Management support, role conflict and role ambiguity among professional nurses at National Health Insurance pilot site in North West.
Mpili, Nomcebo Noxolo.
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Background South Africa’s victory over apartheid meant that the newly elected government needed to address the challenges of a weakened health care system that was characterised disempowerment, discrimination and underdevelopment for over centuries (Coovadia, Jewkes, Barron, Sanders, & Mclntyre, 2009). This was driven by a need to provide essential health care to disadvantaged people and to redress historical inequalities. Coovadia et al. (2009) argued that the public health care system was transformed into an integrated and comprehensive service. This resulted in improved access to primary health care services. This was not the end as the South African National Department of Health (NDoH) strived for more improvements within health care and is currently undergoing various reforms (Khuzwayo, 2015). These reforms included the introduction of National Health Insurance (NHI) and the re-engineering of Primary Health Care (PHC). Noticeably, these reforms require a re-examination of organisational system that promote health care workers (HCWs) to execute changes in the most effective manner. At present, the country’s health care system is highly labour intensive and is mainly nurse-based, thus nurses are placed at the forefront of both public hospitals and clinics (Chopra et al., 2009). It is therefore argued that the quality, efficiency and the success of implemented interventions are largely dependent on the availability, performance and morale of health professionals (Naledi et al., 2011). Thus, it is essential that health workers receive adequate training and support from management to deliver the required services. By management playing their role in supporting and helping to facilitate changes to health care, this could potentially decrease the presence of role conflict and role ambiguity that may result due to challenges brought about by the transformation. Therefore, the need to study the presence of management support, role conflict as well as role ambiguity in primary health care (PHC) facilities is paramount to a good health care system. Objective: The objective of the study was to understand perceptions of management support, role conflict and role ambiguity among nurses within the context of the NHI and re-engineered PHC. The study explored professional nurses’ perceptions and experiences of the following: management support, reforms in the health care system and its influence on their role. The study also sought to understand nurses’ opinions of challenges associated with these reforms and how these challenges can be overcome. Methods: The study used is based on secondary data that was collected through semi-structured interviews which were conducted with eighteen professional nurses in PHC facilities that are also part of NHI pilot sites in the North West province. The study used the interpretative phenomenology approach (IPA) as the researcher aimed to explore the lived experiences of professional nurses, their realities and how these realities are shaped by various challenges associated with working within a health system characterised by many reforms. Findings: Participants shared their perceptions and experiences of a lack of management support in PHC facilities. They argued that management, including their front-line managers did not provide support to staff. This was largely due to managers not always at the facility due to administrative duties. Thus managers were viewed as mainly responsible for disciplinary action processes when there are problems. With regards to reforms in the health care system, the majority of participants had positive perceptions and argued that some of the reform initiatives implemented were beneficial not only to patients but to health professionals as well. However, participants further shared their negative experiences on how reform initiatives were implemented, arguing that there was a lack of consultation and inadequate training to prepare HCWs for these changes. In relation to their role, participants indicated that although the job description was clear however because of several challenges in PHC facilities, they perform more tasks then what is simply stipulated in their job description. Further, participants mentioned several challenges such as shortage of staff, increased patient numbers as well as a lack of management support. Participants further made recommendations on how to overcome some of the challenges faced in PHC facilities such as to increase management support and increasing the staff compliment per facility amongst others. Conclusion: Drawing from the findings, health reforms benefits to clinical outcomes and patient-centred care is undeniable. It is therefore imperative for professional nurses’ to receive management support during this transition. It is also vital for nurses’ to receive adequate resources to ensure they are able to undertake their role with clarify, training and development as well as sufficient resources support to achieve the desired health outcomes in PHC facilities.