Nurses shortage causes strain

CONCERNS have been raised over the high number of unfilled nursing vacancies as well as a decrease in funded posts at the province’s clinics during the Covid-19 pandemic with severe staff shortages weighing heavily on an already strained system.

Nurses at clinics and day hospitals are among front-line workers and the first port of call for Covid-19 patients, especially the poor in the province, which is experiencing the peak of the third wave. As of yesterday, more than 42 000 active cases were recorded. Of those, 3 633 cases were recorded in a 24-hour period over the weekend. An average of 108 deaths were recorded a day.

The province’s day hospitals and clinics have a total of 4 484 funded posts, but of those, 188 are vacant. The majority of the vacancies are for nursing positions in clinics mostly located in the Cape metro and in highly-populated poorer communities.

This information was revealed in response to a written question from the ANC to Western Cape Health MEC Nomafrench Mbombo about the staff complement and shortages in the province’s community health-care centres over the last seven years.

Figures showed that in the past year, the number of vacancies increased by 153 posts, and the department stopped funding 17 posts.

Retreat Day Hospital has seven nursing vacancies of 98 funded posts.

In Bonteheuwel, Vanguard Community Health Centre has 10 vacancies, seven of which are for nurses. Communities serviced by this facility have dedicated a WhatsApp group for complaints about poor service.

Chairperson of the Retreat/Steenberg Civic Association, Mark Solomons, who also sits on the clinic’s health committee, said a shortage of staff was one of the biggest challenges at the clinic.

“I went to the Covid section on

Friday at around 9pm and there were still people sitting and waiting for Covid tests, and you can see that the staff on duty were tired – they are stretched very thinly, mainly because there isn’t sufficient manpower.

“For a facility like Retreat that services such a big community, it is important to operate with a full complement. That is the only way to meet demand that is continuously increasing, and provide better services,” he said.

The Du Noon clinic which also services two surrounding areas deals with a daily, high patient count while its staff complement of 149 has 10 vacant posts, six of which are for nurses.

“As the health committee, we rarely get notified about the staff complement of the clinic, and just know there are new hires when you see new faces, or are introduced to new people, like I was the other day to the new trauma manager,” said Zola Bisholo, chairperson of the local health committee in Du Noon.

“But our facility is under strain, not only from the people in Du Noon, but we also have people coming in from the Joe Slovo and the Volvo informal settlement and some from Table View. On average, there can be 700 patients a day.

“We are trying to use the resource centre, which is currently unused, as an overflow facility where people can be evaluated, to see if they can be escalated to the clinic for medical attention. We also want to use this facility to attract chronic medication defaulters, by cooking a meal for them,” she said.

Western Cape chairperson for the Democratic Nursing Organisation of SA (Denosa) Eleanor Roberts said: “The shortage of nurses has been in existence even before the pandemic, and we have attempted to put measures in place to mitigate this, but it remains an ongoing challenge.

“Our staff members find themselves under strain in this third wave, the rise in Covid-19 admissions, and trauma in our emergency centres is putting our

members under immense pressure.

“The department has made inroads in hiring more staff, but the majority of those have been going to Covid facilities or wards. But these are temporary measures that don’t address the long-standing challenges. This represents a drop in the bucket in dealing with staff shortages, particularly in our rural areas. We have heard reports of three nurses who must work with 45 patients. Incidents like that impact heavily on the quality of services nurses can provide to communities.

“We are still understaffed and will continue to have shortages if we don’t come up with ways to ensure that we get nurses trained who will be able to meet the demand of funded posts,” Roberts said.

The ANC’s spokesperson for health in the provincial legislature, Rachel Windvogel, said the shortages highlighted the department’s shortcomings.

“We know that a lot of our clinics, especially in rural communities and other poor working-class communities, are experiencing serious service pressures as a result of shortages of staff and high demand for health services.

“The MEC has exposed her department’s failures to fill critical posts at clinics, as the number of vacant funded posts has increased when compared to previous years. It is also a concern that the number of funded posts decreased for the 2021 year, compared to the previous year.

“In our follow-up question we will seek to understand how many of these posts are filled by permanent staff, and how many are occupied by agency personnel. This government has spent billions to hire agency personnel, instead of recruiting permanent staff. This raises legitimate concerns of a government that is captured by these agencies,” said Windvogel.

The use of labour brokers in the health sector has also come under the spotlight.

In the Western Cape, Mbombo’s response revealed that R3.7 million of the R125m total expenditure on Covid-19-related projects went to agency support or labour brokers and outsourced services.

Provincial health spokesperson Mark van der Heever said the department tried to fill all funded critical posts as soon as possible.

“However, each appointment is different, and the Department of Public Service and Administration time-frame allows for the process to fill vacancies within six months from (the) date of advertising. We try to manage this process quicker, where possible,” he said.

“Where there is a need for staff, while waiting to advertise the position, the department does make use of agency staff to assist during this process, as this is factored into our personnel cost as the post is funded for,” he said.