Doctor and nurse overtime cuts to bleed hospitals

Amid threats to cut the overtime of doctors and nurses in Gauteng public hospitals by a quarter to save money, nurses say they will not be able to cope.

According to some nurses, one of the key impacts of reduced overtime in Gauteng’s public hospitals and clinics is the strain it places on already overwhelmed facilities, where patient numbers far outweigh the available nursing staff.

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Fewer doctors means even more work for nurses. Nomfundo Dube, a nurse in Johannesburg’s region G, said the recommended patient ratio in wards in a public hospital was 1:3 or 1:4 but, in reality, it was now 1:10.

“Now you find one nurse dealing with 10 patients in a ward. And in a public clinic, a nurse is supposed to deal with a maximum of 35 patients but now 50 patients are sent to one nurse because we are short-staffed,” Dube said.

“If I see 50 patients, I am deprived of time to thoroughly work on my patients’ needs because I am thinking of other patients who need attendance, too. If overtime is cut, I don’t receive external help from other nurses and agencies.”

Budget slashed

The Gauteng health department is allegedly threatening to cut the overtime of doctors in public hospitals by a quarter as the overtime budget has been slashed from R3.45 billion to R2.65 billion.

Gauteng health and wellness MEC Nomantu Nkomo-Ralehoko disclosed this in a written response in the Gauteng Legislature last month.

Nkomo-Ralehoko stated that the overtime changes were made to “address inequalities and irregularities in the approval and management of commuted overtime”.

She noted this would lead to a reduction in paid overtime. Anja Smith, senior researcher in the economics department of Stellenbosch University, said there were likely to be dire consequences from these budget cuts for users of public hospitals.

Smith noted public hospitals in Gauteng were already struggling to deliver basic hospital services.

“Last year, evidence emerged about the failure to provide cancer services at public hospitals in Gauteng. The necessary machinery has still not been purchased.

“Budget cuts in an already very constrained system will definitely impact on overall availability of services and the quality of available services.”

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She said trimming staff remuneration and overtime budgets might make funds available for purchases of hospital equipment.

Ennerdale clinic midwife Nonkululeko Genu said they were already short-staffed and their clinic operated 24/7.

Genu said overtime meant they received assistance from other nurses. “This makes it easier for us to get the job done. As a midwife, I need assistance and if overtime is cut then we are shortstaffed,” Genu said.

“In a day, I attend to more than 10 patients and there are still more people in that queue. We are forced to cut the queue. We have two nurses on a 12-hour shift. How can two nurses properly attend to patients?”

Gauteng department of health head of communications Motalatale Modiba said the department had taken a decision to withdraw the delegation to approve commuted overtime by hospital CEOs for the 2024-25 financial year.

This meant CEOs made recommendations for approval to the head of department and all such requests had been approved.

“This decision was necessitated by challenges related to inconsistencies and inequities on the management of overtime,” he said