Nursing Strategy for South Africa

1. Nursing Strategy for South Africa Presentation to the Portfolio Committee for Health Cape Town 19 June 2007

2. Purpose • To brief the Portfolio Committee for Health on the draft Nursing Strategy for South Africa • To highlight priorities set within the Strategy for Nursing in South Africa • To give an overview of the Nursing Strategy in relation to implementation of the National Human Resources Plan

3. Introduction • The Nursing Strategy as a critical part of addressing the serious challenges faced by nursing • Proposal for its adoption as the basis and a blue-print for strengthening nursing in the country • To highlight the significance of the nursing profession in health care delivery.

4. Introduction • To highlight production and status quo of nurses in the country • Location within the HRH Plan and use of nursing as tracer profession • Location of nursing within Policy on Health Sciences, Education and Training • Ownership of the process by National Health Council

5. Overview • Purpose of a Nursing Strategy: - address challenges faced by nursing - articulate how nursing education & training, practice, resources, social positioning, regulation and leadership are planned & linked in support of nation's health system • Goal of a Nursing Strategy: - achieve and maintain an adequate supply of nurses and strengthen the quality of nursing in the health system

6. Overview • Intention: - Develop a coherent approach towards dealing with nursing challenges thus provide a common platform - Each stakeholder to address issues that affect their core business • Strategy must therefore be a unifying platform explicitly addressing all nursing issues

7. Overview • Central to the Nursing Strategy:- Good quality education and training - Nursing practice (providing an enabling environment for nursing service delivery) - Good nursing leadership in all aspects of nursing - Social positioning and better image of nursing - Resources for nursing (promote accessibility of nursing to all South Africans)

8. Perspectives On Nursing • Largest category of health professionals • Responsibility of bringing health services to all communities • Issues associated with nursing workforce particularly complex & dynamic • Many documented challenges - education right through to migration • Serious problem of resources especially infrastructure related

9. Fundamental Issues • Nursing in a Changing Health System • Nursing as a Career of Choice • Regulating nursing • Educational qualifications • Scopes of Practice • Managing the Nursing Workforce • International/global influences

10. Strategic Focus Areas • Nursing Practice • Nursing Education & Training • Nursing Leadership • Values in Nursing (Professionalism) • Nursing Regulation • Resources for Nursing • Social Positioning of Nursing

11. Strategic Thrust • The strategy to be broad enough to address challenges, leveraging on all possible networks i.e. - How nursing can remain a profession that offers access to all whilst lifting the bar in terms of quality education and training - Finding ways of embracing the benefits of globalization in a manner that improves nursing - How nurses can improve the image of their profession

12. Implementation Framework • Similar approach to HRH Plan • Strategies proposed with understanding that further development & implementation of each strategy will require unifying efforts of all stakeholders • Primary responsibility & output measures for each strategic focus identified. • Cost implications of strategies to be considered by National Health Council

13. Conceptual Roles • Sponsoring (government) • Championing (partners)

14. Concept of Sponsoring • Provide strategic direction & leadership for the implementation • Take the lead in communicating the strategy • Promote joint ownership of the strategy amongst stakeholders • Identify and mobilize resources and support required • Monitor and evaluate progress of the implementation of the strategy

15. Concept of Championing • Putting in place a mechanisms to popularise the objectives of the strategy • Driving the implementation of the education, training & related aspects of the strategy • Identifying major policy implementation gaps & engagement with Department of Health • Assisting and supporting the DOH throughout the implementation process

16. Challenge for Nursing Collective discussed during consultation • Critical contextual analysis of the quality, delivery & associated factors to education • Analysis of strategic role of nursing institutions • Increasing the pool of educators & nursing scientists • Nurturing & entrenching the culture of research, writing & publishing in nursing • Ensuring innovation is entrenched in nursing • Defining practically the social positioning of nursing & addressing values

17. Key Issues raised during consultation • Education & Training - Qualifications - Educators - Research • Scopes of Practice - Repositioning of nursing - Values & human rights approach • Nursing workforce planning • Regulating the nursing workforce

18. Key Issues Raised continued • Implementation of new Scopes of Practice • Ensuring good standard education & training - Clinical & theoretical competence - Integration of theory and practice - Research • Recruitment and selection of learners • Capacity in nursing {capacity understood as ability of People, organizations and society to manage their affairs successfully • Nurse Educators & Leadership

19. Implementation aspects of the Nursing Strategy Strategic Focus Area 1: Nursing Practice • Establishing and enabling legislative environment • Implementable policies in place • Legislation aligned to nursing practice • Policy on public nursing agency in place

20. Implementation aspects of the Nursing Strategy • Improved quality of nursing practice / promote and assure quality of care • Finalized scope of practice in place • Evidence based practice • Operational plans in line with service delivery needs and resources

21. Implementation aspects of the Nursing Strategy • Improve skills and competency levels of nurses in accordance with the competency framework and revised scope of practice • Competency assessment system in place • Skills plan in place • Skills Development Programme in place • CPD activities identified and aligned to revised scope of practice

22. Implementation aspects of the Nursing Strategy • Develop collaborative partnerships with key stakeholders • Identify stakeholders and their roles to participate in the national nurse production, placement and retention strategy for nurses • Adoption of National Nursing Strategy for South Africa • Sustained partnership

23. Implementation aspects of the Nursing Strategy • Develop Nursing Staff establishments that are responsive to service delivery needs • Nursing staffing norms and standards in accordance with service needs in place • Career paths for all categories in place especially clinical specialties • Retention strategy implemented

24. Implementation aspects of the Nursing Strategy • Strengthen role of Nursing in Health Service Delivery • Locate nursing strategically at provincial, local and international levels • Ensure and approve quality of supervision • Build quality nursing teams • Upgrade current enrolled and professional nurses in line with new scopes of practice • Establish provincial and national forums for sharing best practices on nursing

25. Strategic Focus Area 2 – Education and Training • Improve quality of nurse educators • Improved conditions of service • Ensure all nurse educators appropriately qualified and updated in current skills • Ensure harmonization of education and training • Finalize recommendations of the Nursing SGB through the SANC • Nursing Education aligned with legislative requirements, training linked to service needs

26. Strategic Focus Area 2 – Education and Training • Integrate practice and theoretical knowledge • Strengthen collaboration with nursing education institutions and service providers • Provide capacity for mentorship and preceptor programmes • Ensure qualifications are aligned to needs • Proper integration of practice and theoretical knowledge

27. Strategic Focus Area 2 – Education and Training • Increased production of nursing professionals • Identify and accredit health facilities for clinical education and training to increase capacity to accommodate increased production requirements • Audit and increase training capacity of nursing colleges and training courses • Develop a recruitment and selection strategy for young nurses

28. Strategic Focus Area 2 – Education and Training • Skills improvement • Identify, develop and strengthen CPD activities in line with the Nursing Act • Align CPD to clinical outcomes

29. Strategic Focus Area 2 – Education and Training • Recruitment and Retention of Nurse Educators • Develop sustainable retention strategies • Career pathing and succession planning • Develop quality management systems at Nursing Education Institutions • Audit quality of nursing education • Audit quality and skills of nurse educators • Improve capacity of Nursing Education Institutions

30. Strategic Focus Area 2 – Education and Training • Improve quality of nursing education • Nursing Education Institutions to be integrated into higher education institutions • Facilitate registration of nursing education institutions as FET and HET institutions • Review the role of nursing auxiliaries within the health care system

31. Strategic Focus Area 2 – Education and Training • Ensure implementation strategy for recognition of prior learning (RPL) for nurses • Establish RPL assessment centres in provinces • Implement RPL in all provinces

32. Strategic Focus Area 2 – Education and Training • Promote professional development for nurses • Improve selection criteria for trainees • Conduct pre-selection interviews • Conduct pre-selection medical assessment for prospective students • Develop a plan for training and re-training in relation to reviewed scopes of practice

33. Strategic Focus Area 2 – Education and Training • Improve research capacity of nurses • Conduct extensive training in research methodology • Facilitate nursing research amongst academic institutions and health facilities

34. Strategic Focus Area 3 – Nursing Leadership • Identify and position nursing leadership in all aspects i.e. registration, practice, education and labour • Identify and position nursing leadership strategically in organizational structures at all levels i.e. nationally and internationally

35. Strategic Focus Area 3 – Nursing Leadership • Enhance nursing leadership capacity to ensure good governance at all levels • Audit of skills and competencies, training and development plan • Leadership development programmes in place • Recognize, utilize and reward expertise • Develop and implement mentorship and coaching programmes • Deploy nurses to situations which enhance and develop their leadership capacity

36. Strategic Focus Area 3 – Nursing Leadership • Identify and nurture potential and emerging nurse leaders • Increased growth of leadership numbers of nurses involved in academic issues pertaining to health and nursing

37. Strategic Focus Area 3 – Nursing Leadership • Attract young nurses to nursing academia • Encourage academic leaders to positively influence young nurses into academic debates on health systems

38. Strategic Focus Area 4 – Nursing Regulation • Implement the Nursing Act, 2005 (Act No. 33 of 2005) • Establish the Nursing Council in terms of the new Act • Regulate registration and licensing of nurses • Regulate scopes of practice, nursing education • Implement community service for nurses • Introduce CPD for nurses • Regulate ethical code and conduct of nurses

39. Strategic Focus Area 4 – Nursing Regulation • Ensure high standards of professional self governance • Adherence to corporate governance by the professional regulator (SANC) in accordance with the new Nursing Act • Perform periodic governance audits • Ensure quality service and protection of the public • Educational programmes, professional values responsive to public needs

40. Strategic Focus Area 4 – Nursing Regulation • International Benchmarking • Policies compare with international best practice • Nursing legal framework benchmarked and updated regularly

41. Strategic Focus Area 5 – Social Positioning of Nursing • Restore the image of nursing and maintain professionalism • Improve understanding of political focus of the country • Improve social infrastructural support i.e. accommodation, EAP and housing subsidies

42. Strategic Focus Area 5 – Social Positioning of Nursing • Promote nursing as a career of choice • Market nursing as a career of choice • Create attractive employment opportunities for nurses • Recruitment and marketing strategy for nursing implemented

43. Strategic Focus Area 6 – Resources for Nursing • Ensure safe nurse practice with appropriate nursing resources • Guidelines on safe nursing practice • Ensure sustainability of nursing • Adequate funding of nursing services • Attractive incentives and remuneration structures for nursing posts • Adequate provision for continued education and development

44. Strategic Focus Area 6 – Resources for Nursing • Quality assurance of clinical learning facilities • Audit of clinical facilities • Assess quality of learning facilities and upgrade • Enabling accreditation processes to take place internally and externally • Provide adequate funding for nursing research

45. Strategic Focus Area 6 – Resources for Nursing • Improve workforce planning • Work-study to address needs of institutions with the illnesses of staff and HIV in mind to review the staff establishment of health institutions • Develop Human Resource Plans (Nursing) institutional, district, provincial and national level • Develop capacity for Human Resource Planning

46. Strategic Focus Area 6 – Resources for Nursing • Developing nursing academics / nurse educators • Develop a National Health Sciences Academic Programme

47. CONCLUSION In conclusion the Department of Healthlooks forward to the endorsement of theDraft Nursing Strategy for South Africawith a view of developing similar strategies for other health careprofessionals so critical for effective healthcare delivery within the countryTHANK YOU