After working as a nurse at a public hospital in the Eastern Cape, single mother Gwen Sitatu is ready to leave everything behind, including her children, to work in Dubai where she hopes to earn about three times her SA salary.
The 42-year-old mother of three, who resigned as a theatre nurse at Uitenhage Provincial Hospital, is joining the ranks of SA nurses emigrating to countries such as the UK, UAE and Canada in search of greener pastures.
As a qualified and registered nurse, Sitatu is convinced better opportunities await abroad. Not only are there fewer opportunities for further training in SA due to staff shortages, making it impossible to get study leave, “but as a public sector nurse I’m poorly paid and the working conditions are not good.
“I’ve been doing a lot of research ... there are a lot of perks involved. I’ve been told that if I work there I will have my first plane ticket fully paid and free accommodation for the first six months. I hope this will help me save a bit of money, as I’m a single mother and have to pay school fees and provide a better life to my children.
“I’ve heard that nurses in Dubai work hard. For me that is no problem as I’m used to working hard due to chronic staff shortages at our hospitals. At least my hard labour will be rewarded, unlike here, where I’m simply given a day off if I work overtime because the government has no money.”
The shortage of nurses is causing such a headache for the nursing fraternity that last weekend a professional body for nurses and midwives on the continent, known as the East, Central and Southern African College of Nursing (Ecsacon), convened a consultative meeting in Johannesburg to discuss how to address the shortage of nursing skills in Africa.
Nursing regulators, university deans, government heads and trade unions discussed the possibility of having two-year fellowship programmes to standardise the training of specialist nurses on the continent.
Such fellowships would provide advanced training in areas such as critical care nursing, midwifery, paediatric care and critical care nursing in chronic disease management. Delegates hoped this would cushion the region from a worsening skills shortage, particularly of specialist nurses.
Sibongiseni Delihlazo, spokesperson for the Democratic Nursing Organisation of SA (Denosa), which attended the meeting, said: “Every day we are receiving enquiries from nurses about the process of working abroad or whether we have any contact details of recruitment agencies from overseas or local agencies that recruit for overseas markets. We have many nurses from SA working in those countries already,” he said.
Home affairs minister Aaron Motsoaledi recently added various nursing categories to the department’s scarce skills list, including midwife specialists, child nursing, emergency peri-operative nursing, mental health nursing and critical care nursing. People with these skills will be prioritised when applying for critical skills visas.
Sitatu’s plan to leave SA was reinforced by an assault at her former hospital last Sunday when three men arrived with a gunshot victim. They demanded nurses go to their car and carry in the wounded man. When they did not comply a nurse was punched in the face and kicked.
“This incident has made me more resolute. Lack of safety in our hospitals is a huge factor that drives many nurses to consider working abroad. In these richer countries I don’t have to worry about someone pointing [a gun at me] or being assaulted by gangsters.”
Delihlazo said healthcare failures and a lack of appreciation were pushing healthcare professionals out of the country.
“Nurses are generally remunerated poorly despite the essence of their contribution. Horrible working conditions are the other push factors as characterised by severe shortage of resources and equipment and poor continuous professional development opportunities.”
He said another factor making SA nurses attractive abroad is that they are trained well.
Delihlazo said the greatest shortage is among specialist nurses.
“This problem is self-inflicted. The reduction of investment by the government in both infrastructure and numbers of nurses the country produces are what have landed the country in the current crisis. Countries like Switzerland and Norway have at least 17 nurses per 1,000 population and their economies are doing wonderfully. In contrast, SA has about four or five nurses per 1,000 population and its economy is crumbling.”
The Western Cape health department has a shortage of specialist professional nurses, with a vacancy rate of about 11% and a 25.4% vacancy rate for nursing educators. There is a 7% vacancy rate for general professional nurses and 5% for primary healthcare nurses.
Of the 14,888 nursing posts in the province there are 911 vacant funded posts.
Provincial health spokesperson Mark van der Heever said staff shortages saw the department spend R264m on agency nursing staff in 2021/22.
Van der Heever said over the past three years the department had lost about 250 nurses a year to retirement.
Merle Victor, chief nurse officer at Life Healthcare, warned that while the shortage mainly affected specialist nurses, “if we don’t increase our numbers of general nurses in the pool, we won’t have any nurses to specialise in the future”.
Apart from emigration, the unbalanced demographic of nurses, where less than a third of them are under the age of 30, was concerning.
“In 15 years 47% of registered nurses would have retired. We are very concerned that this is aggravated by the lack of training of nurses and that we will not be able to meet the healthcare demands of the population. We are also losing critical skills in our specialised areas such as ICUs, theatres and maternity units.”
As part of attracting and retaining staff, the company offered flexible working hours and extended contracts beyond retirement age to provide support to staff. It’s also been actively recruiting nurses from India to minimise staff shortages.
Foster Mohale, spokesperson for the national department of health, said while it has no record of how many nurses had left the country, within Southern Africa “there is a protocol that commits member states not to poach from each other”.
Globally this is regulated by the World Health Organisation’s global code of practice.
He said the filling of vacant posts was the responsibility of provinces and it depended on their funding and annual recruitment plans.
“The department is concerned about the ageing nursing population, hence vacancies are filled as and when the ageing nursing personnel retire from the health system.”
