First Draft

SCOPE OF PRACTICE OF THE NURSE AND MIDWIFE

OVERVIEW OF PROCESS

The task team perused the current documentation of the South African Nursing Council, other nursing councils, and the outcomes of the Holiday Inn workshop. It was decided to take the following approach to new Scope of Practice Regulations:

1. Define a nurse and a midwife to enable the Council to protect the title and the practice of these professions. The task team used a definition proposed by one of the groups at the workshop and amended it by referring to other documents.
2. Write a preamble, which explains the current approach to Scope of Practice formulations, and leads into the Code of Practice.
3. Developed a Code of Practice for Nurses and Midwives, which would be applicable to all categories.

This proposed regulation will replace the Scope of Practice Regulations (R2598), as well as the Acts and Omissions Regulations (R387), Improper and Disgraceful Conduct of Enrolled nurses (R1648).

PREAMBLE

A Scope of Practice refers to the knowledge, practices and attitudes required to fulfil a professional role. Scopes of Practice can be used as a reference when writing standards for educational programmes and to provide guidelines for workers. As such they can be used to decide what can be expected from a professional in a general way. It usually does not include a complete list of what a professional is allowed to do.

The Scope of Practice of Nurses and Midwives in South Africa should be read in the context of the following:

• The Constitution of the Republic of South Africa, especially the right of everyone to health care services and the right of the state to take reasonable legislative measures to achieve these rights and to regulate the practice of occupations or professions
• The White Paper for the Transformation of the Health System in South Africa which sets out to reduce disparities and increase access based on primary health care principles
•  The Charter of Patient Rights which translates these broad objectives into more specific rights
•  The Human Resources for Health Task Team (2000) which made a range of recommendations to facilitate the implementation of primary health care within the financial and human resource limitations of the country

It is generally agreed that Scope of Practice should not be too restrictive, since that could artificially limit practitioners from assisting where they are able to do so. At the same time a Scope of Practice should not be so vague as to allow for numerous interpretations of what is meant. It is also preferable that a Scope of Practice be stated positively, in terms of what are the expectations of practice, instead of negatively, in terms of what should not be done. It is absolutely essential that a Scope of Practice be embedded in the reality of the country for which it is formulated.

1.    SCOPE OF PRACTICE

1.1    The scope of practice of the nurse and midwife depend on the needs of the community for nursing, midwifery and health care. These national human needs are assessed by the Regulatory Body and the educational programmes prescribed for nurses and midwives are shaped to produce practitioners able to address the needs. The practice of the nurse and midwife is grounded on the ethical principles embodied in the Codes of Practice and is based on the nature and extent of their education, knowledge and experience.

1.2    The practice of a nurse or a midwife requires the application of knowledge and the simultaneous exercise of judgement and skill. Practice takes place in a variety of settings (primary, secondary and tertiary levels of care) and in a context of continuing change and development. Such change and development may result from advances in science and technology leading to improvement in treatment and care; from alterations to the provision of health services or health policies and as a result of new approaches to professional practice. Practice must therefore be dynamic and have the capacity to adjust where and when appropriate to changing circumstances.

1.3    The multidisciplinary team, the support network of clients and the available community and health resources vary according to circumstances and influence the nature of professional interaction and the decision-making and actions of the nurse or midwife. The eventual determinant for practice in each profession is the discretion, decision-making ability and professional integrity of the individual practitioner. As professional practitioners in their own right, it is the duty of each to determine the bounds of personal practice in a given situation and to accept responsibility for it.

1.4    It is recognized that there is a significant overlap between the roles of different health care professionals. The degree of merging of roles and the professions involved differs according to the setting and type of practice of the nurse. The team functioning in such situations should be guided by the needs of the clients, the expertise of the individuals concerned and the principles of mutual respect and cooperation.

1.5    Entry level education programmes prepare the nurse or midwife for generalist practice. Thereafter specialized educational programmes prepare the nurse or midwife for expanded or extended practice.

2.    DEFINITIONS OF A NURSE AND A MIDWIFE

2.1    A Nurse

A nurse is a licensed person who is registered with the South African Nursing Council based on completion of a recognized education and training programme to nurture, assist and treat the client, who can be an individual, family or group, sick or well, in the performance of those activities that contribute to the attainment or maintenance of health, to optima recovery and rehabilitation or to a peaceful, dignified death. In working with the clients according to prescribed professional codes, they are acknowledged as equal partners by helping them gain independence as rapidly as possible.

2.2    A Midwife

A midwife is a licensed person who is registered with the South African Nursing Council based on completion of a recognized education and training programme to nurture, assist and treat the client, who can be a woman, a neonate or a family, in the process of promoting a health pregnancy, labour and post partum period. In working with the clients according to prescribed professional codes, they acknowledge them as equal partners.

3.    CODE OF PRACTICE OF THE NURSE AND MIDWIFE

3.1    Act in such a manner as to protect the health status, interest and well-being of the client, especially clients vulnerable due to health status, age, disability or social position

3.2    Ensure the safety of the client by measures such as correct identification, safe application of diagnostic and therapeutic interventions, appropriate monitoring of the client’s condition and accurate and complete recording of care and observations, timeous and appropriate referral of the clients, consultation and/or giving assistance in an emergency situation

3.3    Recognize and respect the uniqueness and dignity of each client irrespective of ethnic origin, religious beliefs, personal attributes, nature of the health problems or any other factor

3.4    Avoid any abuse of the privileged relationship with clients and of the privileged access allowed to their person, property, residence or workplace. Respect confidential information obtained in the course of professional practice and refrain from disclosing such information without the consent of the client or an authorized person

3.5    Deliver equitable care and use products according to the need of patients, not allowing the receipt of gifts, financial or otherwise, from clients or any other party to influence care decisions

3.6    Maintain and improve professional knowledge and competence expected within the professional practice and ensure that practice is based on current best practice guidelines

3.7    Ensure practice is within the legislative and health policy framework of the country

3.8    Work in an open, gender and culture sensitive manner with clients, foster their independence and recognize and respect their involvement in the planning and delivery of care

3.9    Work in a collaborative and cooperative manner with health care professionals and others involved in providing care and services and recognize and respect their particular contributions within the care team

3.10    If a nurse is asked to perform a function that is not usually seen as being part of the scope of practice, she/he does this only if properly trained, competent and authorized and if she/he takes responsibility for these actions

3.11    Acknowledge any limitations in own knowledge and competence and decline any duties or responsibilities unless able to perform them in a safe and skilled manner. This as to be read with clause 3.6

3.12    Report to an appropriate authority at the earliest possible time any conscientious objection which may influence practice

3.13    Report to the appropriate authority any circumstances in the environment of care that could jeopardise standards of care, safety of clients and colleagues and act as a client advocate when the need arises

3.14    Assist colleagues within own sphere of responsibility to develop their professional competence and to contribute safely according to their own roles

3.15    Manage the human and other resources within own sphere of responsibility in a manner that will ensure that safe and competent nursing and health care services can be delivered

3.16    Refrain from using registration status to promote commercial products or services

3.17    Take over a case from another nurse only when part of a team, or when asked by that nurse, or when asked by the client after notification by the client of the previous nurse