who couldn’t manage to complete Bridging course programme within prescribed period considering that the programme is being phased out .We call for the Department of Health and Limpopo College of Nursing to accelerate pace on the implementation of newly accredited nursing programmes in the province.
Issued by DENOSA Limpopo
For more information, contact:
Jacob Molepo, Provincial Secretary
Mobile: 072 576 4979
Lesiba Monyaki, Provincial Chairperson
Mobile: 072 578 2753
DENOSA urges citizens to drive carefully this Easter Weekend, keeping in mind the shortage of healthcare work...
Thursday, 01 April 2021
As millions of people will be on the road from this afternoon to various destination for the Easter Weekend, the Democratic Nursing Organisation of South Africa (DENOSA) would like to urge them to travel safely and follow all the rules of the road at all times to ensure they arrive safely.
They must also remember that, because of the National Treasury’s austerity measures and commitment to further limit the number of healthcare workers in public facilities, the country is experiencing a severe shortage of healthcare workers in our healthcare facilities. This means, essentially, that the time it often takes for healthcare workers to arrive at places of road accidents and to be attended to when they get to healthcare facilities is much longer than it should be when there were enough nurses and other healthcare workers. This delay, because of the shortage of staff, often leads to many patients succumbing to their injuries.
It a matter of public knowledge now that road carnages are amongst the highest contributors to the country’s deaths. Because many road accidents are caused by the consumption of alcohol, DENOSA is pleased that alcohol sales for outside consumption will be prohibited from Friday until Monday. This is likely to lead to decreased number of accidents, which often put more strain on the already overstretched healthcare system in the country.
Many nurses who are fully qualified and ready to work are sitting at home because of budget cuts in provinces. They are ready to start work any time of the day.
We urge citizens to exercise extreme caution on the road, obey the rules, to get enough rests while on their trips and observe COVID-19 protocols at all times.
DENOSA wishes great strength and protection to all nurses, and particularly our members, many of whom will be hard at work saving lives this Easter Weekend.
We wish all South Africans a healthy and safe Easter Weekend.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Sibongiseni Delihlazo, DENOSA Spokesperson.
Mobile: 072 584 4175
Facebook: DENOSA National Page
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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