The experiences of the ICU permanent professional nurses working with agency nurses at a ...

168 Pages·2016·1.5 MB·English

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THE EXPERIENCES OF THE ICU PERMANENT PROFESSIONAL
NURSESWORKING WITH AGENCY NURSES AT A PRIVATE HOSPITAL IN
GAUTENG

by

DORRIS TINYIKO BALOYI

DISSERTATION

Submission in fulfilment of the requirements for the degree

MAGISTER CURATIONIS

in

MEDICAL AND SURGICAL NURSING SCIENCE: CRITICAL CARE: GENERAL

In the

FACULTY OF HEALTH SCIENCES
DEPARTMENT OF NURSING

at the

UNIVERSITY OF JOHANNESBURG

SUPERVISOR: MRS. I.J. KEARNS
CO-SUPERVISOR: PROFESSOR M.M. CHABELI

AUGUST 2016
DEDICATION

This dissertation is dedicated to my late grandmother Tsatsawani Nwa-Masiya Chauke,
for her unconditional love and support for guiding me through my life. I am who I am
because of her.

Special gratitude to my mother, Lerisa Miluva Maluleke for the direction and for valuing
education from my early years while my father was not there, and even though you
never went to school, I will always love you. Nhlalala Chauke, ‘my son’, thank you for
your support, you will always remain in my heart my dear.

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ACKNOWLEDGEMENTS

My praise and thanks to my Heavenly Father and Creator, who has guided me in my life
and studies, without whose love neither I nor this dissertation would have been
conceived.There is an African saying, Munhu I munhu hiva n’wana vanhu (“a person is
a person because of other people”). A dissertation is not the work of the writer alone;
therefore I would like to give my thanks and appreciation to the following people for their
respective contributions to this dissertation:
 My supervisor, Mrs. I.J Kearns, thank you for your continuous support and
encouragement.
 My co-supervisor, Professor Mary MahlatseChabeli, for your continuous
support, encouragement and guidance even during the difficult times of
my study, when you continued to trust and believe in me as a mother. I
salute you in your retirement.
 Ms Claudia Boffard, for editing the language of the dissertation.
 Ms Agnes Makhene for analysing the data.
 Ms Porchia Bergh for the technical editing.
 My colleagues, Ms M Motseonaka and Ms L Lukhele, for being there for
me.
 To all ICU nursing staff at Lenmend (Ahmed Kathrada) Hospital who
provided me with valuable information. The study would not have been
possible without your input.
 To my sister, Ms Tsakani Florah Nkuna, God bless you for being mother
and sister at the same time.
 To all the members of my family, for supporting me.
 To all my friends who supported me all the way.
 Last but not least, my “big family”, my husband Richard Vonani,
Malwandla, you have been a ‘king’ since you were born my son. My only
‘Princess’ - among the ‘Princes’, Nyeleti, you are a ‘star’ continue to shine.
The twins, Matimba and Matimu, it was not easy sons, but I continue to
stand with your name, ‘Power’ and to make history with my life, I love you
so much.
GOD BLESS YOU!
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SUMMARY

In South Africa, doctors and skilled professional nurses such as Intensive Care Unit
(ICU) nurses, emigrate in significant numbers, causing the country a great loss toits
developed skills base leading to the utilisation of agency professional nurses. Working
with agency professional nurses in ICU places permanent professional nurses in a
challenging situation: they have to carry great responsibility and are accountable for
providing quality care while continuously supervising and working with agency
professional nurses who are unfamiliar with the ICU environment. ICU professional
nurse must undertake a leadership role, be facilitators and act as role models, while
advocating the provision of quality care.

The purpose of the study was to explore and describe the experiences of ICU
permanent professional nurses working with agency professional nurses at a private
hospital in Gauteng, in order to describe recommendations to support ICU permanent
professional nurses. In this study, a qualitative, explorative,
descriptive,phenomenological design that is contextual in nature was used. Semi-
structured interviews were conducted and data saturation was reached at the 15th
participant when no new information was emerging. The data was analysed using
Tesch’s protocols.Trustworthiness was ensured by using strategies, namely: credibility,
transferability, dependability and confirmability according to Lincoln and Guba. Ethical
principles were adhered to.Four themes emerged: (1) Lack of knowledge of the agency
nurses; (2) Negative attitude of agency professional nurses; and (3) Lack of skills of the
agency professional nurses; and (4) Reduced workload by the agency professional
nurses. The themes were conceptualised within the relevant literature.
Recommendations to support the ICU permanent professional nurses working with
agency professional nurses at a private hospital in Gauteng were described.

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TABLE OF CONTENTS PAGE

DEDICATION i
ACKNOWLEDGEMENTS ii
SUMMARY iii

CHAPTER ONE: OVERVIEW OF THE STUDY................................................ 1
1.1 INTRODUCTION, BACKGROUND AND RATIONALE……………......… 1
1.2 RESEARCH PROBLEM STATEMENT..………………………….......…... 3
1.3 RESEARCH QUESTIONS…………………………………………............. 4
1.4 RESEARCH PURPOSE…………………………………………………..… 4
1.5 RESEARCH OBJECTIVES……………………………………………..…... 5
1.6 DEFINITION OF KEY CONCEPTS…………………………………….…... 5
1.7 RESEARCH DESIGN AND METHOD..……………………………………. 6
1.7.1 Research design………………………………………………………………. 6
1.7.2 Research method….………………………………………………………….. 7
1.8 SIGNIFICANCE OF THE STUDY……………………………………………… 10
1.9 ETHICAL CONSIDERATIONS……………………………………………… 10
1.10 OUTCOMES OF THE STUDY……………………………………………... 12
1.11 ORGANISATION OF THE PROPOSED CHAPTERS……………......…. 12
1.12 SUMMARY…………………………………………………...............……… 12

CHAPTER TWO: RESEARCH DESIGN AND METHOD................................... 13
2.1 INTRODUCTION…………………………………………………….…........ 13
2.2 RESEARCH DESIGN ………………………………………………………. 13
2.2.1 Research strategies…………………………………………………………….. 14
2.2.2 Reasoning strategies………………………………………………………. .. 15
2.2.3 Research method……………………………………………………….…….. 18
2.2.3.1 Population……………………………………………………………………. 18
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2.2.3.2 Sample and sampling method..…………………………………………...... 19
2.2.3.3 Data collection……………………………………………………………….. 19
2.2.3.4 Data analysis………………………………………………………...…….... 22
2.2.3.5 Trustworthiness……………………………………………………………… 24
2.3 SUMMARY…………………………………………………...............……… 28

CHAPTER THREE: DESCRIPTION OF FINDINGS........................................... 29
3.1 INTRODUCTION………………………………………………………........... 29
3.2 DESCRIPTION OF FINDINGS………………………………………............ 30
3.2.1 THEME 1: Lack of knowledge of the agency professional nurses…...... …. 30
3.2.3 THEME 2: Negative attitude of agency professional nurses……………….. 33
3.2.3 THEME 3: Lack of skills of agency professional nurses…………………….. 37
3.2.4 THEME 4: Reduced workload by agency professional nurses................... 39
3.3 SUMMARY……………………………………………………………...….…… 40

CHAPTER FOUR: CONCEPTUALISATIONOF FINDINGS............................... 41
4.1 INTRODUCTION…………………………………………………………....…. 41
4.2 CONCEPTUALISATION……………………………………………….......….. 41
4.2.1 THEME 1: Lack of knowledge of the agency professional nurses…......….. 41
4.2.2 THEME 2: Negative attitude of the agency professional nurses…………… 63
4.2.3 THEME 3: Lack of skills of the agency professional nurses……………....... 73
4.2.4 THEME 4: Reduced workload by agency professional nurses….....………. 92
4.3 SUMMARY…………………………………………………………….…...……. 104

CHAPTER FIVE: RECOMMENDATIONS, LIMITATIONS,
AND CONCLUSION…..............................................…..............................… 105
5.1 INTRODUCTION………………………………………………………................... 105
5.2RECOMMENDATIONS TO SUPPORT ICU PERMANENT PROFESSIONAL
NURSES WORKING WITH AGENCY PROFESSIONAL NURSES AT A
PRIVATE HOSPITAL IN GAUTENG….............................................…….. 105
5.3 LIMITATIONS……………………………………………………………................ 108
5.4 CONCLUSION………………………………………………………….....……... 109

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LIST OF REFERENCES………………………………………………......................... 110
LIST OF TABLES

TABLE 3.1: The experiences of the ICU permanent professional nurses working with
agency professional nurses in ICU at a private hospital…………… 30

LIST OF ANNEXURES

ANNEXURE A: Application for Change of Title
ANNEXURE B: Confirmation of final corrections of a Research/Dissertation/Thesis
ANNEXURE C: Higher Degrees Committee; letter of permission to conduct research
ANNEXURE D: Academic Ethics Committee; letter of permission to conduct research
ANNEXURE E: Letter of permission from the private hospital to conduct research
ANNEXURE F: Acceptance letter from Private Hospital to conduct a study
ANNEXURE G: Participant’s letter of request to participate in the study
ANNEXURE H: Consent and additional permission to use a tape recorder
ANNEXURE I: A verbatim transcription of a semi-structured interview
ANNEXUTE J: Language Editor; letter for confirmation

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CHAPTER ONE
OVERVIEW OF THE STUDY

1.1 INTRODUCTION/BACKGROUND AND RATIONALE

There is a need to improve nursing care and the image of the nursing profession.
According to the International Council of Nurses (ICN) Conference (2007), the main
factor causing the inadequate provision of health is staff shortage. Shortage of staff
result from inadequate production of nurses leading to high vacancy rate and increased
utilisation of temporary agency nurses (The Centre of Health Policy in the school of
Public Health in Wits University, 2014:1)

Nurses remain frustrated as they cannot cope with their nursing workload in ICU.The
nursing workload results from increasing challenges, which include highnurse-to-patient
ratios, long working hours, inadequate compensation, shortage of experienced qualified
professionals through emigration and relocation. Nurses are alsooverburdened
byadministrative duties resulting in nurses being unable to effectively prioritise their
nursing duties (Cunningham, Kennedy, Nwolisa, Callard&Wike, 2012: 2).

There is a serious need for quality nursing care in general and in highly specialised care
such as Intensive Care Units(ICU) in particular, both nationally and internationally.
Massey, Essain and Wallis (2009:913) state that shortage of nurses is experienced
worldwide and agency nurses are called upon to provide cover for the permanent
professional nurses’ shortage in ICUs. Under the prevailing circumstances, it seems
that these agency nurses must continue to be utilised to cover the nursing
shortage.Studies have also found that the prevalence of moonlighting varies by area of
speciality as a result of staff shortage, however the financial and professional benefits of
moonlighting must be weighed against the potential to harm patients (McNeeley,
Prabhu, Mooroe&Lyer, 2013:249-254).

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Furtherstudies are needed on the experiences of ICU permanent professional nurses
workingwith agency professional nurses in order to translate findings into better ways
ofutilising agency professional nurses to provide quality critical nursing care, and to
close the gap of staff shortages in ICU (Debergh, Myny, Van Herzeele, Van Maele,
Miranda & Colardyn, 2012:1438).

The ratio of 1:1 patient to professional nurses is a basic tradition in ICUs, and this nurse
to patient ratio should ideally prevail at all times, in order to provide quality nursing care
for critically ill patients.

The intention of using agency nurses is good, but on the other hand, ICU permanent
professional nurses are highly stressed due to the challenging supervisory workload
they have to carry in orientating agency nurses. Additionally, ICU permenetprofessional
nurses are responsible and accountable for the rendering of quality nursing care to
critically ill patients as well as rendering psychological support to the patients’ families
(Muller, Bezuidenhout & Jooste, 2011: 291).

The ICU is a specialised environment that requires adequate numbers of appropriately
trained and experienced nursing staff with adequate knowledge and sophisticated
technological skills to ensure that efficient and safe quality care is provided to critically ill
patients (De Beer, Brysiewicz & Bhengu, 2011:6). The ICU permanent professional
nurse has the responsibility of orientating the agency nurses with different complex
machines, including monitors and ventilators.

The ICU environment is a dynamic one requiring professional and
knowledgeablenurses who increasetheir knowledge base regarding the changes that
are taking place in providing quality care, and are capable of monitoring patients’
conditions, which can beunpredicatable and change at any moment (Urden, Stacy&
Lough, 2014:3-4).Agency nurses are not always familiar with institutional policies and
protocols, standards of care and procedures, and are thus unable to utilise ICU charts
correctly. They are often unfamiliar with the ICU geographical layout, which differs from
one hospital to the other.

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