The views of professional nurses on attracting and retaining nurses at primary health care clinics in South Africa

Abstract

Background Professional nurses are the backbone of the primary health care (PHC) system in South Africa. PHC clinics are the first entry point for the majority of South Africans seeking health services in the community. As such, professional nurses are required in adequate numbers to achieve Universal Healthcare Coverage (UHC) goals under the country’s National Health Insurance (NHI) which is based on the PHC system. As the NHI seeks to improve UHC, professional nurses working at the PHC level are critical for these reforms. Globally, shortages of human resources for health at the PHC level have been recorded. These shortages have been more pronounced for professional nurses. The aim of this study was to explore the views of professional nurses on factors for attracting and retaining nurses working at PHC clinics in South Africa. Method This was a cross sectional descriptive qualitative study using semi structured interviews. The study was conducted at five PHC clinics in Ekurhuleni Municipality in 2018. Purposive sampling was used to select 30 professional nurses who had been working in the PHC clinic for a year or more. To participate in the interviews the respondents needed to provide informed consent. Interviews were audio recorded and transcribed verbatim using sound organizer software that enables the reader to listen to the audio tape at a preferred rate for easy transcription. Thematic analysis of the semistructured interviews was done using NVivo software. Results Thirty professional nurses working in PHC clinics participated in the study (n=29 female and n=one male). Their ages ranged between 20-60 years and they had been working in the PHC clinics between one and 40 years. The majority (n=18) worked for provincial authority clinics and the remaining 12 for the local government/municipality. The professional nurses from these five clinics shared their experiences on the factors that attract and retain nurses. Seven themes emerged from this qualitative study about the key factors that attract and retain professional nurses in PHC clinics mainly; working hours in the PHC clinic, independence in patient management, career progression, remuneration, unsupportive management environment, community interaction/seeing patient health improve and heavy workload. The convenience of the clinic working hours gave flexibility for nurses to meet other obligations such as family. Furthermore, the independence in decision making concerning patient care as well as the opportunity to interact with the community gave nurses satisfaction which made them want to remain but when they felt unsupported by management it made them want to leave the PHC clinic. It was also important from the study to give nurses study opportunities to progress their career and also to manage the heavy workload in clinics to attract and retain professional nurses in clinics. Conclusion The factors that attract and retain nurses in PHC clinics are interrelated and the experiences of the nurses directly influence their decision to stay or leave their jobs. Professional nurses are attracted to PHC clinics by operational working hours, independence in patient clinical management, iv opportunities for study and career progression as well as remuneration for the work done. Manageable workloads and a supportive management environment were also influential in retaining professional nurses in PHC clinics. In light of the National Health Insurance scheme being implemented by the South African government for Universal Health Coverage, the study results provides evidence for policymaking decisions with potential to retain professional nurses in PHC clinics.