• No results found

Nurses’ experiences regarding their leadership roles in a private healthcare day clinic in Gauteng

N/A
N/A
Protected

Academic year: 2021

Share "Nurses’ experiences regarding their leadership roles in a private healthcare day clinic in Gauteng"

Copied!
233
0
0

Loading.... (view fulltext now)

Full text

(1)COPYRIGHT AND CITATION CONSIDERATIONS FOR THIS THESIS/ DISSERTATION. o Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. o NonCommercial — You may not use the material for commercial purposes.. o ShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.. How to cite this thesis Surname, Initial(s). (2012). Title of the thesis or dissertation (Doctoral Thesis / Master’s Dissertation). Johannesburg: University of Johannesburg. Available from: http://hdl.handle.net/102000/0002 (Accessed: 22 August 2017)..

(2) NURSES’ EXPERIENCES REGARDING THEIR LEADERSHIP ROLES IN A PRIVATE HEALTHCARE DAY CLINIC IN GAUTENG. by. ENESTINE NGNIAMEKONG MBEBWO. DISSERTATION. SUBMITTED IN FULFILMENT FOR THE DEGREE. MAGISTER CURATIONIS. in. NURSING MANAGEMENT. in the. FACULTY OF HEALTH SCIENCES. at the. UNIVERSITY OF JOHANNESBURG. SUPERVISOR: DR H. ALLY. CO-SUPERVISOR: MRS E. M. NKOSI. 2019.

(3) DEDICATION This thesis is dedicated to my husband Noel Ndanji Mbebwo (my IT doctor), for your patience, love, friendship, humour. You are one of my greatest blessings from God. Your love is a gift that I open every day. You have been the source of my inspiration, encouragement, and stamina to undertake my higher studies and to face the eventualities of life, with zeal, enthusiasm, and fear of God. Also to my children for letting me experience the kind of love that people freely die for. Each of you has a special place in my heart.. Nesnoella ”The Princess”, Quintabelle “My Queen”, and Dior “The Prince”.. The lord is with you wherever you go! Joshua 1:9.. ii | P a g e.

(4) ACKNOWLEDGEMENTS For the ancestors who paved the path before me upon whose shoulders I stand. This is also dedicated to my family and many friends who have supported me on this journey. Thank you. I would like to express my sincere gratitude to the following people:  The completion of this study could not have been possible without the expertise of Dr Hafisa Ally, my beloved master’s dissertation supervisor. I called her ‘my path finder’; she was always ready to support, encourage, and deflate me each time I wandered off the topic. She is one of a kind, and strong people don’t put others down … they lift them up. Thank you for lifting me up.  To my co-supervisor Mrs Elizabeth Nkosi, my data analyst Mr John Mogakwe and language editor Ms Isabelle Morris, for holding my hand through this journey. Thank you both for your support and guidance.  The clinic management and the research committee for granting permission and providing me with the opportunity to conduct this study.  My beloved parents, Mr Jean Ngniamekong (aka Jean Nyagah) and Mrs Grace Ngniamekong (Mama), never apologise for what you could not give me when I was growing up, as I know you gave all that you could. You have both been my pillar of strength.  My siblings Josephine, Mirabelle, Laura, Serge, Dady Choe, Beverly, Eli and Mariette, I am blessed to be surrounded by you lovely people. It is said family is everything and you all create the magic of togetherness.  Noel, my husband, for always listening to the challenges that I experienced and for continually motivating me by calling me ‘Dr Mrs Ndanji even though I felt as though I was drowning in the work.. iii | P a g e.

(5)  To my son, Dior, for burning the midnight oil with me and telling me to remove my papers because he wanted to see what I was doing. Thanks a lot for your company my boy.  My super daughters, Nesnoella and Quintabelle, for going to bed early so that I could focus on completing this dissertation.  To my colleagues, and all the participants, thank you for all the support and time you gave me to make this happen.  Last but not the least, I would like to thank my super aunt, Ma Gladys (Ma Mbu) without you none of this would be possible. You always offered me your ears and said ‘Nothing good comes easy, hang on you are almost there’. “Life is not a solo act. It’s a huge collaboration, and we all need to assemble around us the people who care about us and support us in times of strife.” Tim Gunn. iv | P a g e.

(6) ABSTRACT Nurses are routinely placed in front-line positions to take on leadership roles with little formal preparation. Nurses who try to balance the dual roles of their specialties as well as leadership roles are likely to encounter conflict or uncertainty, since, while they have received professional clinical training, they may not have been trained in leadership and its concomitant roles. Nurses’ abilities to be shift leaders and to understand their leadership roles will depend not only in their preparation for such leadership roles, but it will also depend on how organisations support and, recognise them in terms of time, resources and personnel. The purpose of this research was to explore and describe nurses’ experiences regarding their leadership roles, and to develop recommendations to enhance the nurses’ leadership roles in a private healthcare day clinic in Gauteng. A qualitative, exploratory, descriptive and contextual research design using a descriptive phenomenological approach was used. A purposive sample of nurses who were in leadership positions (shift leaders) and who were willing to participate in the study was used. Data collection was achieved through in-depth, phenomenological, individual interviews. Data was analysed using Giorgi’s descriptive method of phenomenological data analysis. In order to protect the participants’ rights, the researcher adhered to ethical principles throughout the study. Measures of trustworthiness by ensuring credibility, dependability, confirmability, and transferability were applied throughout the study.. The central theme revealed by the study was that participants experienced their leadership roles to be challenging and multifaceted, with the two main themes emerging as follows: leadership roles’ experiences; and emotional experiences related to leadership roles. Recommendations to enhance the nurses’ leadership roles are made, as are recommendations for nursing practice and policy, nursing education, and future nursing research. The evaluation, limitations, conclusion, and reflection of the study are presented in Chapter 4.. v|Page.

(7) TABLE OF CONTENTS DEDICATION ........................................................................................................................................................................... ii ACKNOWLEDGEMENTS ................................................................................................................................................ iii ABSTRACT ............................................................................................................................................................................... v CHAPTER 1.............................................................................................................................................................................. 1 INTRODUCTION AND BACKGROUND ................................................................................................................... 1 1.1 INTRODUCTION ............................................................................................................................................................ 1 1.2 BACKGROUND AND RATIONALE .................................................................................................................... 1 1.2.1 International Perspective on Nurses’ Leadership Roles ........................................................... 2 1.2.2 Challenges Related to Nursing Leadership Roles......................................................................... 3 1.2.3 South African Perspective on Nurses’ Leadership Roles ........................................................ 4 1.3 PROBLEM STATEMENT .......................................................................................................................................... 6 1.4 RESEARCH PURPOSE AND OBJECTIVES ................................................................................................. 7 1.5 DEFINITION OF KEY CONCEPTS ...................................................................................................................... 8 1.5.1 Nurses........................................................................................................................................................................ 8 1.5.2 Experiences............................................................................................................................................................ 8 1.5.3 Leadership .............................................................................................................................................................. 9 1.5.4 Role.............................................................................................................................................................................. 9 1.5.5 Leadership Role .................................................................................................................................................. 9 1.5.6 Private Healthcare ............................................................................................................................................ 10 1.5.7 Day Clinic............................................................................................................................................................... 10 1.5.8 Gauteng .................................................................................................................................................................. 11 1.6 RESEARCH DESIGN AND METHOD .............................................................................................................. 11 1.6.1 Research Design ............................................................................................................................................... 11 1.6.2 Research paradigm ......................................................................................................................................... 11 1.6.3 Theoretical Framework related to Nurses’ Leadership Roles.............................................. 12 1.6.4 Research Method .............................................................................................................................................. 12 1.6.4.1 Population, Sample, and Sampling ................................................................................................... 13 1.6.4.2 Data collection................................................................................................................................................ 13 1.6.4.3 Data analysis ................................................................................................................................................... 14 1.7 TRUSTWORTHINESS .............................................................................................................................................. 15 1.8 ETHICAL CONSIDERATIONS ............................................................................................................................. 16 1.9 CONTRIBUTIONS OF THE STUDY .................................................................................................................. 18 vi | P a g e.

(8) 1.10. LAYOUT OF CHAPTERS ................................................................................................................................... 19 1.11 CONCLUSION ............................................................................................................................................................ 19 CHAPTER 2............................................................................................................................................................................ 20 RESEARCH DESIGN AND METHOD ...................................................................................................................... 20 2.1 INTRODUCTION .......................................................................................................................................................... 20 2.2 RESEARCH PARADIGM ........................................................................................................................................ 21 2.3 THEORETICAL FRAMEWORK ........................................................................................................................... 22 2.3.1 Application of the Theoretical Framework of Mintzberg’s Leader-Role Theory in the Study ............................................................................................................................................................................ 24 2.3.1.1 Mintzberg’s (1973:59) interpersonal role ....................................................................................... 24 2.3.1.2 Informational role ......................................................................................................................................... 26 2.3.1.3 Decisional role ............................................................................................................................................ 27 2.4 RESEARCH DESIGN ................................................................................................................................................ 28 2.4.1 Qualitative ............................................................................................................................................................. 29 2.4.2 Phenomenological Approach ................................................................................................................... 32 2.4.3 Exploratory Research .................................................................................................................................... 33 2.4.4 Descriptive Design........................................................................................................................................... 34 2.4.5 Contextual Research ...................................................................................................................................... 34 2.5 RESEARCH METHOD.............................................................................................................................................. 36 2.5.1 Population ............................................................................................................................................................. 37 2.5.1.1 Target population ......................................................................................................................................... 37 2.5.1.2 Sample and sampling method.............................................................................................................. 37 . Inclusion criteria........................................................................................................................................... 38. . Exclusion criteria ......................................................................................................................................... 38. 2.5.2 Data Collection ................................................................................................................................................... 39 2.5.2.1 The researcher’s role in data collection ........................................................................................ 41 2.5.2.2 Data collection methods .......................................................................................................................... 42 . Field notes ...................................................................................................................................................... 43. 2.5.2.3 Communication techniques ................................................................................................................... 44 2.5.3 Data Analysis ...................................................................................................................................................... 47 2.5.4 Measures to Ensure Trustworthiness ................................................................................................. 49 2.5.4.1 Credibility .......................................................................................................................................................... 50 2.5.4.2 Transferability ................................................................................................................................................. 52 2.5.4.3 Dependability .................................................................................................................................................. 53 vii | P a g e.

(9) 2.5.4.4 Confirmability.................................................................................................................................................. 53 2.6 ETHICAL CONSIDERATIONS ............................................................................................................................. 57 2.7 CONCLUSION .............................................................................................................................................................. 59 CHAPTER 3............................................................................................................................................................................ 60 PHASE 1- DESCRIPTION OF FINDINGS .............................................................................................................. 60 3.1 INTRODUCTION .......................................................................................................................................................... 60 3.2 DESCRIPTION OF FINDINGS AND LITERATURE INTEGRATION ............................................... 61 PHASE 1 .................................................................................................................................................................................. 61 3.2.1 CENTRAL THEME.................................................................................................................................................. 62 3.2.2 Theme 1: Leadership role experiences .............................................................................................. 68 3.2.2.1 Sub-theme Problem solving .................................................................................................................. 75 3.2.2.2 - Sub-theme Decision-making .............................................................................................................. 81 3.2.2.3 Sub-theme Change Agents/Management Agent....................................................................... 87 3.2.2.4 Sub-theme Creating a positive practice environment .......................................................... 95 3.2.2.5 Sub-theme Motivation and inspiration of others ................................................................... 105 3.2.2.6 Sub-theme Clinical supervision, coaching, and mentoring ........................................... 112 3.2.3 Theme 2: Emotional experiences related to leadership roles........................................... 129 3.2.3.1 Sub-theme Feelings of fear, depression, doubt, demotivation, and frustration 133 3.3 CONCLUSION ........................................................................................................................................................... 140 CHAPTER FOUR.............................................................................................................................................................. 141 RECOMMENDATIONS, LIMITATIONS, CONCLUSION, AND REFLECTIONS ............................ 141 4.1 INTRODUCTION ....................................................................................................................................................... 141 4.2 PHASE 2: RECOMMENDATIONS TO ENHANCE NURSES’ LEADERSHIP ROLES IN A PRIVATE HEALTH CARE DAY CLINIC IN GAUTENG. ............................................................................. 141 4.3 EVALUATION OF THE STUDY ........................................................................................................................ 149 4.3.2 Purpose ................................................................................................................................................................ 149 4.3.3 Objectives........................................................................................................................................................... 149 4.3.4 Research Design ............................................................................................................................................ 150 . 4.3.4.1 Phase 1 ......................................................................................................................................... 150. . 4.3.4.2 Phase 2 ......................................................................................................................................... 151. 4.3.5 Trustworthiness and Ethical Principles .......................................................................................... 151 4.4 LIMITATIONS OF THE STUDY ........................................................................................................................ 151 4.5 RECOMMENDATIONS FOR NURSING PRACTICE AND POLICY, NURSING EDUCATION, AND FUTURE RESEARCH ......................................................................................................... 152 4.5.1 Recommendations for Nursing Practice and Policy: ............................................................. 153 viii | P a g e.

(10) 4.5.2 Recommendations for Nursing Education .................................................................................... 153 4.5.3 Recommendations for Future Research: ....................................................................................... 154 4.6 CONCLUSION ........................................................................................................................................................... 154 4.7 RESEARCHERS’ REFLECTION ON THE STUDY ................................................................................ 155 REFERENCES ................................................................................................................................................................... 157. ix | P a g e.

(11) FIGURE Figure 2. 1: Leader-Role Theory; (Nurses’ Leadership Roles adapted from Mintzberg, 1973:59) ................................................................................................... 233. TABLES Table 2. 1: A summary of strategies to ensure trustworthiness according to Lincoln & Guba’s criteria. ........................................................................................... 55. Table 3. 1: Nurses’ experiences regarding their leadership roles in a PHCD clinic in Gauteng ................................................................................................................... 61 Table 3. 2: Summary of themes, sub-themes, and key recommendations to enhance nurses’ leadership roles in a PHCD clinic in Gauteng. .......................... 139. Table 4. 1: Recommendations for enhancing the nurses’ leadership roles in a PHCD clinic in Gauteng. ....................................................................................... 14142. x|Page.

(12) ANNEXURES Annexure 1: UJ Research Ethics Committee Letter- Ethical Clearance Permission .................................................................................................................................... 194 Annexure 2: UJ Higher Degrees Committee Letter of Permission ...................... 195 Annexure 3: Application Letter to Conduct Research in a Private Clinic. ........ 196. Annexure 4: Letter of Approval to Conduct Research in a Private Clinic ........... 197 Annexure 5: Letter of Consent to Conduct Research in a Private Clinic .......... 199 Annexure 6: Invitation to Participate in the Research ...................................... 20101 Annexure 7: Consent to Participate in the Research ........................................ 20404 Annexure 8: Consent to use an Audio Tape Recorder ..................................... 20505 Annexure 9: Independent Coder Report ............................................................ 20606 Annexure 10: Language Editing Report ............................................................. 20707 Annexure 11: Example of Transcript of Data Collected ..................................... 20808 Annexure 12: Turnitin Report ............................................................................... 21717. xi | P a g e.

(13) LIST OF COMMON ABBREVIATIONS USED IN THE STUDY. ARNNL:. The Association of Registered Nurses of Newfoundland. CLPNNL:. College of Licensed Practical Nurses of Newfoundland and Labrador. CM:. Change Management. CS:. Clinical Supervision. DA:. Democratic Alliance. DM:. Decision Making. DPSA:. Department of Public Service & Administration South Africa. GP:. General Practitioner. HCW:. HealthCare Waste. HST:. Health System Trust. HRH:. Human Resource for Health. ICN:. International Council of Nurses. ISO:. International Organization for Standardization. NCS:. National Core Standard. NDoH:. National Department of Health. NHS:. National Health Service. OHS:. Occupational Health & Safety. OSD:. Occupational Specific Dispensation. P:. Participants. PHC:. Primary HealthCare. PHCD:. Private HealthCare Day. PHO:. Primary Health Organisation. PS:. Problem Solving. PPE:. Positive Practice Environment. R:. Regulation. xii | P a g e.

(14) RCN:. Royal College of Nursing. RuDASA:. The Rural Doctors Association of Southern Africa. RWJF NFS: The Robert Wood Johnson Foundation Nurse Faculty Scholars SA:. South Africa. SAHAHCSF: South Australia Health Allied Health Clinical Supervision Framework. SANC:. South African Nursing Council. SOP:. Standard Operational Procedure. UJ:. University of Johannesburg. VEMEC:. Veterans Emergency Management Evaluation Centre. WHO:. World Health Organization. xiii | P a g e.

(15) LIST OF COMMONLY USED TERMS AND MEANINGS IN THE STUDY Terms. Meaning. Leadership role. Leadership role comprises a set of tasks and responsibilities and coping with change in a Primary HealthCare Day Clinic. that. might. not. be. clearly. communicated to nurses. These entail taking the lead in decision-making (DM) and problem-solving (PS) to ensure the smooth running of the day clinic in the absence of the charge sister. Nurses. Nurses refer to the professional nurses and enrolled nurses working in a Private HealthCare Day Clinic in Gauteng, who are in charge of their shifts, but who also work as shift leaders when the charge sister is not on duty.. Private Health Care Day clinic. Private Healthcare Day Clinic is a private medical and dental centre that operates during the day and offers a wide range of primary healthcare services within a single facility. Services are delivered by a team of full-time doctors, dentists, pharmacists, and medical support staff as well as physiotherapists, other related medical specialists,. and. nurses. that. provide. professional healthcare from assessment to treatment of clients.. xiv | P a g e.

(16) CHAPTER 1 INTRODUCTION AND BACKGROUND. 1.1 INTRODUCTION In this chapter the researcher presents the study’s background and rationale. The study’s problem statement, research question, purpose and objectives are also presented. The research design, research paradigm, a brief overview of the theoretical framework guiding the study, and the research methodology, which includes the population and sample, pilot study, data collection, data analysis, trustworthiness, and ethical principles are briefly discussed.. 1.2 BACKGROUND AND RATIONALE. Leadership refers to the state or position of becoming a leader, Oxford Advanced Learner’s Dictionary, (2010:844) while according to Jooste (2013:197) leadership is broadly accepted as a role that influences others to accomplish common goals and brings about real changes in their workplace.. Leadership is described as a complex and. multifaceted process that involves providing support, motivation, coordination, and resources to enable individuals and teams to achieve collective objectives (Wong, Cummings & Ducharme, 2013: 709-724). There is a need for nurse leadership, hence nationally and globally, nurses are increasingly expected to assume leadership roles. Davis (2014:70-72) asserts that nurses need more theoretical knowledge regarding leadership roles in addition to skills required to lead a team, a shift, or a unit. Leadership roles refer to formal or informal roles, where, in formal leadership roles, shift leaders have specific responsibilities assigned to their job specifications that cause an organisation’s employees to follow them. An informal leadership role refers to instances when the shift leader uses their personal traits, i.e. charisma or inspiration to naturally motivate stakeholders to act accordingly in their organisation (Kokemuller, 2018:n.p). 1|Page.

(17) 1.2.1 International Perspective on Nurses’ Leadership Roles. The International Council of Nurses (ICN) [2014b:n.p] and Davis (2012:n.p) propose that the goal of nursing leadership in global health is to improve nurses’ skills so that they can influence global health. This can be achieved by empowering them through their leadership roles, strengthening and influencing nurses’ voices in strategic planning, since it was identified that the absence of nurses as empowered leaders constitutes a global health crisis that requires urgent attention. On the other hand, the World Health Organization (WHO) [2015:n.p] states that the current global investment in nurses is not sufficient to support healthcare systems’ leadership roles. Therefore, a change in planning, education, deployment, utilisation, and recruitment, and retention strategies for nurses is needed, which can be achieved through enhanced nurses’ leadership roles. WHO further stated that such a change should include strengthening primary healthcare clinics (PHCs) by ensuring that nurses are key care team members and shift leaders for organisational changes. McGilton, Profetto-McGrath, and Robinson (2013:238-247) claim that nurses have little knowledge through leadership education and therefore propose utilising a supportive supervisory framework. This is intended to introduce and reinforce supportive leadership behaviours so that when nurses are employed the framework can provide them with leadership role awareness. Wang, Wei, Li, Deng, Luo, and Li (2013:21-33) argue that nursing has long been subordinate to clinical medicine and professional nurses are challenged in meeting their increasingly important roles in achieving the millennium development goals and health care reform. The authors also state that professional nurses’ leadership roles need to be taken in to consideration for proper healthcare development. Leading and organising nursing care and patients’ needs constitute a large part of all nurses’ work, and setting priorities is a difficult skill for most nurses because they lack leadership role experience. This is considered to be the key to effective decision making, problem solving and the leadership role strengthens and influences nurses’ ability to 2|Page.

(18) prioritise tasks (Ekstrom & Idvalle, 2015:75-86). Jefferson, Klass, Lord, Nowak and Thomas, (2014:811-829) assert that continuing confusion, role ambiguity, disparity between the experiences of nursing shift leaders and nurses, and discomfort with nursing leadership roles or a perceived lack of leadership, results from the co-option of nurses and leadership roles into management positions without clarity in these roles.. Denker’s (2014:10) study identified that there is no leadership orientation for nurses regarding leadership roles, yet they are expected to take on these roles in the absence of operational managers. Parks (2013:28) reports that leadership roles can be taught. Most nurses who graduate and enter the workforce are not ready to assume a leadership role. Opportunities for self-discovery, self-reflection, and critical thinking to explore nurses’ strengths and build their skills are highly needed.. Eneh, Vehvilainen-Julkunen, and Kvist (2012:159-169) reflected on the essential role of nursing leadership and emphasised the necessity for nursing leadership to undertake reflection and self-evaluation by examining the nursing staff’s experiences regarding their leadership actions and practices. These studies did not report on the nurses’ experiences of their own leadership roles. In turn, these practices can influence nurses’ motivation and can positively or negatively influence outcomes for patients, their relatives, and hospital organisations, based on these nurses’ experiences regarding their leadership roles at work (Casida & Parker, 2011:478-486; Schwart, Spenser, Wilson & Wood, 2011:737748). 1.2.2 Challenges Related to Nursing Leadership Roles When nurses have to report to a service manager for operational issues and to senior nurses for professional accountability, this leads to tension and leadership role ambiguity (Carryer, Diers, McCloskey & Wilson, 2010:275-285). Calverley (2012:8) reported that New Zealand PHC collectives also experienced the need for quality nursing leadership role in their organisations. Consequently, directive from past years requested that, they developed new service structures to meet the challenges evident in nurse leadership roles, resulting in better, more convenient leadership roles. 3|Page.

(19) However, Tilton and Thomas (2011:32) report that due to the complexity of comprehensive primary healthcare, the high level of need in clinics, rapidly changing policy and work environments, it is necessary to develop and maintain strong networks in leadership roles and relationships between the PHC services and other organisations, all of which place a very high value on leadership roles of nurses.. Iglesias, Ramos, Serrano, Fabregas, Sánchez, García, and Esgueva (2013:2450), Clark, Smith, Taylor, and Campbell (2011:253), and Martínez-González, Rosemann, Tandjung and Djalali (2015:n.p) emphasise that in many PHC settings, it is essential that nurses that lead shifts as full members of the PHC team assume the leadership role. According to Schaay, Sanders, Kruger, and Olver (2011:6), the health sector continues to face significant challenges placing nurses under significant stress, which may include the quadruple burden of disease, inequitable distribution of health resources, and an emphasis on curative healthcare. These authors further assert that the majority of the country’s population is reliant on the public healthcare system and this places significant pressure on health resources and compromises leadership role execution by nurses. Maillacheruvu and McDuff (2014:5) assert that most clinics lack the number of nurses necessary to fulfil the personal, community-based values of the PHC model outlined in the National Health Bill, which has resulted in nurses that are leading shifts being unable to assume their leadership roles in the PHC clinics. 1.2.3 South African Perspective on Nurses’ Leadership Roles In South Africa (SA), SA Government Notice R425, the South African Nursing Council (SANC) [1985:n.p] prescribes that part of the curriculum for the basic diploma and/or fouryear degree programme includes General, Psychiatric, Community, and Midwifery courses. It should also include unit management and teaching, as well as leadership and leadership role issues (Doherty, 2014: 31-33). The SA National Department of Health’s (NDoH) Strategic Plan for Nursing Education, Training, and Practice in Healthcare (2012/13-2016/17:24) emphasises the steady decline in formal, dedicated nursing leadership at national and provincial healthcare organisations, with a growth in non-nurse 4|Page.

(20) practitioners in leadership and management positions. It further stipulates that management approaches have unintentionally led to the decline of nurses’ morale, as well as experiencing difficulties in identifying and exercising their leadership roles. The National Core Standard (NCS) for Health Establishments in South Africa’s (2011:35) Domain 5 states that effective leadership, in both private and public sectors, should comply with these senior managers’ roles. Demonstration of leadership roles and leadership development should be actively supported at all levels in healthcare. In South Africa (SA), the Health Systems Trust (HST) [2007:n.p] has shown that while governance and leadership structures do exist, the lack of attention from policy makers as to how these structures should function and what the leadership role focus should be, suggests that many facilities are merely complying with the legislation with little attention as to how to maximise the PHC clinics’ efficiency and operations, based on nurses’ leadership roles.. The HST (2012:55) reports that the shift towards the deployment of nurses for PHC outreach programmes is likely to benefit the SA population, especially those programmes in the day clinics. The HST further reports that the successful implementation of the PHC clinics’ outreach programmes is dependent on tackling challenges that have plagued the outreach programmes over the years and taking into consideration factors such as those nurses who lead shifts participating, as well as adequate resourcing to facilitate leadership role effectiveness in the clinics.. The NDoH’s Human Resources for Health (HRH) South Africa: Strategy for the Health Sector (2012/13–2016/17:n.p) and the NDoH South Africa (2011:n.p) state that nurses must have a standardised scope of work, clearly defined leadership roles, defined responsibilities and job description, certified training, specified qualification requirements, employment mechanisms, educational training and supervision packages, and remuneration and conditions of service so that their leadership roles are effective in PHC clinics. In a study conducted in a PHC clinic, Jooste and Hamani (2017:43) recommend that PHC nurses need acknowledgement, organisational responsibilities, strategic planning 5|Page.

(21) and promotion, as well as support, which can be realised during the execution of their leadership role. Moosa, Derese, and Peersman (2017:5) report that clinic managers use school health nurses and district health nurses as shift team leaders, as they are already working outside the clinic. These nurses are expected to manage the clinic in addition to their current leadership roles, resulting in dissatisfaction in the execution of their roles. Modise (2015:18) reports that the shortage of nurses leading shifts and poor supervision of peers has placed PHC clinics under severe constraints, resulting in nurses experiencing severe displeasure in the exercising of their leadership roles at the clinic, resulting in poor quality of service delivery.. Leadership roles in the PHCD clinic focus on the challenges in leadership roles that nurse and shift leaders experience in the absence of their charge sister. These nurses are not fully aware of their leadership roles, hence resulting in shift leaders feeling not competent in assuming these roles. No study on nurses’ experiences of their leadership roles had been done in this PHCD clinic.. It is against this background that the researcher sought to explore and describe the nurses’ experiences regarding their leadership roles in a PHCD clinic in Gauteng in order to make recommendations to enhance the nurses’ leadership roles in this clinic.. 1.3 PROBLEM STATEMENT The researcher observed that in the absence of the charge sister, many nurses do not exercise their leadership roles when placed in leadership positions in the PHCD clinic. The nurses sit back and watch their profession fail, a profession that is determined by its leadership role and its concomitant responsibilities, recognition, authority, and scope of decision making, thus destroying working relationships between nurses. Dolamo (2015:485-497) states that nurses are neither encouraged to, nor positive in assuming leadership roles. Succession planning into leadership positions is not implemented, 6|Page.

(22) leaving nurses unclear about their leadership roles. Dolamo further asserts that nurses who have not undergone leadership training are ill-prepared for the demands of 21st century nurse leadership roles in healthcare.. The NCS for Health Establishments in South Africa (2011:35), Domain 5 (Leadership and Governance) emphasises that effective leadership and leadership role development should be actively supported at all levels in both private and public health sectors. Hayes, O’Brien-Pallas, Duffield, Shamian, Buchan, Hughes, Spence-Laschinger, and North (2012:685-695) claim that the lack of strong leadership roles experienced by nurses can be devastating to the nurse’s morale and ultimately result in increased costs due to retention issues in the profession.. Nurses in this facility did not have the opportunity to express their experiences since no studies on nurses’ experiences regarding their leadership roles in this particular PHCD clinic had been conducted, hence the relevance of this study.. From the above problem statement, the following research questions arose: . What are the nurses’ experiences regarding their leadership roles in a PHCD clinic in Gauteng?. . What can be done to enhance the nurses’ leadership roles in this PHCD clinic?. 1.4 RESEARCH PURPOSE AND OBJECTIVES The purpose of this study was to explore and describe nurses’ experiences regarding their leadership roles, and to develop recommendations to enhance the nurses’ leadership roles in a PHCD clinic in Gauteng.. 7|Page.

(23) The research objectives were:. -. to explore and describe nurses’ experiences regarding their leadership roles in a PHCD clinic in Gauteng; and. -. to develop recommendations to enhance the nurses’ leadership roles in a PHCD clinic.. 1.5 DEFINITION OF KEY CONCEPTS Key concepts in research facilitate the understanding of the study context in which the concepts are used and eliminate uncertainties (Wallen & Fraenkel, 2011:16).. The researcher presents definitions of the key concepts used in the study as well as their operational definitions, which facilitate the understanding of these concepts.. 1.5.1 Nurses Persons registered in a category under section 31(1) of the SANC Act, in order to practice nursing and midwifery (Nursing Act, No 33 of 2005:6).. In this study nurses refer to professional nurses and enrolled nurses working in a PHCD clinic in Gauteng, who are in charge of their shifts when the charge sister is not on duty.. 1.5.2 Experiences The Oxford Advanced Learner’ Dictionary (2010:514) defines experiences as the knowledge and skills that are achieved through doing something for a period of time. On the other hand, Schwandt (2015:103) states that experiences refer to qualitative inquiries that deal with a human’s lived experiences. It is the life world as it is lived, made sense of, and accomplished by human beings, who are the participants of the study.. 8|Page.

(24) In this study, experiences refer to how nurses see and understand their leadership roles at work in a PHCD clinic in Gauteng.. 1.5.3 Leadership Leadership refers to the state or position of being a leader, (Oxford Advanced Learner’s Dictionary, 2010:844). Leadership is an influential relationship among people involving leaders and followers who intend to effect real changes that reflect their shared goals in the organisation (Muller, Bezuidenhout & Jooste, 2013: 414).. In this study, leadership is the position that the nurses (professional nurses and some enrolled nurses who are senior) in the PHCD clinic assume in the absence of a charge sister, in terms of taking responsibility and making decisions while motivating others.. 1.5.4 Role Role refers to the function or position that a person is expected to have in their organisation (Oxford Advanced Learner’s Dictionary, 2010:1282). According to Sullivan and Garland (2013:88) a role is a set of expectations regarding behaviour ascribed to a specific position at work.. In this study, roles are defined as the functions that nurses who lead shifts assume when carrying out their duties at work.. 1.5.5 Leadership Role Leadership roles refer to leaders leading employees to achieve organisational goals, and its role in employees’ performance and productivity in the organisation for which they work (Kadian-Baumeyer, 2018:n.p).. In this study, a leadership role encompasses the set of tasks and responsibilities and coping with change in a PHCD clinic, which duties might not have been communicated to 9|Page.

(25) the nurses expected to assume the leadership roles. These responsibilities include taking the lead in making decisions, and solving problems to ensure the smooth running of the PHCD clinic in the absence of the charge sister.. 1.5.6 Private Healthcare Refers to any private healthcare facility where provision is made for the treatment and care for cases involving medical and surgical treatment and nursing care. According to Regulation (R) 158, (2011:14) a private healthcare facility is a focused medical establishment licensed under the terms of the regulations pertaining to the control of private healthcare.. In this study, private healthcare is a service with multi-disciplinary services including xrays, physiotherapy, dietetics, dentistry, psychology, pharmacology, pathology, travel clinics, and permanent onsite doctors. It provides services mostly to medical aid and cash patients who require services from this PHCD clinic.. 1.5.7 Day Clinic The Day Hospital Association of South Africa (DHASA) [2018:n.p] refers to day hospitals and clinics as services that strive to offer distinct comfort and cost advantages to clients in their areas of operation. Physically, it is a building where patients attend consult with a medical or nurse practitioner only during the day (Bailliere’s Nurses’ Dictionary, 2013:85).. In this study, the day clinic is a medical and dental centre offering a wide range of PHC services within a single facility, delivered by a team of full-time doctors, dentists, pharmacists, and medical support staff including physiotherapists, other related medical specialists, and nurses who provide professional healthcare from assessment to treatment of clients, and such treatment is only provided during the day. Patients return home after treatment while more severe cases are referred to higher level of care in private and public hospitals. 10 | P a g e.

(26) 1.5.8 Gauteng In the Sotho language, Gauteng means ‘Place of Gold’. Gauteng is the smallest province in SA, which was first the metropolitan area known as Pretoria-WitwatersrandVereeniging (PWV), which are the three urban centres that make up the province, (South African History, 2017:n.p).. This study was conducted in a PHCD clinic located in the West Rand, i.e. the western region of Gauteng. 1.6 RESEARCH DESIGN AND METHOD 1.6.1 Research Design Research design refers to the overall plan for addressing a research question, and provides specifications for enhancing the study’s integrity (Polit & Beck, 2012:741).. In this study a qualitative, phenomenological, exploratory, descriptive, and contextual research design was used to explore and describe nurses’ experiences regarding their leadership roles in a PHCD clinic in Gauteng. This is described in detail in Chapter 2. 1.6.2 Research paradigm A paradigm is a way of looking at natural phenomena and encompasses a set of philosophical assumptions with the aim of using one approach to the enquiry, and it provides the researcher with a set of beliefs to guide the research (Polit & Beck, 2012:14; Holloway & Wheeler, 2010:341).. This study was guided by the constructivist paradigm, which focuses on the way in which human beings make sense of their subjective reality and how they attach meaning to. 11 | P a g e.

(27) thereto (Holloway & Wheeler, 2010:25). It refers to the participants’ thoughts and their basic beliefs and how their perspectives are developed. In this study, the constructivist paradigm facilitates how the nurses’ leadership, their roles, and their importance to their organisation are comprehended. A constructivist paradigm is subjectivity based on realities; it points out the unique experience of each of us, and these assumptions are in essence what guides research (Patton, 2015:121-122), hence, the experiences of nurses leading shifts’ leadership roles and the meaning placed on these experiences. 1.6.3 Theoretical Framework related to Nurses’ Leadership Roles The theoretical framework is the structure that holds or supports a theory of a research (Vinz, 2018:n.p). It enables the researcher to show that the study at hand is a logical extension of current knowledge (Brink, van der Walt & van Rensburg, 2015:26). This study adopted the theoretical framework proposed in Mintzberg’s Leader-Role Theory of 1973, which consists of three categories of roles: the interpersonal; informational; and decisional roles. Mintzberg further describes the management/ leadership roles of executives/nurses. This framework guides the study in terms of the nurses leading shifts in a PHCD clinic, and directs pathways to achieving organisational goals with fewer challenges encountered. This is discussed in more detail in Chapter 2 of this study.. 1.6.4 Research Method Research methods are processes for conducting specific research steps (Burns, Grove & Gray, 2013: 707). A descriptive phenomenological method was used in this study. The study methods include population, sample and sampling method, data collection, data analysis, trustworthiness, and ethical principles (Creswell, 2014:247).. This research study was conducted in two phases:. 12 | P a g e.

(28) a) Phase 1: Focuses on the exploration and description of nurses’ experiences regarding their leadership roles in a PHCD clinic. b) Phase 2: Focuses on the development of recommendations to enhance the nurses’ leadership roles in a PHCD clinic, based on the findings from phase 1.. 1.6.4.1 Population, Sample, and Sampling Population is defined as the entire aggregation of cases in which the research would like to generalise the findings of a study (Polit & Beck, 2012:273). In this study, the population comprised professional nurses and enrolled nurses who are in charge of their shift and who also work as shift leaders in a PHCD clinic.. Sample and sampling refer to the process of selecting a sample from a population in order to obtain information regarding a phenomenon in ways that represent the population of interest (Brink et al., 2015:132). A purposive sample was used. Participants were selected based on the study knowledge at hand, voluntary participation and willingness to participate in the study (Annexure 6) was one of the criteria, and participants must have taken charge of a shift in the absence of a charge sister.. Pilot study. According to Holloway and Wheeler, (2010:341) a pilot study is a small scale trial run of the research interview of the study at hand, with the purpose to examine the feasibility of an approach that is intended to ultimately be used in a larger scale study. In this study, a pilot study was conducted on two participants.. 1.6.4.2 Data collection Data collection is a process of gathering data from the participants who voluntarily agreed to take part (Silverman, 2011:65). In-depth, phenomenological, individual interviews were 13 | P a g e.

(29) conducted until data saturation occurred, which is when no new data emerged from the interviews (Burns, Grove & Gray, 2013:268).. The interviewer posed the following central questions to all participants:. - Tell me about your experiences regarding your leadership roles in this PHCD clinic.. - What can be done to enhance your leadership roles in this clinic?. Data collection comprised approximately 30-45 minutes of audio tape recorded interviews with the participants (Annexure 8). Both the researcher and participants agreed on the venue, date, and time of the interview. The interviews were audio tape recorded after obtaining consent from participants (Annexures 7) to ensure that data was captured and transcribed verbatim. The details are described in Chapter 2.. 1.6.4.3 Data analysis Data analysis is a process that reduces, organises, and gives meaning to data that has been collected (Burns et al., 2013:46). The researcher and an independent coder, who is experienced in qualitative data analysis, analysed the data independently from the transcribed tapes of interviews with participants immediate after data collection. Giorgi’s descriptive phenomenological data analysis, as presented in Holloway and Wheeler (2010:222-223) was followed, using the four prescribed steps. Details are presented in Chapter 2. Giorgi’s four steps for analysis are as follows. 1. The entire description is read to get a sense of the whole. 2. Once the Gestalt has been grasped, researchers attempt to constitute the parts of the description. 3. When the meaning units have been illuminated, the researcher actively transforms the original data and expresses the insight. 14 | P a g e.

(30) 4. The researcher integrates the transformed meaning units into a consistent statement about the participants’ experience across individual sources.. 1.7 TRUSTWORTHINESS In a qualitative study, trustworthiness is the degree of confidence that the researchers have in their data (Polit & Beck, 2012:175). Trustworthiness was used to ensure data quality based on Lincoln and Guba’s (2013:104) criteria of credibility, transferability, dependability, and confirmability.. 1.7.1 Credibility in this study was obtained by prolonged contact in the field to gain data saturation and an in-depth knowledge of all participants by asking different questions (Lincoln & Guba, 2013:104).. 1.7.2 Transferability is the degree to which findings can be transferred and applied to other settings. It is the ability to ensure that findings will be applicable in different contexts (Lincoln & Guba, 2013:104-105).. In this study, the researcher provides sufficient descriptive data in the research report so that other researchers can apply it in other contexts (Polit & Beck 2012:525). A chain of evidence was followed, and the demographics of the participants are described, (Annexure 11). A rich description of the results is provided with supporting direct statements from participants.. 1.7.3 Dependability refers to the stability of data over time (Polit & Beck, 2012:585). In this study, dependability was achieved via a detailed and clear description of the study from the research methodology.. 1.7.4 Confirmability refers to the potential for congruence between two or more independent people regarding data accuracy, relevance, and meaning (Lincoln & Guba,. 15 | P a g e.

(31) 2013:105). In this study, the data reflects the participants’ voices, as information was obtained from their responses to the different questions posed to them.. An elaboration of how the trustworthiness was ensured in this study is provided in Chapter 2.. 1.8 ETHICAL CONSIDERATIONS Ethical considerations refer to the researcher responsibly conducting a study in an ethical way right from conceptualisation, through the planning phase and the implementation phase, and finally during the dissemination phase. It ensures that the researcher searches for the truth in the most rigorous way, but never to the detriment of individuals and the communities’ rights (Brink et al., 2015:32).The researcher applied ethical considerations throughout the research process. Participants’ information letter – (Annexure 6). The researcher sought ethical clearance approval to conduct the research from the following departments: . University of Johannesburg (UJ) Faculty of Health Sciences, Research Ethics Committee (Annexure 1);. . UJ Faculty of Health Sciences, Higher Degrees Committee (Annexure 2); and. . Permission from the Private Clinics Organizations Research Committee to conduct research at the day clinic (Annexure 3).. The following principles were used to ensure that participants’ rights were not violated and no harm occurred (Dhai & McQuoid-Mason, 2011:14-15).. 1.8.1 Principle of Beneficence. 16 | P a g e.

(32) Beneficence refers to doing good to others and promoting their interests and well-being (Dhai & McQuoid-Mason, 2011:14-15). In this study the right to equality, justice, human dignity, and protection was ensured through informed consent for data collection and by protecting participants from harm (Annexures 6 & 7).. 1.8.2 Principle of Justice. Justice refers to the distribution of fairness. All participants were treated fairly without discrimination. In this study, the context of the research indicated fairness and equity of all participants (Dhai & McQuoid-Mason, 2011:14-15).. 1.8.3 Principle of Non-maleficence. According to Dhai and McQuoid-Mason (2011:14-15) non-maleficence is avoiding harm to the participants. In this study, the researcher respected and ensured the wellbeing of all participants by refraining from any means of physical, emotional, spiritual, or social discomfort and/or harm to participants.. 1.8.4 Autonomy and Confidentiality. Autonomy acknowledges participants’ right to self-determination. This applies to the participants’ choice to make their own decisions (Dhai & McQuoid-Mason, 2011:14-15). Participants had the right to terminate participation at any time without any negative impact on them, and in this study the researcher also obtained informed consent from all participants before the study commenced (Annexure 7). In terms of confidentiality, the researcher ensured that the participants’ information about the study topic was not divulged without the participants’ permission (Burns et al., 2013:177-178). In this study, confidentiality was ensured by using code names for participants (P1–P8) instead of the participants’ real names (Annexure 6).. 17 | P a g e.

(33) 1.8.5 Risk/Benefit. Risk refers to the possibility that the participants maybe harm during the research process, and the benefits refers to the positive contributions that the findings provides to the study (Brink et al.,2015:42-43). There are no probable risks associated to the study, instead the nurses will benefit from the recommendations to enhance their leadership roles in a PHCD clinic in Gauteng.. 1.9 CONTRIBUTIONS OF THE STUDY. The following contributions of the study are noted.. -. the study is an exploration and description of nurses’ experiences regarding their leadership roles in a specific PHCD clinic in Gauteng and provides an understanding of how nurses experience their leadership roles in this PHCD clinic;. -. recommendations for enhancing the nurses’ leadership roles in a PHCD clinic are developed in this study for implementation;. -. recommendations to nursing practice, policy, nursing education, and further research are also made; and. -. the study also will contribute to the body of knowledge in nursing management and leadership roles in PHCD clinics on the experiences of nurses their leadership roles as well as the recommendations.. 18 | P a g e.

(34) 1.10. LAYOUT OF CHAPTERS Layout refers to the structural arrangement of material on a page, and it ensures a smooth flow of work, material, and information through a system (Merriam-Webster Dictionary, 2018: n.p.).. The layouts of the chapters in the study are as presented next for ease of reference:. Chapter 1:. Introduction, background, and study rationale. Chapter 2:. Research design and method. Chapter 3:. Description of research findings. Chapter 4:. Recommendations to enhance nurses’ leadership roles, an evaluation of the research, the limitations and recommendations for nursing practice and policy, nursing education, future research, conclusion, and reflection of the study.. 1.11 CONCLUSION This chapter provided an overview of the study, the background, and the rationale for conducting the study that included a problem statement. The research design, research paradigm, theoretical framework, and research methods were identified and used. The chapter concluded with the ethical principles that were applied throughout the study. Chapter 2 follows with a detailed presentation of the research design and methodology used in the study.. 19 | P a g e.

(35) CHAPTER 2 RESEARCH DESIGN AND METHOD 2.1 INTRODUCTION Chapter 1 introduced the reader to the background and the study rationale. The problem statement, research questions, study objectives, definition of key concepts, research design, research paradigm, theoretical framework, methodology, measures to ensure trustworthiness, and ethical considerations of the study were presented.. In this chapter, the researcher provides a detailed outline of the research design and methods used. The research design chosen for the study was qualitative, phenomenological, exploratory, descriptive, and contextual. The research methodology uses the qualitative, descriptive, phenomenological research method, which includes the research paradigm, theoretical framework, population, sample and sampling method, pilot study, data collection, data analysis, measures to ensure trustworthiness and ethical considerations.. The purpose of this study was: . to explore and describe nurses’ experiences regarding their leadership roles, and to develop recommendations to enhance the nurses’ leadership roles in a PHCD clinic in Gauteng.. The study objectives were: . to explore and describe the nurses’ experiences regarding their leadership roles in a PHCD clinic in Gauteng; and. . to develop recommendations to enhance the nurses’ leadership roles in this PHCD clinic. 20 | P a g e.

(36) To achieve the study objectives, the study was conducted in two phases: . Phase 1 Focuses on the exploration and description of nurses’ experiences regarding their leadership roles in a PHCD clinic. . Phase 2 Focuses on the development of recommendations to enhance the nurses’ leadership roles in a PHCD clinic based on phase 1’s findings.. 2.2 RESEARCH PARADIGM A paradigm refers to a worldview, the way of thinking and making sense of the complexities associated with the real world; it also informs us on the importance, legitimacy, and reasonableness of the study (Patton, 2015:89). This study pursues a qualitative, phenomenological, exploratory, descriptive, and contextual research paradigm using a constructivist approach, as the study seeks to find truth and add meaning to the lived experiences of nurses’ leadership roles. Constructivism in research refers to the idea that the experienced reality – is actively constructed by the participants and that the observer plays a major role in any theory during the research (Kenny, 2010:65-76).. Crotty, (1998:58) suggests that each nurse’s perspective of the world is as valid and worthy of respect as any other. It refers to how nurses leading shifts experienced their leadership role execution through their own worldview in the PHCD clinic as they relate to the research concepts that address and explore the world. Guba and Lincoln (1994:107) argued that beliefs of the worldviews are basic and must be accepted on faith and there is simply no way to establish the truthfulness. The researcher’s world view is that people will make their own meaning of their lived experiences. These experiences are subjective hence the relevance of the constructivism paradigm for this study. A discussion of the theoretical framework guiding the study is discussed next. 21 | P a g e.

(37) 2.3 THEORETICAL FRAMEWORK According to Gray, Grove, and Sutherland (2017:138), a theoretical framework is an abstract, logical structure of meaning that assists in the development of a study and helps connects research findings to the nursing body of knowledge. It guides and allows researchers to understand natural phenomena, and to merge observations and facts in a systematic way. In this study, Mintzberg’s (1973:59) theoretical framework was used and adapted to guide the study.. Mintzberg developed a list of roles to be observed in his study of executives. The roles account for all leadership/management activities in the organisation, and each activity can be explained in terms of at least one role, although many activities involve more than one role. The theoretical framework of Mintzberg’s Leader-Role Theory (1973:59-66) was chosen for this study and assisted the researcher to classify new discoveries during the data analysis in the description of nurses’ experiences regarding their leadership roles in a PHCD clinic in Gauteng.. The adapted theoretical framework of Mintzberg is presented in Figure 2.1.. 22 | P a g e.

(38) Nurses Leadership Roles Formal Authority & Status. FEEDBACK. Provide Information. Informational Roles - Monitor (supervisor, mentor & coach). Process Information. - Disseminator & - Spokesman. Decisional Roles - Entrepreneur (change agent). Nurses Leadership Roles. Nurses Leadership Roles. (Nurse). Use Information. - Disturbance handler (decision maker) - Negotiator (problem solver). Nurses Leadership Roles. Figure 2. 1: Leader-Role Theory; (Nurses’ Leadership Roles adapted from Mintzberg, 1973:59). 23 | P a g e.

(39) Mintzberg’s Leader-Role Theory (1973) articulates the following leadership roles: figurehead; leader; liaison; monitor; disseminator; spokesman; entrepreneur; disturbance handler; and negotiator, which are evident in the multifaceted roles that nurses in this PHCD clinic experience as challenging. 2.3.1 Application of the Theoretical Framework of Mintzberg’s Leader-Role Theory in the Study According to Mintzberg (1973), the categories of leadership roles can be grouped into three categories, namely:. -. the interpersonal role;. -. the informational role; and. -. the decisional role.. 2.3.1.1 Mintzberg’s (1973:59) interpersonal role Interpersonal contact concerns the contact between a leader and their colleagues in their work environment, develops peer relationships, carries out negotiations, motivates and inspire colleagues, resolves conflict, and uses it as a source of creativity, (Mintzberg, 1973:59). Three of the leader’s roles arise out of formal authority and involve basic interpersonal relationships. The following Mintzberg Leader-Roles are primarily concerned with interpersonal contact. . Figurehead (Mintzberg, 1973:59). By virtue of being in a position of being the head of team as a leader in the healthcare organisational unit, every leader must perform some duties that involve interpersonal roles that may sometimes be routine and involve little serious communication and decision making, hence figurehead is important for the smooth functioning of the organisation, and cannot be ignored by the people in control, Mintzberg, (1973). 24 | P a g e.

(40) In this study, the figurehead is the nurse who is the shift leader and who works with peers as team, so they are bound to have a shift leader who can maintain team spirit.. . Leader (Mintzberg, 1973:59). According to Mintzberg (1973:59) every leader in their workplace should be able to motivate and encourage their subordinates so as to meet the individual needs with that of the organisational goals. In this leading role, the nurses leading shifts motivate and develop staff and foster a positive practice environment (PPE). Nurses leading shifts supervise, coach, mentor, and support staff, enter into conversations with them, assess them and offer education and training courses for their leadership roles, and as a result they are in charge of the unit and responsible for the work of the people in that unit. This is where shift leaders provide leadership to their teams, departments, or the whole organisation. In this study, the leader roles were experienced by nurses who were shift leaders and they ensured that staff and client services were well executed. . Liaison (Mintzberg, 1973:59). The liaison role of Mintzberg (1973:59) made mentioned that leaders make contacts within and outside the organisation in search of information that will assist them in attaining organisational goals.. In this study, nurses leading shifts must communicate with internal and external stakeholders. They need to be able to connect effectively on the behalf of the healthcare organisation, and they must be able to provide information and fulfil the communication obligations of a shift leader. Nurses should engage in information exchange to gain access to knowledge bases. 25 | P a g e.

(41) 2.3.1.2 Informational role According to Mintzberg (1989:17), the leader role involves the processing of information, which means that leaders send, pass on, and analyse information. The managers are responsible for connecting the dots and are expected to exchange flows of vertical information with their colleagues and horizontal flows of information with their fellow managers and the board of directors. The author further articulates that leaders are responsible for filtering and transmitting information that is important for both groups. The following roles elaborate on how shift leaders process information based on their roles. . Monitor. In the role as a monitor, the nurse gathers all internal and external information that is relevant to the changes in the organisation. The monitor seeks internal and external information about issues that can affect the healthcare organisation. Duties include assessing internal operations, a department’s success, and the problems and opportunities that might arise. All the information gained in this capacity must be stored and maintained for the betterment of the organisation. According to this study, peers are supervised and monitored by their shift leader to facilitate the smooth completion of tasks (Mintzberg, 1989:18). . Disseminator As a disseminator, nurses leading shifts transmit potentially useful information to their subordinates, teams, and to other stakeholders within the healthcare organisation. This may be information that was obtained either internally or externally. Based on the study, nurses are required to discuss any challenges they face while at work, and also to provide feedback on any task or project that the clinic has planned (Mintzberg, 1989:18).. 26 | P a g e.

(42) . Spokesperson As spokespersons, nurses leading shifts represent the organisation and communicate to the outside world on unit policies, performance, and other relevant information of its goals to external parties. The shift leader is the person who should organise the channels of communication and ensure that group decisions are made in the clinic’s interests (Mintzberg, 1989:18-19). 2.3.1.3 Decisional role According to Mintzberg (1989:19), the decisional role involves using information, and while information is not, of course, an end in itself, it is the basic input to proper decision making. Leaders are responsible for decision making and they can do this in different ways at different levels in the healthcare organisation. The leadership style is important in effective DM as a leadership role. The roles describe the shift leader as a decision-maker:. . Entrepreneur (Mintzberg, 1989:19) As an entrepreneur, nurses leading shifts design and initiate changes and strategies in the unit. This involves solving problems, generating new ideas with their teams, and implementing them. At various intervals, they put new projects on-stream and discard old ones. According to the study, the shift leader helps to drive the process of change and ensures that other colleagues understand the purpose of the changes made, or to be made, and are on the lookout for resistance.. . Disturbance handler In this role as disturbance handler, nurses leading shifts will always immediately respond to unexpected events and operational breakdowns that occur when they are leading shifts. They aim for usable solutions. The problems may be internal or external, and here change is beyond the leader’s control (Mintzberg, 1989:20). According to this study, the shift leader is always available to identify unforeseen issues, and is in the best position to address these issues with the relevant people.. 27 | P a g e.

(43) . Negotiator As a negotiator, nurses leading shifts participate in negotiations with other individuals, and represent the interests of the healthcare organisation. This may be in relation to colleagues as well as third parties. Negotiations are a “way of life” for the sophisticated shift leader (Mintzberg, 1989:21). Based on this study, nurses leading shifts are responsible for providing feedback to subordinates in situations where there are disagreements with either nurses or stakeholders, and they ensure that suggestions are communicated to the relevant parties. In conclusion to Mintzberg’s Leader-Role Theory, Mintzberg (1989:21) clarified that the roles of a nurse leading shifts are largely predetermined by the nature of the organisational position, but that shift leaders do have flexibility in the way each leadership role is interpreted and enacted. These leadership roles are not easily separable, which is in line with the findings of the study of nurses’ experiences regarding their leadership roles, which are multifaceted with the challenges that accompany these roles.. 2.4 RESEARCH DESIGN Research design refers to the overall research plan that involves methods, procedures for collecting, analysing and interpreting data, and is a systemic process aimed at finding answers to research questions (Holloway & Galvin, 2017:344; Creswell, 2013:64).. According to Burns et al., (2013:43), the research design is a blueprint for conducting a study that maximises control over factors that could interfere with the trustworthiness of findings in the study, and is also the architectural backbone of studies. The research design helps to capture participants’ thoughts and feelings.. 28 | P a g e.

(44) A research design that is qualitative, phenomenological, exploratory, descriptive, and contextual was used in this study to understand the experience of nurses regarding their leadership roles, in order to develop recommendations to enhance the nurses’ leadership roles in a PHCD clinic in Gauteng.. Below are the different designs that the researcher utilised in the study.. 2.4.1 Qualitative A qualitative research design is a systemic, interactive, subjective, and holistic approach used to describe life experiences, and to have an understanding to make meaning of a participant’s life experiences (Burns et al., 2013:23). Qualitative studies are used to answer questions related to the “how and why” of behaviours, which are generally studied as they occur naturally, and through this exploration the research provides evidence for best practices (Schmidt & Brown, 2012:187).. The key features of the qualitative approach are that the research is conducted in the real-life situation that focus more on the process, with the purpose of achieving an indepth description and understanding of a participant’s beliefs, actions, and events (Leedy & Ormrod, 2014:141). In qualitative research, “we need to dig deep” to establish an understanding of the phenomenon under study, and the researcher needs to stand back and allow the participant’s voice be heard (Leedy & Ormrod, 2014:141; Brink et al., 2015:121).. The qualitative design was selected for this study since it facilitates an understanding, describing, and interpretation of the phenomena (Brink et al., 2015:11). In the process of acquiring knowledge, the researcher applied inductive reasoning to dig deeper into the experiences of nurses regarding their leadership roles in a PHCD clinic and to develop recommendations to enhance the nurses’ leadership roles.. 29 | P a g e.

References

Related documents

This study advances by examining numerous psychological health and socio- demographic variables (e.g. socioeconomic status, gender, marital status, and religion) together with

This radio is available using either fully certified Type 1 or 3 embedded encryption, allowing the radio to operate in three different secure modes – fixed frequency,

Observations throuth a window are very disadvantagoues (even if the window is open). The light that is gathered by the telescope has to pass a lot of air and

For the index finger, the minimum and maximum angles of the flexion/extension of the MCP and PIP joint angles and the strain of the soft sensor were mapped using the pose 1 (Figure

In the present study, the most frequent barriers of this dimension were feeling lazy, lack of time and low self-efficacy.. Girls frequently reported the reason “feeling lazy”, a

(PI Opp’n at 28-29.) As a result, the Court finds that the medical conditions defined in the Subclass Two likely qualify under the Rehab Act. The programmatic “benefit” in

In addition, it extends the ActCourseStudent activator (Figure 4, line 18) in CMSRoot so that the Cours- eStudent child AUnit is only activated for the currently ac- tive course;

Women carrying germline mutations in BRCA1 or BRCA2 have an extremely high lifetime risk for devel- oping breast and/or ovarian cancer.. In women carry- ing germline mutations in