Phindeka Mbeki was treated like a hero three years ago — people let her skip shopping queues to be served first.
“As nurses we felt important. People praised us for being on the front line of the pandemic that not only killed our patients but many of our colleagues too ... Everyone in the country was behind us.”
But despite 20 years of experience, the mother from Kuils River in Cape Town faces an uncertain financial future. Her contract as an operational manager at a former Covid-19 field hospital, Brackengate, ends on May 31. The 336-bed facility is now a 128-bed intermediate care facility.
Mbeki will join the ranks of as many as 20,000 unemployed nurses in SA, according to research by the Democratic Nursing Organisation of South Africa (Denosa), despite a critical shortage of public and private sector nurses in the country.
Denosa spokesperson Sibongiseni Delihlazo said Gauteng had an estimated 10,000 unemployed nurses, the Free State 5,000 and Mpumalanga 3,000.
Mbeki and scores of colleagues simply cannot be accommodated in the provincial health department's R96m operational budget earmarked for Brackengate for the 2023/24 financial year.
“The termination of contracts, especially of nurses employed during Covid-19, has worsened the unemployment rate. Those who are still employed are on three-month contracts, which is problematic as that does not give nurses any certainty as far as job security is concerned. Our greatest fear is that if nothing tangible comes those nurses are likely to pack their bags and look for greener pastures,” said Delihlazo.
The Rural Health Advocacy Project (RHAP) estimates in a new report there is a shortage of 26,000 to 62,000 professional nurses in SA and predicts that by 2030 this will have worsened exponentially, threatening the proposed National Health Insurance (NHI).
The report said large numbers of nurses were unemployed because of mismatches between the categories of nurses being trained and the categories of nurses needed, inconsistent and poor-quality training, the reluctance of nurses to work in rural and remote areas, and unfunded vacancies in the public sector.
The SA Nursing Council has confirmed that about 50% of SA's nurses are due to retire in less than a decade. Despite recommendations by world bodies such as the International Council of Nurses and World Health Organisation (WHO) for more nurses to be employed, Delihlazo said SA was shedding jobs.
Mbeki said: “I’m my family’s breadwinner... every night I sit up and try to map out my future. I have a child doing her second year at university, bills to pay. How do I tell my child she might have to drop out because I can no longer afford to pay her fees?”
Occupational health nurse Amanda Nkwintshi, with two decades of experience, will be unemployed on June 1.
“The reality of losing a job has left me with a bitter taste. We moved from being called heroes into zeros post pandemic. I don’t know if I should be angry ... I feel somewhat used. I’ve got debts to pay, a car and school fees, which I will probably default on.
“Even furthering my studies into being a specialist nurse seems to be a waste of time as my skills are clearly not valued. The strangest thing is that the government is busy recruiting nurses from outside the country for critical skills, yet we are sitting with these skills, but clearly not being recognised. It doesn’t make sense,” said the mother of two with a diploma in midwifery and B.Tech in occupational health.
Delihlazo said
during the pandemic many health procedures were postponed but “are coming back in large numbers and the workload for nurses has increased tremendously”.
“It is disappointing that the government is not showing any intention in retaining these experienced nurses. Our greatest gripe is the inclusion of health services, an essential service, when the government imposes austerity measures. It troubles us that health services and employment of nurses are seen as an expense rather than an investment. The economy and wellness of the population go hand in hand.”
Western Cape health spokesperson Mark van der Heever said out of 14,392 funded nursing posts about 13,450 were filled. The province had 942 vacant posts — of those 242 for professional nurses, speciality nurses (223) and nursing assistants (223 vacancies). About 1,593 nurses were close to retirement, aged 56-60.
Hospital group Netcare last week also warned SA faced a looming critical nurse shortage but cautioned that recruiting foreign nurses was “not a sustainable solution”.
Netcare CEO Richard Friedland said the group could train 3,500 nurses a year but was only accredited by the state to train 10% of that number.
“The tragedy is we’ve got tens of thousands of people applying to become nurses every year, and in a country that is beset by such a skills shortage, by rampant unemployment, it’s inexplicable that government isn’t opening the doors to allow the private sector to train,” he said.
Netcare group director, human resources and transformation Dr Nceba Ndzwayiba, in response to queries about the pool of unemployed nurses, said: “We have also noted reports about an available pool of unemployed, qualified nurses. We are continuing to engage with the relevant stakeholders and have issued advertisements on various platforms to put as many of these nurses into jobs.”
He called on unemployed nurses to visit the group's website to seek employment opportunities.
SA Nursing Council spokesperson Adri van Eeden, on the issue of training more nurses, said the council “cannot act irresponsibly by having more students than patients in clinical facilities, thus compromising the quality of clinical learning as well as the safety of patients”. Key aspects considered by council when accrediting training included available resources such as classroom capacity, equipment, availability of clinical labs and study materials.
Life Healthcare has also warned that nursing shortages, compounded by emigration and the ageing demographic of the profession, may in future negatively affect health care.
Life Healthcare chief nurse officer Merle Victor called on national and provincial health departments to “confirm via a database the large number of unemployed nurses in the country being claimed and the reasons for not being employed should be clarified”.
Victor said the private hospital group has introduced various recruitment and staff retention programmes, including financing university students who would work for the group post training and be eligible for postgraduate training.
“As a result of these initiatives our nursing turnover has reduced since 2020. The majority of nurses recruited are general nurses.”
Victor said the group trained about 1,500 nurses in a three-year period across seven nursing colleges and requested approval from the SANC to double those numbers “because we have adequate learning opportunities across all our facilities, but to date no such approvals have been forthcoming”.
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