Development of a pathway for the integration of a new category of nurse into the private healthcare sector in South Africa
Date
2024
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Abstract
The revision of the South African nursing qualifications resulted from changes in healthcare delivery, the introduction of the South African Qualifications Authority and the new, 10-level National Qualifications Framework. The Nursing Act (2005) provided the legislative framework for the review of the scopes of practice for different nursing categories to ensure the alignment of nursing and midwifery practice in South Africa to the needs of the healthcare system. Due to these legislative changes, there was a new category of nurse created, the General Nurse. While it is argued that the new General Nurse will assist in alleviating many of the current challenges, very little preparatory work has been done to facilitate the efficient and effective deployment of this new category of nurse in the private healthcare sector. It is against this backdrop of the introduction of a new category of nurse in South Africa that the researcher investigated how best to respond to these changes in the macro-environment that has an impact on the delivery of nursing in the private healthcare setting. This research study examined the opportunities and constraints regarding the deployment of a new category of nurse and recommended how best to integrate the General Nurse into the future workforce in the private healthcare sector
To achieve the research objectives, there was a multi-method sequential qualitative research design used, with the research study conducted in four phases. Phase one was a scoping review, conducted to explore factors that influence the implementation of new nursing cadre. Phase two consisted of semi-structured interviews to explore the opportunities for, and barriers to, the integration of a new category of nurse within the private healthcare sector. In phase three, a qualitative document analysis determined the role of the General Nurse. Phase four consisted of phases 4A and 4B. In phase 4A, the use of a nominal group was to verify the preliminary populated elements of the logic model and to identify the programme outcomes of successful integration of the General Nurse for the healthcare organisation. A pathway, consisting of a series of steps, was formulated to achieve the identified outcomes and facilitate the successful integration of the General Nurse into already functioning nursing teams of a private healthcare group. In phase 4B, a Modified Delphi Technique was used to review and confirm the pathway as clear, relevant, feasible and acceptable for the integration of the General Nurse. To ensure the validity of this research study, there was adherence to Lincoln and Guba’s model of trustworthiness, which consists of the constructs credibility, transferability, dependability, and confirmability.
The factors most frequently reported in the literature to influence the success of integrating a new nursing role pertain to stakeholders having adequate information on critical details of the new role, the game plan of organisations to harness support for, and negotiate acceptance of, a new role by introducing and managing change. Successful integration of the General Nurse is reliant on a collective understanding and effective communication of the role, a clear scope of practice, equipping the General Nurse with knowledge and skills fit for purpose, and the creation of practice environments that are supportive and ready to embrace and accept the General Nurse. The study revealed the General Nurse would be a patient-focused, clinically orientated independent nursing practitioner, capable of rendering nursing care to patients of any age in a range of clinical settings. The outcomes of successful integration of the General Nurse were efficiency of the General Nurse, realisation of organisational goals and objectives, quality patient care, support and acceptance of the General Nurse, and a sustainable and contented workforce. A pathway, consisting of a series of steps, which are user-friendly and easy to implement, was formulated to achieve the identified outcomes to facilitate the successful integration of the General Nurse into already functioning nursing teams of a private healthcare group. Healthcare organisations, and the nursing profession, will need to rely on the services of the General Nurse to meet the healthcare needs and nursing service demands in the South African healthcare system.
Description
A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2023
Keywords
General nurse, Pathway, New nursing role