The focus of nursing care is persons as individual, family, groups, communities and populations. There is a synergistic relationship among persons, nursing, health, and environment. Nursing began, simply enough, as a practice to help people get healthy. Nurses would help physicians care for patients, which included things like helping them eat, tending to their hygiene, and making sure the physician’s orders were followed for the patient. However, there was no formal education for nurses initially, and nursing duties were most often carried out by nuns or people in the military. It wasn’t until Florence Nightingale worked as a nurse that nursing began to resemble what it is today.
A nursing tradition developed during the early years of Christianity when the benevolent outreach of the church included not only caring for the sick but also feeding the hungry, caring for widows and children, clothing the poor, and offering hospitality to strangers. This religious ethos of charity continued with the rapid outgrowth of monastic orders in the fifth and sixth centuries and extended into the middle Ages. Monasteries added wards, where to care meant to give comfort and spiritual sustenance. Religious orders of men predominated in medieval nursing, in both Western and Eastern institutions (Vern & Bullough “Medieval Nursing,” Nursing History (1993): 89-104).
The Colony of the Cape of Good Hope became the first country in the world to pass legislation for the registration of nurses and midwives in 1891. Significant developments in nursing have usually been achieved through the vision and unwavering commitment of a strong leader, and in the case of state registration for nurses, this person was Sr. Henrietta Stockdale (Paton, 2020)
The following examples of malpractices were observed: job hopping. Although a lengthy job history can provide a nurse with a range of experiences in a variety of care settings, a job-hopping nurse can spell trouble. As well as bad attitudes, gossiping, ignoring protocols, always overwhelmed, shirking job duties and incompetence. Eventually, the South African Nursing Council was established in which the body is entrusted to set and maintain standards of nursing education and practice in the Republic of South Africa. It is an autonomous, financially independent, statutory body, initially established by the Nursing Act, 1944 (Act No. 45 of 1944), and currently operating under the Nursing Act, 2005 (Act No. 33 of 2005). Since the establishment of SANC, nursing changed drastically and progressed.
SANC is involved in the monitoring of nursing standards by:
• registering nurse practitioners, therefore permitting them to practice as nurses;
• accreditation of new nursing education institutions and nursing education programmes;
• inspection of nursing education institutions and clinical facilities;
• Constantly reviewing nursing education and training to be in line with the needs of the Republic of South Africa.
Nursing is a career of love rooted in rich and fertile soil governed by caring philosophies. Individuals within the profession have strong and inexplicable desires to serve and preserve humanity at all cost. The nursing profession is the backbone of the healthcare system and is forever in the forefront of preventing, promoting and management of various diseases. Nursing is as old as humankind – nurses have always been there and have survived trials and tribulations. Nursing demands not only higher cognitive skills, but a humble heart and selflessness in daily duty execution. An individual without passion for the sick will never survive a minute of nursing’s demanding tasks (Miya: 2015).
During 1987, nursing in South Africa was gradually introduced in the tertiary education system and scope of practice and curriculum were amended. Nursing graduates were introduced to a 4-year degree obtaining general, psychiatry, midwifery and community health nursing. This was a brilliant move for all nurses. At this stage it was worthy to explore causes of ritualistic nursing practices. Ford and Walsh (1994) posed the question: how do we know what we know? When a body of knowledge is compiled, founded on research and enquiry, testing and evaluating ideas, then it is open to challenge and change. However, if a body of knowledge is in fact little more than beliefs, opinions and attitudes passing down in a hierarchal way, then challenges and change will tend be stifled as the dead handoff tradition and obedience guides practice along ritualistic tramlines (Ford and Walsh: 1994:18)
This matter caused concern among older nurses to feel bitter and never fully accepted university graduates as satisfactorily trained. Even medical officers were threatened, and witness role change from nurses as hand maids into fully recognised members of the multidisciplinary health team with independent roles and functionality. This was an excellent move. If nurses with critical awareness and enquiring minds engage themselves in day-to-day clinical practice, transforming that practice by a process of reflection and innovation – then it seems more likely that many of our cultural myths will be challenged and displaced. The matter is that it became imperative for nurses to become empowered and that they do not act in a subordinate manner to the doctors and no longer be their handmaidens. These changes failed to bridge the gap of scope of practice and remuneration packages. Even to this date, the university and hospital trained nurses earn the same salary and follow same stream of training regulated by the same nursing Act 50 of 1978 as amended with specification stipulated in Regulation 425 (R.425).
The future of nursing education
One of the strongest and most urgent recommendations is the need for nursing colleges to be declared higher education institutions in compliance with the provisions of the Higher Education Act (as amended in 2008). Failure to do so will mean public nursing colleges, the primary training platform for nurses, will be unable to continue training after 30 June 2013, the deadline for the interim registration of qualifications, with dire implications for the current nursing shortage. The Medical Team Training (MTT) recommends that Nurse Education and Training be regarded as a national competence accounting to the Director General of Health. This will help to address provincial inequalities, norms and standards, quality, decrease fragmentation, eliminate ‘fly by night’ Nursing Education Institutions (NEIs), improve clinical training and enhance social accountability. The South African Nursing Council (SANC) should develop and finalise an accreditation framework for NEIs, their programmes and clinical training facilities according to SANC criteria and those of the Council for Higher Education (CHE). Nursing students should have the status of full students (rather than employees) whilst undergoing their training. They should receive funding support paid monthly for tuition, books and study materials, living costs, medical aid and indemnity insurance, while tuition fees should be paid directly to NEIs. Accommodation, uniforms and transport for training should be provided and students should undergo a rigorous selection process by NEIs to attract suitable candidates to the profession. In order to promote the quality of practical hands-on training, students are to be placed in a variety of health establishments linked to all NEIs for their clinical training. The MTT recommends that clinical education and training be strengthened by re-establishing clinical teaching departments at all NEIs or hospitals, supported by a co-ordinated system of clinical preceptors and clinical supervisors. This must be accompanied by the requisite resources from the relevant authorities.