Managing in Critical Care Settings: A Qualitative Study of South African Nurse Unit Managers and the Psychological Contract.

Introduction: Little is written about the management of psychological contracts by nurse unit managers (NUMs) in critical care settings and how this perspective contributes to the performance, experiences, and views of nurses and nursing teams. Psychological contracts are important regulators of the employer-employee relationship, with managers (NUMs) being the embodiment of the employer in managing the contract. Objectives: This qualitative study answers a call for research on the NUM perspective of the psychological contract given the role they play in the wellbeing of critical care nurses and quality of care provided. The study aims to understand the expectations and obligations that constitute the psychological contract NUMs have with their nursing teams, the nature of the contract, and how NUMs practically manage these aspects on their teams. Methods: Using an interpretive qualitative research design and a purposive sampling technique, semi-structured interviews were conducted with 10 of the 14 NUMs from a public health facility about critical incidents relating to their obligations and expectations of managing critical care nurses. Results: A thematic analysis of their responses revealed five main themes that represent the contents of their psychological contracts with critical care nurses: professional commitment and obligation; leading by example; trust and support; teamwork; and on-the-job training and further development. In their discussion of these components, the NUMs also revealed how they manage the psychological contract with nurses. Conclusion: Based on the expectations and obligations NUMs hold with their staff, their psychological contracts were found to be largely relational, with elements of the balanced type, suggesting that they rely on interpersonal connection and coordination, as well as knowledge dissemination, to uphold the contract. This contract appears to be effective in inculcating the commitment of nurses to their profession and professional standards through the building of trust and offering of support. However, recommendations are offered to ensure NUMs are best prepared to sustain these psychological contracts and continue to support nurse wellbeing and related patient care.

The changing meaning of 'home' in the work of South African women academics during the pandemic-enforced lockdown.

This article shows how the meaning of home and 'working from home' were fundamentally transformed by the pandemic-enforced lockdown for women academics. Drawing on the experiences of more than 2,000 women academics, we show how the enduring concept of home as a place of refuge from the outside world was replaced with a new and still unsettled notion of home as a gendered space that is a congested, competitive, and constrained setting for women's academic work. In this emerging new place for living and working, home becomes a space that is claimed, conceded, and constantly negotiated between women academics and their partners as well as the children and other occupants under the same roof. Now, as before, home remains a deeply unequal place for women's work, with dire consequences for academic careers. It is therefore incumbent upon women academics and higher education institutions to develop a deep understanding of the social meanings of home for academics, and the implications for the 'new normal' of working from home.

Women academics and the changing psychological contract during COVID-19 lockdown.

This study examines the psychological contract between academics and their institutions during a time of great stress-the COVID-19 pandemic. Given that relationships between these parties have been found to be deteriorating prior to the pandemic, we believed it pertinent to explore how environmental changes brought about through lockdown conditions may have shifted the academic-institution relationship. Through a qualitative research design, our data is from 2029 women academics across 26 institutions of higher learning in South Africa. The major shifts in the psychological contract were found to be workload and pressure, provision of resources, top-down communication, as well as trust and support. Whilst these shifts altered the transactional and interactional nature of the psychological contract, violation, rather than breach, occurred since the emotional responses of participants point to incongruence or misalignment of expectations between academics and their institutions during this time of crisis. We offer recommendations for rebuilding trust and negotiating the psychological contract to re-engage academics in the institution.

Us and them: Experiences of agency nurses in intensive care units.

OBJECTIVE: This qualitative case study describes the work experiences of agency nurses from their perspective. It explores their interactions with intensive care unit managers to whom they report in their designated intensive care units and their relationships with fellow permanent nurses. METHODS: A qualitative study was undertaken in three intensive care units at a public hospital in South Africa. Face-to-face interviews were used to collect data from eleven agency nurses. Thematic analysis of the data was undertaken. FINDINGS: The challenges of agency nursing work were haphazard clinical allocation, a lack of self-efficacy and competence, and feelings of exclusion. Positive aspects of the agency nurse experience included feedback and support from permanent nurses and intensive care unit managers and occurrences of belonging and acceptance. CONCLUSION: The findings of this study point to the importance of agency nurse relationships with managers and fellow permanent nurses. To ensure patient care is not compromised, managers and nurse managers have a responsibility to ensure a welcoming, inclusive and nurturing environment for all staff tasked with intensive care unit responsibilities.

Intensive care nurses in South Africa: Expectations and experiences in a public sector hospital.

AIM: To explore the content, fulfilment and potential breach of nurses' psychological contracts and provide a nuanced understanding of the expectations and lived experiences of intensive care unit (ICU) nurses. BACKGROUND: The challenges presented by the South African healthcare system have implications for the motivation and retention levels of ICU nurses. In an environment such as the ICU, personnel dynamics and nursing management's role are crucial to success. METHOD: A qualitative study of 44 ICU nurses from a South African tertiary hospital. Template analysis was used to identify themes. Manifest content analysis established the frequency of those themes. RESULTS: Psychological content elements were predominantly relational in nature. Nurses' contracts were fulfilled by nursing managers, peers and patients. Examples of breach included unfairness, abuse of trust and public reprimands. CONCLUSIONS: The nature of the work, the emphasis on professional and caring values, as well as the relational and intrinsic aspects associated with these, provide important indicators for the composition of nurses' psychological contracts. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding ICU nurses' expectations can ensure that their psychological contracts remain positive and fulfilled. Practical suggestions include public and private appreciation, autonomy, and management visibility and discretion.

The role of the psychological contract in the motivation of nurses.

Purpose Although private health care is regarded as providing a premium quality experience for both patients and staff alike, it is not without its daily challenges for health professionals. This study aims to explore the psychological contract of nurses to develop a greater understanding of how employee-employer interaction impacts motivation levels. Design/methodology/approach Data were gathered through semi-structured interviews with thirteen nurses at a private hospital in South Africa. Five nursing managers were interviewed to provide a management perspective. Thematic analysis was used to identify the salient elements of the psychological contract and to establish connections with motivational features. Findings The psychological contract of nurses was balanced in nature, contained predominantly relational elements and was characterized by the need for manager support, leadership and autonomy. Motivation was a by-product of fulfilment and was enhanced by a combination of tangible and intangible rewards. Practical implications Nursing managers should recognize their role in caring for the wellbeing of their staff and should be trained accordingly. Equipping nurses with the necessary tools to work autonomously, as well as acknowledging their skills, will stimulate confidence and improve motivation. Originality/value This study makes an important contribution to the existing literature on the psychological contract of nurses within the health-care system. It provides insight into relationship-based mechanisms that can be used to improve the motivation of nurses and thus impact the overall quality of patient care.

Human resource management practices in a medical complex in the Eastern Cape, South Africa: assessing their impact on the retention of doctors.

BACKGROUND: Human resource management (HRM) practices have the potential to influence the retention of doctors in the public health sector. OBJECTIVE: To explore the key human resource (HR) practices affecting doctors in a medical complex in the Eastern Cape, South Africa. METHODS: We used an open-ended questionnaire to gather data from 75 doctors in this setting. RESULTS: The most important HR practices were paying salaries on time and accurately, the management of documentation, communication, HR staff showing that they respected and valued the doctors, and reimbursement for conferences and special leave requests. All these practices were judged to be poorly administered. Essential HR characteristics were ranked in the following order: task competence of HR staff, accountability, general HR efficiency, occupation-specific dispensation adjustments and performance management and development system efficiency, and availability of HR staff. All these characteristics were judged to be poor. CONCLUSION: HRM practices in this Eastern Cape medical complex were inadequate and a source of frustration. This lack of efficiency could lead to further problems with regard to retaining doctors in public sector service.