Transcript Experiences and support of the newly qualified

Mrs. Dulcie Tsotetsi
[email protected]
INTRODUCTION
 The 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 STUDY
 Information 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 QUESTIONS
The 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 STUDY
 The study was to generate the findings based on the
experiences and support received by the newlyqualified 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 CONSIDERATION
 Pretoria 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 SAMPLING
 Purposive 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
TRUSTWORTHINESS
Credibility
Transferability
•Prolonged
engagement- 5
months
Generating of thick The use of experts
descriptive and in- during NEA
depth information conference
•Member checkingaccurateness of data
•Triangulationfocus groups,
investigators
•Peer briefing- NEA
Conference
Dependability
Confirmability
Auditing and
confirmation by
the independent
decoder who did
not participate in
the study
TABLE 3.1: SAMPLE DEMOGRAPHIC INFORMATION (N=42)
CRITERION
CHARACTERISTICS
Gender
Males
FREQUENCY
PERCENTAGE
5
11.9%
Females
37
88.1%
Blacks
41
97.7%
Whites
1
2.3%
Ekurhuleni
5
11.9%
Sedibeng
11
27.6%
Johannesburg Metro
27
64.3%
District Hospital
4
9,5%
Regional Hospitals
11
27.6%
Academic Hospitals
27
64.3%
Period of

0 – 5 months
-
-
placement as

6 – 12 months
42
100%
Ethnic Group
Districts
Health Facilities
Levels
community
service nurse
DATA COLLECTION
 5 Focus group interview sessions consisting of 6 – 10
participants
 Pilot study
 Saturation of information reached
DATA ANALYSIS
 Tech’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”.
RECOMMENDATIONS
 Collaborative 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.
Acknowledgement
 Supervisor : Mrs. S. Phiri Pretoria University
 Co-supervisor: Dr. Peu – Pretoria University
 Co coder: Professor Maja
 Assistant Researchers Ms A Ncedani and Mr S
Dikgang
THANK YOU