Mrs. Dulcie TsotetsiDulcieT@gpg.gov.za

INTRODUCTIONThe 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. 2008:337).

INTRODUCTION CONT...Furthermore, criticism, verbal abuse, site

bulling, harassment and intimidation are forms of violence in the workplace (Dunham-Taylor et. al. 2008:337). 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.

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, 2008:27).

Remunerated Community service is regulated by SANC Regulation R765 of 2007

BACKGROUND OF THE STUDYInformation 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, 2008:204)

Best practices in New Zealand – “Nurse entry into practice” – pilot over a period of 8 years and release of graduates for planned training.

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).

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.

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.

RESEARCH QUESTIONSThe 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?

SIGNIFICANCE OF THE STUDYThe 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.

ETHICAL CONSIDERATIONPretoria University Ethics Committee

Gauteng Province Ethics Committee

Ekurhuleni District Ethics Committee

Health Institution Permission

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

SAMPLE AND SAMPLINGPurposive 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

MEASURES TO ENHANCE TRUSTWORTHINESSCredibility Transferabilit

yDependability 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

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%

TABLE 3.1: SAMPLE DEMOGRAPHIC INFORMATION (N=42)

DATA COLLECTION

5 Focus group interview sessions consisting of 6 – 10 participants

Pilot study

Saturation of information reached

DATA ANALYSISTech’s 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

DISCUSSION OF CHALLENGES EXPERIENCED (CATEGORY1.1)Integration of theory to practice

Clinical experience is different from classroom environment (“Theory Practice gap” Davhana Maselesele -200:82)

“Practice is something different from the school”.“You are responsible for everything in the ward”.“Sometimes you feel like you want to quit”

Challenges experienced cont.

Community service placement is good, it allows application of theory to practice (“Correlation of theory to practice“- Mabuda et. al. 2008:20)

“It is very educative in a way”.“It is a learning opportunity for us. We have

to put whatever we learnt into practice”.

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”.

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”.

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”.

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”.

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”.

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 don’t need to ask me, what did they teach you at college”.

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”.

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”.

Support Received Cont...Inadequate support

The majority reported that the support they received was inadequate 

“They didn’t support us that well”.“It varies according to the ward you are

working in”

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”.

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”

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”

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”.

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”.

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”.

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”.

Expectations regarding community service placement cont...Role clarification

The participants expected clear definition of roles for community service nurses

“I don’t 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”.

RECOMMENDATIONSCollaborative meetings between programme

managers and lecturers to discuss policies –”theory practice gap”

Structured orientation and training programme for community service nurses

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

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

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

RECOMMENDATIONS cont...Develop a work book with standardised

procedures and orientation programme

Training linked to PMDS identified training needs

CPD for community service nurses

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

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

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.

AcknowledgementSupervisor : Mrs. S. Phiri Pretoria University

Co-supervisor: Dr. Peu – Pretoria University

Co coder: Professor Maja

Assistant Researchers Ms A Ncedani and Mr S Dikgang