Doctors often emphasize that it is the aftercare, subsequent to surgery or any other major medical procedure that determines the success of any medical intervention or treatment. In many cases classified as medical negligence matters it is sometimes not the treating doctor that caused the harm, but actually the nurses on duty at the time of the patient’s hospital stay and involved with the patient’s after care that are to blamed for subsequent injuries and harm.
A “nurse” is defined as a person registered as either a professional nurse, midwife, staff nurse, auxiliary nurse or auxiliary midwife in terms of section 31(1) of the South African Nursing Act 33 of 2005 (“the Act”), which registration enables such a person to practice nursing or midwifery. The Act further defines the profession of “nursing” as a caring profession practiced by a person registered as aforementioned, who supports, cares for and treats a health user (also known as a patient) to achieve or maintain health and where this is not possible, cares for a health care user so that he or she lives in comfort and with dignity until death. One of the main purposes of the Act is to establish a Nursing Council that must serve and protect the public in matters involving health services generally and nursing services in particular and to uphold and maintain professional and ethical standards within nursing (sections 3(a) and (i)). The Nursing Council must further ensure that registered nurses behave towards patients in a manner that respects their constitutional rights to human dignity, bodily and psychological integrity and equality and that disciplinary action is taken against persons who fail to do so (section 4(f)). This Council must further investigate complaints against registered nurses and take appropriate disciplinary action against such persons in accordance with the provisions of the Nursing Act in order to protect the public (section 4(g)).
Thus when faced with sub-standard nursing care the Act allows for a complaint to be lodged with the Nursing Council. Upon lodgement of such a complaint the Council may appoint a preliminary investigating committee to investigate all matters of alleged unprofessional conduct based on evidence and determine whether the case should be referred for a professional conduct inquiry (section 47(3)).
In consideration of whether the acts or omissions of the respective nurses are of such a nature as to discipline them reference will be made to the Regulations Setting out the Acts or Omissions in Respect of which the Nursing Council may take Disciplinary Steps, issued in terms of the Act and published on 1 October 2014 in the Government Gazette. Regulation 5(a) and (f) specifically determines that the failure to maintain the health status of a patient under the relevant nurse’s control through preventing accidents, injury or other trauma and providing specific care and treatment of the ill and the vulnerable and high risk patients are actions justifying disciplinary steps to be taken against the nurse.
The South African Nursing Council further compiled a Code of Ethics for Nursing Practitioners in South Africa which is a biding document and nurses must comply with its content. This document specifically requires nurses to do good and to choose the “best option” of care under given circumstances and act with kindness at all times – a principle called beneficence. This principle gives expression to compliance with nurses’ “duty of care” as a professional practice imperative. This code is based on and further obliges nurses to treat patients with respect, dignity and kindness, acknowledge the uniqueness of individual patients as well as the diversity of people in their care, the right to access to quality nursing and healthcare for all and the integrity of persons in their care within a culture of safety (amongst others).
Prior to instituting any actions against nurses, it is recommended that a formal complaint be filed with the nursing council.
By Marietjie Botes