South Africa and Victoria—Registration of Nurses and Midwives.

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVI, Issue 2, 1 April 1927, Page 85

South Africa and Victoria— Registration of Nurses and Midwives.

In the January number of the South African " Nursing Record " is published the new nursing regulations which take effect from Ist July, 1927.

The desire of the Nurses' Association to have a separate Act of Parliament for their registration has not yet been granted, and the regulations were framed by the Colonial Medical Council. Although not entirely what the Nurses' Association wish, the new regulations, capable of improvement, are a step m the right direction. It is to be noted that m the regulations for midwives no provision appears to be made for the acceptance of a certificate "from any examining body outside South Africa other

than the Central Midwives' Board for England, Scotland, or Ireland. The Dominion of New Zealand, which imposes a longer training for midwives, is not mentioned, nor are the Commonwealth States, the terms of training of which are similar to that m South Africa, which is six months for a trained and registered nurse, twelve months for all others. This period is considerably longer than previously. Apparently midwives from these parts will be required to sit for examination before registration. Pupils must be 22 years of age and have passed the Sixth Standard. They must attend and nurse 20 labour and 20 lying-in women.

The training must be continuous, i.e., no holidays and sick leave of over seven days must be made up. Another improvement is that the matron must be a doubly qualified nurse. In many ways the regulations are similar to those which were m force m New Zealand before the Act of 1925 was passed. The editor remarks that "we no longer have the stigma on us of supplying a training inferior to that of other countries." It is interesting to note that while New Zealand was the first of the British Dominions to institute a six and twelve months' course for midwives, she is now again leaving Great Britain and her sister colonies behind, and imposing a still longer course for qualification for the great responsibility of a midwife, Midwives arriving from overseas are not, however, shut out on this account from our register, but are allowed to make up the deficient time m one of the institutions and sit for examination. For general nurses the regulations allow the Council to grant a certificate of competence to " any person who has obtained m England, Ireland, or Scotland, or any British possession, or m an}*foreign country, a certificate of qualification as a trained nurse, granted after examination by an institution or body recognised by the Council as competent, through its course of training and material, to grant such certificate." Conditions are imposed such as a declaration of identity, a certificate of good character from medical practitioners, and a sworn declaration before a Justice of the Peace that the applicant has never been debarred from practice m any country by reason of misdemeanour or professional misconduct. It is to be noted, therefore, that nurses proceeding to South Africa with the idea of nursing should be careful to furnish themselves with everything necessary to obtain registration there. Training schools m South Africa are divided into two classes. Class 1 : A resident medical officer must be employed and there must be a minimum daily average of 40 occupied beds, nursed by the female staff. Class 2: A minimum daily

average of 15 beds is required, and daily visits by a member of the medical staff. The Council is to have the right of inspection. Probationers must be at least 19 years of age and hold the Seventh Standard certificate or an equivalent education certificate, or may be allowed to pass an examination. In Class 1 training school the period of training is three and a half years. In Class 2 four and a half years, and the training must be continuous except for one month's vacation each year, or illness, or other reason for which a satisfactory reason is given. Periods of over three months' break must be made up, and if the break exceeds two years no recognition of training shall be allowed. Registered mental nurses and children's hospital nurses are exempted from 25 per cent, of the period of training. Probationers must attend during their whole course at least 100 lectures given by a medical practitioner, and also not less than 100 demonstrations given by a trained nurse. Wherever practicable during her training period, a probationer shall have three months training m an infectious diseases hospital, which shall count as part of her course. These regulations, which are given m detail m the " Record," and of which we can only make brief abstracts, are of interest to New Zealand matrons and nurses. Conditions m South Africa, which is a young country, and which has many small and scattered institutions m which nurses are trained, are m many ways similar to those m New Zealand. We are interested also m reading m " Una," the Victorian nurses journal, some extracts from the interim report of maternal mortality and morbidity m Victoria, by Dr. Marshall Allen, Director of Obstetrical Research, University of Melbourne. After writing of the maternal deaths which it is stated were at the rate of 4.34 per 1,000 live births, the causes were alluded to as follows : — " Puerperal sepsis is responsible for slightly more than onethird of the total deaths. It is a debateable point whether the majority of cases of puerperal phlegrnsesia should not be included with those of sepsis. While puerperal albuminuria, accidents of preg-

nancy and other accidents of labour individually do not cause the loss of so many lives as sepsis, collectively they form an important factor m maternal mortality." The onus of responsibility. — " In the past much time has been wasted m attempts to apportion between the doctor and the nurse the blame for the excessive mortality m childbirth. The maternity allowance returns show that as far as Victoria is concerned the percentage of women attended by a doctor has steadily risen. . . ." " The Training of Nurses. — Victoria is the only State which allows private hospitals to be registered as training schools. Acting on the advice of the Board of Examiners the Midwives' Board has refused to register any more. I agree with the Examining Board that the results of such registration have not justified this recognition.*' It is to be remembered that when the Midwives' Act, New Zealand, first came into force the regulations did not prohibit training m private hospitals, but very shortly afterwards it was recognised that such training was unsatisfactory as regards the pupils, and most unfair as regards the patients, and it was discontinued. Even training m small public institutions such as the cottage hospitals m country districts, is not now allowed for midwives. It is to be noted that many of the difficulties regarding private nursing homes are similar to those m New Zealand, especially before the increased number of nurse inspectors has rendered supervision more complete. Dr. Allen writes of the Bush Nursing Association saying the working of the Association has a very definite bearing on maternal mortality m the country districts. All the nurses possess a general'and an obstetric certificate, and m

addition many hold the mothercraft diploma. Three stages exist m the organisation. First there is the centre where the nurse boards with a family m her district and attends to cases wherever wanted. In addition, medical inspection of school children and instruction m hygiene are given. The next stage is the erection of a small cottage for the nurse. The bush nurses are picked women, and the medical men are emphatic m their appreciation of the value of the help afforded by them. Ante-natal supervision is carried out as far as possible. Regarding general trained nurses, Dr. Allen writes: — i( Not only m the city, but also m country towns, great difficulty is experienced m persuading nurses with a double certificate to engage m private practice. The supply is apparently ample, but man}- take the extra course merely to qualify for positions as matrons. The reluctance to undertake obstetrics is largely caused by the inferior status of the work owing to the influence of the untrained nurse, who is prepared to do domestic work m addition. The general public is largely responsible for this, although m some cases medical men prefer to Work with untrained women. All these factors tend to discourage trained nurses from undertaking this branch of their profession." We have found that this is also the case m New Zealand. Much as it is to be desired that maternity cases should be nursed by fully qualified nurses, they still must largely depend on the midwife or maternity nurse only who has m the past given good and faithful service.