KZN 2014 The Future Practice of Nursing
Will the universities ever cope with the mass production of nurses in South Africa? We have so much, and yet…… Prof Nokuthula Sibiya, R/N Department of Nursing 7 March 2014 The Forum of Professional Nurse Leaders We need to ask difficult questions and have open discussion about these issues! Nursing is the… Introduction Background Nursing is the heart beat of any health care system. Millennium development goals are linked to nursing and midwifery. Socio economic development of each country is linked to health status of the population. Leadership is key in ensuring nursing practice, education and practice development. Introduction Background •Gross shortage of nurses in South Africa. •Need to increase the production of nurses in the country. •Currently mass production of nurses is in colleges. •Nursing education is now located in the Higher Education band. Outline of the presentation • Higher education institutions (HEIs) in South Africa. • Nursing in HEIs. • Funding of HEIs in South Africa. • Challenges of access and success in HEIs. • Challenges faced by Nursing in HEIs. Introduction Status of HEIs in South Africa •23 public universities in SA. •+ 2 new universities (Kimberly & Mbombela). •11 traditional universities. •6 comprehensive universities: combine functions of traditional and Universities of Technology (UoTs). •6 UoTs (previously known as technikons). Status of Nursing in HEIs How many universities offer nursing programmes? • Out of 23 universities in SA, 22 offer nursing (two new universities have nursing in their PQM). • Only Central University of Technology (CUT) does not offer nursing programmes. • In KZN, there are four (4) universities. • Out of the four universities, only three offer nursing programmes. • MUT does not offer nursing programmes (present in their PQM). Status of Nurse How many training in KZN colleges train colleges nurses in KZN? Private Nursing Schools • A number of private nursing schools in KZN. Public Nursing College • KZNCN: 25 campuses-10 campuses and 15 subcampuses. Headcount enrolment : health science professions (2000 to 2011) Average Growth ENROLMENT 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Nursing MBCHB Dentistry Pharmacy Physiotherapy Optometry Radiography Emergency Medical Care 5287 8212 1284 1281 1125 732 872 6260 8555 1264 1320 1155 694 958 5398 8476 1280 2089 1253 751 943 5794 8536 1317 2148 1207 795 969 5451 8499 1095 2271 1246 849 986 5354 8483 1314 2127 1287 882 1008 5084 8268 1263 2230 1488 831 1170 4966 8251 1172 2191 1468 775 1249 4979 8295 1165 2147 1437 719 1336 5810 8298 1126 2298 1438 644 1464 5873 8708 1182 2503 1514 606 1523 6529 8771 1114 2642 1567 571 1595 2% 1% -1% 7% 3% -2% 6% 196 174 174 217 323 367 417 434 468 504 546 543 10% Data represents undergraduate enrolment. Occasional and Postgraduate excluded - Should there be a concern regarding the decrease in certain professions. - High growth within other professions - do we steer the system towards unemployment or oversupply? Average annual growth in enrolment from 2000 to 2011 12.0% 9.7% 10.0% 8.0% 6.8% 5.6% 6.0% 4.0% 3.1% 1.9% 2.0% 0.0% -2.2% -1.3% Average Growth 0.6% -2.0% -4.0% Actual average annual growth. What does SA need? EMC the fastest growing profession. Are our Universities coping and did they prepare for such a high growth? Graduates : health science professions (2000 to 2011) SUPPLY GRADUATES Nursing MBCHB 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Average Growth 895 1023 1259 2% 1131 1229 1214 1296 1394 1511 1366 1297 1309 1255 1329 1300 1% 986 1307 847 933 881 808 873 920 867 Dentistry 220 239 175 244 168 239 268 206 214 193 271 201 -1% Pharmacy 261 204 370 369 460 425 515 513 435 396 389 445 5% Physiotherapy 246 222 251 265 246 262 351 326 335 329 310 303 2% Optometry 151 131 144 145 123 157 190 123 177 156 142 131 -1% Radiography 279 300 276 303 298 320 363 385 387 470 431 519 6% Emergency Medical Care 16 22 25 22 27 53 77 65 76 120 137 146 22% Data represents undergraduate enrolment. Occasional and postgraduate excluded Average annual growth in graduates : 2000 to 2011 25.0% 22.3% 20.0% 15.0% 10.0% 5.0% 5.0% 0.0% -1.3% -0.8% 1.3% 1.9% 5.8% 2.2% -5.0% Graduate growth should be higher than enrolment growth. Average Growth Capacity, Intake and Eligible Applicants Nursing 1200 18963000 by 2011 1000 800 Capacity Intake 600 2010 Eligible Applicants 2009 Eligible Applicants 400 2008 Eligible Applicants 200 0 UKZN CPUT NMMU UFS UJ UWC WITS Intake lower than capacity – NMMU, UFS, UJ, UWC Noticeable the increase in the number of eligible applicants Challenges Health Science Deans - 17 Nov 2011 As presented by Prof S Essack on the 17 November 2011 • Inadequate infrastructure – teaching and learning spaces, skills laboratories, residences • Inadequate clinical teaching and training platform both in available student placement sites as well as the facilities at these sites for non-clinical teaching and learning • Shortage of clinical supervisors within the clinical teaching and training platform as a result of high vacancy rates and high workloads within public sector student placement sites. • Staff:student ratios mandated by the professional councils are increasingly difficult to effect • Increased operational costs, particularly transport costs linked to expanded clinical teaching and training platform • Limited and dwindling pool of credentialed healthcare professionals pursuing careers in the academic health sciences Unleashing academic talent Pillar 1 Pillar 2 Pillar 3 • Teaching & learning-40% • Research-40% • Community engagement-20% Career pathing Promotion Informal Formal Noninformal Funding of HEIs Block grant-input subsidy Number of students enrolled at the institution. Subsidy higher for PG students. Block grant-output subsidy Number of students who complete their qualifications. Block grant-research output subsidy Research products of academics and students-publications in accredited journals. Earmarked grants Specific projects such as infrastructure and students loan-CTG for the clinical training for the UG students. Other sources of funding • Two other major sources of funding: 1. Student fees often supported by National Student Financial Aid System (NSFAS). 2. Donations and grants (often through funding for research, for example Atlantic Philanthropies, NRF, MRC, STTI etc.). Funding for provincial Nursing Colleges Sources •Most nursing colleges function according to provincial legislation. •Funded from the provincial health budgets. •Funding based on a budget submitted by the college principal. •Funding not based on any norms or standards. •Budgets do not automatically increase with increased activity, e.g. more publications, more funding. Access and success in higher education Challenges •Access and success are primary concerns of university system throughout the world. •Admitting and graduating students is the core business of universities. •Access and success are profoundly linked to the social and political context within which universities operate. •These must be understood in historical terms. Factors affecting student access and success Access Social context Admission/ Application/ Testing Academic staff • • • • • • • • Curriculum Pedagogy Teaching Technology Language Theories of knowledge, teaching and learning Academic Development Tracking – early warning systems - Institutions Enrolment/Placement Transition Students Leadership Systems Data • • • Finance Housing Student support services Non - Academic E Academic • Race • Gender • Socio–economic status • Schooling • Choice • Career guidance • Preparedness • Literacy • Post-school opportunities • Disadvantage • Equity • Family support Political and economic context Individual agency • • • • Student engagement Campus culture Peer support First year experience Retention Attrition Success Postgraduate Pathways Graduation Throughput Achievement Employment Graduate Attributes Capabilities • Partnerships • Higher education system • Policy • Funding • Quality assurance • Data • Expectations of higher education (HE) • Political and economic forces impacting on HE • Post-school pathways • Youth unemployment & NEETS • Articulation gap Stopout, Or Dropout Access and success in higher education Challenges • In the early 1990s, a massive expansion of black student enrolment in HE occurred. • Numbers increased from 495 356 in 1994 to 938 201 in 2011. • Black student numbers increased from 55% in 1994 to 81% in 2011. Graduation rates in higher education Challenges •15% of students at SA universities graduate (Mtshali, 2013). •The target set in the National Plan for HE (NPHE) is 22.5% on an average three-year contact UG programmes and 13.5% for UG distance programmes. •The bar has been raised to 25% for 2030. Success rates in higher education Challenges •79% for contact students and 69% for distant UG students. •Success rates of African students are 10% below those of White students (DHET, 2012). •University success rates in SA are relatively low compared to similarly developed countries (National Planning Committee 2011). Drop-out rates in higher education Challenges •SA has high attrition (low retention) rates. •Of the year 2000 cohort of students, only 30% had graduated after 5 years of study, while 50% had left the institutions without graduating and 14% of students were still registered after 5 years (Scott et al., 2007). •Black completion rate is less than half the white completion rate (Scott et al., 2007; CHE 2013). Implications for nursing •Nursing is not the first choice of career for the high school learners (Mbangi & Sibiya, 2013). •Nursing still attracts more African than White students (Manson & Sibiya). •The three universities are graduating far less than the number of students that are graduated by nursing colleges in KZN. Implications for nursing •Enrolment plan submitted to DHET for 20142019. •Where is the subsidy going to come from for Nursing Colleges if they move to HE? •Research culture still at its infancy stage-subsidy for block grant-research? •Entry qualifications is Masters. •Pressure for staff to obtain doctoral qualifications. Collaboration with practice Together we can do more • Advisory board meetings • SANEN • Partnership in organising conferences-2014 ANEC in collaboration with FPNL on 25-27 June 2014 Conclusion
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