Retaining community service nurses in the Western Cape public health sector

Kruse, Beverley-Ann (2011-03)

Thesis (MBA)--University of Stellenbosch, 2011.


Healthcare systems of the world’s poorer nations have been heavily impacted by economic globalisation. This has resulted in a steady deterioration of working conditions, resulted in less job security and has led to an increase in the spread of communicable diseases in developing countries such as South Africa. It is factors such as these, against the backdrop of a global recession, that have contributed to the escalation in global healthcare costs which has itself augmented the strain on already strained hospital resources in developing economies (Issues paper: Economic Globalisation, 2009). The current workplace faces complicated challenges which extend beyond the effects of the global recession. One of these challenges is the task of managing the diversity of the modern day workforce. This includes differences in gender, race, religion, culture, language, physical and mental ability, sexual orientation as well as generational differences. As a result, organisations that choose to exploit these differences are able to leverage a competitive advantage from them. This ability is however determined by the flexibility of organisations’ policies and practices. Furthermore, adapting an organisation’s human resource policies and practices pertaining to attracting, retaining, developing, promoting and managing a generational diverse workforce is only possible once these cohorts have been clearly identified, analysed and understood (Manion, 2009). Nurses are the pillar of healthcare systems throughout the world. In South Africa, however, the high staff turnover of nurses compared to the relatively small number of new recruits is of great concern due to its impact on the South African government’s capacity to provide a healthcare model of sustainable service delivery (Mokoka, 2007). The reality of the decline in the number of newly qualified nurses was clearly evident in the results of this study. Twenty-eight percent of the current community service nurses had previously considered leaving the profession, eight percent reported that they were considering leaving the profession within the next year and 20 percent intended leaving the public health sector after completing community service. The purpose of this qualitative study was to determine factors that preclude better remuneration that would influence community service nurses’ decision to remain employed in the public health sector. According to the Western Cape Nursing directorate, 270 nurses were registered to complete community service in the Western Cape in 2010. The 25 registered nurses who were scheduled to complete community service at Groote Schuur Hospital at the end of 2010 constituted the study sample. A self-administered questionnaire was used as the instrument for data collection from this fixed, convenient sample. Confidentiality of the participants was assured throughout the study and findings were reported as combined facts and figures using histograms. The majority of the participants were between the age of 20 and 25 years (48%). Furthermore, 88 percent of the participants were below the age of 35 years, largely representative of Generation X and the Millennials, Generation Y. The results of this study suggested an extremely complex interplay between intrinsic and extrinsic motivators, in influencing the decision of whether or not to remain employed in the public health sector. It was further evident that most of the factors that were rated to be of high importance were strongly self-centred, largely geared at personal reward and recognition. This finding is in clear agreement with literature published by Manion (2009) who supports the thinking that generations representative of Generation X and Y have a strong need for personal achievement and reward. Eighty percent of participants indicated a dire need for hospital management to recognise and manage generational diversity in the current workforce as this presented a daily challenge in the workplace. It was perceived that fundamental differences in needs, work ethic and values exist between Generations X and Y, compared to those of nurse and hospital managers who were representative of Baby Boomers. Consequently, there appeared to be a mismatch in the expectations and opportunities presented in the current workplace among the three generations. These findings merit further discussion on whether the permanent multi-disciplinary team at hospitals understand the influential role that they have on the complex task of retaining community service nurses in the public health service. Furthermore, 92 percent of community service nurses highlighted the need for mandatory orientation and induction programmes in each ward prior to commencing duty. This in itself was identified as a huge cause for anxiety and discord. In conclusion, even though this study was designed to establish factors that preclude better remuneration which could influence the decision of community service nurses to remain employed in the public health sector, it found that more than half the participants of this study recommended that receiving a more competitive salary was still an important issue for government to prioritise. However, it did not appear to be the overshadowing theme of dissatisfaction amongst community service nurses.

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