Will the universities ever cope with the mass production of nurses in

South Africa? We have so much, and yet……

Prof Nokuthula Sibiya, R/NDepartment of Nursing

7 March 2014The 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 training in KZN

colleges

How many colleges train

nurses in KZN?

Private Nursing Schools• A number of private nursing schools in KZN.

Public Nursing College• KZNCN: 25 campuses-10 campuses and 15 sub-

campuses.

ENROLMENT 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Average Growth

Nursing 5287 6260 5398 5794 5451 5354 5084 4966 4979 5810 5873 6529 2%MBCHB 8212 8555 8476 8536 8499 8483 8268 8251 8295 8298 8708 8771 1%Dentistry 1284 1264 1280 1317 1095 1314 1263 1172 1165 1126 1182 1114 -1%Pharmacy 1281 1320 2089 2148 2271 2127 2230 2191 2147 2298 2503 2642 7%Physiotherapy 1125 1155 1253 1207 1246 1287 1488 1468 1437 1438 1514 1567 3%Optometry 732 694 751 795 849 882 831 775 719 644 606 571 -2%Radiography 872 958 943 969 986 1008 1170 1249 1336 1464 1523 1595 6%EmergencyMedical Care 196 174 174 217 323 367 417 434 468 504 546 543 10%

Data represents undergraduate enrolment. Occasional and Postgraduate excluded

Headcount enrolment : health science professions (2000 to 2011)

- 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?

-4.0%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

-2.2%

-1.3%

0.6%

1.9%

3.1%

5.6%

6.8%

9.7%

Average annual growth in enrolment from 2000 to 2011

Average Growth

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 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Average Growth

Nursing 986 1307 847 933 881 808 873 920 867 895 1023 1259 2%

MBCHB 1131 1229 1214 1296 1394 1511 1366 1297 1309 1255 1329 1300 1%

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%

EmergencyMedical Care 16 22 25 22 27 53 77 65 76 120 137 146 22%

Data represents undergraduate enrolment. Occasional and postgraduate excluded

Graduates : health science professions (2000 to 2011)SUPPLY

-5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

-1.3% -0.8%

1.3% 1.9% 2.2%

5.0% 5.8%

22.3%

Average annual growth in graduates : 2000 to 2011

Average Growth

Graduate growth should be higher than enrolment growth.

Capacity, Intake and Eligible Applicants Nursing

UKZN CPUT NMMU UFS UJ UWC WITS0

200

400

600

800

1000

1200

CapacityIntake2010 Eligible Applicants2009 Eligible Applicants2008 Eligible Applicants

18963000 by 2011

Intake lower than capacity – NMMU, UFS, UJ, UWCNoticeable the increase in the number of eligible applicants

ChallengesHealth 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

• Teaching & learning-40%Pillar 1

• Research-40%Pillar 2

• Community engagement-20%Pillar 3

Career pathing Promotion

Formal

InformalNon-informal

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

Admission/ Application/ Testing

Academic staff - Institutions E

Leadership Systems DataAcadem

ic

• Curriculum• Pedagogy• Teaching• Technology• Language• Theories of

knowledge, teaching and learning

• Academic Development

• Tracking – early warning systems

Enrolment/Placement

Transition

StudentsIndividual agency

• Student engagement• Campus culture• Peer support• First year experience

Retention Attrition

• Finance• Housing• Student support services

Non - Academ

ic

Success

Graduation Throughput

Achievement

PostgraduatePathways

EmploymentGraduate Attributes

Capabilities Stopout,Or Dropout

Social context

• Race• Gender• Socio–economic

status• Schooling• Choice• Career guidance• Preparedness• Literacy• Post-school

opportunities• Disadvantage• Equity• Family support

Political and economic context

• 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

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 2014-2019.•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