The skills gap in nursing management in the South African public health sector

ABSTRACT Objectives: Nurse managers are central to health delivery in South Africa. However, there is a paucity of research that analyzes their competence to successfully discharge their managerial role. To identify the competencies perceived to be important for effective nursing management in the South African public sector and the managers' self‐assessed proficiency in these. Design and Sample: A cross‐sectional survey using a self‐administered questionnaire. 215 senior nursing managers at South African public sector hospitals. Measures: Respondents rated the level of importance that 51 proposed competencies had in their job and indicated their proficiency in each. Results: Public sector managers ranked controlling as the most important competency, followed by leading, organizing, and self‐management. Health/clinical skills, planning, and legal/ethical competencies were ranked as being relatively less important. They assessed themselves as being most competent in self‐management, followed by planning, controlling, leading, and specific health skills. The competency gap was the largest for legal/ethical issues, organizing, and controlling. The competency gap for planning and self‐management was relatively smaller. Conclusions: This research confirms that there is a lack of management capacity within the public health sector and also identifies the areas in which the lack of knowledge or skills is most significant.     

Essential managerial attributes of the nowadays nursing service manager in the South African context

Nursing service managers need certain essential managerial attributes in taking the lead in effective management of the nowadays health care organisations in South Africa. Major changes in restructuring and human resources planning are taking place through transformation of health services and specific managerial attributes are needed in this scenario. Without nursing service managers with the necessary managerial attributes, change in the health care environment will be hampered and planning, organising, directing and control of the delivering of quality care will be negatively influenced. The research problem was addressed in the following question that guided the study: Which essential attributes/characteristics should a nursing service manager possess to run a health care service effectively? It was unclear what the opinions of all level of nurse managers were regarding the necessary managerial attributes the health services manager currently need to run the current health care services effectively. This study aimed at highlighting the necessary attributes of the nowadays nursing service manager in running a health care institution in the current health care environment of South Africa. Purposive sampling was done and forty-five functional, middle and top-level managers registered for a second year degree course in Health Services Management at a South African university participated in the study. The findings indicated important managerial and leadership attributes, which the current nursing service manager should possess. This article will only discuss the important managerial attributes needed. A conceptual framework came to the fore according to which an example of a self-evaluation instrument was compiled for nursing service managers for future use. The results of the data analysis indicated that the nursing service manager should promote good interpersonal relationships with colleagues, subordinates and patients through the attributes of openness, being inviting and empowering behavior. The purpose of this article is to make nursing service managers more aware of the necessary attributes they should possess and should develop to manage nursing services more effectively.     

Nurse managers' challenges in project management

suhonen m. & paasivaara l . (2011) Journal of Nursing Management 19, 1028–1036
Nurse managers’ challenges in project management Aim To analyse the challenges that nurse managers meet in project management. Background Project management done by nurse managers has a significant role in the success of projects conducted in work units. Methods The data were collected by open interviews (n = 14). The participants were nurse managers, nurses and public health nurses. Data analysis was carried out using qualitative content analysis. Results The three main challenges nurse managers faced in project management in health-care work units were: (1) apathetic organization and management, (2) paralysed work community and (3) cooperation between individuals being discouraged. Conclusions Nurse managers’ challenges in project management can be viewed from the perspective of the following paradoxes: (1) keeping up projects–ensuring patient care, (2) enthusiastic management–effective management of daily work and (3) supporting the work of a multiprofessional team–leadership of individual employees. Implications for nursing management It is important for nurse managers to learn to relate these paradoxes to one another in a positive way. Further research is needed, focusing on nurse managers’ ability to promote workplace spirituality, nurse managers’ emotional intelligence and their enthusiasm in small projects.     

The skills gap in nursing management in South Africa: a sectoral analysis: a research paper

pillay r . (2010) Journal of Nursing Management  18, 134–144
The skills gap in nursing management in South Africa: a sectoral analysis: a research paper Aim To identify competencies important for effective nursing management and to assess managers’ proficiency therein. Background A lack of management capacity has been identified as the key stumbling block to health delivery in South Africa. Despite nursing managers being central to overcoming the challenges facing health care, there has been a paucity of research that empirically evaluates their skill levels. Methods A survey was conducted among 171 senior nursing managers in South Africa using a self-administered questionnaire. Results Public sector managers assessed themselves as being relatively less competent than private sector managers. The largest skill gaps for public sector managers were for ‘ethico–legal’, ‘task-related’ and ‘controlling’ skills whereas those for private sector managers were for ‘ethico–legal’, ‘health-related ‘ and ‘task-related’ skills. Conclusions This research confirmed the lack of management capacity within the health sector and identified areas in which the skills deficit was most significant for both the public and private sectors. Implications for nursing management These findings reflect the needs of nursing managers and will be useful in the conceptualization, design and delivery of health management programmes aimed at enhancing management and leadership capacity in the health sector in South Africa.     

Meeting the policy agenda, part 1: the role of the modern district nurse

The challenges posed by the current context of health and social care offer opportunities for different models of care delivery. District nursing has evolved, and continues to evolve to meet these challenges. The traditional reactive role of district nursing has developed as contemporary practice expects district nurses to meet both planned and unplanned care required by practice populations. Modern anticipatory care approaches to care are being adopted, while care and case management is being facilitated and delivered to patients and families with complex health and social care needs. Additionally, district nurses are recognizing the need to further develop management and leadership skills as the teams delivering care consist of a skill mix of nurses and other disciplines. They are also charged with evidencing the impact of what they do and influencing care delivery at every level of healthcare organizations. This first paper of two will explore the current UK policy context and ways in which district nursing services within each country are changing to meet the challenges posed. A second article will argue the need to ensure the district nursing workforce is underpinned by robust educational standards that ensure protection of the public. The influences of education and development from professional and organizational perspectives will be examined.     

Growing leaders in a professional membership organization

shekleton m .e ., preston j .c . & good l .e . (2010) Journal of Nursing Management  18, 662–668
Growing leaders in a professional membership organization Aims This study describes the background, development and delivery of an innovative approach to prepare elected state association leaders for their new leadership roles in their respective state organizations. Background State-based professional associations face unprecedented threats to scope of practice in the current volatile healthcare environment. In 2009 the American Association of Nurse Anesthetists (AANA) began offering a Leadership Development ‘Boot Camp’ for all nurse anesthetist state association presidents-elect designed with the intent of providing the participants with information, resources and tools they need in their new role. Methods An organizational assessment examined the philosophy of and need for leadership development across the entire organizational structure. Results Recommendations from the assessment included the need for intensive leadership development at the state level. A 3-day intensive workshop was designed and implemented. Adult learning theory was used for its development. Conclusions The success of this programme has lead to its implementation as part of leadership development of the AANA. Implications for nursing management Nurse managers and elected volunteer leaders in state-based professional associations face similar challenges requiring sound leadership ability. Principles applied to the development of the AANA programme can be applied to leadership development for new nurse managers.     

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

Aims  To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary.
Background  Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role.
Methods  A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100.
Results  Less than 10% of journal titles contained the word strategy . What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident.
Conclusion  The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent.
Implications for nursing management  Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.     

Creating a quadruple aim model for nursing education

Baccalaureate nursing education is moving to adopt the new American Association of Colleges of Nursing Essentials for Professional Nursing Education. As identified in two of the six domains of the essentials, graduates need to be prepared to address population health and utilize informatics and healthcare technologies. Community/public health nursing also has eight domains for generalist nurses linked to population health which will help prepare a skilled nursing workforce for the 21st century. The Institute for Healthcare Improvement's Triple Aim which evolved into the Quadruple Aim is focused on improving health outcomes within healthcare delivery. Through a literature review, a need for a Quadruple Aim model for nursing education was identified. Mirroring the Institute for Healthcare Improvement's Triple Aim for healthcare delivery, a Quadruple Aim for Nursing Education Model was developed. The model dimensions include (1) Population-focused Care, (2) Maximize Student Learning Experience, (3) Cost-effective Pedagogy, and (4) Nurse Educator Well-being. The Quadruple Aim for Nursing Education Model supports nursing education to prepare future nurses effectively and efficiently bridging population health concepts and issues with nursing informatics. Nurse educators are encouraged to utilize the model to transform nursing education.     

Management and leadership in nursing: an Australian educational perspective

dignam d., duffield c., stasa h., gray j., jackson d. & daly j. (2012) Journal of Nursing Management 20, 65–71
Management and leadership in nursing: an Australian educational perspective Aim In this article, we present an Australian perspective on issues influencing management and leadership education in nursing. Background Nurse leaders and managers work in a context of high pressure, uncertainty and rapid change, and face unprecedented challenges on a daily basis. Evaluation and Key Issues In the present paper, we reflect on the issues and challenges facing providers of management education for nursing, and consider these challenges in relationship to current trends and imperatives. Conclusions Collaborative approaches between educational and clinical settings are needed to ensure quality, relevant educational support for managers and leaders, and enhance curriculum integrity. Implications for Nursing Management There is a need for contemporaneous and relevant research to inform innovative models of collaborative education.     

Towards a competency-based framework for nursing management education

Defining a competency-based model for nursing management development will help to establish core competencies for nursing managers which will not only strengthen their practice and provide further learning and development opportunities, but will also provide the basis to focus training and professional development efforts. This paper identifies the competencies important for effective nursing management in the public and private health sectors. A total of 420 senior nursing managers in South Africa were surveyed using a self-administered questionnaire. Respondents had to rate the importance of 51 competency items as it pertains to effective nursing management. Self-management, controlling, health/clinical, organizing, people management, planning and ethical/legal competencies were found the most valuable for optimal nursing management. These findings reflect the reality of the nursing management milieu and will be useful in the design and delivery of management development programmes aimed at enhancing nursing management capacity.     

Reinstating district nursing: A UK perspective

As policy directives gather pace for service provision to be delivered in primary care, district nursing has not been recognised as a valuable asset to facilitate this agenda. Investment in district nursing and specialist district nursing education has fallen. This is concurrent with an ageing district nursing workforce, a lack of recruitment and growing caseloads, as district nursing adapts to meet the challenges of the complexities of contemporary healthcare in the community. The district nurse role is complex and multifaceted and includes working collaboratively and creatively to coordinate care. Redressing the shortages of specialist district nurse practitioners with increased numbers of health care support workers will not replace the skill, knowledge, experience required to meet the complex care needs of today's society. District nursing needs to be reinstated as the valuable asset it is, through renewed investment in the service, research development and in specialist practice education. To prevent extinction district nurses need to be able to demonstrate and articulate the complexities and dynamisms of the role to reinstate themselves to their commissioners as a valuable asset for contemporary practice that can meet current health and social care needs effectively.     

Implementing graduate entry registration for nursing in England: a scope review

Aims  A graduate entry workforce for nurse registration has been approved for England by 2010/11. The aim of this research was to discover the immediate tasks facing nurse managers in implementing that change. Previous research has focused on making the case for change rather than on implementation.
Background  Similar to the implementation of Project 2000, this change in nurse education and employment will raise questions for employers and for higher education institutions. It will also raise questions about nurse recruitment numbers, workforce development, and the profiles of entrants to a changing workforce.
Method  In preparation for these changes, we conducted a scope review of published and grey literature in the English language. We also reviewed the earlier experiences of transfer to graduate status amongst other workforces such as teaching and social work and we investigated reported practice in other industrialised countries.
Results  The education provider changes necessary for such a large professional workforce will need considerable leadership skills from within nursing and nurse management. At present, there are too many employers and education providers in England who appear to be relatively unaware of the changes facing nurse education and professional practice and the urgency needed to lead that change.
Conclusions  Education, training and development as well as employer/commissioner practice will rely on leadership from within the nurse profession itself. For nurse managers, this requires a rapid planning process in order to ensure smooth implementation. The danger is that either education providers or commissioners of nursing services will react rather than proactively plan for the changes that are already in progress.     

Global nurse leader perspectives on health systems and workforce challenges

gantz n.r., sherman r., jasper m., choo c. gek, herrin-griffith d. & harris k . (2012) Journal of Nursing Management  20, 433–443 Global nurse leader perspectives on health systems and workforce challenges Aim As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. Background Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. Evaluation Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. Key issues Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. Conclusion There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing’s future. Implications for nursing management Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies.     

Challenges in healthcare delivery in an economic downturn,in the Republic of Ireland

carney m . (2010) Journal of Nursing Management 18 , 509–514
Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland Aim The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Background Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Evaluation Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study’s aim. Key issues Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. Conclusions In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. Implications for nursing management As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.