South African Nursing Council

Rules Setting Out the Acts or Omissions in Respect of Which the Council May Take Disciplinary Steps

The Minister of Health and Welfare has, on the recommendation of the South African Nursing Council, determined that the acts or omissions meant in section 35 of the Nursing Act, 1978 (Act 50 of 1978), are the acts or omissions specified in the Rules set out in the Schedule hereto.

SCHEDULE

CHAPTER 1

Definitions

1.    In these rules “the Act” shall mean the Nursing Act, 1978 (Act 50 of 1978), and any expression to which a meaning has been assigned in the Act shall bear such meaning, and, unless the context otherwise indicates-

“advertisement” shall mean any written, illustrated, visual or other descriptive material or verbal statement or reference-

(a)    which appears in a newspaper, magazine, pamphlet or other publication;

(b)    which is distributed amongst members of the public;

(c)    which has been fixed to, or appears on walls, windows or boards; or

(d)    which is brought to the attention of members of the public in any other manner whatsoever,

and which is meant to –

(i)    promote a specific practice or a specific practitioner’s technique or treatment;

(ii)    make known a practitioner’s professional proficiency or knowledge;

(iii)    make known a product or business or institution or organisation of any nature whatsoever, for whatever purpose and in any way whatsoever,

and “advertising” shall have a corresponding meaning;

“bona fide patient” shall mean a patient who has at any time previously been treated by the practitioner concerned;

“section” shall mean a section in the Act.

CHAPTER 2

REGISTERED NURSES

2.    Subject to the proviso in section 35, it is hereby determined that the acts or omissions set out in this chapter, are deemed to be acts or omissions in respect of which the council can take disciplinary steps against a registered nurse in terms of Chapter 4 of the Act.

Practice

3.    Wilful or negligent omission to carry out such acts in respect of the diagnosing, treatment, care, prescribing, collaborating, referral, co-ordinating and patient advocacy as the scope of his profession permits.

4.    Wilful or negligent omission to maintain the health status of a patient under his care or charge, and to protect the name, person and possessions of such a patient, through-

(a)    correct patient identification;

(b)    determining the health status of the patient and the physiological responses of the body to disease conditions, trauma and stress;

(c)    the correct administration of treatment, medication and care;

(d)    the prevention of accidents, injury or other trauma;

(e)    the prevention of the spread of infection;

(f)    the checking of all forms of diagnostic and therapeutic interventions for the individual;

(g)    specific care and treatment of the very ill, the disturbed, the confused, the aged, infants and children, the unconscious patient, the patient with communication problems and the vulnerable and high-risk patient; and

(h)    the monitoring of all the vital signs of the patient concerned.

5.    Wilful or negligent omission to keep clear and accurate records of all actions which he performs in connection with a patient.

6.    Purporting to perform the acts of a person registered in terms of the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act 56 of 1974), and the Pharmacy Act, 1974 (Act 53 of 1974), unless the nurse is also registered in such a capacity.

Advertising

7. (1)    Subject to the provisions of subrule (2) a nurse may not-

(a)    advertise;

(b)    permit his name to be used in a professional capacity in connection with advertising.

(2)    The following actions of a nurse are not deemed to constitute advertising:

(a)    A communication to a bona fide patient concerning change of address, hours of consultation and telephone numbers or the establishment or dissolution of a partnership, provided such communication is addressed to the patient concerned and is enclosed in an envelope;

(b)    A communication to another nurse, midwife, medical practitioner, dentist, member of a supplementary health service profession, social worker, hospital, person or institution approved by the council, that he has commenced a practice, provided such communication is addressed to the persons concerned and is enclosed in an envelope;

(c)    The entry, in ordinary print, of his name, profession, field of practice, residential and consulting rooms addresses and telephone numbers and the name, profession and field of practice of a partner, in an official telephone directory;

(d)    The publication of articles of a health science nature in professional journals and books in connection with health, with mention of his name and professional qualifications;

(e)    The divulgence of his views on topics of a health science nature in the lay press or on the radio or television or the holding of a lecture or address for a lay audience, with mention of his name, where such a nurse-

(i)    serves in a full-time or part-time capacity in health services or post-secondary educational institutions and is not in private practice; or

(ii)    acts as an officer or member of the South African Nursing Association or of the council and on instruction of such association or the council;

(f)    the use of a name plate as stipulated in rule 8 or rule 9;

(g)    the use of stationery as stipulated in rule 10;

(h)    the acts referred to in rule 12(2) or rule 18(3); and

(i)    the promotion of the interests of an organisation registered in terms of the National Welfare Act, 1978 (Act 100 of 1978), a professional nursing association or society, a health service at any level of government, an educational service approved by the council and any other organisation, body or institution approved by the council.

Name plates

8. (1)    The permanent consulting rooms of a nurse in private practice shall, and the permanent residence of such a nurse may, be indicated only by a name plate as stipulated in this rule, which shall not exceed 360mm x 210mm in size and which shall bear only the nurse’s-

(a)    title, initials and surname;

(b)    registered profession and field of practice;

(c)    professional qualification or qualifications the use of which, in the case of such a nurse, is authorised by the council;

(d)    telephone number(s); and

(e)    hours of consultation:

Provided that where a nurse prefers not to have particulars concerning telephone numbers and hours of consultation indicated on such name plate, a separate plate, not exceeding 360mm x 210mm in size, with the nurse’s telephone number(s) and hours of consultation, may be affixed directly below such name plate.

(2) (a)    In the case of an itinerant practice the nurse’s consulting rooms shall be indicated only by a name plate as stipulated in subrule (1), with the addition of the days and hours of consultation when the said nurse is available at the said consulting rooms.

(b)    The further information stipulated in paragraph (a), may be indicated on a separate plate or surface, not exceeding 360mm x 210mm in size.

(3)    Not more than one name plate may be displayed at each entrance to a building in which a nurse’s consulting rooms are situated and one on or next to the door of such consulting rooms: Provided that a name plate may be affixed to an outer wall or pillar of such building with the prior approval of the council, where such a building does not have suitable facilities for a name plate to be affixed thereto: Provided further that the particulars stipulated in subrule (1) may, with the prior approval of the council, be affixed in a framed area of 360mm x 210mm on a glass window as close as possible to the entrance of the building in which the consulting rooms are situated, where such a building has no facilities for a name plate to be affixed thereto.

(4)    Where facilities exist in the entrance hall or on the ground floor of a building in which a nurse’s consulting rooms are situated, to indicate the names of tenants, the nurse’s title, initials, surname and profession may be indicated in such places.

(5)    A plate with the initials and surname of a nurse and a direction indicator thereon, may be displayed in the corridor of the floor where the nurse’s consulting rooms are situated.

9. (1)    If a nurse takes over the practice of another nurse or if a partner in the practice dies or retires, the name plate of the predecessor concerned, the deceased or the retired partner may be displayed for no longer than 12 months after the date of such take over, death or retirement, during which period the name of the person who has taken over the practice shall appear on such name plate.

(2)    If a nurse moves to consulting rooms at a new address, a notice to this effect, mentioning the new address of his consulting rooms, may be displayed at his previous address for no longer than 12 months from the date of such move.

Stationery (including visiting cards)

10.    Only the following information may appear on professional stationery:

(a)    The name of the nurse and partner, if any;

(b)    the registered profession, field of practice and abbreviations in respect of qualifications registered by the council;

(c)    addresses and telephone numbers;

(d)    hours of consultation.

Canvassing

11.    A nurse may not, either personally or through the mediation of an agent or in any other manner, canvass or tout for a patient for himself or for any other person.

Itinerant practice

12. (1)    An itinerant practice may be carried on where a nurse renders a complete and satisfactory service to his patients in such a practice on a regular basis.

(2)    Such service shall be rendered at least once a month and shall be similar to the service which he renders at the place where he carried on his main practice.

(3)    Subject to the provisions of rule 8(2)(a) and (b) a nurse may make his intention to visit a place known to the persons mentioned in rule 7(2)(a) and (b).

Financial interest

13.    A nurse may not-

(a) (i)    accept or insist on any commission or remuneration, financial or otherwise, from manufacturers of, or dealers in medicines, remedies or any equipment, apparatus, instrument, appliance or material which is used in the course of his practise or prescribed to patients;

(ii)    pay or give anybody commission or remuneration, financial or otherwise, or offer anybody anything for the recommendation of patients;

(iii)    accept any commission or remuneration, financial or otherwise, from somebody for the recommendation of patients;

(b)    share any fees collected for a service, with anybody other than a partner, unless such sharing is commensurate with the extent of such other person’s participation in the rendering of such service.

(c)    charge higher fees for professional services rendered than any fees prescribed in terms of section 45(1)(r) of the Act.

Certificates

14. (1)    A certificate required from a nurse in his professional capacity, may only be issued by such a nurse if, as a nurse, he is convinced, from his personal observation or from what the patient has communicated to him, that the facts stated in such a certificate are correct.

(2) Where such a certificate is issued only on the grounds of the communication of a patient or another person, such fact shall be specifically mentioned in the said certificate.

Professional secrecy

15. (1)    Subject to the provisions of subrule (2), a nurse may not divulge any information concerning a patient which has become known to him in his professional capacity.

(2)    This rule is not applicable if such information is made known-

(a)    with the explicit consent-

(i)    of a patient who is of age;

(ii)    of the parent or guardian of a patient who is a minor; or

(iii)    of the surviving spouse or child who is of age, of a patient who is deceased;

(b)    where instructed thereto by a court of law or where a nurse is otherwise lawfully bound thereto;

(c)    in the exclusive interest of a patient who is not able to, or is not capable of, granting permission; or

(d)    in a professional consultation with anybody involved in the treatment of the patient or, in the exclusive interest of the patient, with somebody else.

Medicines, apparatus and processes

16.    No use may be made in a practice of-

(a)    any form of treatment, apparatus or process which is secret or claimed to be secret;

(b)    any apparatus which upon inspection by the council does not prove to be capable of fulfilling the claims made in respect thereof;

(c)    diagnostic and treatment methods which do not comply with the accepted standards as determined by the council from time to time.

Impediment

17.    A nurse may not impede a patient or a person properly acting on behalf of a patient, who desires to obtain the advice of or treatment by another person who is authorised by law to advise or treat persons concerning their health, to consult such a person.

Acts and exhibition of certificates

18. (1)    Except in case of emergency a nurse may not perform an act-

(a)    which does not pertain to his registered profession;

(b)    for which he has inadequate training or experience.

(2)    A nurse may not-

(a)    use consulting rooms connected to or with a corridor to a premises or portion thereof where another business, trade, work or profession than that profession in which he is registered in terms of the Act, is practised or carried on: Provided that the entrance and corridors of a public building in which his consulting rooms are situated, or a connection which may not be used by patients, are not deemed to be an unauthorised connection or thoroughfare;

(b)    practise or carry on from his consulting rooms any business, trade, work or profession except the profession in which he is registered in terms of the Act, except with the prior written consent of the council and subject to such conditions as the council may determine; or

(c)    share consulting rooms with someone other than a person referred to in rule 19(1)(a), without the prior written consent of the council.

(3)    A practitioner may display only the following certificates in his consulting rooms:

(a)    Certificates, diplomas and degrees which have a bearing on the profession in which he is registered; and

(b)    membership certificates of professional associations with which he is affiliated.

(4)    A nurse shall display clearly in his consulting rooms the registration certificate issued to him in terms of the Act.

Co-operation, partnership and service contracts

19. (1)    Subject to the provisions of subrule (2), a nurse may not, in the practise of his registered profession-

(a)    enter into a partnership or where such partnership already exists at the coming into effect of these rules, other than with the council’s approval and subject to conditions which the council determines, maintain it or co-operate with a person who is not-

(i)    registered or enrolled in terms of the Act;

(ii)    registered in terms of any other act in respect of a profession which is approved by the council in the public interest and with consideration of professional ethics, as an acceptable profession for the purposes of partnership or professional co-operation;

(b)    unilaterally and without the approval of the other party, break a contract of service into which he has entered;

(c)    refuse or in a deliberate or negligent manner fail to execute any lawful duties for which he has been employed;

(d)    support or assist any person in any way in illegal practice or action;

(e)    employ somebody to perform nursing acts, who is not registered or enrolled in terms of the Act.

(2)    Subrule (1) shall not apply in an emergency.

Tendering

20.    A nurse may not tender for a full-time, part-time or any other kind of nursing appointment.

Supersession

21.    A nurse may not-

(a)    take the place of another nurse or midwife who is in charge of a case in respect of which he acted together with or on behalf of such a nurse or midwife, except with the consent of such nurse or midwife who was in charge of the case originally, unless the consent is refused unreasonably or unless no other nursing, midwifery or medical assistance is available;

(b)    take over a case of another nurse or midwife unless he is convinced that the patient or person in charge of the case has notified such nurse or midwife that he no longer requires his services.

Delay in obtaining medical assistance

22.    In accordance with the exigencies of the circumstances and the seriousness of the patient’s condition, a nurse may not neglect-

(a)    to refer the patient for medical care where such care is beyond the scope of practice of the nurse and may not delay such referral;

(b)    to do what he can to save a life, to arrest deterioration in the health status of the patient, to prevent deformity or to reduce pain and suffering;

(c)    in circumstances where a patient is in the care of such a nurse but the control over the medical treatment of a patient rests with someone other than the nurse, to execute without reasonable grounds any verbal or written prescriptions or any request made to the nurse by that person with regard to the medical treatment of such a patient, or where such prescription or request is not executed, to inform such a person of the non-execution thereof as soon as practicably possible.

Professional reputation of other persons

23.    A nurse may not unjustly cast reflection, explicitly or by implication, upon the probity or professional reputation, skill, knowledge, service or qualifications of any person registered or enrolled under the Act or under any other act.

Relations with the council, its members and officials

24.    A nurse may not perform any wilful act which is calculated to-

(a)    prevent the council, a committee of the council or the registrar from performing a duty which may be lawfully performed by the council, such committee or the registrar;

(b)    bring the council or any member or official into contempt or discredit.

Exploitation

25.    A nurse may not permit himself to be exploited in a manner detrimental to the public or to professional interest.

Repeal

26.    The regulations published under Government Notice R.1650 of 14 September 1973, as amended by Government Notice R.481 of 10 March 1978, are hereby repealed.

CHAPTER 3

REGISTERED MIDWIVES

27.    Subject to the provisio to section 35, it is hereby determined that the acts or omissions set out in this chapter, shall be deemed to be acts or omissions in respect of which the council may take disciplinary steps against a registered midwife in terms of Chapter 4 of the Act.

28.    Rules 7 to 25 shall mutatus mutandis apply to a registered midwife.

29.    Wilful or negligent omission to carry out such acts in respect of the monitoring, diagnosing, treatment, care, prescribing, collaboration, referral, co-ordination and patient advocacy as the scope of his profession permits.

30.    Wilful or negligent omission to protect the name, person and possessions of a mother and child under his care or charge in the course of pregnancy, labour and the puerperium through-

(a)    the correct identification of the mother and child;

(b)    the prevention of accidents, injury or other trauma;

(c)    the prevention of infection and of the spread of infection;

(d)    the checking and monitoring at reasonable intervals of all forms of diagnostic and therapeutic interventions;

(e)    the specific care and treatment of the vulnerable, high-risk mother and child, the seriously ill, the disturbed, the confused, the unconscious patient and the mother with communication problems.

31.    Wilful or negligent omission to keep clear and accurate records of the progress of pregnancy, labour and the puerperium and all acts which he performs in connection with a mother and child.

32.    Failure to comply with the conditions under which he may carry on his profession, as promulgated by Government Notice No. R.2488 of 26 October 1990.

33.    Purporting to perform the acts of a person registered in terms of the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act No. 56 of 1974), or the Pharmacy Act, 1974 (Act No. 53 of 1974), unless the registered midwife is also registered in such capacity.

CHAPTER 4

ENROLLED MIDWIVES

34.    Subject to the proviso to section 35, it is hereby determined that the acts or omissions set out in this chapter shall be deemed to be acts or omissions in respect of which the council may take disciplinary steps against an enrolled midwife in terms of Chapter 4 of the Act.

35.    Rules 7 to 25 shall mutatis mutandis apply to an enrolled midwife.

36.    Wilful or negligent omission to identify health needs and to promote the health of mother and child through such acts and procedures as the scope of his practice permits.

37.    Wilful or negligent omission to protect the name, person and possessions of a mother and child under his care or charge through-

(a)    the correct identification of the mother and child;

(b)    the prevention of accidents, injury or other trauma;

(c)    the prevention of infection and of the spread of infection;

(d)    the carrying out at reasonable intervals of all observations and interventions while the mother and child are in his care, and the recording thereof.

38.    Failure to comply with the conditions under which he may carry on his profession, as promulgated by Government Notice No. R.2488 of 26 October 1990.

39.    Purportion to perform the acts of a person registered in terms of the Act, the Medical, Dental and Supplementary Health Service Professions Act, No. 56 of 1974, or the Pharmacy Act, No. 53 of 1974.