title: The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?
abstract: BACKGROUND
  Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.
  
  
  OBJECTIVE
  This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.
  
  
  METHODS
  During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis.
  
  
  RESULTS
  The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers' recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration.
  
  
  CONCLUSIONS
  The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care.
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; sue.armstrong@wits.ac.za.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Armstrong
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Laetitia C
authors.initials: LC
authors.lastname: Rispel
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Loveday
authors.initials: L
authors.lastname: Penn-Kekana
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D006801:Humans; D009745:Nursing, Supervisory / Q000458:organization & administration*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*; D013019:South Africa; D013996:Time and Motion Studies
keywords: South Africa; hospitals; nursing unit managers; quality of care; time and motion