The Responsibilities of Nurses, the Heartbeat of Health Care

By Jolane van der Walt-Nieuwoudt (LLB) (LLM)

Nursing is a vital part of the healthcare system, and nurses are often described as the “heartbeat of healthcare.” They direct their energy towards the prevention, promotion, maintenance, and restoration of individual health. Expansive knowledge is required for nurses to perform their duties and render holistic patient care competently, ethically, and legally. Nurses pledge to take responsibility for the care they provide and to answer for their own decisions. They are expected to perform their actions in accordance with the requirements of the nursing professional bodies and the law.

The Nursing Act (Act 33 of 2005) regulates all matters concerning the nursing profession. It falls under the authority of the Minister of Health, but for all intents and purposes, its administration and regulation are in the hands of the South African Nursing Council (SANC). The SANC is a statutory professional body mandated to regulate the Nursing and Midwifery professions by establishing and maintaining nursing education and training and practice standards. The council also advocates on behalf of the public in matters concerning nursing. However, the SANC is not an employer or a trade union, and the council does not become involved in labour disputes, salaries, working conditions, or staff shortages, etc.

Nurses are expected to apply their knowledge, skills, and experience to care for the needs of the patient. When care falls short of standards due to resource allocation or a lack of understanding of relevant policies and legislation, the nurse bears this responsibility. There is a close collaboration between the government and the SANC, as the Nursing Act assigns powers to the SANC. Although the SANC has the independence to regulate the profession, it is accountable to the government in terms of its activities and the profession. Amongst a host of functions, an important function of the SANC is the regulation and control of professional conduct. The Nursing Act provides for disciplinary control of the profession by the SANC.

In cases of misconduct, the SANC is given quasi-judicial powers to enquire into charges of misconduct and to impose sanctions or penalties where misconduct is evident. The procedure for misconduct and the penalties are prescribed by law. A patient has the right to lodge a complaint with the Nursing Council about the alleged misconduct of a nursing or midwifery professional/student. The Nursing Council will investigate any complaint of conduct that violates the high standards of care to which a patient is entitled.

All complaints are treated as confidential and must be in writing. For each written complaint received, the nursing or midwifery practitioner/student concerned must be clearly identified, and the allegation well specified. All relevant information will be obtained, and the matter will be duly investigated. A report is submitted to the Preliminary Investigation Committee. The Preliminary Investigation Committee may either impose a fine or refer the complaint to the Professional Conduct Committee for a professional conduct inquiry. In the latter case, a formal professional conduct inquiry will be held during which evidence is heard, and a finding reached.

A nursing or midwifery practitioner/student found guilty in accordance with the Nursing Act is liable to one or more of the following penalties:

• Removal from the register of practitioners/students
• Suspension from practicing/training
• A caution
• A reprimand
• A fine
• Payment of the costs of the proceedings

Complaints against a nursing practitioner must be distinguished from complaints lodged against all other healthcare professionals. Health care professionals, such as doctors, dentists, physiotherapists, etc., are regulated by a different body called the Health Professions Council of South Africa (HPCSA). Formal complaints against a doctor must be lodged with the HPCSA. Formal complaints against private hospitals may be lodged with the Hospital Association of South Africa (HASA) and formal complaints against a public hospital may be lodged with the Department of Health.