Public hospitals in Gauteng, South Africa, are operating with outdated staffing models that may severely understate the shortage of nurses. The current organograms, last reviewed in 2006, do not reflect the current population growth or the increased pressure on hospitals and clinics. As a result, the actual number of nurses needed may be significantly higher than the official estimates of 15,820. The chairperson of the Gauteng Legislature's Health and Wellness Portfolio Committee, Advocate Ezra Letsoalo, has expressed concerns that the current staffing model is inadequate.
The Gauteng Department of Health operates 372 clinics and 40 provincial hospitals, with a significant shortage of nurses. There are 2,272 funded nursing vacancies and 1,186 vacant posts for which funding is unavailable. Filling the unfunded posts alone is estimated to cost R607.8 million. The department's presentation to the committee listed a shortage of 15,820 nurses across various categories, including professional general nurses, specialist nurses, and nursing assistants. However, stakeholders believe the real requirement could be as much as three times the department's estimate.
The outdated staffing model has severe consequences for patients. With too few nurses, patients experience longer waiting times, low morale, burnout, and missed or inconsistent care. The shortage also leads to increased pressure on nurses, who work extended hours and sometimes miss meal and tea breaks. Letsoalo emphasized that the system is still functional but is taking strain. He cited casualty units where two doctors manage a stream of emergency cases, highlighting the need for proper data analytics to determine staffing levels.
The shortage of nurses has a significant impact on mental health facilities. Committee visits found too few psychiatric and rehabilitation nurses, overcrowding, and deteriorating buildings. At Dr. George Mukhari Academic Hospital's mental health unit, the committee recorded high numbers of patient-safety incidents and nursing ratios of one nurse to six stable patients and one to four acute patients. Letsoalo stressed that the province is struggling to bring younger nurses into the workforce, with many experienced professionals approaching retirement.
The Gauteng College of Nursing is accredited to train 500 general nurses and 415 specialist professional nurses annually. However, there are no annual places for enrolled nurses or nursing assistants, despite projected shortages of 4,375 and 3,395, respectively. Letsoalo called for a review of nursing curricula, particularly where graduates enter demanding facilities without midwifery or other specialist capabilities. He emphasized that complex pregnancies and South Africa's combined burden of communicable and non-communicable disease require a broader mix of skills.
The shortage of nurses is attributed to various factors, including national austerity measures, slow recruitment, administrative weakness, and difficulty retaining nurses in the public sector. Pay and career progression are part of the problem, with the occupation-specific dispensation for nurses introduced in 2007 and due for review in 2012, but still not reviewed. Letsoalo said some nurses can no longer meet their living costs because their remuneration has not kept pace. The failure to update a measure originally intended to retain scarce skills has made public-sector nursing less attractive.
The Gauteng Department of Health proposes asking the provincial treasury to unfreeze posts, introducing a differentiated wage bill, and recruiting newly qualified nurses within six months of their registration with the South African Nursing Council. The department also wants a five-year workforce plan and a provincial strategy for nursing and midwifery. To cover immediate gaps, the department uses overtime in specialized units and private nursing agencies.
Key points
- The current organograms used to determine staffing levels in Gauteng's public hospitals are outdated, having been last reviewed in 2006.
- The Gauteng Department of Health operates with a significant shortage of nurses, including 2,272 funded nursing vacancies and 1,186 vacant posts for which funding is unavailable.
- The shortage of nurses has severe consequences for patients, including longer waiting times, low morale, burnout, and missed or inconsistent care.
