Nursing Services: Managing Healthcare Facilities During Load Shedding

Most people in South Africa will be familiar with that sudden silence when the lights go out, and you realise that load shedding has just started. Load shedding or power cuts – we should call a spade a spade, as this has become an inconvenience most people have no choice but to endure.

Many have experienced an even worse situation: When the power kicks out, but it’s in a hospital room or theatre that is plunged into darkness. As stated in a 2019 paper in the South African Medical Journal, power failures and the lack of a robust contingency plan could prove catastrophic in any healthcare environment, with varied and far-reaching consequences.

The consequences of power cuts in healthcare facilities can be “varied and far-reaching.” These include losing power in theatre, various types of electrical equipment not working, food spoiling, refrigerated medicines becoming too warm, or computer systems becoming temporarily unusable.

Hospitals need to keep their equipment functioning correctly at all times, and, to do this, facilities rely on backup diesel generators. But diesel is more expensive than ever, having increased by more than 50% over the past year. What makes matters worse, neither load shedding nor fuel price hikes are expected to end anytime soon.

“The instability of the national electricity grid in South Africa remains a key risk, as frequent power outages necessitate an increasing reliance on diesel-powered generators, where prices are escalating,” noted Netcare.

While load shedding and rising diesel costs make it more expensive to care for patients, finding qualified nurses and doctors has become more challenging. It’s not just a South African phenomenon. Still, local doctors and nurses are more inclined to look for work abroad due to remuneration, work conditions, safety reasons, and the government’s National Health Insurance plan.

What are the implications of load shedding on South Africa’s healthcare facilities?

Hygiene and infection control

Maintaining sewage and running water systems is vital for healthcare facilities to ensure adequate infection prevention. SA’s sewage and water systems are known to be poorly maintained and already struggle to meet the demands of public sanitation and water requirements. When load shedding occurs, these systems become further dysfunctional. In the case of a prolonged power failure, reservoirs may even run dry.

In addition, during load shedding, staff may be unable to sterilise surgical instruments and other essential items, potentially delaying emergency interventions and increasing the risk of complications. Ultraviolet light sources, helpful in reducing the presence of resilient microbes in critical care areas, may also be dysfunctional during load shedding periods.

Light and temperature control

A well-lit environment is of paramount importance to any medical facility. According to the regulations about private healthcare facilities, hospitals must provide lighting in maternity delivery rooms, operating rooms, ward corridors and critical care areas during power failures. 

Currently, there is no legal requirement for healthcare facilities to provide backup power for maintaining thermoregulation. Temperature control during power failures presents a unique challenge in the healthcare industry. Excessively high temperatures have been associated with increased proliferation and spread of infection, whereas excessively low temperatures may induce hypothermia and hypercoagulability.

Cold storage

Healthcare facilities must store various medications, vaccines and blood products within specific temperature ranges. Power cuts may compromise the efficacy and safety of these products during prolonged and unpredictable power outages. Erratic temperatures in hospital mortuaries may accelerate corpses’ decomposition, which may compromise postmortem examination, delay the burial of the deceased and potentially increase the risk of spreading infection.

Equipment

Tertiary hospitals provide care for a large number of critically ill and injured patients, who often require the use of multiple electronic devices. Although most critical devices have built-in backup battery power, they are subject to various limitations, including a limited power supply duration. Should these devices fail, policies may require healthcare staff to intervene manually, thereby decreasing the availability of staff for other essential duties. 

Although portable oxygen cylinders can be used when the central oxygen supply system is dysfunctional during power outages, such contingencies would likely fail during prolonged periods of power loss and ultimately affect patient outcomes. In addition, the non-function of hospital elevators during load shedding can severely restrict the movement of patients and staff.

Diagnostic services

There have been reports of complete loss of radiological and pathological services during natural disasters and extreme weather events due to power outages. Although these services may be fully functional at more extensive facilities with adequate backup power supply, smaller facilities with inadequate power backup would be unable to provide them. This situation would necessitate the transfer of patients to more extensive facilities and further burden both the EMS and the receiving hospital.

Communication and administrative services

The loss of communication during power outages presents a significant challenge. This includes but is not limited to an inability to recharge cellular phones, inadequate network signals and loss of internal electrically dependent telephonic systems. Patients, family members and other public members may be unable to communicate with the affected hospital or clinic. 

Inside the hospital, communication between wards, staff members and departments will also be compromised, which could cause significant delays in relaying pertinent information. Many hospital pharmacies use electronic scripting and dispensary systems to provide and issue medications to patients and healthcare staff. Although contingencies may be in place for manual medication dispensing, this may increase the time to process medication prescriptions, causing significant backlogs.

Financial and psychological implications

Prolonged or frequent loss of essential services, including power outages, has precipitated several mental health conditions such as depression, anxiety and post-traumatic stress disorder. This may add further strain to local mental health services. Staff morale is vital in executing professional duties, particularly among those employed in the healthcare industry. Healthcare workers are not immune to the psychological implications of load shedding.

Suggested measures to enhance load shedding preparedness

In conjunction with the National Department of Health, healthcare facilities and related services must implement various contingency measures and strategies. Some of these include:

• Storage and maintenance of fully charged backup batteries for essential communication devices
• Load shedding roster to activate additional clinical and admin staff
• Stringent maintenance of generators and backup devices
• Additional fuel reserves
• Storage of extra backup equipment such as oxygen tanks
• Ensure you have additional nurses to cater for all patients 

One of the most significant issues that healthcare facilities must address is securing additional staff from nursing services that can assist with the care of patients through the bouts of load shedding. 

What role do nursing services provide and fill during load shedding?

Nursing services are becoming more important than ever. Nurses play a critical role in the healthcare system and can help ease the burden of the current load shedding by adding to the workforce of the healthcare facility.

They are often the first point of contact for patients, providing basic care and treatment and offering support and guidance. Nurses can also help diagnose and treat patients and provide more primary care services such as screenings and vaccinations. This helps prevent illnesses and diseases, potentially reducing the strain on the healthcare system. Power cuts can also result in increased admissions. 

A study looked at the effect of load shedding on paediatric hospital admissions in Cape Town. Researchers found a 10% increase in admissions for days where hospitals experienced load shedding on the same day, or no more than two days prior, compared to when there was no load shedding in the past two days. These shocking numbers highlighted the need for healthcare providers to have more nurses on the ground and additional nursing staff on demand.

The current state of the healthcare sector means nurses are adapting to meet patients wherever they seek care, far beyond the hospital. Nursing services specialists like Greys can provide qualified nurses for nursing homes, home health care, and other private institutions.

Bridging the gap

Load shedding is a problem that is affecting all parts of our country. Nursing services can help bridge the gap to at least one of the concerns during load shedding by providing nursing staff to nursing homes, home health care organisations, and other private institutions. This nursing staffing strategy helps reduce the strain on the healthcare system and provides better patient care for those who need it the most.

If you are a healthcare provider or someone seeking home care nursing services, Greys is here to help. We are an operationally minded, entrepreneurial, client-first business offering:

• Care Givers
• Ward Aides
• Registered Nurses
• Enrolled Nurses
• Enrolled Nursing Assistants

We can help you find the nursing staff you need to deliver more sustainable and impactful patient care. Contact us to learn more about our nursing services.