Quality of Patient Care and the Activities of Hospital Nursing Unit Managers in South Africa: A Paradox?

Thursday, 25 July 2013: 3:55 PM

Laetitia Rispel, PhD, RN, RM
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

Learning Objective 1: Gain new knowledge on how hospital nursing unit managers spend their time in selected hospitals in two South African provinces

Learning Objective 2: Gain insights into interesting methodologies used in the research study


Improving the quality of patient care is central to the proposed health care reforms in South Africa. This paper examines whether quality of care is supported by the activities of hospital nursing unit managers in South Africa, done as part of a larger project to examine the relationship between the quality of nursing unit management and quality of care in hospitals.


The overall project combined in-depth qualitative and quantitative methods, including reflective diaries, semi-structure interviews, record reviews and observation. As part of the latter, the activities of 36 unit managers in private and public hospitals in two South African provinces were recorded. Each unit manager was observed for a period of two hours a day and their activities recorded on a minute by minute basis. The data was coded into categories and analysed according to the time spent on activities in each category. Data validation was done through a workshop with unit managers and examining data from other the components 


The study found that nursing unit managers spent 22% of their time on patient care. The remainder of the time was spent on patient administration (16%); staff management (15%), stock management (13%), support and communication (12%) and education (5%).  Of concern was that nursing managers spent 17% of their time on miscellaneous activities, including tidying the ward, maintenance & support services; and meetings.


Although nursing unit managers are held responsible for the quality of patient care, their workloads, the range and diversity of activities as well as current work organisation, make it difficult for them to meet this responsibility. A combination of leadership training, better use of unit managers’ time, internal agency and supportive supervision from executive nursing management is needed to enable the provision of consistent and high quality patient care.