The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

Susan J Armstrong,Laetitia C Rispel,Loveday Penn-Kekana

doi:10.3402/gha.v8.26243

Susan J Armstrong, Laetitia C Rispel + Show 1 more

Open Access

https://doi.org/10.3402/gha.v8.26243

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Abstract

BackgroundImproving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.ObjectiveThis paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.MethodsDuring 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis.ResultsThe study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration.ConclusionThe creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care.

Highlights

IntroductionNursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals
Improving the quality of health care is central to the proposed health care reforms in South Africa
With the exception of a 1934 study that focused on ‘head nurses’ in the Unites States [30], we could not find recent studies that focus on the nursing unit manager or studies that concentrate on a lowand middle-income country (LMIC) setting. In light of this dearth of empirical evidence and the major emphasis of the South African government on quality of care, this paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in selected South African hospitals

Summary

Introduction

Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. The observation data were complemented by semistructured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care

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