Mandatory fee lapses add to health staff crisis as over 21,000 nurses deregistered

AT LEAST 21,332 nurses were deregistered from the SA Nursing Council (SANC) from 2021 to 2022, Health Minister Joe Phaahla has revealed.

Briefing MPs, Phaahla added that of this cohort, 21,090 were removed from the service “due to their registration lapsing”. This despite nursing being a critical skill.

A standing resolution – signed by the Public Health and Social Development Sectoral Bargaining Council chief negotiator Maile Ngake and labour unions in September 2019 – stipulated that nurses and other staff would be subjected to mandatory deductions.

SANC’s website shows its annual fees for 2023 to be R730 for registered nurses and midwives, R440 for enrolled nurses and midwives, and R310 for enrolled nursing auxiliaries.

Nonetheless, 21,090 nurses had failed to pay annual fees amid a nursing shortage crisis highlighted during and after the Covid-19 crisis.

The rest of the nurses – 242 nationally – left due to deaths, disciplinary actions and own requests, while some were “removed administratively”.

DA MP Michéle Clarke had quizzed Phaahla on the number of nurses from each province that were “terminated” due to their registration lapsing at the SANC; the reasons for the registration lapses; the critical shortage of nurses; and steps taken to assist nurses with their lapsed registration.

Phaahla said that the department, in an attempt to assist nurses with their lapsed registrations, signed Resolution 3 of 2019 at the bargaining council, an agreement on payment of annual statutory registration fees in respect of health and social development professionals, including nurses.

Phaahla said the resolution aimed to create “mandatory deductions” of the registration fees from nurses’ salaries and to “assist in the monitoring of potential risks and compliance with registration requirement for appointment and practice” in line with statutory professional bodies in the departments.

The Cape Argus asked Health Department spokesperson Forster Mohale how many nurses had since been re-registered; whether the department felt any impact; if Phaahla had any meetings with the unions about the matter; and whether reasons were furnished to the minister or the department on the mass de-registrations.

“Not really. This has some negative impact on the provision of health services, and we always urge all the health professionals including nurses to ensure that their registrations with professional bodies are up to date.”

Mohale didn’t respond when asked why the deductions were not enforced.

SANC’s communications office failed to respond to queries on Tuesday.

Democratic Nursing Organisation of SA general secretary Kwena Manamela said the high numbers in lapsed de-registrations were a “great concern, given the dire shortage of nurses in South Africa in terms of skill, experience and speciality.

“While SANC can give a better perspective of the underlying reasons behind this high number, it could be highlighting the arrival of the catastrophe we have been warning about: that almost half the nursing population on the SANC registrar is approaching retirement age, with a great possibility of many taking early retirement.”

Citing a 2022 International Council of Nurses (ICN) study, he said nurses were citing burnout, depression, anxiety, poor support and low wages as among the factors forcing nurses out of the profession.

Clarke said the department had also blamed the budget’s decrease and rising costs of employment for the shortage of nurses, despite R42.6 billion spent on 44 posts for the National Health Insurance posts in 2021/22.

“We lose around 9,000 nurses per annum due to retirement and emigration,” she said, adding that 4,965 specialised nurses graduated in 2021, but only 15% of those were absorbed into the service.

“We only have one nurse per 128 patients currently,” she said.