RESEARCH THE SOUTH AFRICAN NURSING COUNCIL - Semantic Scholar

Masseurs, as well as on the Northern andSouthern Disciplinary Committees, so thatthere was at least partial input by nurses in thecontrol of training and the investigation ofcomplaints relatijig to the behaviour of nursesand midwives. Miss Alexander served asitinerant nurse examiner for the Council fromSeptember 1933. The involvement of nursesin the control of their own affairs was furtherstrengthened in 1943 by the co-opting of theMisses M.G. Borcherds and S.M. Marwick tothe Training, Examination and RegistrationCommittee.The involvement of the nurse representativesin the examinations was restricted to themonitoring of practical examinations whichinitially was the responsibility of the itinerantexaminer. In 1935 the principle of a panel ofexaminers for this purpose was adopted. Thewritten Preliminary and Final Examinationsw ere conducted exclusively by medicalpractitioners.’A point of interest, which became evidentfrom d isp u tes on the in te rp retatio n oftranslated examination questions, is that thewell-known author-poet C. Louis Leipwldt,himself a doctor, was for many years theofficial translator of nursing examinationpapers into Afrikaans.The investigation of complaints of allegedmisconduct or negligence by registered nursesand midwives and the exercising of disciplinewas the one area that showed deficienciesduring these pioneer years. Between 1928 and1943 - a period of 15 years -approximately 19complaints were investigated by the MedicalCouncil. Many of these complaints whichjustified action against the practitioners wered ealt w ith by m erely issuing a w rittenadm onishm ent to the guilty party. Thefollowing are two examples taken from the1931 and 1932 minutes "T h e ( D is c ip lin a r y ) C o m m itte eAGREED: 'That the midwife be in form ed that she was not justified in leav ing the case; that she should havestayed there until relieved, and that inattending cases she should see that shewas properly equipped with neces saries, such as Lysol." "The committee trfter making investiga tions including a statement from Nurse"N" in which she admitted having ad ministered an anaesthetic . when thepatient was in great pain AGREED thatNurse “N" be i orm ed that she must notgive chloroform without the instruc tions and without the presence o f amedical practitioner"*The fact that since 1891 provision was madeonly for voluntary registration of nurses andmid wives meant that the interests of the publicwere partially protected only. Unqualifiedpersons could still practice freily - they werejust not permitted to represent themselves asregistered nurses or midwives. It is also trueCurationis, Vol. 18, No. 3, August 1995that many who were eligible for registrationdid not avail themselves of this privilege.Despite the resolute efforts of HenriettaS tockdale to m ake reg istratio n legallyenforceable from the outset, this was onlyaccomplished with the promulgation of thefirst Nursing Act in 1944. The ineffectivenessof voluntary registration to protect the publicis obvious in the following example from theSeptember 1942 minutes,"The Committee CONSIDERED a letterfrom the Secretary o f Public Healthreferring to previous corresporuiencewith the Council and enclosing a copyo f a letter from the Commissioner o fPolice in which it was stated that Miss"L" appeared before the Magistrate atPretoria on a charge o f contraveningSection 61 il){c ) o f Act 13 o f l 928.' Shepleaded guilty and was cautioned anddischarged. The Secretary for PublicHealth suggested that the Council con sider the question o f dealing with thisnurse under the provisions o f Section45" o f the Medical, Demal and Phar macy Act.The Committee RESOLVED to informthe Secretary. that the Council did notagreeas by doing so, no object willbe achieved. Should the Council hold anenquiry and resolve to erase the nameo f Nurse "U'from its register o f nurses,it will not prevent her from practisingas a nurse, as the registration o f nursesin South Africa is not compulsory. TheCommittee suggests that the Secretcv . proceed under Section 81 o f Act 13o f1928 as, if this is done, and the Coun cil recom m ends, and the M inisteragrees. Nurse "L" can be suspendedfrom practising altogether, and this willbe the best procedure to adopt in theinterest o f the public.' At least one other similar example is recordedwhere, during the time of the Colonial MedicalCouncil (pre-1910), the practice of a midwifewas suspended by the intervention of theMinister of Public Health on the grounds ofher "infamous and disgraceful conduct.' Thismidwife was refused reinstatement until 1932when at its September meeting the SouthAfrican M edical Council in response torepresentations and proof of continued goodconduct, instructed the Registrar to reinstateher name on the Register for Midwives of theUnion of South Africa.The following amendment to the examinationregulations for Medical and Surgical Nurses in1937 was an apparent attempt to enforceregistration in at least the training schools. Itreads as follows "No application fo r recognition o f aninstitution as a training school shall beentertained unless (a) the matron, sisters and st nursesare registered nursesD e sp ite th e se d e f ic ie n c ie s im p o rta n tgroundwork was done, particularly in theyears following the 1928 legislation. All theingredients for statutory professional controlwere present to a greater or lesser extent, as thefollowing list illustrates; admission to the professional registers wascontrolled training standards were established bydetermining minimum content and levelsof knowledge and skills; curricula wereprescribed; training schools had to complywith sp ecific legal req u irem en ts forapprovd; programmes and schools werem onitored by m eans o f insp ectio n s;national examinations were conducted andcertificates were issued. Training schoolswere required to submit annual reports. m is c o n d u c t and n e g lig e n c e byp ra c titio n e rs w as in v e s tig a te d anddiscipline applied. the titles "nurse" and "midwife" wereprotected. This was demonstrated in thedisciplinary hearings conducted in cases ofmisrepresentation. Anotherexampleof thisis seen in the intervention by the ExecutiveCommittee in 1931 when the L adies’Branch Free Dispensary in Cape Townissued ce rtifica tes e n title d "L a d ie s’Monthly Nurse" the Minister and health authorities wereadvised on m atters o f public interestc o n c ern in g the n u rsin g p ro fe ssio n .Examples of this include- March 1931 ; The Council voices itsconcern about the serious shortage ofnursing and midwifery services to theblack population' - March 1943 : The Council advises theMinister about the urgency of amendingth e A ct to m ak e p r o v is io n fo rcompulsory registration of nurses andmidwives. At the same time a noticewas sent to health authorities with therequest that only registered nurses and11midwives be employed.- 1943 and 1944: The Minister is advisedon the opposition of the Council to thecreation of a separate statutory Councilfor nursesAt no time, not even during the decades of itscontrol by medical legislation, was the SouthAfrican nursing profession ever isolatedwithin its national or professional borders.Examples from the pre-1944 period illustratethis The South A frican M edical C ouncilconducted the examinations for the nursesof Southern Rhodesia (now Zimbabwe)before that country acquired its ownstatutory control17

; S0A'''CAP'-W .P .j n u r s e s b i l u sr e j e c tr a c ia lD IS C R IM IN A T IO NP R O P O S A L S; O u t - v o t in ife a rsa re i'i seenaso r o m id le s sB2 3 0 voles 10 2 9 , a sp ec ia l m eeting of the S o u thA fric a n N u rsin g A ss o c ia tio n (W e s te rn P ro v in ceb ra n c h ) in C a p e T o w n a d o p te d last night a resolutionre je c tin g th e in tro d u ctio n o f ra c ia l discrim ination in thef fciiion.y V o' .yv* . m m / u g u si\995

an agreement existed with both the GeneralNursing Council for England and Walesand the New Zealand Nurses and MidwivesB oard for rec ip ro c al reco g n itio n of12qualifications.'T H E D EV ELO PM EN T OFP R O F E S S IO N A L S E L F R E G U L A T IO NIn 1943 the Organizing Secretary of the SouthAfrican Trained Nurses Association, MrsSharley Cribb, submitted a memorandum tothe Commission for Health Services, in whichshe stated "It is only too evident that we havereached the stage in the history o f then u rsin g p ro fe s s io n w hen d ra sticreforms are necessary to prevent aserious decline in the quality and quan tity o f nurses . Whilst appreciatingfully the necessity fo r complete under standing and co-operation between thedoctor and the nurse the intelligentwoman o f today cannot be expected tobe content after extensive and iruricatetraining to be denied the control o f herown destiny .W e can see no reasonwhy a body o f highly qualified profes sional women should be denied selfgovernment . In the interests o f thecommunity the nursing service shouldbe a legally constituted national body,devoting the best intellects from itsranks to the achievemeru o f progressiveimprovement o f training, etc, in orderthat the patieru may always receive themost skilful nursing. Only by giving nur ses the control o f their own professionwill that sense o f civic responsibility bedeveloped in the rmrse and the true na tional character o f the work em erge.It seems to me that the provision o fsatisfactory nursing legislation is thetest o f the sincerity o f any government'spolicy regarding natioruil health, forthe nursing service is basically essentialto national health. "* Pressure from the nursing profession wasclearly evident in the parhamentary debatesduring the second reading of the Draft Bill on29 and 31 May 1944. Over and over, theMinister used the opinions of the TrainedNurses Association to support his arguments,for example, he argued inter alia as follows "U nder the present system , in theopinion o f the Nursing Association,there is no means o f ascertaining howmany unregistered but qualified rmrsesare practising; and, in regard to theregistered nurses, there is no record o fhow many are practising and how manyare not. Therefore to make a computa tion o f the strength o f the nursingprofession o f the country at the presenttime is very difficult indeed. The com pulsory registration o f practising nur se s p r o v id e d fo r in the B ill w illCuralionis, Vol. 18, No. 3, August 1995immediately enable an estimate to bemade o f the active nursing force in thecountry; it will enable the output o ftrained nurses and midwives to meet thedemand to be planned; arui it will meanthat all practising qualified nurses aruimidwives will be under control" *Judging from the records of the parliamentarydebates, it seems clear that the nurse leaders ofthe time had enlisted wide fXDUtical support forthe passage of nursing legislation. In thecourse of the debates, the high regard in whichthe politicians held the nursing profession wasalso obvious. Mrs Margaret Ballinger was aleading proponent in this regard. In the courseof a turn to speak she said "/ think anyone who has had experienceo f the nurses o f this country knows thatthe impulse behind this Bill is simply thegenuine and sincere desire to providethe country with the services on whichalone can be built up that standard o fpublic health and public health servicesthe whole public is now desirous of."Another parliamentarian. Dr Swanepoel, hadthis to say "On several occasions when I was inPretoria I was interviewed by the rep resenta tives o f the South A fricanTrained Nurses Association, and judg ing by the evidence which they placedbefore me I can only say that I wasth o r o u g h ly im p r e s se d w ith th ethoroughness o f the work which thesepeople do." The first Nursing Act, No.45 of 1944, wasapproved for promulgation on 22 June 1944,and the South African Nursing Council,established in terms of section 2 of that Act,began its activities under the direction of 24Council members appointed by the Ministerfor a two-year term of office.At the first meeting, not only were the officebearers and standing committees elected, butMr J A H van Niekerk, was also appointed asthe first Registrar. The Council was housed inoffices made available by the Medical Counciland the fin an ces en ab lin g it to beginoperations came from a 1 000 donation fromthe South African Nursing Association,together with further small donations of cashand office furniture. For the first two years ofits existence, the staff of the Council consistedof 11 people - the Registrar and a further 8permanent and 2 temporary members of staffThe pioneering work of these first councilmembers and staff laid the foundation for theactivities of the subsequent councils. One ofthe first tasks was the creation of electionregulations with a view to the coming intobeing of a council in which the nursingprofession would have a share by theirparticipation in the election of its members.The first elections duly took place during thesecond half of 1946.It quickly became apparent that amendmentsto the Act were necessary and a number ofthese were promulgated during 1946 whileothers were submitted to the Minister in 1948.However, the Government itself, in keepingwith the policy of apartheid, introduced otheramendments which radically altered the spirito f th e 1944 A ct. T h o se a m en d m e n tsculminated in the Nursing Act, no.69 of 1957,d e s p ite o p p o s itio n fro m th e n u rsin gprofession.The documentation of meetings of the NursingCouncil, newspaper reports and records of theparliamentary debates demonstrates that therew ere serio u s p ro b lem s and d issen sio nregarding the content of the Nursing Bill, notonly among members of the Council, but alsoamong the public and members of the nursingprofession as a whole.Press reports such as those illustrated appearedunder such headlines as ”WP Nurses rejectbill’s racial discrimination proposals", "Racediscrim ination rejected by WP N urses","Nurses march in city apartheid Bill protest","Nurses to defy protest march ban" and"Nurses seek no colour bar". Mrs Ballinger’sreaction was described as follows in the CapeTimes of 13 June 1957 "Speaking as a former vice-president o fthe Nursing Council and the member o fParliament who was asked by the nurs ing profession to introduce the NursingBill o f 1943, Mrs Margaret Ballingery e s te r d a y f l a t l yd e n ie dth eGovernment's assertion that the whitenurses o f South Africa wanted a colourbar in their profession .M rs Ballingerwarned the Government that its NursingApartheid Bill was ‘not only wicked butincredibly dangerous' . Reading atelegram from prominent senior nursesurging her to oppose ‘all the racial dis crimination clauses’ o f the Bill, MrsBallinger said that this was typical o f,16the feeling among rutrses to-day.In her parliamentary speech Mrs BaUingerstated "Our difficulty in discussing this Bill isnot in discussing what the rmrses haveasked for, but what the Government hasdone with it. There are two sections tothis Bill. The one is administrative .and then there are the colour barprovisions. Thus the clauses o f the Billfa ll into two categories, one asked forby the rutrses arui one imposed upon thenurses by the Government. / tU nk thisis the most tragic irUerference with thep r iv a te r ig h ts o f a p r o fe s s io n a l.17b o d y.The division within the Council itself isillustrated by the equality of votes when amotion against the discriminatory provisionsin the proposed legislation was consideredduring the March 1955 Council meeting. Themotion was rejected with the casting vote of19

THURSDAY, JUNE 13, 1957‘NURSES SEEK NOCOLOUR BAR’er 'Warnsof ‘Dangerous Bill’Op(L-C ape T iiiie» P a r lia m e n ta r y C o rr e s p o n d e n tOn (AN u rse s-HO U SE O F A SSE M B L Y .— Speaking.« fo rm e r vicep re sid en t of tlie N ursing C ouncil and th e m em b e r o P a rlia m e n t wlio w a i asked by th e n u rsin g profession toin tro d u c e llie N ursing B ill of 1943, Mrs. M argaretB a llin g er yesterday flatly d en ied th e G o v ern m en t’s asser tion th a t th e W h ite n u n e j of S o u th .\fric a w antedPro testb a r iu th e ir profession.AndspeakingasaN a t i v e s ' 1M r»,R alllnger said .'« lin g iT U E SD A Y ,l9SiRACEREJECTED BYW.P. NURSESAS P E C IA L m eeting called by the "T rstern Provincebrancii o f ith e South Afric.iu .N'ursin" A ssociationlast nig iit passed a- m otion by 230 votes to 20 rejectin gracial d iscrim inatiba-, in tlie n u r« in ; profession.T n e n ie e tii -' a s cailcd to d isciisa th e N u rsin g.'V niendm ent Bilfc- which last n i” h t pa fc l thec o m m itte e a n d re p o rt stai:e9 in ih c H o u se " fA aacrably.A lto g etlic r. a b o u t ZoO p e o p le ofd ille r c n l ra c e s attcn ilcil.T h e m o tio n r e a d : “ T h is b r.m cit rralT iriu s its ilain lin tro d u c tio n of ra c ia l iisc rin iiiia iiu n iiiloiii*n, .iii'l'i n 'n in oi:aII%' r r j r r t’' " “'.I .r iv (lie20Curationis, Vol. 18, No. 3. August 1995

18the President. The discriminatory provisionsof the 1957 legislation were as follows: 19 membership of the Council was limited toWhite persons (Section 4) only White registered nurses and midwivesand students had voting rights in theelection of Council members (Section 3) the creation o f A dvisory Boards forColoured and Black persons (Section 16)Each of these Advisory Boards elected aWhite person, registered as both nurse andmidwife, to the Council (Section 3) separate registers for Whites, Colouredsand Blacks (Section 12(4)) the Council acquired the authority toprescribe different distinguishing devicesand uniforms for Whites, Coloureds andBlacks (Section 11(1 )(k)) prohibition of the control of or supervisionover White registered or enrolled persons bypersons who were not White (Section 49).In the report of the Third Council, the Registrarpointed out that the Council had not asked forany of these amendments. The Council haddiscretionary powers regarding distinguishingdevices and uniforms and could thus resolvenot to prescribe separate distinguishingdevices. O th e r c h a n g e s in c lu d e d thefollowing Increasing the membership of the Councilto 33 of which 16 would be appointed and17 elected Election according to 10 regions, withnational nominations but regional election,so that each registered person would havevoting rights only in heiMiis region (onevote only) Election of office bearers for the 5-yearterm of office instead of the previousannual electionAmendment Act includes that of "enrollednurse" instead of "enrolled auxiliary nurse",and in th e A frik a a n s te x t, " s tu d e n tverpleegster" and "leerling- verpleegster" inthe place of, "leerling-" and "leerlinghulpverpleegster" respectively. This Act alsoprovided for an Advisory Board for Indians. Afu rth e r im p o rtan t am endm ent was therequirem ent that the president and vicepresident of the Council should be personsregistered in terms of the Act - a measurewhich had not previously existed.The Nursing Act 1978, Act 50 of 1978, waspromulgated on 19 April 1978. In manyresf ects, this Act could be regarded as theb eg in n in g o f th e tra n sfo rm a tio n andnormalization of the Council. During thesecond reading of the Bill on 17 February,1978, the Minister explained the point ofdeparture on which the amendments werebased as follows"The basic principle underlying the es tablishment o f a council o f this natureis that it should be a knowledgeablebody composed o f know-ledgeable per sons, since the council must control theprofession in the inlerests o f the patieni.It . has never been the intention thatsuch a body should be a representativebody. Therefore the persons attached tothe various bodies that are mentionedwill serve on the council because o ftheir knowledge o f the specific field andnot in order to represent that particularb o d y.And then the Minister made this importantannouncement "Thepresent requirement that the coun cil should consist only o f Whites is nolonger applicable in the times in whichwe live. Representation have accord ingly been received from the professionfo r the provisions in this connection tobe changed completely. apartfrom theSOUTHAFRICANNURSINGA D M IN IS T R A T IV t COUNCILSTRUCTUREProvision for the training and enrolment ofauxiliary nurses and midwives.The legislation did not include the Council’srecommendation that the practice of Nursingand Midwifery for gain be hmited to registeredand enrolled persons. This meant that p ersonsnot qualified in nursing could still practice forgain in some parts of the country at that time a situation which was untenable in the publicinterest.election o f members there (ther ore) isno refererKe to race in the Bill. A s fa ras the election o f members is concerned,an attempt has been made to provide fo rthe registered nurses in the various racegroups to elect a number o f memberswhich is as fa r as possible propor tionate to the respective rmmbers o feach group."This Act also abolished the Advisory Boardsand in addition the offensive prohibition oncontrol and supervision over a White by anon-White person was abolished at the requestof the profession.For the first time, provision was made in thisAct for the registration of accoucheurs (malemidwives) and Afrikaans title of the Councilwas changed from "Die S A Verpleegstersraad" to "Die Suid-A frikaanse Raad opVerpleging", which was more suitable andalso linguistically correct.The preparations by the Council, which beganin 1987 to prepare for amendment of the Actto liberate it finally from the disastrousrestric tio n s o f the 1957 le g isla tio n byeliminating all references to racial groups,culminated in the Nursing Amendment Act,1992 (No 21 of 1992). This A ct makesprovision for electoral regions taking accountof the geographical distribution of the nursingpopulation, the av ailab ility o f trainingfacilities and the development regions of thecountry. It m akes provision for enlargement ofthe elected component of the Council, drasticreduction of representation by the State and theelection of a deputy vice president. O f the 30Council members, at least 24 would beregistered nurses, of whom 15 would beelected members.A D M IN IST R A TIV ED E V E L O PM E N T O F T H E C O U N C ILIn 1994 the administrative structure of theCouncil is illustrated in Figure 1.WCCtSTRAA IOCrUTV Rfr.ISTRMRJ WNrwThe Nursing Amendment Act, No.50 of 1972addressed this important deficiency by makingprovision for a roll for nursing assistants,conUolling the training of nursing assistantsand lim iting the practice of nursing andmidwifery for gain to persons who wereregistered or enrolled by the Council. Thisprovision made nursing a "closed firofession".Terminology which was amended in thisFIGURE 1 ADMINISTRATIVE STRUCTURECurationis, Vol. 18, No. 3, August 199521

TABLE 1 COUNCIL STAFF 194419691994111RegistrarDeputy Registrar1Chief Professional Officer1Data Manager1Senior Professional Officer2Senior Assistant Registrar2Assistant Registrar21Senior Law Assistant1Professional Officer25Senior Administrative Officer5Other (All categories)1044112TOTAL1149133Apart from the top management, the Council’sadm inistrative functions and policy areexecuted by 12 further departments. At presentthe Council has 133 full-time members ofstaff. The development of the post structureduring the past 50 years can be illustrated asin Table 1.Table 2 sets out the growth in the budget of theCouncil over the 50-year period. From itsinception the Council has been dependentupon the generation of its own funding and,apart from the initial gifts already mentioned,has never received any fmancial support orsubsidy from the state or any other source. TheTABLE 2 FINANCIAL GROWTH OF THE COUNCIL 1944 -1994 1944( )1954(2)1964(R)1974(R)1984(R)1994(R)1 00039 141129 254496 2904 652 2819 130 2009 606 400Expenditure?32 645122 843433 5022 383 122Surplus?6 4996 41162 7882 269 159476 20033 78814 046372 25441 23 14627 922 155AssetsLeadershipTABLE 3 GROWTH IN REGISTRATIONS AND ENROLMENTS OF THE SOUTHAFRICAN NURSING COUNCIL 1944 -1994 (average annual growth) 9 35215 32227 52141 96065 96886 549Midwriferegistrations5 6449 34417 90129 04148 57351 47314 96624 676(6,5%)45 422(8,3%)71 001(5,6%)114 541(6,1%)138 022(2,1%)Persons onthe register?30 86443 521(4,1%)62 345(4,3%)79 350(2,7%)Singl

THE SOUTH AFRICAN NURSING COUNCIL : 50 YEARS OF PROFESSIONAL SELF-REGULATION WJ Kotze INTRODUCTION Self-regulation of the professions of nursing and midwifery became a reality in South Africa on 8 November 1944, when the first council meeting of the South African Nursing Council took place in Pretoria. Most appropriately, the opening speaker on .