Theme 1: Ineffective Management Practices

The opposite of the word ineffective is the word effective which denotes, to be successful in producing desired or intended results (The Long South African School Dictionary, 2009:226). Ineffective therefore denotes not producing any significant or desired effect.

Something that does not work quite the way it is supposed to (Dictionary.com, www.dictionary.com>browse>ineffective).

Additionally, the word Management in healthcare refers to the process of planning, organising, staffing, leading, and controlling the resources of a healthcare organisation to predetermined, stated organisational goals, as productively as possible and to the highest standard (Jooste, 2013:78). Consequently, Ineffective management practices refer to management that is not producing any significant or desired effect. It does not function and coordinate the efforts of people to accomplish their goals and objectives by using available resources efficiently and effectively (Google Dictionary; Wikipedia.org).

In the context of this study ineffective management practice refers to managers that are not engaged in promoting the implementation of SDP as perceived by professional nurses. Managers are expected to get involved in planning for SDPs, and to collect evidence that staff development of nurses has taken place. Dymoke and Harrison (2006:80); Heaney (2004:42); Mewborn and Huberty (2004:6), assert that managers are to keep evidence through records of staff development programmes that have taken place and who has attended, to ensure equitable allocations of staff to SDPs. Ineffective management practices do not involve the commitment to identifying the needs of nurses and appropriate training to meet these needs (Heaney, 2004:43; Lee, 2005:46).

In this study participant’s perceptions were that ineffective management practices affected the implementation of staff development programmes in the hospital.

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Participants perceived as unfair the treatment of staff not being considered for SD, the long waiting period before being sent for SD, no staff involvement, poor planning for staff development programmes (SDPs), poor implementation of staff development programmes and a lack of support by management towards the implementation of SDPs.

Some participants commented as follows:

“I feel that the staff is treated unfairly. I personally had to work for thirteen years before I could be sent to school. It took long for me to go to school. I am now over forty with arthritis. People get sick and even die before they can be sent to school. This could have been taken seriously when we started working in this institution. With internal staff development programmes, it’s fine but it takes long and we sent to school at old age.”

“I do not have midwifery. I am now stuck because I cannot do any other course but am interested in children and help my community. I love working with children with psychological problems. Management does not consider the likes and dislikes of their staff members.”

“To add on upon what my colleague has just said, one will have to wait for two years before one is sent (to go study) and as young sisters, that have just started working in this hospital, we have to be developed. That means you have to wait long to be sent for training because they say you are, eh…, Mafikizolo. (Translated as novice in English).”

According to Roussel, Russell, Swansburg and Swansburg (2006:470) staff development programmes are designed to motivate nurses to consider the learning process as a natural part of living. People must be continuously developed, to ensure continuous development of staff according to their leaning needs to be knowledgeable to improve the standard of patient care as nurses are capable of learning if opportunities arise. Working in an environment where there is development motivates and encourages the staff. With staff development, nurses play an important role in the clinical practice for the provision of quality care and the elevation of the profession. Knowledge acquired in basic nursing education programmes quickly becomes obsolete. Staff education is the key to success (Roussel et al., 2006:470).

Participants mentioned that they feel that staff is not treated fairly as they have to wait long before they are sent on staff development courses. They stated that SD should have

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been taken seriously when they started working in the institution. They are sent on SD courses at an advanced age. They added that as young sisters who had just begun working they had to wait for extended periods to be sent for training and believed that the reason for this delay was because they were new in the institution.

The researcher is of the opinion that staff development programmes are for nurses’

growth to gain knowledge, skills and advance their competence. Nursing staff development is imperative to an organisational strategic plan not only because of its influence on the quality of patient care but also because of its relation to workforce satisfaction and stability.

When participants were asked what could be done to facilitate the implementation of staff development programmes in this hospital?

Some participants replied:

“If you want to be developed, you must go to school and not to wait too long. Young ones who want to be developed must be sent to school for the institution to retain them and benefit.”

“Staff development is my responsibility because I need to grow and everybody needs to be developed.”

Staff development is a lifelong professional process that takes place after the completion of the pre-registration nurse education programme (Gallagher, 2007:467). It consists of planned learning experiences which are designed to augment the knowledge, skills, and attitude of registered nurses for the enhancement of nursing practice and patient care.

Nurses need to be encouraged by being sent for educational opportunities that improves job satisfaction. Create a learning culture in the hospital where all staff are encouraged to attend SDPs whether formal or informal.

In this regard participants mentioned:

“There must be communication, fairness and transparency.”

“For an example, if I want to be developed, they must send me and not to send someone who is not interested. There must be a committee to foresee that staff is sent for training fairly. Send staff with an interest for staff development.”

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Post-registration continuing education should be structured in such a way to ensure the development of nurses for clinical nursing roles (Gallagher, 2007: 471). SD should increase nurses’ interest, level of responsibility, develop skills and expertise, and expand their scope of practice. Work environments are known to influence staff to be effective and efficient. There must be accessible for staff to be engaged in SDPs. Continuing Professional Development (CPD) must be encouraged and interest and learning needs must be considered.

Nurses’ perceptions were that unfairness in the allocations to SDPs, sending staff to programmes without assessing their learning needs and interests, poor communication and transparency during allocations affected the implementation of SDPs. The ineffective management practices are described under specific subthemes which are discussed below.

3.2.1.1 Sub- Theme 1: Bureaucratic Management

Bureaucratic management refers to a leader who is insecure and who finds security in following established policies (Booyens & Bezuidenhout, 2014:291). A manager who practices a bureaucratic management style, exercises power by commanding employees to follow relatively inflexible rules and interpersonal communication is not a bureaucratic leader’s strong point, consequently, this type of leader tends to relate to staff members on an impersonal level. Because bureaucratic leaders lack confidence they avoid having to make decisions without having standards or norms as a guide.

Muller, Bezuidenhout and Jooste (2011:422) assert that with bureaucratic management the manager buries herself in administrative detail and paperwork and does not associate with personnel, does not involve them and blames failures in the organisation on the members of her team. The bureaucratic manager does not know how to set goals or organise by objectives and cannot make decisions and does not involve the staff in decision making.

Participants perceived management as being bureaucratic where staff development is run by matrons only, without the involvement of staff. This is evidenced by the following quotations:

“Matrons are the ones running staff development alone.’’

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‘’We always hear that there are people for staff development committee’’

“When it comes to staff selection to send people for courses, it’s only done by management.”

“At the moment studying committee just consists of area managers. They decide which staff to go, they’ve got the say there’s no other categories.”

“The area managers have so many departments of their own they do not know who needs this and that even if people apply to do courses they do not even approach us as operational managers that someone applied. You know that staff actually has no say on that. Nurses feel that operational managers knows who is going for courses and do not tell them. They normally say that you know someone is going for study but you have failed to tell us?”

The claims made by the above participants are endorsed by Ono and Ferreira (2010:1) who refer to this lack of involvement as demotivating for nurses. A lack of involvement of nurses in the selection for attending SDPs affects their morale and consequently impacts the facilitation of the selection process for attending the SD programmes. Papastamatis, Panitsidou, Giavrimis and Papanis (2009:84), argue that any management that fails to consult and involve nurses in SD has not been successful in their staff development programmes. Since selection is a contentious issue, it is imperative to consult with and involve nurses in selection for SDPs.

Professional development is a driving force that motivates nurses to continue their growth (Gallagher, 2007:471). It is the managements/coordinators responsibility to be committed to ensuring that nurse’s skills and knowledge are extended. Nurses who are not involved in professional development become unproductive and demotivated and are unable to deliver quality nursing care.

It is obvious from the above information provided by the participants; that bureaucratic management in the hospital under study does not involve nurses in staff development programmes. The researcher is of the opinion that staff need to be part of the staff development committee and know the people who serve on the committee. Professional nurses who ensure participation should be involved in the selection of staff for SDPs.

When participants were asked what can be done to facilitate the implementation of staff development programmes in this hospital? Their responses were as follows.

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“If nurses can be involved in selection of staff to go for studying and not done by management only, I think that can be well done.”

“They need to allow us to give some input.”

Nurses should provide input on matters regarding staff development programmes for their own learning. When nurses are given the opportunity to provide input, they become absorbers of knowledge that is transmitted to them (Ono & Ferreira, 2010:1).

The researcher is of the opinion that nurses need to be involved in the selection of staff to attend SD programmes. Operational managers need to give some input regarding selection because they work with staff and they know them.

‘’What I have realised in other institutions they include all categories of staff in staff development committee that is; one sister, one enrolled nurse, one auxiliary nurse and even infection control sister is in the staff development committee.”

“I think eh… they should network with other institutions so that they can change their way of doing things. They must also involve staff.”

Learning could be maximised by involving nurses in the staff development committee (Hand, 2006:61). Managers should work together with nurses to maintain high professional standards in the clinical area at all times.

Another participant commented thus:

“That is why we must have the staff development committee. There is a friend of mine working at Steve Biko and she phones me to say ‘where are you? We are in your hospital attending in-service.”

“We don’t even know who to ask hence if we had a staff development committee, we would ask them.”

A staff development committee is a committee responsible for planning and implementing programmes and activities which build unity and familiarity among members of staff and meeting professional development needs (www.ithaca.edu/sacl/committees/staff).

According to Roussel et al. (2006:471), a staff development committee is vital for identifying needs resources and for planning programmes. Members of the committee should represent all categories of staff in the institution. Other members may include people with the necessary expertise. Committee members may increase participation

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because they can communicate the purpose of staff development programmes directly to the people they represent.

A staff development committee is important regardless of the size of the institution and governance of staff development. In this regard, Bantwini (2009:174) pointed out that a staff development committee is required to s cater for staff needs which could be accomplished through the involvement of nurses. Their contribution will assist in matters that concern their learning and Staff Development Programmes should accommodate nurses and their needs in order to improve their performance.

To involve nurses in the staff development committee is to enhance their professional development (Dymoke & Harrison, 2006:80). However, the facilitation of staff development programmes can only be effective if both managers and nurses work as a team to make changes in their workplace. Nurses are able to help in sharing ideas regarding educational offerings claims Roussel et al. (2006:474). Professional nurses are more committed to an activity when they have been involved in the decision making process for their development and see themselves as self-directed when they participate in their learning.

It is evident from the above participants’ statements that there is bureaucratic leadership where staff development is run by area managers only. Nurses’ perceptions and recommendations are that they must be involved in decision making for their learning programmes.

Consequently, from the above information, it may be inferred that there is a lack of involvement regarding nurses in sharing ideas pertaining to their learning programmes.

There is a need for nurses to be given the opportunity to participate in their own development and should not be the sole responsibility of area managers. If nurses’ work with area managers regarding involvement in SD, it will boost their self-esteem, promote their personal growth, improve the quality of patients care and uplift the standard of the institution. The sub theme pertaining to poor planning for staff development programmes is discussed next.

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3.2.1.2 Sub-Theme 2: Poor Planning for Staff Development Programmes

Planning is the first step in the management process and is part of strategy development in organisations (Jooste, 2013:79).

Planning and provision of the necessary educational programmes is the opportunity for staff to be developed and it is management’s responsibility to ensure that the development of staff is planned for adequately (Marquis & Huston, 2006:10).

Planning is described by Muller et al. (2011:23) as the fundamental element of management that should predetermine what the organisation proposes to accomplish, and how this is supposed to be achieved. Consequently, poor planning is when managers do not plan for the future and develop an alternative plan of action for staff development programmes in the organisation. Poor planning prevents managers from dealing with the present and anticipating the future. One cannot decide what is to be done first about staff development programmes, when is it to be done, how it is to be done and who is to do it (Yadav, Lim, Hashim & Saad, 2011:30).

Participants identified poor planning because they are sometimes called to attend staff development programmes without prior notice or planning.

“With staff development you know mmm…, there is no proper planning in our institution.

You can be phoned that morning and be told come transport is waiting you must go and attend of which you were not told in advance.”

Poor planning results in being unexpectedly informed to attend SD. Invariably, nurses are unable to attend because of the short notice. In order to enable staff to attend, it is necessary to prepare in advance, a roster for staff to attend SDPs, and to allow staff to organise their own schedules to facilitate their own attendance. The participants also indicated their concern that poor planning affects the organisation of the working conditions in their units.

“What I think is lacking firstly eh… is planning, you know what you want to achieve. If there is no planning, there is no direction.”

While most professional nurses perceive SDP as beneficial to their personal and professional growth and believe that it could lead towards improving the quality of patient care, barriers exist which prevent them from undertaking continuous educational

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programmes, this is exacerbated by a lack of coherent staff development planning (Richards, Potgieter & Litt Phill, 2010:41) Poor planning affects professional nurse’s interest to attend staff development programmes (Roussel et al., 2006:321).

Poor planning discourages the potential for the development of staff, hinders the capacity for professional nurses taking responsibility and the readiness to follow direction to attend staff development programmes for their own growth. Poor planning inhibits nurses from organising themselves in order to attend SD and achieve their goals by being directed towards the objectives of the institution.

“It is as if they just got the invitation the very morning. Everything is always done at the last minute.” (Angrily).

Without proper planning for SDP, there will be no effective delivery or development of a reflective practitioner and critical thinker which is essential to improve patient care (Hughes, 2005:42). Planning for nurses to attend SD, encourages nurses to think and reflect upon their practice since proper planning and reflection is at the heart of professional development.

In McConnel’s (2003:50) opinion, managers in an institution have much to do in determining which management functions are to be carried out and perhaps should have time and exert the effort to plan in advance consequently, preventing poor planning of staff development programmes. Poor planning however, prevents the smooth facilitation of SDP and affects staff especially when they are given short notice to attend staff development programmes.

Some participants mentioned that because of poor planning they are sometimes sent to attend the courses that are not related to their work or their interest. When they arrive at the venue, they are expected to have an idea of the training they are to receive only to find that they are not prepared for that particular topic under discussion at the staff development session.

“I think eh… staff development is not done enough for an example, I’m working in Gynae and I’m sent for things that don’t benefit me. If working in paeds, then be sent for paeds courses. For me, staff establishment is not done properly.’’

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“You’ll find that you are sent to study and when you come back, you are not placed appropriately thus knowledge you have gained cannot be implemented. With staff development you want people to grow in the profession. Staff must be sent and when coming back must practice what they have learned.”

“Recently I have attended a course on HIV and TB and I work in the Gynae ward. It was

“Recently I have attended a course on HIV and TB and I work in the Gynae ward. It was