Discontent among registered nurses in the public health sector in Tshwane Metropolitan area

Abstract

The researcher used the integration of both qualitative and quantitative approaches. The respondents were drawn from three district, one regional, one academic and two private hospitals. Data was collected by means of questionnaires. The open-ended questions in the questionnaire allowed the respondents to respond in their own words (“etic” description). This enhanced the organisation and reduction of the relevant data for analysis as well as the validity and trustworthiness of the study. The study revealed that even though most of the South African government health policies were very advanced and among the best in the world, some crucial policies appeared to have encountered problems with implementation, from conflicting ideologies and opinions from hospital management, different unions, professional associations, the provincial government, the South African Nursing Council (SANC) and patients. Too many groups appeared to have discussed nurses‟ issues with government and made decisions for nurses, leaving nurses disillusioned. The majority of the respondents attributed this to poor representation at government level. Furthermore, some decisions, resolutions and strategies agreed upon between the unions and bargaining councils appeared to have worked against nurses, further dividing RNs and failing to accomplish the intended purpose. Although most of the respondents had hoped that the Occupational Specific Dispensation (OSD) for nurses would address chronic low salaries for all nurses in the PHS, it favoured certain specialty qualifications (which were based on the description of post-basic courses in R212 and R48, which were not clearly delineated). In addition, RNs were not informed about the meaning and implications of the OSD prior to implementation. The study thus found an information gap between government and RNs at the production level, which appeared not to be with the government and the nurses, but in between.

Most importantly, nurses seemed to be represented more by unions to government and bargaining councils, as opposed to nurses, while most of the respondents did not favour the division of nurses between professional associations and unions. Decisions in the PHS appeared to have been dominated by leaders who had no experience with pragmatic issues of health care services (HCS), particularly at the operational level, and the dynamics of the nursing profession. The study therefore concluded that, if the right people (nurses, doctors and systems) were put in place, and nurses were represented by nurses at government level, bargaining councils and parliament, discontent among RNs in the PHS could be reduced significantly. Existing strategies were found to deal with the symptoms and not the root cause of discontent among RNs in the PHS.