SUBMISSION NURSING BILL OCTOBER 2005

1. SUBMISSIONNURSING BILLOCTOBER 2005 Society of Private Nursing Practitioners of South Africa

2. Who is a Private Nursing Practitioner Any Registered Nurse who provides nursing care in the private sector in an independent position: • An independent registered general nurse or midwife in the community; • A general nurse / midwife in the pharmacy or doctor’s rooms; • A general nurse providing care or education in a setting other than fulltime occupational health or as a paid employee

3. Who are the Private Nursing Practitioners? • Practice for their own account • Do not draw a regular salary • Work independently, although often in association with other health care professionals • Often provide employment for others - SMME

4. Services provided • Maternity: Ante- & Postnatal care, Childbirth preparation, Midwife deliveries, Contraceptive services • Well-baby clinics & Immunizations • General health: Wound care, Chronic care • Psychiatric nursing services • Specialist education: Diabetes education, HIV/AIDS, etc • Occupational Health and School Nursing • Palliative care of Terminally ill persons.

5. Support for the legislation • The Society welcomes the introduction of this Bill which has taken more than 5 years to reach this point. • Many of the concepts are welcomed as being in the best interests of the public and profession – particularly the introduction of continuing education for renewal of registration

6. Functions of the Council • subject to prescribed conditions and upon payment of a prescribed fee, issue a licence (sic)for a professional nurse to conduct a private practice • No definition of “private practice” • No indication that there will be consultation in respect of what would constitute prescribed (regulations or rules)

7. Payment of fees for license • Discriminatory as annual fees are already paid to Council for registration, in addition to costs for a Practice number (BHF), Dispensing License, and others, but ……. • In negotiating PPPs to extend services to clients who are able or choose to contribute toward their medical care, provincial governments insist that we not charge for consultations if State provides the materials (eg. vaccines, immunizations)

8. 31. Registration as a pre-requisite to practice (3) An employer must not employ or retain in employment a person to perform the functions pertaining to the profession of nursing, other than a person who holds the necessary qualification and who is registered under subsection (1) or (2).

9. 32. Registration of learners • (5) A health establishment must not allow access to clinical facilities for training purposes to anyone who is not registered as a learner nurse in terms of this Act.

10. Impact on training and services The impact of these clauses will prevent access to learning and utilisation of skilled support at a time when the health services are seriously understaffed. • Ancillary Health Workers are recognised by the public sector as legitimate health workers. Integral to the functioning of palliative, community and frail care facilities. • Doulahs– birthing support attendants

11. Registration of Additional Qualifications • The proposed legislation has omitted the previous distinction which recognises specialisation of nursing (advanced nursing practice) • This is viewed as a regressive step for the profession which struggles to retain skilled practitioners. Staff shortages result in practitioners being required to work in fields in which they do not have expertise.

12. 56. Special Conditions • Section 38A was added to the previous Act to enable a select group of suitably qualified nurses in the public sector to diagnose, prescribe and dispense as these have not traditionally been part of the Scope of Practice of the RPN • New s56(1) – (5) remedies this by enabling the Council to extend the function of suitably qualified RPNs. However, this section also extends this function to the midlevel nurses – RM & RSN

13. Proposed s56(1) • Section 30 (1) & (2) define the scope of practice of the professional nurse and midwife as “qualified and competent to independently practise comprehensive nursing / midwifery in the manner and to the level prescribed and who is capable of assuming responsibility and accountability for such practice.” • (3) defines a “staff nurse is a person educated to practise basic nursing in the manner and to the level prescribed”, • It is not logical that a practitioner who is a midlevel practitioner and does not assume responsibility and accountability should practice at this advanced level. They may have skills, but they lack the critical knowledge, placing patients’ lives in jeopardy

14. Proposed s56(6) This section restates the old S38A, but enables the DG to authorise any public sector nurse to carry out activities which require additional qualifications, and appears to override the Council’s quality assurance systems ….”after consultation with the Council, … if the services of a Medical Practitioner or Pharmacist … are not available”

15. Is this Act binding on the State? • Unlike other health related Acts, this Act appears to have omitted the section which binds the State to the Act. • In light of the previous comment, this is of particular concern.

16. S56 (7) Sale of medicines • This clause restricts pharmacy ownership and “open shop”, but only for the categories RPN & RSN • Concern that lower categories are not included in this restriction. The public seldom distinguishes between levels of qualification and leaves a potential loophole for ownership.

17. Erosion of the Principals of Democracy • The removal of the right of the profession to elect either a proportion of the Council members or the Chairperson is considered to be an encroachment on democratic rights. • This disenfranchisement of the profession makes the Council a subordinate structure of the Dept of Health, rather than being the controlling body of a profession.

18. Exclusions from Council Unfitness to practice due to mental illness In previous submissions, we requested an inclusion of the definition of “mental illness” and “mental health care user”. The Society supports the rights of people who have undergone treatment to take their rightful place in society and not be discriminated against. Provision should be made for membership of the Council to be resumed where a person has returned to full function.

19. Conclusion • We believe that the proposed legislation is urgently required and should proceed with a minimum delay to enable nurses to provide quality care to patients and clients, particularly in regions where there are insufficient service. • To ensure the safety of our patients and clients, it is essential that safe levels of practice and professional levels of control and accountability are exercised, and the principals of democracy should not be compromised.

20. Thank you

21. Contact Details • President: Monika Springer 0837020018 • monika@mecosa.co.za • Presenter & Immediate Past President: Debbie Regensberg 021-6716259 • spnp@comficor.co.za • P O Box 1844, Bromhof 2154