published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

There is alleged to be a severe nursing shortage in Canada. While the shortage is attributed in large part to fiscal restraint in the hospital sector in the early 1990s, there are competing claims addressing why nursing employment levels changed over this period. Supply-side proponents argue that deteriorating working conditions and stagnant wages led nurses to voluntarily leave the profession, province, or country for better employment prospects. Demand-side proponents argue that hospitals reduced staff levels in response to a decline in inpatient utilization. There is also considerable disagreement on what impact, if any, reduced nursing employment levels had on access to hospital care. However, while there is no shortage of anecdotal evidence and plausible rhetoric, the debate is being carried out in a largely data-free environment. This thesis attempts partially to fill this void. Part I of this thesis examines trends in the nursing employment level in Canada over the hospital restructuring period. Results indicate that the number of nurses employed in hospitals decreased significantly during the cut-backs period and that the decrease was particularly severe among young nurses. The employment level is decomposed into three separate components for each age group: the change in the potential supply of nurses, the change in the employment rate of this group and the change in the likelihood that an individual will work in the nursing profession conditional on being employed. Results indicate that the third factor is most important. To determine whether the observed shift toward non-nursing employment was voluntary, an occupational sector choice model is developed and the pattern of nursing wages, non-nursing wages, and hospital expenditure (a proxy for demand) is examined. The evidence strongly suggests that the reduction in the nursing employment level in hospitals during the downsizing period was a result of a decrease in the demand for nursing labour and did not represent voluntary movement out of the nursing sector. That the decrease in demand primarily affected young nurses appears to reflect the influence of seniority in the highly unionized nursing sector.

There is alleged to be a severe nursing shortage in Canada. While the shortage is attributed in large part to fiscal restraint in the hospital sector in the early 1990s, there are competing claims addressing why nursing employment levels changed over this period. Supply-side proponents argue that deteriorating working conditions and stagnant wages led nurses to voluntarily leave the profession, province, or country for better employment prospects. Demand-side proponents argue that hospitals reduced staff levels in response to a decline in inpatient utilization. There is also considerable disagreement on what impact, if any, reduced nursing employment levels had on access to hospital care. However, while there is no shortage of anecdotal evidence and plausible rhetoric, the debate is being carried out in a largely data-free environment. This thesis attempts partially to fill this void. Part I of this thesis examines trends in the nursing employment level in Canada over the hospital restructuring period. Results indicate that the number of nurses employed in hospitals decreased significantly during the cut-backs period and that the decrease was particularly severe among young nurses. The employment level is decomposed into three separate components for each age group: the change in the potential supply of nurses, the change in the employment rate of this group and the change in the likelihood that an individual will work in the nursing profession conditional on being employed. Results indicate that the third factor is most important. To determine whether the observed shift toward non-nursing employment was voluntary, an occupational sector choice model is developed and the pattern of nursing wages, non-nursing wages, and hospital expenditure (a proxy for demand) is examined. The evidence strongly suggests that the reduction in the nursing employment level in hospitals during the downsizing period was a result of a decrease in the demand for nursing labour and did not represent voluntary movement out of the nursing sector. That the decrease in demand primarily affected young nurses appears to reflect the influence of seniority in the highly unionized nursing sector. / Arts, Faculty of / Vancouver School of Economics / Graduate

Thesis (MBA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The shortage of nurse educators has an effect on the training of current and future nurses. A shortage of nurse educators leads to the inability to increase the number of student nurses, which results in a lack of trained nursing staff to meet the healthcare needs of the South African population. There is a need to gain an understanding of why nurse educators enter into and remain in academia versus the reasons why nurse practitioners – specifically registered nurses (RN) – choose to enter into and remain in practice. The prioritised reasons for entering into and remaining in nurse academia were investigated with a focus on: i.) The difference between the reasons why RNs enter into and remain in nursing practice ii.) The difference between the reasons why nurse educators enter into and remain in academia iii.) The difference between the reasons why RNs enter into nursing practice and reasons for nurse educators entering into academia iv.) The difference between the reasons why RNs remain in nursing practice and reasons why nurse educators remain in academia A descriptive, quantitative design was used to explore the factors that lead to nurses entering into and remaining in academia. An on-line, self-administered survey was used as the primary data collection instrument. Data was tabulated and presented in histograms and frequencies. The study found that: i.) RNs enter into and remain in nursing practice for the same reasons ii.) That nurse educators enter into and remain in academia for different reasons iii.) That RNs enter into nursing practice and nurse educators enter into academia for different reasons iv.) The primary reason for RNs remaining in nursing practice and nurse educators remaining in academia are the same The shortage of nurse educators is critical and it is essential that NEIs begin to institute plans focussing on the reasons behind nurse educators’ decision to stay in nursing education. Private NEIs should use the findings of this study to focus on areas that indicate satisfaction with the position rather than dissatisfaction in order to develop specific attraction and retention strategies.

Thesis (MTech (Public Management))--Cape Peninsula University of Technology, 2018. / Organisations spend large sums of money on staff after they have been recruited in order to make them proficient in their jobs. It is therefore important to ensure that staff remain with the organisation for as long as possible, allowing the organisation to reap the benefit from its investment in the form of good performance by staff. Work performance can however, be affected negatively when labour turnover is high. This research project reflects on staff turnover amongst professional nurses, posing the question, “What can be done to alleviate high staff turnover?” A quantitative approach to research was followed within a Western Cape Metropolitan Municipality. The significance of the research is reflected in the recommendations made to the management of the municipality to address staff turnover in the specified category of employees.

M.Cur. / This study addressed the shortage of qualified nursing staff by means of an empirical research questionnaire according to the principles of the Delphi method. The study has as its objective the design of a marketing strategy for a nursing college, and also determines the contribution of marketing staff and formulates guidelines for a marketing programme and the implementation of a marketing strategy. The research consisted of three phases, being a literature survey and analysis of existing marketing models for service careers; the use of the Delphi method In three rounds, as well as critical Interviews with members Included In the sample to verify results; and the final validation with a marketing consultant and three respondents who are experienced marketing staff members. Marketing was regarded as a total system of Interactional activities, and the potential contribution of all involved persons was addressed in compiling a strategic marketing formula. A possible framework for a marketing strategy was determined with specific emphasis on the elements of such a formula, namely marketing staff, target market, products, price, promotional activities, venue and marketing research. It became clear from the research results that a marketing strategy and the guidelines for implementing such a strategy could enable marketing staff to enhance the Image of this career in an organised and planned manner, thereby contributing to the recruitment of nursing students who could resolve the shortage of qualified nursing staff.

The last decade has seen an exodus of South African nurses migrating to "greener pastures". As a result of this migration, the South African Healthcare Service has been drained of one of its most essential resources – nurses. Subsequently, the crippling flight of nurses has thrown the nursing profession into a state of crisis. The Kingdom of Saudi Arabia is one of the more popular destinations for South African nurses, the main reason being the attractive financial rewards. One agency reports that they send an average of thirty nurses a month to various hospitals within the Kingdom of Saudi Arabia. Saudi Arabia is an Islamic country. Due to the uniqueness of the enforcement of the Islamic faith and the Saudi culture, many restrictions are imposed, particularly on women. The challenges and problems facing the South African nurses were, therefore, unique compared to elsewhere in the world. This research study had a primary and a secondary objective: The primary objective of this study was to explore and describe the lived experiences of South African nurses related to living and working in Saudi Arabia; The secondary objective of this study was to develop orientation guidelines to support South African nurses working and living in Saudi Arabia. The researcher utilized a qualitative, explorative, descriptive and contextual design based on a phenomenological approach to inquiry, in an attempt to answer the question: "What are the professional and personal experiences of the South African registered nurses working and living in Saudi Arabia?" Eleven registered nurses were selected to participate by means of purposive sampling. These nurses had been living in Saudi Arabia between three and six months. Consent was obtained from participants and the ethics committee of both the Nelson Mandela Metropolitan University and King Faisal Specialist Hospital and Research Centre. The central theme emanating from the study was recognized as being 'Cultural Diversity'. The sub-themes identified related to the registered nurses’: - Religious/spiritual adaptation - Environmental adaptation - Emotional/psychological adaptation - Professional adaptation Based on the identified themes, guidelines were formulated to assist South African registered nurses when migrating to Saudi Arabia. Utilization of these should assist the South African registered nurse in assimilating into both the cultural and working environment. However, in reality, the outcome showed that no one can be prepared fully for what awaits them in Saudi Arabia.

M.Cur. / A staffing programme does not exist in a private hospital that compiles with the criteria cost effectiveness and quality nursing care. For this reason a study was undertaken to develop a staffing programme that would facilitate cost-effectiveness as well as quality nursing care. The nursing managers' role is not only to maintain cost-effectiveness but also to facilitate wholeness in patients and nursing staff. To achieve wholeness an exploratory. descriptive instrumental study was conducted and the Nursing Theory of Wholeness was used as a foundation for this study. Various research techniques were used such as scheduled observation, a structured questionnaire, nursing audit and a semi structured interviewing technique to quantify results. An analysis was conducted retrospectively to verify the statistical significance of a cost effective staffing programme. A staffing programme was designed consisting of seven steps to provide a basis for validity and reliability of the programme. The staffing programme proved to be cost-effective and proved to be statistically significant and shows a significant difference on a I% significance level (p = <0,003). The most important conclusion made is that valid, reliable staffing programme was designed for a nursing service in the private hospital. The staffing programme proved to be easily comprehended, useful, and relevant to its purpose. Cost-effectiveness was proved. A patient questionnaire was implemented to test the construct quality nursing. Partial validity of the construct quality nursing was confirmed.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The shortage of nurses in the intensive care units (ICU) affects both the nurse and the patient with regard to quality care and the quality of work life. Job satisfaction as well as factors within the organisation and work environment predisposes dissatisfaction. Identifying these factors may improve the quality of life at work and reduce staff shortages. The aim of this study is to evaluate the contextual factors influencing the turnover of intensive care nurses in specified hospitals in the Cape Metropole. The objectives were: • To determine the factors influencing the turnover of intensive care nurses in specified hospitals in the Cape Metropole. • To compare the findings of the data in the specified hospitals. An explorative, descriptive design with a quantitative approach has been applied. The research sample consists of all nurses working in the intensive care units in the specified hospitals at the time of the study. A convenience sampling was applied. A structured questionnaire containing predominantly closed-ended questions was used and data collection was conducted by the researcher herself. A pilot study consisting of 10% (N=21) of the sample was done in one of the hospitals to validate the reliability of the questionnaire. The 21 participants who completed the pilot test did not participate in the actual study. The reliability and validity of the findings was assured by the utilization of the statistician and experts in the nursing department. The data is presented in tables and histograms. A Chi -square test is used to test the statistical significance association between variables. Spearman’s ranks (rho) order correlation is used to show the strength of the relationship between two continuous variables. The findings of the study show that discontent with salaries, inferior working environments, organisational factors, physical as well as emotional stress and the lack of career development opportunities, were major determinants in the poor quality of life at work with regard to the two set objectives. Recommendations include those for better remuneration, improved career opportunities and the creation of a safe as well as a friendly work environment. The aim is to create a positive work environment and improve the quality of life at work. / AFRIKAANSE OPSOMMING: ’n Tekort aan verpleegsters in die intensiewesorgeenheid beïnvloed beide die verpleegster en die pasient sovêr dit die gehalte van sorg lewering en die kwaliteit van arbeidservarings in die werkplek betref. Werkstevredenheid, sowel as faktore binne die organisasie en omgewingsfaktore in die werkplek, is aanleidend tot ontevredenheid binne die organisasie. Deur hierdie faktore te identifiseer, mag die kwaliteit van werkslewe verbeter word en die verlies aan personeel verminder word. Die doel van hierdie studie is om die kontekstuele faktore wat die personeel omset van intensiewesorgverpleegsters in spesifieke hospitale in die Kaapse Metropool beïnvloed, te evalueer. Die doelwitte was: • Om die faktore wat die omset van intensiewesorgverpleegsters in spesifieke hospitale in die Kaapse metropool beinvloed, te bepaal • Om die bevindinge van die studie binne verskeiehospitale te vergelyk Om hierdie navorsingsvrae te beantwoord, is ’n verkennende en beskrywende ontwerp met ’n kwantitatiewe benadering aangewend. Die steekproef het bestaan uit alle verpleegspersoneel werksaam in die intensiewesorg-eenhede in die gespesifiseerde hospitale binne die studie vermeld . ’n Gerieflikheids-steekproef is uitgevoer. ‘n Goedgestruktueerde vraelys met hoofsaaklik geslote vrae is gebruik vir datainsameling en vraelyste was persoonlik deur die navorser ingeneem. ’n Loodsstudie wat 10% van die steekproef beslaan, (N= 21), is in een van die hospitale onderneem om sodoende die betroubaarheid van die vraelys te bevestig. Die 21 deelnemers was nie deel van die werklike studie nie. Die betroubaarheid en geldigheid van die betrokke studie is bevestig deur die statistikus en kenners in die verplegingsdepartement van sodanige inrigting. Data is voorgelê in die vorm van tabelle en histogramme. ’n Chi-vierkanttoets is gebruik om die statistiese-beduidends verwantskap tussen veranderlikes te toets. Spearman se rangorde (rho) korrelasie is gebruik om die sterkte van die verhouding tussen twee aaneenlopende veranderlikes aan te dui. Die bevindinge dui aan dat ontevredenheid oor salarisse, ‘n swak werksomgewing en organisatoriese faktore, sowel as fisiese en emosionele stres, asook ’n gebrek aan loopbaanontwikkeling, groot bepalers was van swak werkskwaliteit in terme van die twee voorgestelde doelwitte. Aanbevelings bestaan uit voorstelle vir beter salarisse, die skepping van loopbaangeleenthede en die daarstelling van ’n veilige, vriendelike, werksomgewing. Die doel is om ’n positiewe werksomgewing te skep en om die kwaliteit van werkslewe te verbeter.

Thesis (MPA)--Stellenbosch University, 2000. / Full text to be digitised and attached to bibliographic record. / ENGLISH ABSTRACT: Managing human resources is crucial to the efficient and effective delivery of quality health care. However, turnover of nurses constitutes a major factor in the shortages of staff which are being experienced by the nursing profession in the Republic of South Africa. Shortages of trained nurses with experience, particularly in public sector hospitals, have adverse effects on the provision of efficient and effective quality health care to the consumers of this service. The aim of the study was to provide an understanding of and insight into those inherent problems in the health sector that propel nurses to leave public sector institutions. The overall objective was to investigate and identify some of the factors which exercised an influence on the turnover of registered nurses in public sector hospitals, so as to be able to provide suggestions to hospital managers on the more effective management of human resources, in order to retain nursing personnel. Theresearch was based on a model of nursing turnover which regarded voluntary withdrawal as a process in which feelings of satisfaction with pay, on the one hand, and the opportunity of obtaining alternative jobs in the labour market, on the other, were proposed as the primary causative factors of turnover behaviour. In addition the propositions, made in literature reviewed, that age, tenure, kinship responsibility, general training, education, professionalism, marital status, lintent to stay', job satisfaction, routinization, job autonomy and responsibility, instrumental communication, promotional opportunity, integration, supervisory relationships, distributive justice, work-load, and local kin acted as predictors of turnover, were also investigated. The research was conducted with a sample of 123 nurses in one hospital, Groote Schuur, situated in the Western Cape Province of the Republic of South Africa. The sample included registered nurses, senior professional (registered) nurses, and chief professional (registered) nurses. The data was gathered from respondents by means of a selfadministered questionnaire. In addition, data was gathered by means of semi-structured, open-ended discussions with nursing management. The hypothesised interactions between variables influencing nursing turnover were explored by means of basic statistics, which made it possible to assess the effects of both independent and dependent variables. The results of data analysis provided some support for the proposition contained in the hypothesis. The determinants whose increase produced a greater degree of turnover were firstly, the many jobs available outside the hospital and secondly, professionalism. The determinants whose increase resulted in reductions in turnover were "intent to stay" (which the researcher views as a dimension of commitment), the existence of local kin (kinship responsibilities), participation in making job-related decisions (job autonomy), the receipt of sufficient work-related information (instrumental communication and good supervisory relationships), and tenure. The determinants whose decreaseresulted in increased turnover werepromotional opportunities, distributive justice, pay satisfaction, job satisfaction, integration, opportunity for self-development,age and tenure. Turnover of nurses has serious ramifications for employers, patients, and the nursing profession itself. Effective management of employee turnover is of critical importance to health care providers, employees, and patients. Better control of turnover can improve the quality of patient care, reduce labour costs, and improve employee morale. / AFRIKAANSE OPSOMMING: Die bestuur van menslike hulpbronne is die deurslaggewende omstandigheid ten einde die lewering van effektiewe en doeltreffende gesondheidsorg van gehalte. Nietemin, dra die omset van verpleegkundiges grotendeels by tot die personeeltekort wat tans deur die verpleegprofessie in Suid-Afrika ondervind word. Die tekort aan ervare, opgeleide verpleegkundiges, veral in die openbare sektor staatshospitale, het 'n nadelige uitwerking op die voorsiening van effektiewe en doeltreffende gesondheidsorg van gehalte aan die verbruikers van hierdie diens. Die doelwit van die studie was om 'n begrip te ontwikkel vir, en 'n insig te probeer kry in, daardie inherente probleme binne die gesondheidsektor wat verpleegkundiges dryf om die staatsinstellings te verlaat. Die oorkoepelende doel was die ondersoek en identifikasie van sommige faktore wat die omset van geregistreerde verpleegkundiges in staatshospitale beïnvloed. Die doel hiervan was om voorstelle aan hospitaal bestuurders te kan voorsien ten opsigte van die meer doeltreffende bestuur van menslike hulpbronne, in die strewe na behoud van verpleegpersoneel. Die navorsing is gebaseer op 'n model van verpleegomset wat vrywillige onttrekking as 'n proses beskou het waar gevoelens van salaristevredenheid, aan die een kant, en geleentheid tot alternatiewe betrekkings in die arbeidsmark, aan die ander, as die primêre veroorsakende faktore van omset-gedrag voorgestel is. Daarbenewens is die stellings vanuit die literatuurstudie dat die volgende dien as voorspellers van omset ook ondersoek: ouderdom, ampstermyn of dienstyd, verantwoordelikheid teenoor familie, algemene opleiding, opvoeding, professionalisme, huwelikstatus, 'voorneme om te bly', werksbevrediging, roetine, selfbestuur en verantwoordelikheid in die werksomgewing, bevorderlike kommunikasie, bevorderingsgeleenthede, integrasie, toesighoudende verhoudings, toedelende gereg, werkslading en plaaslike naasbestaandes. Die navorsing is uitgevoer met gebruik van 'n monster van 123 verpleegkundiges van een hospital, die Groote Schuur Hospital, geleë in die Wes-KaapProvinsie van die Republiek van Suid Afrika. Die monster het geregistreerde verpleegkundiges, senior geregistreerde verpleegkundiges en hoof geregistreerde verpleegkundiges ingesluit. Die data is verkry van respondente deur middel van 'n self-toegediende vraelys. Daarbenewens is data versamel deur half-gestruktureerde, niegeslote besprekings met van die verpleegbestuur. Die interaksie tussen veranderlikes ten opsigte van verpleegomset wat veronderstel is, is ondersoek deur middel van basiese statistiek, dus kon die uitwerking van afhanklike en onafhanklike veranderlikes bepaal word. Die uitslae van data-ontleding het wel ondersteuning verleen aan die voorstelling soos uiteengesit in die hipotese. Die determinante wie se toename 'n toename in die omsetkoers tot gevolg gehad het was, eerstens, meer werksgeleenthede buite die hospitaal en, tweedens, professionalisme. Die determinante wie se toename tot 'n vermindering in omset bygedra het was 'voorneme om te bly' (wat die navorser as binne die omvang van toewyding beskou), deelname aan werksverwante besluitneming (werks outonomie), die ontvangs van genoegsame werksverwante inligting (bevorderlike kommunikasie en goeie toesighoudende verhoudings), en ampsduur (dienstyd). Die determinante wat tot 'n vermindering in omset lei is bevorderingsgeleenthede, toedelende gereg, salaris bevrediging, geleenthede tot self-ontwikkeling, ouderdom en ampsduur. Die omset van verpleegkundiges het verreikende gevolge vir werkgewers, pasiënte en die verpleegsberoep self. Doeltreffende bestuur van werknemer-omsetis van kritiese belang vir gesondheidsorg voorsieners, werknemers en pasiënte. Die meer effektiewe beheer van omset kan die kwaliteit van pasiëntesorg verbeter, arbeidsonkoste verminder en die moraal van werknemers verbeter.