Abstract
Background Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013. Objective We undertook a policy analysis study of the development of the new Nursing Qualifications Framework in South Africa. Design We used a policy analysis framework derived from Walt and Gilson that interrogated the context, content, actors, and processes of policy development and implementation. Following informed consent, in-depth interviews were conducted with 28 key informants from national and provincial government; the South African Nursing Council; the national nursing association; nursing academics, managers, and educators; and other nursing organisations. The interviews were complemented with a review of relevant legislation and policy documents. Documents and interview transcripts were coded thematically using Atlas-ti software. Results The revision of nursing qualifications was part of the post-apartheid transformation of nursing, but was also influenced by changes in the education sector. The policy process took more than 10 years to complete and the final Regulations were promulgated in 2013. The two most important changes are the requirement for a baccalaureate degree to qualify as a professional nurse and abolishing the enrolled nurse with 2 years training in favour of a staff nurse with a 3-year college diploma. Respondents criticised slow progress, weak governance by the Nursing Council and the Department of Health, limited planning for implementation, and the inappropriateness of the proposals for South Africa. Conclusions The study found significant weaknesses in the policy capacity of the main institutions responsible for the leadership and governance of nursing in South Africa, which will need to be addressed if important nursing education reforms are to be realised.
Highlights
There is global emphasis on transforming health workforce education in support of universal health coverage
There is a good foundation to provide stewardship for the implementation of the recommendations contained in this volume, which are based on empirical findings and complement those contained in the Strategic Plan [2]
Social accountability, which is an essential component of transformative education, necessitates that attention be paid to the issues of governance, responsive curricula, educator preparedness, and appropriate student recruitment and selection
Summary
There is global emphasis on transforming health workforce education in support of universal health coverage. Methods: Using a policy analysis framework, we conducted in-depth interviews with 28 key informants and 73 front-line nurses in four South African provinces. Objective: The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. At the time of the study in the second half of 2011, Hospital 2 (a large regional hospital) had stopped using agency nurses due to cash flow problems and because of a directive from the Provincial Department of Health to discontinue the use of agency staff Both hospitals had utilised agency nurses in the 2009/10 financial year on a daily basis, in the maternity and critical care units. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care
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