The South African Nursing Council Aspects of Its Development 1944-1984 Establishment of the Council Port Elizabeth and Vice-president of the South African Nursing Council. V O L 8 N O 4 Role of the S.a. Trained Nurses' Association

In a m em orandum subm itted to the Com mission on N ational H ealth Services in 1943 th e O rganising Sec­ retary of the South A frican T rained N urses' A ssociation, M rs. Sharley C ribb, w rote th e following, quoted from th e S outh A frican N ursing Jo urnal, F eb ru ary 1943 — It is only too evident that we have reached a stage in the history o f the nursing profession in South A frica when drastic reform s are necessary to prevent a serious decline in the quality and quantity o f nurses. The recent agitation fo r the fo rm a ­ tion o f a Trade Union o f Nurses is a warning that unless we are able to achieve legal stability fo r the p rofes­ sion, we shall be fa ced with a state o f chaos and cleavage am ongst nurses which will be to the serious detri­ m ent o f the patient, and therefore collectively to the co m m unity. .. W h ils t a p p r e c ia tin g f u l l y the necessity fo r com plete understand­ ing and cooperation between the doctor and the nurse the intelligent w om an o f today cannot be expected to be content, after extensive and in­ tricate training, to be denied the con­ trol o f her ow n destiny. She is ex­ pected at times to take the responsi­ bility o f life and death into her hands, but the conditions under which she is to w ork are laid down by a body [referring to the S.A. M edical and D en tal C ouncil — W .J.K .], the nursing representation on which is 2 o u t o f 25. The D epartm ent o f Justice does n o t presum e to legislate fo r Barris­ ters or A ttorneys, who have their separate field s o f activity and re-OPSOMMING Die S.A. Raad op Verpleging is in 1944 ingestel en hierin het die professionele vereniging van die verpleegberoep 'n groot rol vertolk. As werkgewer en ekonomiese entiteit dra die Raad by tot algemene maatskap-like ontwikkeling. Sy bydrae tot die ontwikkeling van 'n geordende samelewing lê verder in die p rofession ele o n tw ik …

In a m em orandum subm itted to the Com mission on N ational H ealth Services in 1943 th e O rganising Sec retary of the South A frican T rained N urses' A ssociation, M rs.Sharley C ribb, w rote th e following, quoted from th e S outh A frican N ursing Jo urnal, F eb ru ary 1943 -It is only too evident that we have reached a stage in the history o f the nursing profession in South A frica when drastic reform s are necessary to prevent a serious decline in the quality and quantity o f nurses .The recent agitation fo r the fo rm a tion o f a Trade Union o f Nurses is a warning that unless we are able to achieve legal stability fo r the p rofes sion, we shall be fa ced with a state o f chaos and cleavage am ongst nurses which will be to the serious detri m ent o f the patient, and therefore collectively to the co m m unity . . .W h ils t a p p r e c ia tin g f u l l y the necessity fo r com plete understand ing and co-operation between the doctor and the nurse the intelligent w om an o f today cannot be expected to be content, after extensive and in tricate training, to be denied the con trol o f her ow n destiny.She is ex pected at times to take the responsi bility o f life and death into her hands, but the conditions under which she is to w ork are laid down by a body [referring to the S.A .M edical and D en tal C ouncil -W .J. K .], the nursing representation on which is 2 o u t o f 25. 'n Hoogtepunt is bereik met die herorganisasie van die verpleegonderwysstelsel en die amptelike erkenning van pro fessionele verpleegonderwys as nasekondêre onderw vs. sponsibility.We can see no reason why a body o f highly qualified p ro fessional w om an should be denied se lf governm ent . .

. In the interests o f the com m unity the nursing service should be a legally constituted national body devoting the best intel lects fro m its ranks to the achieve m ent o f progressive im provem ent o f training, etc., in order that the patient m ay always receive the m ost skilful nursing. O nly by giving nurses the control o f their ow n p ro fession will that sense o f civic re sponsibility be developed in the nurse and the true national character o f the w ork emerge . . . It seems to m e that the provision o f satisfactory nursing legislation is the test o f the sincerity o f any g o v e r n m e n t's p o lic y reg a rd in g national health, fo r the nursing ser vice is basically essential to national health.
W ith these w ords M rs.C ribb had voiced the frustrations of a united nursing profession dem anding the legal and public recognition that its leaders had been fighting for for m ore than half a century.

Role of the S.A. Trained Nurses' Association
The m ajor role that the South A fri can Trained N urses' A ssociation played to unite and involve the p ro fession in the developm ent of a Nursing Bill, through its Organising Secretary and especially through its official Journal, The South African Nursing Journal becom es clear when one pages through the '40s publications of this m agazine - We have entered the last lap o f the race and we m ust p u t our utm ost ef forts into it.Your co-operation and unity have won the day so far, m ain tain and strengthen these, and the race is won.
When our Bill becomes law it will be up to each and every one o f us to show that we have deserved the con fidence placed in us, and I think we m ust all begin to think now o f our responsibilities as citizens and m ake up our m inds that we will each do our share in giving the people o f South africa the very best nursing service possible.12)

First meeting
O ne feels strangely touched and filled with a sense of solidarity, a part of the proud m om ent as d e scribed by Miss

The meeting was held in the beautiful setting o f the Union Build ings, Pretoria (W est Wing, Confer ence Room ), and the considerable g a th e rin g p r e s e n t in d ic a te d the extent o f the general interest in this auspicious occasion.
The Minister (Mr. Lawrence) who sponsored the Nursing A ct through Parliament . . .opened the meeting and . .

. made special refer ence to those who had laboured so industriously to place the N ew A ct on the Statute B ook, particularly to the South African Trained Nurses' Association in the person o f their Organising Secretary, whose efforts materially assisted in the results achieved. 141
The continual striving untiring work and enthusiasm on the part of leaders of the profession and the com m unity in the cause of nursing, and their faith in the ability of nurses and the nursing profession, led to the birth of the South African Nursing Council.As a result the safety of the com m unity was guaranteed and com m unity confi dence in nursing as a profession becam e visible.T h erefore, it w ould be b etter to deal with th e facts ra th e r than draw ing idealistic conclusions.
T here is no in ten tion of em pha sising the principles underlying the functioning of a N ursing C ouncil, or to discuss th e functions of the Council as th e institution respons ible for control of th e professional.As much as th e au th o r would have p referred to do so it will not be possible to analyse developm ents in full.It will tak e m any hours of re search to give an accurate, concise overview of developm ents since the establishm ent of the Council.

Terms of office
It is interesting to n o te th at the First Council existed for two years only and th at its m em bers, in accordance with an oral agreem ent betw een the leaders of the profession and the M inister, w ere all appointed by the M in ister.15

Composition of Council
According to an extract from the G overnm ent Gazette of 27 O ctober 1944, tw enty-four m em bers as stipulated by the A ct, w ere ap pointed to Council for the tw o-year period 1 Novem ber 1944 to 31 O ctober 1946.These m em bers were  The num ber of Council m em bers who served on the various councils are shown in table 1.20)An im portant characteristic of the com position of the Council is that the em phasis over the years has been on professional expertise rather than on representation of group interests.A t the start of the term of office of the F ourth Council two W hite m em bers w ere elected to represent the interests of the Black and C oloured nurses on the C oun cil.21*The Eighth Council intro duced the era of representation of Black, C oloured and Indian nurses at this level by registered nurses from their own population groups.
The Presidents elected for the various term s of office are also indi cated in table 1.The longest serv ing President was Miss.C onstance N othard who served for sixteen years.
The term of office of the 3rd Council is noticeably long.The re vision and replacem ent of the Act at this stage is probably the reason for this.T h e S o u th A f r ic a n N u r s i n g Council is the em ployer of 125 people; its current annual expendi ture on salaries exceeds R l,2 million, the average per capita am ount spent annually on salaries being R9 700.
The growth of the post structure of the Council from 1945 to 198423' is reflected in table 2.
A part from salaries the C ouncil's em ployees enjoy all the fringe b en efits offered by a m odern em ployer, that is, retirem ent, medical aid, h o liday and sick leave benefits.The policy with regard to post structure and personnel affairs is sufficiently flexible to allow for dynam ic and ef fective personnel adm inistration in which the interests of both the em ployee and consum er are best served.
The Council also contributes to the South A frican econom y as can be seen when some aspects of finan cial interest are taken into consider ation.Tables 3 and 4 give an idea of the grow th th at has occurred over the past four decades and indicates that within ten years the Council was, and still is, self-supporting.
P art of the C ouncil's incom e is derived from th e annual fees paid by th e various categories o f nurses to m aintain th eir registration and/or enrolm ent.T he grow th in this re spect was from 25c (2/6) p er qualifi cation p er annum to R25 p er person per annum for all categories, irre spective of th e n u m b er of qualifica tions.T he fees for the enrolled nursing categories w ere originally substantially low er than those for the registered group.H ow ever, since adm inistrative costs are not bound to level, o r qualification, this difference was elim inated and since 1980 all categories o f nurses pay the same fees.
A fu rth er co n trib u tion m ade by the C ouncil to social o rd e r is th at which is m ade possible by personnel developm ent.E very em ployer con tributes, to a g re ater o r lesser degree, to th e developm ent of people by on-duty and in-service education.P art of this contribution, although som ew hat indirect, is the setting of p re-requisites for the granting of a post.T he fact th at the Council issues regulations for train ing of nurses in which scholastic and other adm ission req uirem ents are set also con trib u tes to discourage m ent of early school-leaving and in this way helps considerably tow ards the educational upliftm ent o f the South A frican p o p u lation.P roof of this can be found in the fact that although statistics reflect an initial decrease in stu d en t regis trations in th e years following the raising of scholastic adm ission re quirem ents, the in tak es o f students time and again re tu rn e d to norm al. T he aspects m entioned thus far represent but som e of the m ore ob vious contributions th at the South A frican Nursing Council has been able to m ake over a period o f four decades to the social o rd e r, uplift m ent and developm ent of the RSApopulation.
T he following com prises a brief look at the C ouncil's contribution tow ards the evolvem ent o f an o r derly com m unity by m eans of p ro fessional developm ent and control.It is once again not the aim to look at this in detail or com prehensively, but rath er to highlight som e of the m ain features.

Rolls and registers/enrolment and registration
First and forem ost, since its incep tion, is the contribution o f th e S. A . Nursing Council by m eans o f its control of the nursing profession by keeping registers and rolls and the registration and en ro lm en t o f p er sons to ensure th at nursing is p rac tised in accordance w ith th e norm s set for safe practice.Since 1972, with the establishm ent of the roll for nursing assistants, nobody in South A frica is allow ed to practise nursing unless he o r she com plies with the entrance requirem ents to the register o r rolls, is in fact reg istered o r enrolled w ith the Council and is m aintaining th at registration or enrolm ent through annual re newal.T he latter is no t a new con cept.The Nursing C ouncil was faced with the problem o f how to maintain the registers accurately and how to ensure that names would not be un fairly erased.It should be rem em bered that the registers are o f little value unless they contain the names only o f persons still living and who are interested in their profession, to gether with their correct addresses.A fter the matter had received fu ll consideration by the Council, it was decided that the only m anner in which the ideal system could be achieved was by the levying o f a nom inal yearly subscription o f five shillings.
The tables th at follow offer a syn opsis of the growth of the nursing m anpow er in South Africa over the past 40 years.

Basic registration
The greatest degree of grow th oc curred in psychiatric nursing.The num ber of registrations in this field however, and especially w hen com pared with those in the o th er fields of basic registration, is still grossly inadequate.Basic registrations ob tained through the new com prehen sive basic training are reflected for the first time in the 1984 statistics.The new approach to basic training will undoubtedly bring considerable change to these statistics in the future.

Additional qualifications
The situation regarding the addi tional qualifications is reflected in table 8 according to the levels of service in a com prehensive health service structure.T he statistics for the Black group reflect a tendency of developm ent away from the qualifications th at w ould prepare them for delivery of prim ary health services.H opefully the new ap-proach to basic training, with C om munity Nursing Science as a full com ponent, will alter this picture m arkedly in the next decade.D e spite the obvious growth at all levels, the additional qualifications of all groups rem ain, for the m ost part, inadequate for the health needs of South Africa.

Enrolment
Discussion with regard to enrol m ents with the C ouncil is restricted to that of the en rolled nurse.E n ro l m ent of this category becam e com pulsory in 1957 w hen A c t 69 o f 1957 cam e into effect.Statistics, th e re fore, are reflected as from this date.
T here is a m ark ed decline in these figures.T he m ajority of the persons rep resen ted by the en ro l m ents reflected in this table belong to the B lack p o p u latio n group, that is 78 % of the 1964, 74 % of the 1974 and 67 % of the 1984 figures.This observation is em phasised by the R egistrar in th e report of the Seventh C ouncil and ascribed to the fact th at few er pupil nurses are being tra in e d .33*

Students and pupils on the registers and rolls
The following extract is tak en from the D ecem b er 1944 edition of the S.A .N ursing Jo u rn a l.34* The only m atter discussed (that is at the first m eeting of the C ouncil -W .J.K .), which specifically af fected student nurses was Section 12 o f Part 11 o f the A ct.In this section the A c t requires C ouncil to keep a register o f student nurses and student midwives.This is com m on practice wherever students are doing training e.g. in universities . . .It is antici pated that the C ouncil will charge a registration fe e sufficient to cover the expense o f keeping such a register.This will give all p u p il nurses the status o f students.

. The object o f (stu dent) registration is to grant specific status to student nurses and student m idw ives and to do away with the practice o f regarding them merely as junior em ployees on the staffs o f hospitals.
The student and pupil totals (ex cluding pupil nursing assistants) have never again reached the 1978 record of 19 251, which is not re flected in table 10.T hese figures do not reflect the fluctuations th at oc curred at short intervals o r within th e p o p u l a t i o n g r o u p s .W h e n assessing tendencies in statistics it is safer to observe phenom ena or changes over a longer period.A constant growth in the num bers of students is evident over the period covered by the statistics.M ention has already been m ade of the R egis tra r's com m ents in the R ep o rt of Seventh Council on the decreasing num bers of pupils on the roll over the years.

Approval of training schools for nurses
The Council has, from the outset, had the legal authority to approve nursing schools.The num ber of ap proved schools for basic nursing   It is obvious that the m ajority of these schools are concentrated around the m etropolitan areas.This is a logical and healthy phenom enon, since this is w here the large academic and training hospitals are located.They offer the best training opportunities with regard to extent and nature of facilities and clinical learning opportunities.

Table 14 Number of inspec tions of nursing schools 1944 -1984
The Council has always had a positive approach tow ard inspec tions -not to find fault or to criti cise, but rath er to assess and de scribe the situation and to give the necessary advice and guidance.A fter considering an inspector's rep o rt, Council may take the steps required to correct the situation found.The inspection is regarded as an im portant m eans of prom ot ing contact betw een the Council and the profession and a m eaning ful instrum ent of control since its prim ary goal is developm ent and com m unication on the educational philosophy of Council.
A last aspect which m ust be em phasised is the developm ental ele m ent inherent in the goal-directed and systematic approach to nurse training that the S.A .Nursing Council conveys to the profession through circulars, training regula tions, program m e directives, pos ition statem ents and its inspec torate.
From the very beginning the Council has had, as part of its func tional structure, an education com m ittee.O ver the years its nature, com position and functions have been adapted to satisfy the needs of the developing profession.

Disciplinary investigations
A pproxim ately 570 investigations have been carried out over the past 40 years.R esearch carried out by the President at the end of 1984 showed that the following trans gressions occurred in the tw o-year period February 1982 to August 1984.
The disciplinary function of the Council is prim arily aim ed at p re venting the developm ent of an unsafe climate for service by elim i nating those factors which reflect adversely on the image o f the pro fession.It has how ever always striv en to prom ote the integrity of the persons being disciplined.

Control of agencies
The im portance of the control of nursing agencies has been recog nised from the outset.Recalling this early continuing battle of the profession m akes the im plem entation of the new system of nursing education in the RSA in the fortieth year of the C ouncil's existence (1984) so much more m e a n i n g f u l.T h e r e o r g a n i s e d system of basic training, whereby colleges of nursing, in association with universities, gain control of all basic nursing diplom a courses, is il lustrated in figure 3.
The educational philosophy of the S.A .Nursing Council as con tained in its definition of nursing science must becom e a reality in the p r e p a r a tio n o f s tu d e n t n u rse s within this system.C onceptionally the definition can be seen as de picted in figure 4.
As for 1985 the highlight of the developm ents in nursing education undoubtedly is to be found in the letter recently received by the S.These developm ents in the field of basic nursing education are m ajor breakthroughs in the history of the nursing profession in this country, since they represent the final phase in the official recogni tion of professional nursing educa tion as post-secondary education.

SOURCES
Prof. W .J. Kotzé, D .C ur., Head, De partment of Nursing, University of Port Elizabeth and Vice-President of the South African Nursing Council.by tot algemene maatskaplike ontwikkeling.Sy bydrae tot die ontwikkeling van 'n geordende samelewing lê verder in die p rofession ele o n tw ik k elin g van en beheer oor die verpleegberoep.Dit word gedoen deur die hou van registers en rolle, die goedkeuring en inspeksie van opleidingskole, tugondersoeke en beheer oor verpleegagentskappe.
The concept o f m aintaining a live register was first considered during the term of office o f the First C oun cil and was provided for in 1946 in the first am endm ent to the Nursing A ct o f 1944.The Editorial of the June 1946 edition of the S.A .N urs ing Journal contained the following explanation for a levy of annual fees.

T
he following fu rth er reference in this reg ard is m ade in the M ay 1945 ed itio n .35*O f special interest to the p ro fession are the new regulations deal ing with the registration o f student nurses and student midwives.In contrast to the conditions pertaining to all other professions, students in training fo r adm ission to the nursing or m idw ifery professions have not hitherto had any professional or aca dem ic status ...

Figure 2
Figure 2 Distribution of training schools for nurses in the RSA, 1984 Since th e p rom ulgation of the first N ursing A m e n d m e n t A ct, 1946, all agencies are reg u lated by C oun cil in o rd e r to m aintain o rd er in their own ran k s, in the profession and in the com m unity.CONCLUSION It would be in ap p ro p riate not to close on an ed u cational note.It was most interesting to study the con tents of the first training policy for m ulated at the second m eeting of the Council early in 1945.43)The deficiencies in the nursing num bers are seen as the result of poor and u nstructured training and a plea is m ade for -• firstly, recognition o f nursing training in a post-secondary con text as is the case w ith o th er p ro fessional training • secondly, the establishm ent of D epartm ents of N ursing E duca tion, which will accept total re sponsibility for nursing training, in the four provinces and the U nion governm ent • thirdly, the establishm ent of nursing schools with status equal to T eachers' Training Colleges in the larger centres of the country • fourthly, an increase in the num ber of student posts by de creasing the working hours of registered nurses • fifthly, co-operation betw een the D epartm ent of N ational E duca tion and m edical schools at uni versities, financed by th e govern m ent, to create advanced aca dem ic training opportunities for nurses.

Figure 4
Figure 4 Conceptual model of the SA Nursing Council's defini tion of nursing science A. Nursing Council from the Joint M a triculation B oard (J.M .B .).It is dated 25 February 1985 and reads as follows: I . . .have pleasure in informing you that the C ouncil (J.M.B.) has, at its recent meeting in Cape Town, agreed that the fo u r year diplom a in Nursing . . . in fu tu re . . .will be ac cepted fo r the purposes o f uncondi tional exemption o f the Matricula tion examination.
The Nursing Bill, in the June 1944 edition,9) the editor gives a detailed report of events of May 16th and M ay 31st of the first and second fo rm a l readings of the Bill in Parliam ent.In the A ugust 1944 edi tion tribute is paid to the then M in ister of W elfare and D em obilisa tion, M r.H arry Law rence, fo r the strong and able m anner in which he was handling the Bill, to M rs.M ar garet Ballinger, fo r introducing the Bill and after that for her advice and support to Mr. J.S.
• Calling all nurses ... unless nurses one and all unite to fo rm one associated body, speaking on behalf o f all nurses . . .they cannot secure fu ll legal and effec tive recognition o f their rights H ard the fig h t fo r our Bill may be, but we shall not fig h t alone . . . it is up to all o f y o u to see that the m em ber fo r yo u r constituency is converted -that he or she re alises that this legislation which we seek fo r nurses is but com m on justice (Mrs.S.M. Cribb) March 1943) 5> • Bill -To provide fo r the incor poration, registration, and con trol o f Nurses and M idw ives . . .
The 8th N ovem ber, 1944, was a memorable day in the Nursing W orld o f South Africa in that at 11 a.m. on that date, the first meeting o f the South African Nursing Council, which came into being in terms o f the new South A frican Nursing A ct N o .45o f 1944, took place.

Table 1 Number of Council members who served on the various councils. No of Council Term of office Members Appointed Elected Total Members President 1
Can we at this stage say that the Council has m ade a significant and positive co n trib u tio n to the South A frican com m unity?A gainst w hat can one m easu re th e achievem ents of an establishm ent of this nature?W hat is th e place o f Council in m odern society and on what grounds can it justify its continued existence?F o rty years is but a m om ent in th e life of a civilisation.
and 16) T he N otice for election of M em bers for the Second Council was given on 17 M ay, 1946,17) Notice of nom inations was published in the G overnm ent G azette of 22 July, 1 9 4 6 (18) a nd the first elections of m em bers for a Nursing C ouncil in South A frica, ie. for the Second C ouncil, was held during the second half of 1946.These m em bers w ere elected for the five-year p erio d 1 N ovem ber 1946 to 31 O cto b er 1951.