Nurses in clinics and health posts, through Botswana Land Boards, Local Authorities and Health Workers Union (BLLAHWU), have dragged government to court over their continued performance of non-nursing duties without any remuneration.
Disgruntled and frustrated over their conditions of service, which have seen negotiations with the employer drag on for over six years, nurses last week filed papers before Justice Mercy Garekwe seeking an order declaring that nurses employed in the public service shall not perform non-nursing duties. The lawsuit follows back and forth correspondence spanning several years between MoH, Ministry of Local Government and the union. In January 2014 BLLAHWU notified the employer (DPSM) that they will approach court for redress if the latter fails to ensure that nurses stop performing non-nursing duties. They nurses want court to "review and set aside DPSM's refusal to issue a written instruction or directive to relevant authorities to the effect that nurses and midwives employed in clinics and health posts should stop performing (non-nursing duties)." The nurses further want court to order the employer through supervisors not to instruct or direct nurses and midwives in clinics and health posts to perform non-nursing duties.
According to nurses, the non-nursing duties include keeping and maintenance of inventory of furniture and equipment in a facility, monitoring infrastructure projects in clinics, preparation and signing of pay sheets, tendering of equipment, furniture and linen, authorising clinic orders, collection and safe- keeping of revenue, registration of births and deaths, portering on non-ambulatory patients, off- loading of drug cartons from central medical stores, rationing of food to beneficiaries among others.
Government has ignored recommendations of an eleven-man task force established by a team from the MoH and union representatives, which investigated the issue of nursing versus non-nursing duties since 2010. The report was delivered to MoH for implementation, but has been shelved since. The task force, through a position paper dated 14 January 2011, found that there were duties performed by nurses which were non-nursing duties. The committee found that the current nurses and Midwives Act is broad and not specific in what nurses should not do given that they practice what they have been trained in, and is not compatible with the regulations which are based on the Act of 1969 which are not in line with current developments in health care system. An urgent review of the Act was recommended to come up with nursing standards, scope of practice, education and practice standards, competencies, code of ethics. The committee emphasised the compelling and urgent need for the development of a national nursing strategy, currently non-existent, to chart the path for the development of nursing in Botswana.
Other recommendations were that:
• There should be reassessment and subsequent re-grading of the job to recognise the broad scope of nursing. Job descriptions of nurses at the clinic level and those at the hospital level should be reviewed, harmonised and re-graded to ensure consistency at all levels of the health care system within three months.
•Those specialties like midwifery and post basic diplomas be recognised accordingly such that progression is according to professional achievements. Currently such are not taken into consideration during registration by the Nursing and Midwifery Council.
•There be recognition for the expanded role, an immediate review or development of the scope of practice for nurses and midwife taking into consideration the expanded roles because all clinics offering different types of health care services are administratively managed by nurses and midwives, where they provide all interventions of the different types of health care service provided without exception to ensure coverage and access.
Further government was advised to be proactive in augmentation of the other cadres such as doctors and pharmacy technicians at the lower level facilities, and to introduce administration and supply cadres to relieve nurses of these responsibilities for better patient care. At the lowest level, like health post, auxiliary staff was recommended to augment nurses.