“Mpathy Clinics are nurse-led, low-fee primary healthcare facilities with a vision of transitioning from nurse-led to nurse-owned clinics, creating opportunities for nurses to own and operate clinics in their own communities,” said Rhiza Ventures managing director Linda Dunkley.
For decades, nurses were the backbone of South Africa’s healthcare system, present in every ward, every emergency and every recovery room, but rarely in positions of ownership and leadership.
Now, as South Africa marks International Nurses Day on May 12 under the global theme “Empowered Nurses Save Lives”, a growing network of township clinics is transforming nurses from employees into entrepreneurs while helping to ease pressure on overcrowded public healthcare facilities.
Affordable Healthcare and Building Local Economies
In communities where patients often endure long queues at public clinics or cannot afford private healthcare, nurse-led Mpathy Clinics are emerging as an accessible and affordable alternative rooted in empowerment, dignity and community-based care.
The model, driven by NPO Rhiza Babuyile, currently operates 11 clinics in township areas including Umlazi, Naledi, Gugulethu, Tembisa and Diepsloot. Beyond expanding primary healthcare access, the initiative is creating something rarely seen in South Africa’s nursing
“South Africa’s public sector serves roughly 80% of the population, yet clinics routinely face long queues, staff shortages and medicine stockouts. Most primary healthcare services fall within the legal scope of a Professional Nurse and policies like NIMART (Nurse Initiated Management of Antiretroviral Treatment) – leaning on nurses is the only way to scale primary healthcare capacity at a cost the country can afford,” says Rhiza Ventures, Managing Director Linda Dunkley.
For Mpathy, this means helping the Department of Health extend healthcare services into underserved communities while aligning with the Ideal Clinic Realisation programme and supporting the long-term National Health Insurance (NHI) rollout, where accredited primary healthcare facilities serve as the first point of entry.
“Nurse-led PHC clinics like Mpathy are where early detection is possible, response rates are highest, and the cost to both the patient and the public system is lowest,” said Dunkley.
Dunkley added that the clinics were designed to complement, rather than compete with, the public healthcare system. “Mpathy is positioned explicitly as an extension of the Department of Health rather than a parallel system,” she said.
The clinics also contribute to local economic development, not only creating jobs for administrators and community health workers, but enabling non-nursing entrepreneurs to own clinics and employ qualified nurses, broadening community-based healthcare investment and expanding access to care.
This month alone, a new Mpathy Clinic will open in Orange Farm on 21 May, led by nursepreneur Sister Mbalenhle, and on 19 May an entrepreneur will be inducted into the model in Zithobeni, Bronkhorstspruit.
‘It’s My Answered Prayer’ — A Nurse Returns Home as Nursepreneur
For professional nurse and nursepreneur Sindiswa Nhlabathi, the model has become deeply personal. Nhlabathi will this week open the Mpathy Clinic in Naledi, Orange Farm on 14 May, serving the same community where she was born and raised.
“I was born at Zola, right across from where the Naledi clinic is based. I grew up in a family where no one was formally employed but they were ‘business people’,” she said. Her mother and grandmother sold cakes and goods to support the family. “It wasn’t easy as there was no money for university,” she said.
Before nursing, she worked at a government hospital as a personal assistant manager. Until a friend changed everything. “One day my friend came to me with nursing application forms and persuaded me to apply. I refused telling her that ‘you know I don’t like nursing’ but she insisted. I was accepted and the minute I was exposed to clinical experiments I knew I was born for this.”
After years in public healthcare, including at Zola Clinic, Nhlabathi resigned from her permanent post and was later offered the opportunity to run the Naledi clinic. “When I was studying it never crossed my mind that one day I might own a clinic. It’s my answered prayer. I feel empowered and I don’t even have the words to articulate my heart but one thing I know is that I intend to take this opportunity and make the best out of it,” says Nhlabathi.
At the clinic, children can receive treatment for under R200, while adult consultations with medication cost up to R350.
“Our clinic is private but very affordable,” Nhlabathi adds that “Our community relies on social grants and low incomes, while public clinics remain overwhelmed. Mpathy Clinics are a bridge between private and public healthcare and our priority is to build trusted relationships with the community.”
Every day, across South Africa, nurses stand at the frontline of saving lives. They are the steady hands in moments of uncertainty, the compassionate voices during times of fear, and the dedicated professionals who work tirelessly to ensure that patients receive the care they need when it matters most.
As the world commemorates International Nurses Day 2026 under the theme “Our Nurses. Our Future. Empowered Nurses Save Lives,” the South African National Blood Service pays tribute to the remarkable nurses whose compassion, strength, and dedication continue to save lives every single day.
Behind every successful blood donation is a nurse who chose to care.
A nurse who arrives before sunrise. A nurse who comforts anxious donors with a smile. A nurse who stands for hours ensuring every unit of blood collected is safe enough to save a mother, a child, a trauma victim, or a cancer patient. These are the quiet acts of heroism that often go unseen, yet they change lives every day.
At SANBS, nurses are more than healthcare professionals. They are the heartbeat of the organisation’s lifesaving mission. They carry the emotional weight of the work with grace and continue to show up with compassion even on the hardest days.
“Nurses carry the human side of healthcare. They give comfort in moments of fear and hope in moments of uncertainty. At SANBS, we see their sacrifices, their long hours, and the care they pour into every donor and patient. Today we honour them not only for what they do, but for who they are.” said Monique Schreiner, Senior Manager: Donor Relations.
Every drop of blood collected carries the fingerprints of a nurse who cared enough to make sure someone else gets another chance at life.
Whether working at donor centres, mobile clinics, community blood drives, or behind the scenes ensuring quality and safety, SANBS nurses continue to serve with unwavering commitment. Their work demands patience, emotional strength, skill, and empathy. Yet despite the pressure and responsibility they carry, they continue to give so much of themselves to others.
“There is something deeply powerful about the work our nurses do. They stand beside people in vulnerable moments and remind them that humanity still exists through kindness and care. SANBS is proud to walk alongside these incredible professionals who continue to keep the spirit of service alive,” said Monique Schreiner, Senior Manager: Donor Relations.
International Nurses Day is a moment to pause and recognise the people who dedicate their lives to caring for others, often placing the needs of patients and donors before their own. It is a reminder that healthcare is not only built through medicine and technology, but through compassion, patience, and human connection.
This year’s theme speaks directly to the future of healthcare. Empowered nurses strengthen healthcare systems, uplift communities, and save lives. Their wellbeing and support matter because when nurses are valued, entire communities benefit.
For SANBS, celebrating nurses is deeply personal. These are the individuals who hold hands during difficult moments, calm fears with gentle words, and continue to give their all so that others may live.
To every nurse who continues to wear their uniform with pride, compassion, and courage, thank you.
Thank you for the sacrifices no one sees. Thank you for the comfort you give so freely. Thank you for keeping hope alive. And thank you for helping keep the blood of life flowing across South Africa.
Some healthcare workers in the public sector are allowed to moonlight in the private sector to earn extra money, subject to certain conditions. Photo by CDC on Unsplash
By Joan van Dyk
The Department of Health allows some public sector doctors and nurses to moonlight in the private sector, but the relevant policy and its implementation caused much controversy over the years. Set against the wider management dysfunction in several provincial health departments, the issue is now coming to a head.
Professional nurse Nomsa Dlamini* has been picking up extra shifts in Gauteng’s private health sector for years, without the required approval from her public sector managers.
The health department has no record of this work, a breach of the rules meant to regulate “moonlighting” among state employees.
She says the benefits of keeping her extra shifts off-book far outweigh the risks of getting caught. If that ever happens, she’s happy to face the consequences, such as disciplinary action. For her, that’s still preferable compared to the cost of following the rules.
Over the course of her 20-year career, Dlamini says she has watched retaliation against her complying colleagues, often in the form of a punishing shift schedule that makes rest unlikely and private sector shifts impossible.
Losing the extra income would be the worst-case scenario, she says.
Dlamini is not the only one bending the rules to avoid backlash.
Moonlighting often not declared
A survey of 1 397 health workers in Gauteng and Mpumalanga found that among public sector employees who were moonlighting, just 20% of professional nurses said they had permission, compared with 85% of doctors and 13% of rehabilitation therapists. The results were published in the South African Medical Journal in 2025.
The fear that managers would refuse permission, or that the act of asking would be met with hostility were high on nurses’ list of reasons for side-stepping the system.
The policy that allows moonlighting – usually called Remunerative Work Outside of the Public Service (RWOPS) – started in the 1990s as a retention strategy with few official rules. The government has gradually layered oversight roles and overtime limits into the system to stem abuse, with mixed success.
The latest policy guideline includes compulsory quarterly reporting to the Department of Public Service and Administration and tighter consequence management. Circulars and job adverts suggest the government is in the process of further beefing up its moonlighting monitoring systems but for now there is little detail about their plans on the public record.
A broader overhaul of South Africa’s health system staffing strategy is on its way too. A ministerial advisory committee (MAC), set up by Health Minister Dr Aaron Motsoaledi in April 2025, hosted an indaba in November 2025 and has sent out questionnaires to gauge health workers’ expectations and concerns about issues including moonlighting, overtime, and community service.
But for some nurses, the details of how their work is regulated has become less important than the everyday task of making a living. Dlamini says she and her colleagues understand why the government needs to make these rules, but they feel the health system no longer has the legitimacy to enforce them. They suggest that years of corruption has gutted the system by draining resources, stripping services, and eroding trust.
Over at Tembisa Hospital, for instance, the Special Investigating Unit (SIU) found that medical supply spending dropped by nearly three-quarters in the year after massive graft was uncovered there. This suggests that money was being spent on ghost stock and overpriced consumables, not the supplies nurses need to do their work. Health workers and patients often flagged medicine shortages at the hospital and were reportedly still borrowing food and drugs from other facilities late in 2025.
Dlamini herself says she has had to push her aching body through understaffed shifts with stretched resources for years, and now she’s being asked to help restore what others have taken.
Worst of all, she says, is an ethics course the higher ups want staff to complete. The request feels alien and disconnected from the realities of a department that has allowed syndicate-linked health workers to siphon millions away from patients. A professional nurse at Tembisa allegedly pocketed nearly R28 million by approving appointments and managing the illicit flow of one of the three syndicates described by the SIU. According to the SIU, a nurse assistant made at least R7.3 million, the equivalent of well over two decades of legitimate salary.
So until Dlamini hears that her pay will be withheld if she doesn’t do the ethics course, she simply refuses. “It’s a slap in the face,” she says.
Standoffs and moonlight mistakes
In 2023, City Press reported that more than 8 700 Gauteng health employees meant to file disclosures had failed to report their financial interests. Nearly two-thirds of the province’s health staff were facing suspension.
The health department’s risk office sent an email saying the rule breakers should “make themselves available at the MEC’s boardroom … to explain themselves”. City Press reported that at least one hospital told its staff not to go.
Whether it is such standoffs between governmental leadership and public servants or the state’s inability to effectively regulate moonlighting, it is patients who ultimately pay the price.
Sometimes, patients aren’t being monitored because their nurse is selling cosmetics for a multi-level marketing scheme in the tea room, Dlamini says. Or a nurse has called in sick when they’re really working in the private sector while still being paid by the government.
There’s also a gruelling cycle that begins after a nurse spends their day at a private facility and then reports for night duty at a public hospital. At some point in the night, they might disappear to get some sleep, leaving an even smaller team to make sure dozens of patients are clean, comfortable and medicated by morning.
Jacky James and Isaac Rabotapi, both Gauteng shop stewards for the Democratic Nursing Organisation of South Africa (Denosa) say they know of many night shift tragedies. The pair regularly represent nurses during disciplinary hearings.
In one instance, they say a six-month-old baby needed a drip. The ward was short staffed and the nurses in attendance were exhausted. Nobody was monitoring the infant once the drip was in. By the time somebody checked up several hours later, the infusion had leaked into the surrounding tissue, causing irreversible damage. Surgeons had to amputate the infant’s entire hand.
The two shop stewards say this is one of many instances they believe are linked to exhaustion and compromised judgement of nurses who work non-stop.
In one nationally representative study from 2015 just over half of surveyed nurses said that they are too tired to work while they’re on duty. This study found no statistically significant link between moonlighting and medico-legal claims but South Africa’s action plan for health sector staffing acknowledges that burnout and clinical mistakes probably contribute to the health department’s sky high malpractice bill.
In a submission to Motsoaledi’s advisory committee, the South African Medical Association (SAMA) describes a health system trapped in a destructive loop in which low base salaries and chronic understaffing feed off each other. Clinicians rely on excessive overtime and side jobs as a financial lifeline. While this keeps services running 24/7, they say extreme burnout and fatigue triggers medical errors and drives overextended staff to quit. When people leave, SAMA says, the staffing gap widens, forcing those who remain to work even more hours. This restarts a cycle that ultimately relies on overworking clinicians to prevent the system from collapsing, SAMA maintains.
The high cost of low salaries
Dlamini, James and Rabotapi are all professional nurses. Among them, they have about 85 years of experience in South Africa’s public hospitals.
“I love my job,” Dlamini says. “For me, it’s about the patients. But the workplace has become unbearable.”
It is worth pointing out here that, even while much of what we describe in this article is negative about the state of nursing in South Africa, we have in the course of our reporting over the years come across scores of nurses who are deeply committed to serving their patients. We have profiled some of these nurses – see here, here, here, and here.
James and Rabotapi say they also used to love nursing, but they both switched to union work in an effort to help patients by improving the system in which they’re treated.
Rabotapi’s view of the system is even worse now that he’s on the road for Denosa because he can see the full extent of poor nursing care. “The lack of empathy is shocking. I’ve seen nurses addressing their patients by conditions instead of their names. That’s a violation of their right to privacy and confidentiality.”
Harsh treatment seems to have become a rite of passage, passed on from older nurses to young recruits, says James. This is especially visible in maternity wards where nurses can be judgemental or cruel towards young mothers, she says.
Obstetric violence, which includes verbal or physical abuse, humiliation or forced medical procedures is widespread. A 2025 report estimates that 1.79 million people who gave birth in KwaZulu-Natal and Gauteng experienced some form of obstetric violence in the past decade.
In February, a coalition of local human rights organisations including Embrace and the Centre for Applied Legal Studies sent Motsoaledi a memorandum demanding change.
By August, they want legal recognition of this abuse and for respectful maternity care to be added to district performance dashboards. They also demand an explicit ban on hiring freezes in sexual and reproductive health services to ensure good staff levels and an adequately funded budget to upgrade dilapidated infrastructure.
“We wouldn’t have any of these problems if nurses were paid well,” Dlamini says.
It’s a sentiment that was repeated by everyone Spotlight interviewed, and in line with the findings of multiple studies conducted over the past decade.
A 2023 study published in BMJ Open found low baseline government pay, the desire for financial freedom, and the need to pay off debts were the biggest drivers of moonlighting among doctors, rehabilitation therapists and professional nurses.
Today, nurses are caught in a financial squeeze. According to our analysis of DSPA data, below-inflation wage increases cumulatively wiped out about 8 percentage points of public sector nurses’ buying power between 2021 and 2023. After three years of losses, their pay has started to recover thanks to lower inflation and wage increases but ultimately, they’re still worse off than they were before the COVID-19 pandemic.
Dlamini says many nurses also earn too much to qualify for government housing subsidies or NSFAS funding for their children’s education, yet they don’t earn enough to afford a bond or expensive university fees on their own.
Professional nurses typically progress through three tiers of seniority as they gain experience. They also get annual salary increases based on performance. The upper limit for the most experienced professional nurse (who isn’t a manager) is about R50 000 per month before tax, according to the DPSA’s latest salary data. This amount includes benefits such as pensions so take-home pay is lower.
Civil servants’ contributions to the state’s medical aid, the Government Employees Medical Scheme (GEMS), are outpacing their earnings. In two years, monthly contributions have jumped 23% in total, and members say they’re paying more for less.
There are reasons for hope. For the first time in two years, Treasury is adjusting tax rules so that inflation doesn’t eat into raises, helping people keep more of their take-home pay.
It’s hard to get a representative picture of what nurses are paid in the private sector. Leading public health researcher Laetitia Rispel, who chaired the process that led to government’s 2030 staffing strategy, explained that private sector partners are not obliged to share this information. They wouldn’t disclose what they paid nurses during the drafting of the staffing plan and withheld this information as confidential during the Competition Commission’s Health Market Inquiry (HMI).
According to the government’s staffing plan, reimbursement data shows that junior nurses tend to have higher salaries in the private sector, while private sector senior nurses may earn less than their counterparts in the public sector.
The coming retirement wave
A retirement crisis now looms over South Africa’s nursing profession, which remains the heart of the public healthcare system.
The latest data from the South African Nursing Council shows nearly half (48%) of the country’s nurses and midwives are aged 50 or older, with about a fifth already in the 60-69 year age bracket.
This exodus will be a massive loss of the nursing expertise and institutional knowledge essential for high-quality care. Their retirement could also exacerbate the existing nurse shortages, which already force nurses to the brink and often, out of public service.
This is more pronounced in rural areas, where exhausted nurses have described stress-related headaches, sleep disturbances and chest pains to researchers. One nurse at a psychiatric hospital in Limpopo told researchers she was responsible for 40 patients on a single night shift. Another collapsed in the ward while she was pregnant. “It’s a prison sentence,” a third nurse told the researchers.
The researchers at the University of Venda argued that low wages could explain why some nurses steal and resell hospital supplies, and why they don’t consider it outright theft.
South Africa is also battling a critical shortage of nurse educators, an unintended consequence of the Occupational Specific Dispensation, which favoured clinical practice over teaching, and thereby created a pay gap that pushed faculty to transition into better paid clinical roles within government hospitals.
The health department’s staffing strategy until 2030 admits that South Africa needs to view nursing as an investment rather than an expense. It describes the many benefits of investing in nursing care which include economic growth and improved health services.
The document, drawn up in 2020, included measurable goals to address workforce issues by 2025, including a plan to meet a shortage of nurse educators and to train and employ up to 34 000 professional nurses and midwives.
The government hasn’t yet tracked progress against these targets, says spokesperson Foster Mohale, but a review by the Department of Planning, Monitoring and Evaluation is in the pipeline to guide the strategy’s remaining period.
In the meantime, the government is building a Human Resources for Health information system and registry and rolling out systems to track workforce indicators, he says. Coordination structures are also being strengthened, and occupational health and safety committees are coming to facilities around the country.
Money isn’t everything
In her 2024 presentation to a panel of experts tasked with getting buy-in from the broader health sector, called the Health Workforce Consultative Advisory Forum, Rispel warned that the 2030 human resource strategy could not be rolled out with an austerity mindset.
Research published in the journal PLOS One in 2025 backs this up. It suggests that professional nurses would give up moonlighting in exchange for a minimum 20% pay increase. That’s much lower than doctors (46%) and rehabilitation specialists (43%).
Modelling suggests however that if the government banned moonlighting, the state would need to bump salaries up by 50% to counteract an exodus among all three cadres.
The study found that a well-resourced environment is worth more than money to many nurses. Nurses would trade a large portion of their pay checks if it means finally having the resources to provide quality care.
Bitter laughter
Dlamini says she became a nurse to continue her mother’s legacy. “I saw how passionate she was. People would come up to her in the streets and say ‘sister, do you remember me, you helped me give birth’, she was so loved.”
She knows that she’s operating in the shadows of the system her mother served and recognises the danger of her own exhaustion. “We really should all be declaring,” she says.
But the feeling fades when she thinks of all the nurses who remain jobless on the one hand, and those who joined syndicates on the other.
It hurts to think about those moonlighting to pay for their children’s education or basic needs while others have opted to “order their skinny jeans through Tembisa hospital”, she says referring to rigged tender contracts that the hospital is mired in.
The two shop stewards laughed when Spotlight relayed Dlamini’s disgust with the hypocrisy of the system. That particularly South African, absurd kind of laughter that sits on the edge of anger and resignation.
“She’s right,” says Rabotapi. “How many more nurses could we have hired with that money?”
*Dlamini is not her real name. Spotlight has agreed to withhold her real name since we believe there is a risk she will be persecuted for speaking to the media.
To significantly expand access to affordable, quality primary healthcare in underserved communities, the Cipla Foundation’s Sha’p Left initiative has partnered with the FirstRand Empowerment Foundation (FREF). The partnership aims to aggressively scale the cost-effective nurse-driven surgeries in local communities, across the Western Cape, KwaZulu-Natal and Gauteng.
HEALTHCARE CLOSER TO HOME
This collaboration will help to overcome systemic barriers to healthcare, particularly in terms of equitable access for low-income, uninsured individuals. For many people living in peri-urban and rural areas, access to quality primary healthcare services poses a significant challenge. Over-burdened State medical facilities are often congested, resulting in long waiting times for patients.
Sha’p Left is a patient-centred, cost-aware, nurse-driven primary healthcare service, in the heart of local communities. These nurse surgeries are located in easily accessible hubs such as busy taxi ranks to promote ease of access. The greatest benefit of Sha’p Left is that in addition to saving travel time, it helps to empower people both in terms of caring for their health, but also financially: the lack of queues mean that people don’t need to take a full day off work (resulting in a loss of income) to access basic healthcare.
Currently, Sha’p Left serves more than 5 000 patients monthly, with the patient profile comprising a 60% / 40% female / male split. The existing clinics are GMP compliant containerised solutions, as part of environmental sustainability initiatives and lowering overhead costs, solar solutions are being implemented at these clinics.
CHAMPIONING CHANGE
Strengthening community-based primary healthcare supports national health priorities by reducing the burden on State facilities, promotes preventative healthcare and creates an empowering, dignified experience for patients.
The investment by FREF will help Sha’p Left to deploy more nurse surgeries, and these solutions will ultimately help address inequality and reduce poverty as access to quality healthcare is basic human right. The partnership will scale Sha’p Left from 11 to 61 surgeries by the end of 2029.
SUSTAINABLE SOCIAL IMPACT
The business model involves enterprise development in conjunction with qualified, predominantly female clinical nurse practitioners (CNPs) and assists them to establish sustainable, owner-operated clinics in identified communities to provide affordable primary healthcare services.
This fee-for-service model, driven by the “entreprenurses”, provides a dignified and holistic patient experience. The surgeries have dispensing licenses and therefore a consultations includes the necessary medication required, up to Schedule 4 medicines.
The first three nurse surgeries being deployed in 2026, as part of this partnership, are in these areas:
· Senoane (Gauteng)
· KwaNyuswa (KZN)
· Verulam (KZN)
Blending social impact with sustainability creates a blueprint for scaling primary healthcare in South Africa. With FREF’s support, the Sha’p Left model will expand further into communities where access gaps remain widest, ensuring that more South Africans can easily receive the care they need. This investment ensures that good health is not merely a privilege for a select few people, but for all South Africans.
A landmark international study finds that hospitals with better nurse staffing and work environments not only benefits nurses but is significantly associated with less physician burnout and job dissatisfaction. The research, published in JAMA Network Open, provides a clear solution to the global crisis of physician burnout.
A research team, led by Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR), surveyed more than 6400 physicians and 15 000 nurses across the United States and six European countries (Belgium, England, Germany, Ireland, Norway, and Sweden). The findings show that hospitals with better nurse staffing, supportive work environments, and effective interdisciplinary teamwork had substantially lower rates of physician burnout, job dissatisfaction, and intent to leave.
“Physician burnout is a global crisis, but few actionable solutions have been identified,” said Linda H. Aiken, PhD, RN, FAAN, FRCN, Professor of Nursing and Sociology and Founding Director, CHOPR. “Our study provides evidence that investing in nurses is a ‘two-for-one’ solution – improving both nurse and physician wellbeing while also strengthening patient care.”
Key findings include:
In US hospitals, a modest 10% improvement in the nurse work environment including staffing adequacy was associated with a 22% reduction in physician intent to leave, a 25% reduction in physicians unwilling to recommend their hospital as a place to work, a 19% reduction in physician job dissatisfaction, and a 10% reduction in physicians experiencing high burnout.
In European hospitals, a 10% increase in nurse staffing adequacy was linked to 20% lower physician intent to leave, 27% lower odds of not recommending their hospital, 15% lower physician job dissatisfaction, and 12% lower odds of high burnout.
Hospitals with stronger physician-nurse teamwork consistently reported better physician outcomes.
The results come at a critical time, as both physicians and nurses face unprecedented levels of stress, burnout, and turnover. According to the study, 20–44% of physicians surveyed reported intentions to leave their hospital positions due to dissatisfaction, and up to 45% reported high burnout.
“These findings highlight a path forward that hospital leaders can act on immediately,” said Karen B. Lasater, PhD, RN, Chair in Nursing and Health Policy, Associate Professor, and Associate Director, CHOPR. “Improving nurse staffing and creating supportive work environments are organisational reforms that are feasible, evidence-based, and capable of retaining both nurses and physicians.”
With only 22 090 nurses to serve the country’s public health sector of more than 50 million citizens1, urgent intervention is required to bolster their numbers and protect the wellbeing of our nation. After all, without their tireless dedication, who will be there to guide you through the corridors back to health? writes Bada Pharasi, CEO of the Innovative Pharmaceutical Association of South Africa (IPASA)
As the global healthcare industry commemorates International Nurses Day on 12 May, it is an opportune moment to reflect on the role of nurses as the heartbeat of healthcare systems globally. Amid turmoil and triumph, nurses stand as the unsung heroes and compassionate caretakers who embody empathy, endurance and expertise.
In South Africa, where healthcare challenges often loom large and resources are stretched thin, nurses serve as the frontline warriors, bridging the gap between suffering and healing. Yet, despite the invaluable role they play, a concerning trend looms.
Minister of Health, Joe Phaahla, recently revealed a pressing concern – the anticipation of a staggering 30% of South African nurses retiring within the next decade, and 38% retiring the decade thereafter. Compounding the issue, 5060 vacancies remain unfilled on the back of crippling budget constraints1.
Representing over 90% of global healthcare workers2, nurses are indispensable in the healthcare ecosystem, and addressing this impending crisis of their reducing numbers demands comprehensive and multifaceted solutions that approach the challenge from every angle.
The nurse shortage crisis in South Africa stems from multiple factors. Firstly, the escalating healthcare needs of a growing population, compounded by the burden of infectious diseases such as HIV/AIDS, have strained the healthcare system to breaking point.
Another factor is the restricted capacity of the private sector to train nurses comprehensively due to existing regulations. Moreover, poor working conditions, particularly in the public sector, and comparatively low salaries have led to high turnover rates, prompting nurses to explore alternative career paths or seek employment opportunities abroad3.
While there are many challenges to defusing the proverbial ticking time bomb which is the declining number of qualified nurses in South Africa, increased investment across the board is critical to strengthening their ranks.
Despite financial investment being central in realising this, addressing the problem demands a focus on improving the working conditions of nurses. Healthcare facilities must prioritise nurses’ well-being by offering competitive salaries, manageable workloads, and opportunities for career growth. By creating a supportive work environment, South Africa can retain more nurses and deter them from seeking opportunities abroad3.
Furthermore, granting private hospitals full participation in nurse training programmes is crucial. Private sector entities, such as Netcare, have the capacity to train as many as 3,500 nurses annually. However, limited accreditation from the government hampers their potential contribution to resolving the nurse shortage. Expanding private sector involvement in nurse training could substantially increase the number of trained nurses in the country3.
In addition to these measures, collaborative efforts between the government, healthcare institutions, and nursing organisations are essential. Such partnerships can identify and implement strategies to alleviate the shortage, including targeted recruitment drives, mentorship programmes, and initiatives to improve nurses’ job satisfaction and work-life balance3.
Innovative approaches to addressing the nurse shortage in South Africa extend beyond traditional solutions. Telemedicine platforms are emerging as a promising tool, allowing nurses to deliver care remotely and reach patients in underserved areas.
Additionally, community health worker programmes are being expanded to complement nursing services and extend healthcare access to marginalised communities. Furthermore, initiatives to empower and support nurse entrepreneurs are gaining traction, encouraging the development of innovative care models and healthcare solutions.
These diverse approaches reflect a multifaceted response to the nurse shortage crisis, leveraging technology, community engagement, and entrepreneurship to strengthen the healthcare workforce and improve access to care for all South Africans.
The South African healthcare landscape is undergoing a transformative shift, driven by the rapid advancement of technology. At the forefront of this change is the rise of the “digital nurse,” a testament to the increasing integration of technology into the nursing profession. This transformation is not only streamlining processes; it is addressing critical challenges like the nation’s nurse shortage while ultimately improving patient care.
Embracing convenience and accessibility
Virtual platforms have become commonplace in the nursing world, facilitating efficient and accessible professional development for nurses through online meetings, networking opportunities, and educational resources. This fosters a more connected and knowledgeable nursing community, better equipped to serve patients.
Telehealth consultations, another facet of digital nursing currently revolutionising patient care, provide convenient and accessible medical consultations from the comfort of one’s home, eliminating long wait times and unnecessary travel.
Mitigating nurse shortages and ensuring quality care
South Africa grapples with a significant nurse shortage, placing a strain on the healthcare system to which digital nursing offers a practical potential solution. By leveraging technology, nurses can effectively manage larger patient volumes, reducing the burden on the existing workforce and optimising resource allocation. Remote monitoring systems and AI-powered tools further empower nurses by providing real-time patient data and facilitating early intervention, ultimately improving the quality of care delivered.
Additionally, embracing technology ensures that patients, even in underserved areas, receive quality care. The efficiency gained through virtual platforms allows nurses to allocate their time effectively, addressing minor health concerns remotely and reducing the strain on healthcare facilities for non-emergency cases.
However, it must be pointed out that although leveraging technology allows nurses to effectively manage larger patient volumes, which can alleviate the strain on the current system, this doesn’t necessarily mean fewer nurses are needed, but rather that technology empowers existing numbers to reach a wider patient base to deliver more efficient, personalised care.
Evolving alongside technology: the digital nurse of tomorrow
As the healthcare industry embraces digital technologies, the role of the nurse will continue to expand. While traditional nursing skills will remain essential, the “digital nurse” of the future must possess additional competencies. Acquiring proficiency in digital tools and equipment, along with the capability to interpret and analyse digital data, will be crucial for delivering effective patient care. However, the most critical attribute for the digital nurse will be the willingness to adapt and embrace constant technological advancements. This will require a mindset shift that comes with acknowledging that traditional methods might not be sufficient in the face of evolving patient needs.
The challenges and opportunities in change
While the adoption of digital nursing brings numerous benefits, challenges remain. Resistance from individuals accustomed to traditional healthcare practices is one hurdle. However, with the younger generation being more adaptable, the shift towards digital nursing is expected to gain wider acceptance as technology advances. To ensure the success of this digital-first healthcare, it will be necessary to focus our attention on upskilling, which means recognising that continuous training and development programs are vital for nurses to remain proficient in the face of change.
On the flip side, a change in perspective from nursing professionals themselves will be necessary. This means embracing a growth mindset and being open towards new technologies to adapt and thrive in the digital age. Lastly, healthcare professionals as a whole need to bear in mind that transformation is essential to meet the evolving needs of patients, which includes catering to a growing preference for digital healthcare solutions. Continuing to meet the needs of patients is the only guaranteed way for nursing professionals to ensure their relevance in the future. By embracing technology and fostering a culture of continuous learning, South Africa can empower its nurses to become the digital healthcare leaders of tomorrow.
The Department of Health has averted a standoff with nurses in the public sector with a last-minute agreement to pay nurses a temporary allowance to buy uniforms.
Nurses threatened to work in their own clothes if the department failed to provide them either with uniforms or with an allowance by 1 October. This plan was put on hold pending negotiations between unions and the health department.
Since 2005, nurses received an annual allowance to buy their uniforms. But this ended on 31 March this year after a new agreement was signed by the Public Health and Social Development Sectoral Bargaining Council. Under the new agreement, nurses would be provided with uniforms.
As a result, nurses did not get the usual allowance in April this year. Instead, they were supposed to be provided with uniforms by 1 October 2023.
The agreement stated that in the first year, the department must provide nurses with four sets of uniforms, one pair of shoes, and one jersey. In the second year, it must provide three sets of uniforms, one belt, and one jacket.
But then, at a last-minute meeting of the bargaining council in September, the department told unions that it would be unable to meet the 1 October deadline. It proposed to put on hold the supply of uniforms until 2024.
Spokesperson for the Democratic Nursing Association of South Africa (DENOSA) Sibongiseni Delihlazo said labour unions said that if the department was unable to supply the uniform by 1 October, they must pay nurses an allowance as previously.
If the department failed to provide uniforms or pay an allowance, DENOSA said, its 84,000 members would embark on an indefinite protest action by wearing their own clothes at work from 1 October.
Following the last-minute bargaining council meeting in September, a new agreement was signed on 4 October.
The bargaining council resolved that a temporary uniform allowance of R3,153 be paid to all qualifying nurses by 30 November 2023. The health department also agreed to provide nurses with uniforms by 1 September 2024.
If the department fails to provide the uniforms by 1 September 2024, “the uniform allowance shall continue, considering the applicable inflation rate annually, as pronounced by the National Treasury in February”, the agreement read.
A UK nurse has been sentenced to life in prison for murdering seven babies in a neonatal unit. In what is the longest murder trial in recent UK history, 33-year old Lucy Letby was also convicted of attempting to kill six other babies, and further investigation by the BBC has also revealed how hospital management at the time deflected concerns by doctors and actively silenced them.
Between June 2015 and June 2016, Letby deliberately injected air into babies’ parenteral nutrition lines, force-fed milk to others and administered huge doses of insulin to two others. In the years before, less than three death per year had been recorded at Countess of Chester Hospital at the neonatal unit where she worked.
According to The Guardian, Mr Justice Goss said during her sentencing: “This was a cruel, calculated, and cynical campaign of child murder involving the smallest and most vulnerable of children, knowing that your actions were causing significant physical suffering and would cause untold mental suffering.”
She was found not guilty of two other counts of attempted murder, but the jury consisting of four men and seven women were unable to reach a verdict on six additional attempted murder charges. The court will consider whether to attempt to retry these six charges.
Dr Stephen Brearey, lead consultant at the neonatal unit where Letby worked told the BBC he first raised concerns about the nurse in October 2015, but not no action was taken and she went on to attack five more babies.
He that hospital management failed to investigate allegations against her and also tried to silence doctors. An investigation by BBC Panorama BBC News revealed just how Letby was able to get away with murdering and harming the babies for so long.
The hospital’s top manager ordered doctors to make written apologies to to Letby, and two consultants had to undertake mediation with the nurse, despite their suspecting she had killed babies. Efforts to bring in the police were also quashed by senior management, who said in an email “This is absolutely being treated with the same degree of urgency … All emails cease forthwith”.
Dr Ravi Jayaram, a consultant paediatrician at the hospital, wrote on social media that he felt relief at the oft-maligned justice system working “this time”.
But he continued there were “things that need to come out about why it took several months from concerns being raised to the top brass before any action was taken to protect babies”.
He also added: “And why from that time it then took almost a year for those highly-paid senior managers to allow the police to be involved.”
Advancements in AI have resulted in typically human characteristics like creativity, communication, critical thinking, and learning being replicated by machines for complex tasks like driving vehicles and creating art. With further development, these human-like attributes may develop enough to one day make it possible for robots and AI to be entrusted with nursing, a very ‘human’ practice. But… would it be ethical to entrust the care of humans to machines?
In a step toward answering this question, Japanese researchers recently explored the ethics of such a situation in the journal Nursing Ethics.
The study was conducted by Associate Professor Tomohide Ibuki from Tokyo University of Science, in collaboration with medical ethics researcher Dr Eisuke Nakazawa from The University of Tokyo and nursing researcher Dr Ai Ibuki from Kyoritsu Women’s University.
“This study in applied ethics examines whether robotics, human engineering, and human intelligence technologies can and should replace humans in nursing tasks,” says Dr Ibuki.
Nurses show empathy and establish meaningful connections with their patients, a human touch which is essential in fostering a sense of understanding, trust, and emotional support. The researchers examined whether the current advancements in robotics and AI can implement these human qualities by replicating the ethical concepts attributed to human nurses, including advocacy, accountability, cooperation, and caring.
Advocacy in nursing involves speaking on behalf of patients to ensure that they receive the best possible medical care. This encompasses safeguarding patients from medical errors, providing treatment information, acknowledging the preferences of a patient, and acting as mediators between the hospital and the patient. In this regard, the researchers noted that while AI can inform patients about medical errors and present treatment options, they questioned its ability to truly understand and empathise with patients’ values and to effectively navigate human relationships as mediators.
The researchers also expressed concerns about holding robots accountable for their actions. They suggested the development of explainable AI, which would provide insights into the decision-making process of AI systems, improving accountability.
The study further highlights that nurses are required to collaborate effectively with their colleagues and other healthcare professionals to ensure the best possible care for patients. As humans rely on visual cues to build trust and establish relationships, unfamiliarity with robots might lead to suboptimal interactions. Recognising this issue, the researchers emphasised the importance of conducting further investigations to determine the appropriate appearance of robots for facilitating efficient cooperation with human medical staff.
Lastly, while robots and AI have the potential to understand a patient’s emotions and provide appropriate care, the patient must also be willing to accept robots as care providers.
Having considered the above four ethical concepts in nursing, the researchers acknowledge that while robots may not fully replace human nurses anytime soon, they do not dismiss the possibility. While robots and AI can potentially reduce the shortage of nurses and improve treatment outcomes for patients, their deployment requires careful weighing of the ethical implications and impact on nursing practice.
“While the present analysis does not preclude the possibility of implementing the ethical concepts of nursing in robots and AI in the future, it points out that there are several ethical questions. Further research could not only help solve them but also lead to new discoveries in ethics,” concludes Dr Ibuki.
