This thesis examines the ways in which a deeply entrenched nursing hierarchy is being reconfigured and challenged, and the status of nurses reshaped, in relation to wider political and social processes in the post-apartheid context. Specifically, it offers an ethnographic analysis of nurses working at Bethesda Hospital, a rural government hospital in northern KwaZulu-Natal. It argues that at this moment of liminal uncertainty characterising the current political and social transformation, nurses’ experiences are made meaningful both through a nostalgic reconstruction of the hospital’s missionary past, as well as through idioms that generate opportunities for – and a sense of control over – the future. These are all manifestations of a contemporary post-apartheid moment, yet they are also extensions of longer historical processes. This thesis, therefore, poses important questions about the nature of ‘transition’ in South Africa, and to what extent this has been marked both by rupture and continuity, in the localised context of a rural government hospital and its surrounding area. The thesis begins with an historical account of Bethesda hospital from its inception in 1937 as a Methodist mission hospital, and its eventual transfer to state control, describing a complex and changing micro-struggle for power in the context of a wider political economy of health care. It goes on to consider the influence of the hospital’s mission past on current practices, exploring the ways in which nostalgic memories feed into contemporary workplace debate. Such debate is framed by a context of severe and widespread ill-health exacerbated by the HIV/Aids epidemic, and the problems of staff shortage, fragmentation and poor pay and working conditions that provide ongoing and critical challenges to the institution and its employees. It considers how the moral concern provoked by this perceived crisis, and the preoccupation with hierarchy that has long been a feature of the South African nursing profession, are played out in relation to the emerging post-apartheid ideologies of ‘accountability’ and ‘rights’. Finally, it explores the ways in which nurses generate a mutual sense of purpose and control, while at the same time engaging in embattled struggles for status and self-recognition, through the practices of Born-again Christianity and international migration, showing how these offer new and powerful forms of status acquisition in the post-apartheid context. Based primarily on ethnographic fieldwork conducted at Bethesda hospital between December 2006 and October 2007, this thesis engages with theoretical discussions about social change and relationships of hierarchy within – and beyond – the workplace. Finally, it contributes to debates about the shifting fields of nursing and health care delivery in the wider South African context of immense political and social transformation.

Text in Afrikaans / 'n Opname is onder geregistreerde verpleegkundiges in diens van plaaslike besture onderneem met die doel om 'n perspektief op die gehalte van hul werkslewe te verkry, faktore te identifiseer wat hulle motiveer om 'n loopbaan in plaaslike besture te kies en die faktore te identifiseer wat werkstevredenheid positief /negatief be"lnvloed. Ontleding van die data het aangedui dat negatiewe faktore in die werkslewe soos onder andere die gebrek aan deelname in besluitneming en beperkte loopbaangeleenthede werksontevredenheid tot gevolg kan he. Positiewe faktore soos die geleentheid om gereelde diensure te werk en die status wat geregistreerde verpleegkundiges in die gemeenskap geniet, bevorder werkstevredenheid. Dit is hoofsaaklik hul belangstelling in primere gesondheidsorg en die geleentheid om gereelde diensure te werk wat geregistreerde verpleegkundiges motiveer om 'n loopbaan in plaaslike besture te kies. Aanbevelings om die kwaliteit van die werkslewe van geregistreerde verpleegkundiges te verbeter en werkstevredenheid te bevorder, is geformuleer. / A survey was undertaken among registered nurses in the service of local authorities to obtain a perspective on the quality of their worklife, to identify factors that influence registered nurses in local authorities and to identify those factors that influence the quality of the worklife and job satisfaction positively /negatively. Analysis of the data indicated that negative factors in the worklife such as limited participation in decision-making and limited career opportunities could lead to dissatisfaction in the work situation. Positive factors such as the ability to work regular hours and the status of registered nurses in the community promote job satisfaction. It is mainly their interest in primary health care and the opportunity to work regular hours of duty, that motivate registered nurses to choose a career in local authorities. Recommendations to improve the quality of the worklife of registered nurses and to promote job satisfaction were formulated. / Nursing Science / M.A. (Verpleegkunde)

Text in Afrikaans / 'n Opname is onder geregistreerde verpleegkundiges in diens van plaaslike besture onderneem met die doel om 'n perspektief op die gehalte van hul werkslewe te verkry, faktore te identifiseer wat hulle motiveer om 'n loopbaan in plaaslike besture te kies en die faktore te identifiseer wat werkstevredenheid positief /negatief be"lnvloed. Ontleding van die data het aangedui dat negatiewe faktore in die werkslewe soos onder andere die gebrek aan deelname in besluitneming en beperkte loopbaangeleenthede werksontevredenheid tot gevolg kan he. Positiewe faktore soos die geleentheid om gereelde diensure te werk en die status wat geregistreerde verpleegkundiges in die gemeenskap geniet, bevorder werkstevredenheid. Dit is hoofsaaklik hul belangstelling in primere gesondheidsorg en die geleentheid om gereelde diensure te werk wat geregistreerde verpleegkundiges motiveer om 'n loopbaan in plaaslike besture te kies. Aanbevelings om die kwaliteit van die werkslewe van geregistreerde verpleegkundiges te verbeter en werkstevredenheid te bevorder, is geformuleer. / A survey was undertaken among registered nurses in the service of local authorities to obtain a perspective on the quality of their worklife, to identify factors that influence registered nurses in local authorities and to identify those factors that influence the quality of the worklife and job satisfaction positively /negatively. Analysis of the data indicated that negative factors in the worklife such as limited participation in decision-making and limited career opportunities could lead to dissatisfaction in the work situation. Positive factors such as the ability to work regular hours and the status of registered nurses in the community promote job satisfaction. It is mainly their interest in primary health care and the opportunity to work regular hours of duty, that motivate registered nurses to choose a career in local authorities. Recommendations to improve the quality of the worklife of registered nurses and to promote job satisfaction were formulated. / Nursing Science / M.A. (Verpleegkunde)