Analysing the nature and dynamics of nursing management at primary health care clinics in two South African provinces

A thesis completed by published work Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 25 November 2016Background: In South Africa, nurses form the backbone of the health system, because of their numerical dominance, their skills and training, their close contact with patients and communities and their prominence in managerial and leadership roles at all levels of the health system. Objective: The aim of this PhD was to analyse the nature and dynamics of nursing management at primary health care (PHC) clinics in two South African provinces. The specific objectives were to: describe the social-demographic characteristics of selected PHC nursing managers; determine their job satisfaction levels; examine the work environment; determine the functionality of PHC support systems; and assess their managerial competencies. Methods: In 2012, a mixed methods cross-sectional study was conducted in Gauteng and Free State Provinces. Using stratified random sampling, 111 PHC nursing managers working in eight hour clinics were selected. After obtaining informed consent, these managers were invited to participate in three surveys: job satisfaction, facility assessment and a 360 degree competency evaluation. A sub-set of these managers (n=22) was requested to keep a diary for six weeks. STATA® was used to do quantitative data analysis, while the qualitative data was analysed using thematic content analysis. Results: A 95% response rate was obtained for all surveys. The majority of PHC clinic nursing managers were female (92%), black, married, with a mean age of 49 years (SD = 7.9), 90% were in permanent positions, and 36% had between 21-30 years of professional nursing experience. The overall job satisfaction scores for Gauteng and Free State PHC clinic nursing managers were 142.80 (SD± 24.3) and 143.41 (SD± 25.6) out of a possible score of 215. The predictors of their job satisfaction were: working in a clinic of choice (RRR = 3.10), being tired at work (RRR = 0.19) and experience of verbal abuse (RRR = 0.18). The facility assessment found that none of the selected clinics obtained scores of 100% for the vital elements of the National Core Standards. Overall, clinic nursing managers rated themselves high on the domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was the financial management domain where the nursing managers gave lower ratings (7.94). Health system deficiencies, human resources challenges, leadership and governance, and unsupportive management dominated the diary entries, and coalesced to produce many negative emotions experienced by these PHC clinic nursing managers. Conclusion: This PhD study has underscored the importance of PHC nursing managers, and has generated new knowledge on the overall levels and predictors of job satisfaction, the perceived competencies of these managers, together with information on the work environment and support systems. The successful implementation of PHC revitalisation and universal health coverage reforms cannot be achieved without addressing the concerns of PHC nursing managers and the health system issues affecting them.MT201