NATIONAL ASSEMBLY
FOR WRITTEN REPLY
QUESTION NO. 2077
DATE OF PUBLICATION IN INTERNAL QUESTION PAPER: 02 NOVEMBER 2009
(INTERNAL QUESTION PAPER NO. 26)
Mr M Waters (DA) to ask the Minister of Health:
(1)
(a) How many intensive care units (ICU) are there in each province, (b) where are they situated, (c) how many (i) beds does each unit
accommodate and (ii) nurses work at each unit and (c) what is the nurse/patient ratio for each unit;
(2)
whether all ICU (a) nursing managers and (b) nurses working in the ICU had ICU training; if not, (i) why not and (ii) how many have not
received such training in each case?
NW2731E
REPLY:
The following information was obtained from the Provinces
EASTERN CAPE
(1)
(a)
There are 11 ICU units in the Province
Mthatha Hospital Complex
ICU Units
(i) No of beds in each
(ii) No of nurses working in each
Nurse patient ratio
4
21
39
1:2
Port Elizabeth
Hospital Complex
4
30
105
1:1.2
East London
Hospital Complex
3
39
114
1:1.5
Total
11
90
258
1:2
(2)
The following table reflects the situation in this regard
Nursing managers
No. trained for ICU
Reasons why
training not done
Nurses not received
training
Mthatha Hospital Complex
Yes
Not all have received training
Staff shortages make it difficult to
release staff.
PE Hospital Complex
Yes
Not all have received training
Staff shortages make it difficult to
release staff.
EL Hospital Complex
Yes
Not all have received training
Staff shortages make it difficult to
release staff.
Also there is shortage of available slots
for training at the training centres
8
Also there is shortage of available
slots for training at the training centres
66
Also there is shortage of available
slots for training at the training centres
28
Total
102
FREE STATE
The Free State Department of Health has One (1) Academic Hospital and five (5) Regional hospitals with ICUs. The status of each hospital ICU has
been highlighted in the following table:HOSPITAL
TYPE OF ICU’S
NUMBER OF ICU BEDS
NUMBER OF ALL NURSES WORKING IN
EACH ICU.
NURSE -PATIENT
RATIO
Pelonomi Regional Hospital
ICU facility = 1 which is
currently a temporary facility
Adult = 10
Prof Nurses = 62
1:1
Bongani Regional Hospital
General
Peads = 5
Adult = 7
Peads = 1
Prof Nurses = 19
Staff Nurses = 3
E Nursing Asst = 1
1:1
Neonatal
Incubators = 16
Mofumahadi Manapo Mopeli
Regional Hospital
1 General ICU
Beds = 6 Active
Boitumelo Regional Hospital
1 General ICU
Beds = 6
TOTAL = 23
Prof Nurses = 11
Staff Nurses = 2
E Nursing Asst = 8
TOTAL = 21
Prof Nurses = 12
Staff Nurses = 1
E Nurse Asst = 3
TOTAL = 16
Prof Nurses = 7
E Nurse Asst = 7
2
1:3
2:1
1:1
TOTAL = 14
Multidisciplinary
Dihlabeng Regional Hospital
1 General ICU
Beds = 3
Universitas
Hospital
Multidisciplinary
8
beds.
Usable 6 7th opened when
needed
Beds = 6
Neonatal ICU
Beds = 14
TOTAL = 29
PN = 28
SN = 1
1:1 if unstable
1:2 stable patients
Neuro ICU
Beds = 5
TOTAL = 29
PN =17
SN =2
1:1 if unstable
1:2 if stable.
Paeds ICU
Beds = 5
TOTAL = 19
PN =16
SN =4
1:1 unstable pts
1:2 stable
Coronary
X6 beds
+ 1 bed cardioversions/
temporary pts
Beds = 6
TOTAL = 20
PN =20
SN =1
1:1 if unstable
1:2 if stable
Surgical ICU includes Kidney
Transplant Unit
Beds = 5
Academic
TOTAL = 14
PN = 26,
SN = 2
NA= 1
TOTAL = 21
PN =18
TOTAL = 18
PN =6
NA =1
Adult Heart catheterisation lab
(Interventional Unit(half ICU, half
theatre)
Peaeds Cardiology & day clinic
in unit
Beds = 4
PN =5
SN =2
NA =2
TOTAL = 9
No staff to run unit at the moment. Unit is
fully furnished with equipment through the
KFC/ Carte Blanche (ADD Hope) initiative.
Paeds High Care
x4 beds
3
1:1
1:1 unstable
1:2 is stable.
1:1 unstable
1:2 stable
All staff on duty MONFRI. Deal with State &
Netcare lists. X 2 sisters
on standby daily for both
hospitals.
24hr high care MonFriday
(Half ICU/ half theatre
set up)
1:2 stable pts
(2)
Hospital
Pelonomi
Regional
Hospital
Number
of
ICU
managers
1
Post
available
Number of ICU
Trained Managers
Number of ICU
Professional
Nurses
Number
Trained
Nurses
Of
ICU
Professional
4
62
47
General
1
Neonatal
19
14
Has 70% ICU trained nurses.
Professional nurses untrained
-1 failed
-2 on study leave doing critical care
-1 for training from January 2010.
-1 application rejected at college.
9 experienced
because of age they indicated that they cannot study
3 Operational
Managers
2 ICU trained
Bongani
Regional
Hopital
.
1
Reasons for not having ICU Trained Nurses
Mofumahadi
Manapo
Mopeli
Regional
Hospital
Boitumelo
Regional
Hospital
1
1
11
12
10
3
4 Transferred to other hospitals. The hospital is training 1 per year.
1
Nursing
Manager
1 Trained Manager
7
PN = 7
Inability to send more than 2 due to shortage of staff.
No young PN that is interested to do ICU.
Dihlabeng
Regional
Hospital
Universitas
Academic
Hospital
1
1
14
3 Not trained and 1
applied for 2010 training
8
10+1
X4
Operational
Managers
X1
Assistant
Manager
174 PNs = 89%
of total staff in
ICU.
15 SNs = 8% of
total
6 NAs = 3% of
total staff
72 =41% of PsN ICUtrained
Problems with filling of posts (e.g. funding). It becomes problematic to send
people on study leave when there will be no complementary staff to ensure
continuity of quality patient care.
Comments at the end of the template
X8 =4% PNs Advanced
Paediatric Nursing
x8 =4% PNs Nephrology
Nursing
Pelonomi Intensive Care Unit is undergoing revitalization project (24 hours project). A 32 bedded unit in the ultimate end will be established. The
current area serves as a temporary accommodation for ICU.
4
Universitas
1.
Most of the Operational Managers were appointed a long time ago as Unit Managers and were therefore simply translated to Operational
Managers when the change took place. We must remember that in the old dispensation, experience in ICU rather than a qualification in
Critical was used as the inherent requirement. Equally a qualification in Healthcare Management Nursing was not seen as essential for
appointment as a Unit Manager, and still is with OSD;
2.
Some of our Managers are in an aging category and therefore see no incentive in further studies especially in Critical Care or Healthcare
Management;
3.
Trained staff turnover is a serious limitation in maximising the numbers of trained staff. In real terms, units are abound with experienced staff
and therefore this limitation is mitigated to some extent;
4.
Shortage of staff or lack of funds to reappoint staff as they leave puts a serious dent on our ability to allow more staff to go on study leave. In
the past we could send up to three people in one unit to study but next year for instance this number has been curtailed to only one per
department and we may have to cut even further in future if the status quo remains;
5.
In Peads and Adult Cardiology units there are no managers appointed in line with OSD requirements. Junior officials (PNB 1) take charge of
the units purely on the basis that they want to gain experience. At the time the institution has taken a decision not to upgrade these positions
to appoint Operational Managers to run these cost centres that are quite expensive;
6.
At this time we experience severe staff limitations in Neonatal, Renal and Cardiothoracic units especially on night duty. This situation is most
serious whenever most of the units are working on full capacity. We simply do not have the reserve to cope with the demands when that
happens;
7.
The fact that in more than half of the ICU departments have been without ward clerks for more than 2years to support nurse managers with
administrative work means more nursing staff have to be diverted to non nursing work which leads to more strain on limited nursing resources;
8.
It is clear when you look in the ICU staff constituency that the numbers of personnel can be improved by dilution of the high concentration of
sisters with staff nurses and assistant nurses. We have so far suggested that the number of trained professional nurses be capped 45%,
untrained 20% and 35% comprise both staff nurses and assistant nurses. This way your experienced staff can be used for complicated work
and the supporting staff for the less complicated work.
5
KWAZULU/NATAL
(1)
(a)
Number of Intensive Care Units in KwaZulu Natal is 29 which are provided in 16 Hospitals.
A number of Hospitals have more than one Unit to accommodate specialties e.g. neonatal, paediatrics, surgical and medical.
(b)
The situation, number of units, beds and staffing ratio’s is illustrated in the column below:
The norm that is utilized is 5 nursing units per 1 ICU bed.
The ratio in KwaZulu Natal has been calculated to include Professional Nurses and Other categories of Nurses.
The average ratio in KwaZulu Natal is 0.7 Nursing units per ICU bed.
District
Ethekwini
Ugu
Ilembe
Umgungundlovu
Uthukela
Amajuba
Uthungulu
Hospital
Addington
King Edward V111
Prince Mshiyeni Memorial
RK Khan
Inkosi Albert Luthuli Central
King George V
St Aiden’s
Port Shepstone
Stanger
Greys
Edendale
Ladysmith
Madadeni
Newcastle
Lower Umfolozi War Memorial
Ngwelezane
No
Units
No
beds
1
2
1
2
6
1
1
2
1
4
4
3
16
16
19
69
6
1
6
2
24
27
Nursing
Staff
PN
Total
Other
Posts
18
62
52
29
262
14
4
36
7
95
60
0
0
15
0
68
10
0
10
6
25
25
18
62
67
29
330
24
4
46
13
120
85
Trained ICU /
Advanced
Ratio
1
1
1
2
1
6
10
15
19
8
11
21
21
29
28
2
6
9
0
6
13
27
30
29
34
15
42
31
15
172
14
4
22
7
70
28
5
5
11
15
16
29
247
749
182
931
472
6
1.2
0.7
0.8
0.3
0.9
0.8
0.8
1.5
1.3
Nurse to
Patient
Midwifery
(2)
(a)
All nurse managers in ICU Units are trained in ICU, the only exception is in Ladysmith Hospital.
(b)
The number of Professional Nurses working in ICU Units is 749, of this number only 472 are trained which reflects an average of 63%.
The percentage includes Professional Nurses who have a qualification in Intensive Care Nursing or Advance Midwifery (for Neonatal
Units).
The Province should have 1235 posts filled with adequately trained Professional Nurses in order to meet the required number of 5
posts per 1 ICU bed to reach the required nurse to patient ratio.
The Natal College of Nursing provides training for the qualification in ICU and has 2 intakes per annum of 25 students per intake.
The College also provides training for the qualification in Advanced Midwifery and has 2 intakes per annum of 25 students per intake.
Staff attrition is causing a high turnover which results in annual losses of Intensive Care Nurses. The OSD has assisted in improving
this, however this category of scarce skills is highly sought after by the private sector.
The course accommodates staff who has not had an opportunity to attend the full time course in the Province.
There are no specialised courses for staff nurses or enrolled nursing assistants.
A large number of Professional and other categories of nurses have had many years of experience in ICU and provide a high standard
of technical nursing care.
The “New” Nursing Act (2005). The regulations to provide training for Enrolled nurses to be formally trained in Intensive Care Nursing
techniques are being finalized by South African Nursing Council.
Hospitals are actively encouraging Professional Nurses to undertake training, however the financial constraints and attrition of staff
limits the number of Professional Nurses that each hospital can release for training at one time.
The Province provides ongoing in-service training in special skills e.g. suction techniques for neonatal patients.
7
LIMPOPO
(1)
(2)
(a)
The following table reflects the situation in this regard:
Hospital
Mokopane
ICUs
2 Neonatal & Main ICU
Beds
3
Nurses in ICUs
11
Warmbaths
Tshilidzini
Letaba
St Ritas
Philadelphia
1
1
1
2
1
8
4
4
8
8
9
6
3
12
2
Nurse/Patient Ratio
1:1 for critically ill patients ventilated.
2:1 for high care patients.
1:1 depending on the acuity level of the patient.
1:2
2:1
1:3 neonatal, 1:2 main
2:1
The following table reflects the situation in this regard
Hospital
Mokopane
Warmbaths
Nurse
managers
in ICUs
0
8
Tshilidzini
St Ritas
Philadelphia
12
6
2
ICU trained
ICU
trained
0
1
1 trained and 1 still being 6
trained
12
4
3
2
1
1
not Reason for lack of ICU training
Trained in 1981 and there was no exposure to ICU
Lack of midwifery course as a requirement before post-basic
diploma
2 scheduled to start with training
Nurses take turns to go for training
Appointed as a manager
8
MPUMALANGA
(1)
(a)
There are no ICUs in hospitals in the Province except at the following:
Institution
where
there is an ICU
Mapulaneng
Rob Ferreira
No of ICUs
No of beds
Patient ratio
Training offered to nurses
Why training not given
03
6
Nurses in each
Unit
05
17
01
1
1:1
1:2
YES
Only 15 are trained
1
5
17
Only 11 are trained
1 Adult
1 neonatal
10 Adult
16
neonatal
16 Professional
14 Professional
1:1 ventilator
1:2 high care
1:1
1:2
Not applicable
2 not trained of which 1
will be trained next year
and other nurse is not
interested as he will be
60 next year
Training still continue for
others
We
trained
two
professionals every year
Themba
Witbank
9 trained
2 on training
NORTHERN CAPE
Kimberley Hospital is the only hospital in the Northern Cape Province with three Intensive Care Units, namely
(1)
(a)
Number of Intensive Care Units = 3



Closed Adult Intensive Care Unit (one of about 10 in the country)
Paediatric Intensive Care Unit
Neonatal Intensive Care Unit
(b)
Kimberley Hospital
(c)
(i)
Number of beds



Adult = 10 beds
Paediatric = 6 beds
Neonatal = 5 beds
9
No not received
training
Not applicable
1
6
1
11
(ii)
Total number of nurses working in each unit



(d)
Nurse/patient ratio in each unit



(2)
(a)
Adult ICU = 1:1.7
Paediatric ICU = 1:3
Neonatal ICU = 1:3
ICU Trained Managers



(b)
Adult ICU = 23
Paediatric ICU = 12
Neonatal ICU = 10
Adult ICU = No
Paediatric ICU = No
Neonatal ICU = Yes (Neonatology)
ICU Trained Nurses



Adult ICU = 7 (Critical Care)
Paediatric ICU = 2 (Child Health)
Neonatal ICU = 1 (Neonatology)
(i)
Training plan for all the units are in place with one Professional Nurse per unit identified for training per year.
(ii)
Number of Nurses not ICU trained



Adult ICU = 17
Paediatric ICU = 10
Neonatal ICU = 9
10
WESTERN CAPE
(1)
(a)
There are three Intensive Care Units (ICU's) in the Province.
(b)
They are situated at the level 3 tertiary Hospitals at Red Cross Memorial Children's Hospital, Tygerberg Hospital and the Groote
Schuur Hospital.
(c)
Information is as follows
Red Cross Hospital
(2)
(i)
No. of ICU Beds: 20 beds open
(ii)
No. of Nurses: Professional Nurses: 53; Staff Nurses: 10; and Auxiliary Nurses: 28
(d)
Ratio of Nurses to patients: 1 Professional Nurse and 1 Staff Nurse/Assistant. One nurse is assigned for every 2 patients.
(a)
Nursing Managers: Both Assistant Manager and Operational Manager are ICU trained.
(b)
Professional Nurses at present 40% of PN's are ICU trained. A further 6 are currently (2009) in training and another 5 will train in 2010.
(i)
Not applicable;
(ii)
Therefore in 2010 the percentage of trained ICU PN's will increase to 50%.
In order to continue to provide the ICU services operationally we can only send a proportion of staff each year and still continue to be fully
operational. Trained ICU staff are in short supply and sought after both within South Africa and Internationally so we continue to loose trained
staff each year. This is even more marked in pediatrics as the pool of trained pediatric ICU staff is very limited.
Tygerberg Hospital
(1)
(i)
8 x ICU units
(ii)
70 x High Care beds
Number of ICU beds in each unit + nurses work in each unit:
11
Staff needed 24 hours
(Day + Night)
A1 West Surgical x 10 beds
A1 East Burns x 6 beds
A2 Cardiothorasic x 8 beds
A4 Neuro x 10 beds
A5 Medical/Respiratory x 7
A6 Cardiology x 8 beds
A7 Nephrology x 4 beds
A9 Paediatrics x 6 beds
A9 Neonatology x 8 beds
Staff available 24 hours
(Day + Night)
PRN
SN
NA
Total
PRN
SN
NA
Total
20
8
24
16
16
16
8
12
14
4
8
4
8
4
0
4
4
4
4
8
4
0
4
0
0
4
4
28
24
32
24
24
16
12
20
22
16
8
16
12
12
12
4
8
6
4
4
8
4
0
0
4
0
4
4
8
4
0
4
0
0
8
4
24
20
28
16
16
12
8
16
18
4
6
8
4
8
8
4
8
4
4
4
8
4
4
4
4
4
4
8
4
4
8
4
16
12
12
8
0
8
4
12
22
16
24
24
24
16
12
20
12
0
4
8
4
4
4
4
8
4
4
4
4
2
4
4
4
0
4
8
4
4
8
4
8
12
12
8
0
0
0
8
16
14
16
20
20
12
12
12
8
High Care beds :
A1 West Surgical x 2 beds
A1 East Burns x 16 beds
A2 Cardiothorasic x 6 beds
A4 Neuro x 20 beds
A5 Medical/Respiratory x 13
A6 Cardiology x 14 beds
A7 Nephrology x 9 beds
C2A Labour/Maternity x 4
A9 Paediatrics x 10 tracheas
A9 Paediatrics x 2
(c)
(2)
Nurse/patient ratio for each unit: Professional Nurses 1:2 (1 Professional Nurse per 2 patients for ventilated or critical patients and
depending on the acuity of patients). Other categories of nurses (Staff Nurses and Auxilliary Nurses) average Nurses to Patients 1
nurse to 6 patients.
(a) and (b)
(ii)
The number of trained Professional Nurses needed are not available to appoint. New appointments have to be made (at times
with untrained staff) to fill vacant posts in order to cope with the patient load. Replacement trained staff is not available to send
nurses for training courses. The services have to cope without nurses on training courses. Staff Nurses and Nurse Auxiliaries do
not have specific ICU courses and deliver a support function to the Professional Nurses in ICU's.
Professional Nurses x 81 out of a total number of 144 working in the ICU's; Staff Nurses x 68 and Nurse Auxiliaries x 100.
12
Groote Schuur Hospital
Unit
C27 respiratory
CCC Cardiology ICU
E26 Source Isolation ICU
F4 Haematology High Care (HC)
E12 Transplant High Care
D12 General Surgical ICU
D13 Neurosurgery ICU
D22 Cardiothoracic ICU
C27 Spinal ICU
TOTAL
No of beds
8
6
3
6
7
8
6
6
6
55
Number of Nurses
RN – 17; EN/ENA - 16
RN- 9; EN/ENA – 8
RN – 5 ; EN/ENA - 8
RN – 9; EN/ENA- 8
RN – 5; EN/ENA - 4
RN – 17; EN/ENA - 16
RN – 13 ; EN/ENA – 8
RN – 13 ; EN/ENA – 8
RN – 13 ; EN/ENA – 8
Nurse/Patient Ratio
1 RN : 2 patients
1 RN : 3 patients
1 RN : 3 patients
1 RN : 3 patients
1 RN : 7 patients
1 RN : 2 patients
1 RN : 2 patients
1 RN : 2 patients
1 RN : 2 patients
RN – Registered Nurses
EN/ENA – Enrolled Nurses; Enrolled Nurse Assistants
Registered Nurses in the Units are supported by the EN/ ENA’a for the patient care. 30% of Registered Nurses are from the Nurse Agency
Services.
(a)
Nurse Manager: Critical Care Diploma and Nurse Management Qualifications; Operational Managers in Charge of the above Units: all
have the Diploma in Critical Care; 30% of them have the qualification in nursing management.
(b)
Nurses working in ICU Units: approximately 20% of staff has the Diploma in Critical Care – they are strategically placed.
(i)
The majority of staff working in the Units have gained clinical skills and experience (+/ - 10 years) in the Units although they
have not completed the Diploma. There is a constant motivation for staff to complete the course but some staff opted not to.
(ii)
Community Service Nurses and new appointments to Nursing Critical (approx 30%) care come without the exposure or
experience.
GSH – Critical Care has a dedicated mentor who arranges weekly in service training and evaluations. 7. For Critical Care Diploma
Training we are aligned to the training providers: Western Cape Collage of Nursing and University of Stellenbosch (both provide 1 year
training).
END.
13