Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces

Abstract

BackgroundSouth Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC). Nursing managers will play a critical role in these reforms.ObjectiveThe aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries.DesignDuring 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings.ResultsFifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15) were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management.ConclusionsDiaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level.

An evaluation of the competencies of primary health care clinic nursing managers in two South African provinces

“…Nursing managers’ self-ratings on the domain of staff management contradicts the findings from the diary and job satisfaction studies where they expressed difficulties in managing unplanned staff absences and human resources shortages (15, 36). Therefore, these PHC managers need training in staff management to steer complex health system changes in facing staff shortages (46).…”

“…The leadership and management functions that nursing managers encounter daily involve decision-making, delegating work, problem-solving, communication, and acting with moral integrity (1, 15, 36). That only one-third of nursing managers indicated the need for leadership and management training in this study contradicts the findings of the job satisfaction survey among the same managers which found that the majority wanted training in leadership and management (15).…”

“…Firstly, numerous times during the day, nursing managers are forced to abandon managerial duties to provide direct care to patients (15, 36). Secondly, the diary study among a subset of these clinic managers found that their supervisors were unsupportive and often derailed the activities of these nursing managers through unannounced clinic visits and setting unrealistic targets and deadlines (36). This could explain the lower scores of the supervisors.…”

“…In 2012, a cross-sectional study was conducted in two South African provinces (15, 36) – Gauteng (an urban province) and Free State (a mixed urban–rural province) – selected on the basis of geographical access to the researchers, existing health authority approval, and financial considerations (15, 36). In 2012, there were 343 PHC clinics in Gauteng province (37) and 256 PHC clinics in Free State province (38).…”

“…The PHC nursing managers are responsible for clinic management, including health care service delivery, staff, and implementation of policies (15, 36). Non-nursing managers in charge of clinics operating for more than 8 hour a day, weekend or mobile clinics and community health centres, and those linked to hospitals were excluded from the study.…”