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|Port Elizabeth |East London |Total |
| | |Hospital Complex |Hospital Complex | |
|ICU Units |4 |4 |3 |11 |
|(i) No of beds in each |21 |30 |39 |90 |
|(ii) No of nurses working in each |39 |105 |114 |258 |
|Nurse patient ratio |1:2 |1:1.2 |1:1.5 |1:2 |
(2) The following table reflects the situation in this regard
| |Mthatha Hospital Complex |PE Hospital Complex |EL Hospital Complex |Total|
|Nursing managers|Yes |Yes |Yes | |
|No. trained for |Not all have received |Not all have received |Not all have received | |
|ICU |training |training |training | |
|Reasons why |Staff shortages make it |Staff shortages make it |Staff shortages make it | |
|training not |difficult to release staff. |difficult to release staff.|difficult to release staff.| |
|done |Also there is shortage of |Also there is shortage of |Also there is shortage of | |
| |available slots for training|available slots for |available slots for | |
| |at the training centres |training at the training |training at the training | |
| | |centres |centres | |
|Nurses not |8 |66 |28 |102 |
|received | | | | |
|training | | | | |
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 ICUâs |NUMBER OF ICU BEDS |Number of all nurses working in|Nurse -patient |
| | | |each ICU. |ratio |
|Pelonomi Regional |ICU facility = 1 |Adult = 10 |Prof Nurses = 62 | 1:1 |
|Hospital |which is currently a | | | |
| |temporary facility |Peads = 5 | | |
|Bongani Regional |General |Adult = 7 |Prof Nurses = 19 |1 : 1 |
|Hospital | |Peads = 1 |Staff Nurses = 3 | |
| | | |E Nursing Asst = 1 | |
| | | | | |
| | | |TOTAL = 23 | |
| |Neonatal |Incubators = 16 |Prof Nurses = 11 |1 : 3 |
| | | |Staff Nurses = 2 | |
| | | |E Nursing Asst = 8 | |
| | | | | |
| | | |TOTAL = 21 | |
|Mofumahadi Manapo |1 General ICU |Beds = 6 Active |Prof Nurses = 12 |2 : 1 |
|Mopeli Regional | | |Staff Nurses = 1 | |
|Hospital | | |E Nurse Asst = 3 | |
| | | | | |
| | | |TOTAL = 16 | |
|Boitumelo Regional |1 General ICU |Beds = 6 |Prof Nurses = 7 |1 : 1 |
|Hospital | | |E Nurse Asst = 7 | |
| | | | | |
| | | |TOTAL = 14 | |
|Dihlabeng Regional |1 General ICU |Beds = 3 |Multidisciplinary |1 : 1 |
|Hospital | | | | |
| | | |TOTAL = 14 | |
|Universitas Academic|Multidisciplinary 8 |Beds = 6 |PN = 26, |1:1 unstable |
|Hospital |beds. Usable 6 7th | |SN = 2 |1:2 is stable. |
| |opened when needed | |NA= 1 | |
| | | | | |
| | | |TOTAL = 29 | |
| |Neonatal ICU |Beds = 14 |PN = 28 |1:1 if unstable |
| | | |SN = 1 |1:2 stable |
| | | | |patients |
| | | |TOTAL = 29 | |
| |Neuro ICU |Beds = 5 |PN =17 |1:1 if unstable |
| | | |SN =2 |1:2 if stable. |
| | | | | |
| | | |TOTAL = 19 | |
| |Paeds ICU |Beds = 5 |PN =16 |1:1 unstable pts|
| | | |SN =4 |1:2 stable |
| | | | | |
| | | |TOTAL = 20 | |
| |Coronary |Beds = 6 |PN =20 |1:1 if unstable |
| |X6 beds | |SN =1 |1:2 if stable |
| |+ 1 bed | | | |
| |cardioversions/ | | | |
| |temporary pts | |TOTAL = 21 | |
| |Surgical ICU includes|Beds = 5 |PN =18 |1:1 unstable |
| |Kidney Transplant | | |1:2 stable |
| |Unit | |TOTAL = 18 | |
| |Adult Heart | |PN =6 |All staff on |
| |catheterisation lab | |NA =1 |duty MON-FRI. |
| |(Interventional | | |Deal with State |
| |Unit(half ICU, half | | |& Netcare lists.|
| |theatre) | | |X 2 sisters on |
| | | | |standby daily |
| | | | |for both |
| | | | |hospitals. |
| |Peaeds Cardiology & |Beds = 4 |PN =5 |24hr high care |
| |day clinic in unit | |SN =2 |Mon-Friday |
| | | |NA =2 |(Half ICU/ half |
| | | | |theatre set up) |
| | | |TOTAL = 9 | |
| |Paeds High Care | |No staff to run unit at the |1:2 stable pts |
| |x4 beds | |moment. Unit is fully furnished| |
| | | |with equipment through the KFC/| |
| | | |Carte Blanche (ADD Hope) | |
| | | |initiative. | |
(2)
|Hospital |Number of |Number of ICU|Number of |Number Of ICU |Reasons for not having ICU Trained Nurses |
| |ICU |Trained |ICU |Trained | |
| |managers |Managers |Professiona|Professional | |
| | | |l Nurses |Nurses | |
|Pelonomi |1 Post | | | |Professional nurses untrained |
|Regional |available |4 |62 |47 |-1 failed |
|Hospital | | | | |-2 on study leave doing critical care |
| |3 | | | |-1 for training from January 2010. |
| |Operationa| | | |-1 application rejected at college. |
| |l Managers| | | |9 experienced |
| | | | | |because of age they indicated that they cannot |
| |2 ICU | | | |study |
| |trained | | | | |
| | | | | | |
| |. | | | | |
|Bongani |1 |General |
|Regional | | |
|Hopital | | |
| | |1 |19 |14 |Has 70% ICU trained nurses. |
| | |Neonatal |
| | | |11 |10 | |
|Mofumahadi|1 |1 |12 |3 |4 Transferred to other hospitals. The hospital |
|Manapo | | | | |is training 1 per year. |
|Mopeli | | | | | |
|Regional | | | | | |
|Hospital | | | | | |
|Boitumelo |1 Nursing |1 Trained |7 |PN = 7 |Inability to send more than 2 due to shortage of|
|Regional |Manager |Manager | | |staff. |
|Hospital | | | |3 Not trained | |
| | | | |and 1 applied |No young PN that is interested to do ICU. |
| | | | |for 2010 | |
| | | | |training | |
|Dihlabeng |1 |1 |14 |8 |Problems with filling of posts (e.g. funding). |
|Regional | | | | |It becomes problematic to send people on study |
|Hospital | | | | |leave when there will be no complementary staff |
| | | | | |to ensure continuity of quality patient care. |
|Universita|10+1 |X4 |174 PNs = |72 =41% of PsN |Comments at the end of the template |
|s Academic| |Operational |89% of |ICU-trained | |
|Hospital | |Managers |total staff| | |
| | |X1 Assistant |in ICU. |X8 =4% PNs | |
| | |Manager |15 SNs = 8%|Advanced | |
| | | |of total |Paediatric | |
| | | |6 NAs = 3% |Nursing | |
| | | |of total | | |
| | | |staff |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.
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.
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 ratioâs 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 |Hospital |No |No |Nursing |Total |Trained ICU / |Nurse to |
|Â | |Units |beds |Staff |Â |Advanced |Patient |
|Â |Â |Â |Â |PN |
|Mokopane |2 Neonatal & Main ICU |3 |11 |1:1 for critically ill patients |
| | | | |ventilated. |
| | | | |2:1 for high care patients. |
|Warmbaths |1 |8 |9 |1:1 depending on the acuity level of |
| | | | |the patient. |
|Tshilidzini |1 |4 |6 |1:2 |
|Letaba |1 |4 |3 |2:1 |
|St Ritas |2 |8 |12 |1:3 neonatal, 1:2 main |
|Philadelphia |1 |8 |2 |2:1 |
(2) The following table reflects the situation in this regard
|Hospital |Nurse |ICU trained |ICU not |Reason for lack of ICU training |
| |managers | |trained | |
| |in ICUs | | | |
|Mokopane |0 |0 |1 |Trained in 1981 and there was no exposure to |
| | | | |ICU |
|Warmbaths |8 |1 trained and 1 still |6 |Lack of midwifery course as a requirement |
| | |being trained | |before post-basic diploma |
|Tshilidzini|12 |12 |4 |2 scheduled to start with training |
|St Ritas |6 |3 |2 |Nurses take turns to go for training |
|Philadelphi|2 |1 |1 |Appointed as a manager |
|a | | | | |
MPUMALANGA
(1) (a) There are no ICUs in hospitals in the Province except at the
following:
|Institution |No of ICUs|No of |Nurses in |Patient ratio|Training offered |Why training not |No not |
|where there is| |beds |each Unit | |to nurses |given |received |
|an ICU | | | | | | |training |
|Mapulaneng |01 |03 |05 |1:1 |YES |Not applicable |Not |
| | | | | | | |applicable |
|Rob Ferreira |1 |6 |17 |1:2 |Only 15 are |2 not trained of |1 |
| | | | | |trained |which 1 will be | |
| | | | | | |trained next year| |
| | | | | | |and other nurse | |
| | | | | | |is not interested| |
| | | | | | |as he will be 60 | |
| | | | | | |next year | |
|Themba |1 |5 |17 |1:1 |Only 11 are |Training still |6 |
| | | | |ventilator |trained |continue for | |
| | | | |1:2 high care| |others | |
|Witbank |1 Adult |10 Adult|16 |1:1 |9 trained |We trained two |1 |
| |1 neonatal|16 |Professional |1:2 |2 on training |professionals |11 |
| | |neonatal|14 | | |every year | |
| | | |Professional | | | | |
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
(ii) Total number of nurses working in each unit
⢠Adult ICU = 23
⢠Paediatric ICU = 12
⢠Neonatal ICU = 10
(d) Nurse/patient ratio in each unit
⢠Adult ICU = 1:1.7
⢠Paediatric ICU = 1:3
⢠Neonatal ICU = 1:3
(2) (a) ICU Trained Managers
⢠Adult ICU = No
⢠Paediatric ICU = No
⢠Neonatal ICU = Yes (Neonatology)
(b) 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
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
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.
(2) (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:
Staff
needed 24 hours Staff available 24 hours
(Day + Night)
(Day + Night)
PRN SN NA
Total PRN SN NA Total
A1 West Surgical x 10 beds 20 4 4 28 16 4 4
24
A1 East Burns x 6 beds 8 8 8 24 8 4 8 20
A2 Cardiothorasic x 8 beds 24 4 4 32 16 8 4 28
A4 Neuro x 10 beds 16 8 0 24 12 4 0 16
A5 Medical/Respiratory x 7 16 4 4 24 12 0 4 16
A6 Cardiology x 8 beds 16 0 0 16 12 0 0 12
A7 Nephrology x 4 beds 8 4 0 12 4 4 0 8
A9 Paediatrics x 6 beds 12 4 4 20 8 0 8
16
A9 Neonatology x 8 beds 14 4 4 22 6 4 4 18
High Care beds :
A1 West Surgical x 2 beds 4 4 4 12 0 4 4 8
A1 East Burns x 16 beds 6 8 8 22 4 4 8 16
A2 Cardiothorasic x 6 beds 8 4 4 16 8 2 4 14
A4 Neuro x 20 beds 4 4 16 24 4 4 8 16
A5 Medical/Respiratory x 13 8 4 12 24 4 4 12 20
A6 Cardiology x 14 beds 8 4 12 24 4 4 12 20
A7 Nephrology x 9 beds 4 4 8 16 4 0 8 12
C2A Labour/Maternity x 4 8 4 0 12 8 4 0 12
A9 Paediatrics x 10 tracheas 4 8 8 20 4 8 0 12
A9 Paediatrics x 2 4 4 4 12 4 4 0 8
(c) 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.
(2) (a) and (b) 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.
(ii) 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.
Groote Schuur Hospital
|Unit |No of beds |Number of Nurses |Nurse/Patient Ratio |
|C27 respiratory |8 |RN â 17; EN/ENA -|1 RN : 2 patients |
| | |16 | |
|CCC Cardiology ICU |6 |RN- 9; EN/ENA â 8|1 RN : 3 patients |
|E26 Source Isolation ICU |3 |RN â 5 ; EN/ENA -|1 RN : 3 patients |
| | |8 | |
|F4 Haematology High Care (HC) |6 |RN â 9; EN/ENA- 8|1 RN : 3 patients |
|E12 Transplant High Care |7 |RN â 5; EN/ENA - |1 RN : 7 patients |
| | |4 | |
|D12 General Surgical ICU |8 |RN â 17; EN/ENA -|1 RN : 2 patients |
| | |16 | |
|D13 Neurosurgery ICU |6 |RN â 13 ; EN/ENA |1 RN : 2 patients |
| | |â 8 | |
|D22 Cardiothoracic ICU |6 |RN â 13 ; EN/ENA |1 RN : 2 patients |
| | |â 8 | |
|C27 Spinal ICU |6 |RN â 13 ; EN/ENA |1 RN : 2 patients |
| | |â 8 | |
|TOTAL |55 | | |
RN â Registered Nurses
EN/ENA â Enrolled Nurses; Enrolled Nurse Assistants
Registered Nurses in the Units are supported by the EN/ ENAâa 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 â 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 â 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.