EXPERIENCES AND SUPPORT OF THE NEWLY-QUALIFIED FOUR-YEAR TRAINED PROFESSIONAL NURSES PLACED FOR REMUNERATED COMMUNITY SERVICE IN GAUTENG PROVINCE - PowerPoint PPT Presentation

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EXPERIENCES AND SUPPORT OF THE NEWLY-QUALIFIED FOUR-YEAR TRAINED PROFESSIONAL NURSES PLACED FOR REMUNERATED COMMUNITY SERVICE IN GAUTENG PROVINCE

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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

2
INTRODUCTION
  • 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).

3
INTRODUCTION 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.

4
INTRODUCTION 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

5
BACKGROUND 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.

6
BACKGROUND 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).

7
BACKGROUNG 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.

8
OBJECTIVES
  • 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.

9
RESEARCH 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?

10
SIGNIFICANCE 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.

11
ETHICAL CONSIDERATION
  • Pretoria University Ethics Committee
  • Gauteng Province Ethics Committee
  • Ekurhuleni District Ethics Committee
  • Health Institution Permission

12
ETHICAL 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

13
SAMPLE 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

14
MEASURES 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

15
TABLE 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
16
DATA COLLECTION
  • 5 Focus group interview sessions consisting of 6
    10 participants
  • Pilot study
  • Saturation of information reached

17
DATA 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)
19
DISCUSSION 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

20
Challenges 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.

21
Challenges 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.

22
Challenges 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.

23
Challenges 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.

24
Challenges 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.

26
Interpersonal 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.

28
DISCUSSION 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.

29
Support 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

30
Support 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.

31
Support 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

32
Support 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

33
Expectations 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.

34
Expectations 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.

35
Expectations 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.

36
Expectations 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.

37
Expectations 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.

38
RECOMMENDATIONS
  • Collaborative meetings between programme managers
    and lecturers to discuss policies theory
    practice gap
  • Structured orientation and training programme for
    community service nurses

39
RECOMMENDATIONS 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

40
RECOMMENDATIONS 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

41
RECOMMENDATIONS 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

42
RECOMMENDATIONS cont...
  • Develop a work book with standardised procedures
    and orientation programme
  • Training linked to PMDS identified training needs
  • CPD for community service nurses

43
LIMITATIONS 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

44
Acknowledgement
  • 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

45
Conclusion
  • 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.

46
Acknowledgement
  • 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

47
THANK YOU
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