Description

Training of specialist nurses is of critical importance for the continued delivery of quality health services globally and in South Africa. In accordance with international trends, nursing education in South Africa has undergone significant educational reforms in the past few years. The aim of this paper is to critically reflect on current nursing education reform in South Africa and the implications for the postgraduate diploma in nursing programmes. The paper highlights some of the challenges encountered with the development, accreditation and implementation of the new nursing postgraduate diploma programmes. Successful nursing education reform requires collaborative and proactive conversations between all stakeholders before changes are made to existing nursing categories and skills mix, during the development of new programme frameworks, during programme development and after implementation of the reform strategies.

Reforms in nursing education have been a global trend since the 1990′s since the introduction of stronger regulations to ensure autonomy and public accountability. There has been a move towards harmonisation of nursing standards and a higher proportion of degree nurses being prepared due to its association with better patient outcomes and the articulation possibilities for post-baccalaureate specialisation. Specialist nurses are especially needed in low- and middle-income countries, to increase access to high quality care for populations in remote and underserved areas. Nursing specialisations increase the attractiveness of nursing as a career with the subsequent strengthening of the health workforce. Hence, many eastern and southern African countries have introduced postgraduate diploma programmes leading to the registration of an additional qualification in a nursing specialisation.

South Africa has committed to ensuring a competent nursing workforce through various educational reforms as well as occupational-specific dispensation. Occupational-specific dispensation refers to a revised salary structure that is unique to specially identified occupations, for example, certain nursing specialisations, in the public service. Education and training of both undergraduate and postgraduate nurses in South Africa are of critical importance to ensuring the continued delivery of quality health services in the country. Therefore, acknowledging the importance of the education of nurses in South Africa, the nurse educator, a specialist nurse who has completed a postgraduate nursing qualification, was added as one of the critical skills by the minister of home affairs in 2022.

Nursing Education

Aligned with international trends, nursing education in South Africa has undergone significant reforms in the past 20 years. The national strategic plan for nurse education training and practice identified several major challenges facing the nursing profession that necessitated programme and other reforms. Firstly, there was a national mandate to ensure that nurses are competent to drive progress in primary health care and universal health coverage, address the quadruple burden of disease in South Africa and work in their full scope of practice, requiring comprehensive education and training. The national strategic direction for nursing and midwifery education and practice, backed by the 2030 human resources for health strategy, reaffirms the need to provide an adequate number and relevant categories of nurses to ensure an effective nursing workforce, relevant to the current and future health care needs in the country. Secondly, there was a need to align the various nursing qualifications with Higher Education Qualifications Sub- Framework (HEQSF). Prior to the reforms, nurse training was provided by different providers (public and private sector colleges and universities) with varying governance and educational practices. For example, there were different streams for obtaining an additional (post-basic) nursing qualification through diploma, or master’s degree programmes, which compromised the status of specialist nurses. Post-basic nursing training was also governed by separate regulations for the minimum requirements leading to registration of an additional qualification, for example, clinical nursing science, clinical nursing science, health assessment, treatment and care, community nursing science, Psychiatric Nursing, nursing administration and nursing education. Thirdly, accreditation bodies such as the South African Nursing Council (SANC) had to develop norms and standards for postgraduate education and training and the accreditation of Nursing Education Institutions (NEIs).

The decision to incorporate nursing education into the higher education band meant that urgent action had to be taken to declare public and private nursing colleges higher education institutions to comply with the higher education act, align nursing qualifications with the HEQSF, and develop a framework for the accreditation of NEIs, their training programmers and clinical facilities that are aligned with the Council of Higher Education (CHE) and the SANC. The educational reforms resulted in new nursing qualification frameworks.

A key reform for obtaining an additional qualification (nurse specialists) included the requirement to complete a postgraduate diploma in the specific specialisation at level 8 on the National Qualifications Framework (NQF). The South African Qualifications Authority (SAQA) level descriptors specify the learning achievements required at a specific level and provide a broad indication of the specific learning outcomes and associated assessment criteria. Within the new qualification framework, the bachelor of nursing degree and the postgraduate diploma offered in a range of specialisations are on the same NQF level. However, since the bachelor’s degree prepares nurses more broadly to register as a professional nurse and midwife, the purpose of the postgraduate qualification is to prepare nurses in a range of clinical and non-clinical specialisations. The SANC had to redefine competency frameworks for the new PGDip specialist qualifications (clinical and non-clinical) and develop a new scope of practice. Together these reforms aimed to improve the standards of nursing education in South Africa, and ultimately the delivery of quality health care to the people. Sadly, the process was fraught with problems due to the poor policy capacity of the institutions responsible for governing nursing in South Africa.

The aim of this paper is to critically reflect on current nursing education reform in South Africa and the implications for the postgraduate diploma in nursing programmes. The paper highlights some of the challenges encountered with the development, accreditation and implementation of the new nursing postgraduate diploma programmes.