The emigration of trained professionals poses an ongoing challenge in South Africa. Among nurses, this phenomenon--and the pressure it places on nurses who remain--may be contributing to a high rate of maternal mortality in that country. The Population Council's Frontiers in Reproductive Health program, in collaboration with the University of Witwaters-rand, conducted a study to learn more about the workloads, morale, and career plans of maternity nurses in South Africa.
The study was carried out in Limpopo, KwaZulu-Natal, and Mpumalanga provinces in South Africa. All public sector hospitals providing maternity services in the three provinces were notified of the study and then faxed a questionnaire. Site visits were made to 15 hospitals and 27 clinics.
Workload challenges and poor motivation
Overall, hospitals and clinics had vacancy rates of 23 percent and 27 percent respectively, with clinics in Mpumalanga having the highest percentage of positions that had been vacated. Turnover for skilled midwives was also high. Eighty-three percent of hospitals but only 11 percent of clinics had nurses specially trained in midwifery, and 42 percent of facilities reported that they had lost an advanced midwife during the last year.
The results suggest that although nursing staff turnover, shortages of staff, and workload are extremely problematic at some facilities, not all facilities are equally badly affected. In the sampled clinics, the mean workload was 770 clients per month per professional nurse. The mean number of deliveries performed per professional nurse per month in hospitals was 16.5. In terms of absenteeism, the study found that although a large number of days were taken off sick, these were often isolated days and not long periods of sick leave. The average length of service of sisters-in-charge (charge nurses) was more than five years. The mean number of years that professional nurses had worked at a facility was nine years in Mpumalanga and KwaZulu-Natal and nearly six years in Limpopo.
A high percentage of nursing staff working in public facilities said they were discouraged, burnt out, and considering leaving the facility where they worked. Sixty percent of professional nurses agreed or strongly agreed with the statement, "These days I don't feel motivated to work as hard as I could," and 43 percent agreed with the statement, "When I get up in the morning, I dread having to face another day at work."
Reasons for leaving service
A range of factors was associated with nurses considering going overseas. Pay levels, poor opportunities for promotion, feeling unsupported by management, and having bad relationships at work were all associated with lack of desire to stay in one's job. …