Title: EXPERIENCES AND SUPPORT OF THE NEWLY-QUALIFIED FOUR-YEAR TRAINED PROFESSIONAL NURSES PLACED FOR REMUNERATED COMMUNITY SERVICE IN GAUTENG PROVINCE
1 EXPERIENCES AND SUPPORT OF THE
NEWLY-QUALIFIED FOUR-YEAR TRAINED PROFESSIONAL
NURSES PLACED FOR REMUNERATED COMMUNITY SERVICE
IN GAUTENG PROVINCE
- Mrs. Dulcie Tsotetsi
- DulcieT_at_gpg.gov.za
2INTRODUCTION
- The aim of the study was to highlight the
experiences and support of the newly-qualified
four-year trained professional nurses placed for
remunerated community service in Gauteng
Province. - Literature revealed that Horizontal hostility
occurs in academia and in clinical setting -
old nurses eating their young (Dunham-Taylor
et. al. 2008337).
3INTRODUCTION CONT...
- Furthermore, criticism, verbal abuse, site
bulling, harassment and intimidation are forms of
violence in the workplace (Dunham-Taylor et. al.
2008337). This negative attitude towards new
employees contributes to a shortage of nurses as
qualified staff leave their current positions to
seek for greener pastures outside health care
arena.
4INTRODUCTION CONT...
- Globalization in S.A Post 1994 ANC in power -
open boarders and staff shortage in S.A nurses
migrated to UK. - Remunerated Community Service for Nurses was
implemented in 2008 (Nursing strategy for South
Africa, 200827). - Remunerated Community service is regulated by
SANC Regulation R765 of 2007
5BACKGROUND OF THE STUDY
- Information on successes of Community Service for
Nurses exist in developed countries America,
Canada, Australia New Zealand etc. - Literature reflect that praise, reinforcement
and support creates a conducive environment for
learning and development (Haag-Heitman, 2008204) - Best practices in New Zealand Nurse entry into
practice pilot over a period of 8 years and
release of graduates for planned training.
6BACKGROUND OF THE SYUDY CONT...
- In South Africa remunerated community service for
nurses is new limited information. - The late Minister of Health Dr Mantombazana
Tshabalala-Msimang introduced remunerated
community service for nurses as a retention
strategy (Nursing strategy for South Africa,
2008 1). -
7BACKGROUNG OF THE STUDY CONT...
- Section 40 (3) of S.A Nursing Act 33 of 2005
states that the minister may, after consultation
with SANC, make regulation concerning community
service for nurses. -
- The SANC regards remunerated community service
placement as a prerequisite for registration as a
professional nurse. - Community service placement is new in South
Africa. This created a need for the study.
8OBJECTIVES
- To explore and describe the experiences of the
newly- qualified four-year trained professional
nurses who were placed for remunerated community
service in Gauteng Province. - To explore and describe the support, received by
the newly qualified four-year trained
professional nurses placed for remunerated
community service in Gauteng Province.
9RESEARCH QUESTIONS
- The following research questions guided the
study - What are the experiences of the newly -qualified
four-year trained professional nurses placed for
remunerated community service in Gauteng
Province? - What is the support received by the newly
-qualified four-year trained professional nurse
placed for remunerated community service in
Gauteng Province?
10SIGNIFICANCE OF THE STUDY
- The study was to generate the findings based on
the experiences and support received by the
newly-qualified four-year-trained professional
nurses who were placed in various gazetted health
facilities in Gauteng Province - The outcomes of the study would inform policy
makers on the successes and challenges
experienced by the existing community service
nurses on completion of community service
placement.
11ETHICAL CONSIDERATION
- Pretoria University Ethics Committee
- Gauteng Province Ethics Committee
- Ekurhuleni District Ethics Committee
- Health Institution Permission
12ETHICAL CONSIDERATION CONT..
- Beneficence
- -Protection from harm and exploitation
- Confidentiality
- -Protection of information
- Informed consent
- -Detailed explanation of the research study
- Deception of participants
- -transparency of information/ findings
13SAMPLE AND SAMPLING
- Purposive sampling
- Population Newly-qualified four-year trained
professional nurses placed for remunerated
community service in gazetted health facilities
in Gauteng Province from universities and nursing
colleges - Inclusion- placement for six to twelve months
trained in universities and nursing colleges - Exclusion bridging students
14MEASURES TO ENHANCE TRUSTWORTHINESS
Credibility Transferability Dependability Confirmability
Prolonged engagement- 5 months Generating of thick descriptive and in-depth information The use of experts during NEA conference Auditing and confirmation by the independent decoder who did not participate in the study
Member checking- accurateness of data
Triangulation- focus groups, investigators
Peer briefing- NEA Conference
15TABLE 3.1 SAMPLE DEMOGRAPHIC INFORMATION (N42)
CRITERION CHARACTERISTICS FREQUENCY PERCENTAGE
Gender Males 5 11.9
Females 37 88.1
Ethnic Group Blacks 41 97.7
Whites 1 2.3
Districts Ekurhuleni 5 11.9
Sedibeng 11 27.6
Johannesburg Metro 27 64.3
Health Facilities Levels District Hospital 4 9,5
Regional Hospitals 11 27.6
Academic Hospitals 27 64.3
Period of placement as community service nurse 0 5 months 6 12 months - 42 - 100
16DATA COLLECTION
- 5 Focus group interview sessions consisting of 6
10 participants - Pilot study
- Saturation of information reached
-
17DATA ANALYSIS
- Techs method of data analysis used
- Listening to the video tapes
- Verbatim transcripts
- Field notes compiled by two assistant researchers
- Independent researcher decoding- consensus
reached on themes, categories and subcategories
18(No Transcript)
19DISCUSSION OF CHALLENGES EXPERIENCED (CATEGORY1.1)
- Integration of theory to practice
- Clinical experience is different from classroom
environment (Theory Practice gap Davhana
Maselesele -20082) - Practice is something different from the
school. - You are responsible for everything in the ward.
- Sometimes you feel like you want to quit
20Challenges experienced cont.
- Community service placement is good, it allows
application of theory to practice (Correlation
of theory to practice- Mabuda et. al. 200820) - It is very educative in a way.
- It is a learning opportunity for us. We have to
put whatever we learnt into practice.
21Challenges experienced cont...
- Deliberate practice and risk taking
- Some participants reported that there was a lack
of support in the ward but eventually they
managed to find their way - You would not know where you stand and what is
going to happen. - You are responsible for everything in the ward.
22Challenges experienced cont...
- Some participants reported that Community Service
empowered them with skills and they enjoyed
working with a multidisciplinary team - There is a good multidisciplinary team and we
all work nicely together. - It has been good and bad, but the good has
outclassed the bad.
23Challenges experienced- cont...
- Role conflict
- All five focus groups reflected role conflict by
reporting that the roles of community service
nurses were not clearly defined in health
facilities where they were placed - There is no clear line that divides between a
registered professional nurse, community service
nurse and a student. - A confusing experience.
24Challenges experienced cont...
- Staff Shortage
- Most of the community service nurses reported
that they experienced severe shortage of staff
which had a bad impact on their placement. - I was thrown into the deep end due to staff
shortage. - Everybody tells us that staff shortage is
global, they can allocate us anywhere they like.
25 DISCUSSION OF INTERPERSONAL RELATIONSHIP
BETWEEN STAFF AND COMMUNITY SERVICE NURSES (CAT.
1.2)
- Environment not conducive to learning
- All participants in the study reported that the
working environment was not conducive to
learning - If you are new in the ward they allocate you
with the auxiliary nurses who are very rude to us
because we are younger than them. -
26Interpersonal relationship between staff and
community service nurses cont
- Staff attitudes
- Participants reported that bad attitudes and
verbal abuse came from all different categories
of staff - I had to blow a whistle for assistance when the
baby was gasping but no one came to assist me. - She only came yesterday, what does she know
about tea time? - You dont need to ask me, what did they teach
you at college.
27 Interpersonal relationship between staff and
community service nurses cont
- Adverse events
- In all focus group interviews conducted,
participants reported that they had been linked
to adverse events while placed as community
service nurses in Gauteng province due to
inadequate staffing. - I started resuscitating the baby alone and the
baby died due to lack of knowledge and
assistance. - I had a maternal death, the sister-in-charge and
the area manager assisted me to write the
statement.
28DISCUSSION OF SUPPORT RECEIVED DURING REMUNERATED
COMMUNITY SERVICE PLACEMENT (CAT. 2.1)
- Adequate support
- Some community service nurses related that
remunerated community service placement offered
them good experience and adequate support - Community service is for us to grow
professionally.
29Support Received Cont...
- Inadequate support
- The majority reported that the support they
received was inadequate - They didnt support us that well.
- It varies according to the ward you are working
in
30Support received during community service
placement cont
- Incidental support
- Some of the participants reported that they were
able to get support from the staff only after
they had been subjected to bad incidences in the
ward - While I was working in maternity, the baby died
of aspiration and the support I received
thereafter was overwhelming, I was even supported
by the matrons.
31Support received cont...
- Lack of support
- Some of the participants felt that there was lack
of support in the health facilities where they
were placed for remunerated community service - It has been such a rough ride I must say
32Support received during community service
placement cont...
- Remuneration discrimination move
- The work they performed was not worth the salary
they were getting. Professional who followed the
bridging course were paid the salary of a
qualified professional nurse on completion of
training. - It is about not giving us money we deserve on
completion of our training. - I am angry because we are doing everything in
the ward but we get a salary of a community
service nurse. - We are doing the work of a registered nurse, the
difference is the salary
33Expectations regarding community service
placement (Cat. 2.2)
- Orientation
- They expected to be orientated on arrival in the
health facilities where they were placed - I was expecting a structured and relevant
orientation in the ward. - I expected that they will start by orientating
us, but we started in the wards.
34Expectations regarding community service
placement cont
- Coaching
- Community service nurses were expecting to be
nurtured by experienced professional nurses, unit
managers and zonal matrons in the health
facilities where they were placed but this did
not happen - I was expecting to work a shift of 07h00-16h00
because I am still learning as a community
service nurse.
35Expectations regarding community service
placement cont
- Mentorship
- Participants explained that mentorship and
guidance differed according to the individual
professionals they were working with - Other staff members are willing to support us
when we need help others are not.
36Expectations regarding community service
placement cont...
- Incentives and resources
- Participants were dissatisfied with PMDS policy
excluded - I expected to fill in the performance management
and development (PMDS) forms and benefit out of
them but it did not happen.
37Expectations regarding community service
placement cont...
- Role clarification
- The participants expected clear definition of
roles for community service nurses - I dont know what community service is all about
we are just being forced into a bus that is
driving at a speed of 120 kilometers per hour. - I expected a clear direction on how to handle
community service nurses.
38RECOMMENDATIONS
- Collaborative meetings between programme managers
and lecturers to discuss policies theory
practice gap - Structured orientation and training programme for
community service nurses
39RECOMMENDATIONS CONT...
- Allocation of a mentor for community service
nurses - Correction of salary gap between community
service nurses and bridging students on
completion - starting salary - Establishment of a call centre for community
service nurses
40RECOMMENDATIONS cont...
- Community service review team consisting of
lecturers, matrons, provincial coordinator and
community service nurses representatives - SANC to develop a dedicated scope of practice for
community service nurses
41RECOMMENDATIONS CONT...
- Implementation of PMDS policy to community
service nurses - Design a pocket procedure manual
- A need for a signed policy guidelines for
community service nurses implementation
42RECOMMENDATIONS cont...
- Develop a work book with standardised procedures
and orientation programme - Training linked to PMDS identified training needs
- CPD for community service nurses
43LIMITATIONS OF THE STUDY
- Study limited to Gauteng Province due to lack of
financial resources - Limited racial group representation in the study
- Limited number of males
44Acknowledgement
- Mrs S.S Phiri Supervisor Pretoria University
- Dr M.D Peu co-supervisor Pretoria University
- Assistant researchers Andiswa Ncedani and Saul
Dikgang - Independent decoder Professor Maja
45Conclusion
- Based on the findings of the study, it is
concluded that the objectives of the study were
achieved -
- It is hoped that majors will be put in place to
improve the remunerated community service policy
for nurses - The researcher has made recommendations based on
- best practices implemented by other countries to
improve community services for nurses.
46Acknowledgement
- Supervisor Mrs. S. Phiri Pretoria University
- Co-supervisor Dr. Peu Pretoria University
- Co coder Professor Maja
- Assistant Researchers Ms A Ncedani and Mr S
Dikgang
47THANK YOU