Rationalisation of Nursing Education in Limpopo province : Nurse educators ’ perspectives

Curationis 30(4): 61-72 Nursing education institutions are facing a challenge of realigning its functioning according to the changes that are taking place within the country. The intention of the government post apartheid was to correct the imbalances which were brought about by the apartheid government and the following regulations and policies influenced the change in nursing education, that is, Reconstruction and Development Programme (RDP), W hite Paper on Higher Education (WPHE), and the National Qualification Framework (NQF) (South Africa, 1995:6). In 1996 the government introduced the first democratic constitution of the Republic of South Africa (RS A) according to Act 108 of 1996. In the light o f those increasing changes in nursing education, led by political change, the experiences o f nurse educators is a critical issue facing nursing cam­ puses. The purpose of this study was two-fold; namely: to explore and describe the experi­ ences of nurse educators with regard to the rationalisation of nursing education and to use information obtained to describe guidelines for the effective rationalisation of a nursing college in the Limpopo Province. A qualitative, exploratory, descriptive and contextual research design was used. Quali­ tative interviews were conducted with nurse educators who worked in nursing col­ leges before and after 1994. Measures to ensure trustworthiness were applied and ethical issues were adhered to throughout the research process. Data was analysed following Tesch’s method (Creswell 1994:154-155). The research established that nurse educators experienced dissatisfaction in several areas relating to the rationalization of nursing education. Support was also expected from bureaucracy at higher level. This study developed guidelines to policy makers and nurse educators to ensure effective rationalisation process. Correspondence address: Dr. M Davhana-Maselesele 46 Protea Street Makhado 0920 T e l: (015)962-8125 Fax: (015)962-4749 E-m ail: mmasele@univen.ac.za 61 Curationis December 2007


Introduction and Background
During the apartheid era, the Nationalist governm ent succeeded in dividing the eth n ic g ro u p s o f th e th e n N o rth e rn Transvaal, now called Limpopo Province.The province was divided into hom e lands, and each had to m anage its own affairs, duplicating the country's scarce resources.One o f the N ationalist gov e rn m e n t's firs t acts (G e ld e rb lo m & McKay, 1995:57) after com ing to power in 1948 was to appoint the Eiselen Com mission on Native Education.The task of the comm ission was to form ulate the principles and aims o f education for na tives as an "independent" race.The act (Gelderblom & McKay, 1995:51) was passed supposedly to give A fricans an education that was appropriate to their needs and opportunities as a separate community.
The African pupils and students had to be taught that their future lay in the hom e lands (Gelderblom & McKay, 1995:57).Nursing education was not im m une to this system.It was used as an instrum ent of apartheid.For exam ple, a white nurse was m eant to teach a w hite student who would nurse a white patient (Gelderblom & McKay, 1995:57).Student nurses who would be future health care providers were expected to internalize this "value" o f separate developm ent in order to be come fully-fledged law -abiding citizens (Searle & Pera, 1995:249).
The apartheid system o f South A frica (SA) prior to 1994 succeeded in fragment ing the nursing education system , dupli cating services, prom oting inefficiency and inequalities, and causing m al-distri bution o f resources w ithin the health system.The result was that the Lim popo Province, before 1994, had three nursing colleges w hich w ere estab lish ed and m anag ed b a se d on eth n ic d iv isio n s.These nursing colleges were nam ely:-  Health Act 1985).Each had to run its own program m e of nursing education provided for by its own statute.Each college had its ow n college council for adm inistrative m anagem ent, its own college senate for academic m an agem ent and its own teaching personnel and students.The colleges each entered into an agreem ent with a preferred uni versity o f affiliation, w hich served as watchdogs for the m aintenance o f indi vidual college standards.Som e o f the universities were for blacks within and outside hom elands and one was for both blacks and whites within the greater R e public o f South Africa.
The intention o f the governm ent post apartheid was to correct the im balances which w ere brought about by the apart heid government and the following regu la tio n s a n d p o lic ie s in flu e n c e d the change in nursing education, that is, R e c o n stru c tio n and D e v e lo p m e n t P ro gramme (RDP), W hite Paper on Higher Education (W PH E), and the N ational Qualification Fram ework (NQ F) (South Africa, 1995:6).In 1996 the governm ent introduced the first dem ocratic constitu tion o f the R epublic o f South A frica (RSA) according to Act 108 o f 1996.The constitution requires transform ation o f the health system and nursing education with the aim o f ensuring accessibility and equity (The Constitution o f the Republic o f South Africa, 1996:6).The prom ulga tion of the constitution was follow ed by legislation and policy changes so that institutional practices should be trans formed.
RDP is the governm ent's way o f trans forming previously disadvantaged struc tures, to ensure accessibility, availability and affordability o f resources.Nursing education is not excluded; it should re flect and encompass the new mission and vision o f the governm ent in developing nursing education towards the dream o f the government (ANC (b), 1994:19).RDP affects nursing and nursing education in a way that new clinics are being built for previously disadvantaged com m unities which require m ore nurses.The policy provides equal opportunities for indi viduals and institutions such as bring ing m ore financial resources to previ ously disadvantaged nursing schools.
Rationalisation o f any nature may be sur rounded by m any c h allen g es, w hich should be faced and addressed.Im ple m entation o f policies may bring about challenges w hich could have an im pact on nursing education.R ationalisation was therefore im portant to redress the imbalances brought about by apartheid policies o f the past.

Statement of the problem and research objectives
Based on the background o f the study, it is evident that changes in the nursing education system were taking place fast.Nurse educators were expected to im ple m ent these new policies regarding the education system and health service de livery.The process o f rationalisation poses a challenge to nurse educators because they have a responsibility o f m aking integration a reality over and above their teaching function.They have to ensure that frequent m eetings were held to develop a new curriculum .They also have to orientate them selves to the demands of a new situation.This brought along fear and uncertainty o f their work and m any left the teaching fraternity and w ent back to the hospitals, som e re signed whilst others left the country.This brought interest on the researcher to find out the experiences o f nurse educators regarding the process o f rationalisation o f nursing education.This study seeks to address the follow ing questions:  (Fowler & Fowler, 1995:1139).In this study it refers to the am algam ation of three former homeland colleges into a sin gle college w ithin the province.N ursing college is an institution/corpo rate that is affiliated to a university and controls the provisioning o f nursing sci ence program m es for nurses (Fow ler & Fow ler, 1995:220;Provincial G azette, 1995:3).In this study, a nursing college refers to the nursing education structure in Lim popo Province w hich was form ed after the amalgamation of the three former colleges.
Nursing cam pus is an educational insti tution that operates under the college and provides nursing science programmes for nurses (Fow ler & Fowler, 1995:161).In this study a nursing cam pus refers to one of the three cam puses that form a nurs ing college.

Research design and method
A qualitative, explorative, descriptive and contextual research design (M outon & M arias, 1990:175;Brink & Wood, 1994: 106) was used to conduct this research.The design was selected in order to ex plore the experiences o f nurse educators as they w ere the best people who knew and understood w hat it was like to live with the rationalisation o f nursing edu cation.
A non-probability, purposive sampling (De Vos, 1998:198) was used to select nurse ed ucators w ho had w orked for m ore than five years; those who had pre viously been em ployed by form er hom e land colleges, that is had w orked at the college before and after 1994, within the period in which rationalisation had taken place and had been directly involved with the rationalisation process, includ ing those who had left the college during the process o f rationalisation.
Ten participants with ages ranging from 43-56 years were selected from a pool of nurse educators who volunteered from a cam pus o f the Limpopo College o f Nurs ing (LCN).Two o f the participants had already left the college.The sample of nurse educators was chosen as the best suitable for this study as they would give the best inform ation on the topic, and have experiences and expertise on the topic (Poggenpoel & M yburgh, 1998:33;Polit & Hungler 1991:37).
In-depth individual interviews were con ducted with nurse educators sharing their experiences regarding rationalisation of nursing education.Each individual was interview ed separately to allow partici pants to speak freely while the researcher noted w hat she was being told.The cen tral question was "what are your experi ences with regard to rationalisation o f nursing education in Lim popo Provin c e T ' S u b s e q u e n t q u e s tio n s w ere stated to encourage the participants to elaborate and clarify their experiences regarding the rationalisation o f nursing education.The interview was conducted in English.Some participants expressed their w ish not to have the conversation recorded as their voices could easily be recognized.Their right o f anonymity and confidentiality was upheld.
Tesch's open coding method which com prises o f eight steps o f data analysis (in Creswell, 1994:155) were em ployed as a guide in developing main categories, cat egories and subcategories, and direct quotes were extracted from the transcrip tions.Field notes were also analyzed to develop their relationship with the inter views and categories (Wilson, 1989:380)

Discussion of findings
Two them es emerged from the interview as well as categories and sub-categories; table 1 gives a summary o f the findings.The them es, categories ad subcategories were discussed in detail and were sup ported by direct quotes from the inputs and nurse educators.Literature control was done to verify the findings.Anger, frustration and fear were observed dur ing the interviews.These em otions were evidenced by the m anner in which some o f the participants expressed their expe riences, by their way of looking at the researcher, as well as hand and shoulder movements.All these were noted as field notes.
A detailed description o f the themes will be given and direct quotes from partici pants were used to support those themes.During the interviews, nurse educators expressed their views in respect o f ex cessive adherence to protocols and the impact it had on day-to-day adm inistra tive activities.They expressed how they felt with regard to the way in which nurs ing education was m anaged; this was explained by mentioning problems relat ing to the centralisation o f adm inistra tive tasks as follows: Problems relating to the centralisation of administrative tasks.
N urse ed u cators iden tified p roblem s which were caused by the centralization o f adm inistrative tasks as characterized by: • prolonged decision making which leads to delayed service delivery;

•
Institutions are expected to pro duce the results which the gov ernm ent desires.The above notion could be true when one c o n sid e rs d e la y s th a t c o u ld be caused by protocols built into the sys tem.
The findings in this study showed that the centralisation o f adm inistrative tasks created delays in rendering services, as administrative tools such as policies and circulars did not reach the institution on time.This is highlighted by the follow ing direct quotations: "There is a delay in accom plishing tasks as authorization is done 200 km away fro m two cam puses" and "the ultimate control is in Polokwane, and the budget is not fu lly utilized because control is at the college aw ay fro m the cam pus and things are slow, e.g.budget m a tters".R esearch has revealed the challenge that has been brought about by the protocol, w hich furtherm ore im pacts on adm inis tration.The following quotation by three participants indicates this delay."Im m ediate decisions cannot be taken in cam puses as they have to be fir s t a p proved by the principal; quotations ex pire before authorization is effected." In the researcher's view statem ents such as these provide a fram ew ork for short com ings in the system as they undermine the B atho Pele principles which put the em p h asis on serv ice d e liv e ry w hich sta te s th a t p e o p le (n u rse e d u cato rs) should be told about the level and qual ity o f public service they are entitled to receive so that they should be aware of it.It is also true that nurse educators be com e dem otivated in the process when there is a delay in service delivery and a prolonged decision-m aking process."Em ergencies are not catered for, things do not reach the cam pus tim eously e.g.circulars, a nd fo llo w up on issues is dif fic u lt due to bureaucracy".This statement may im pact negatively on service delivery and can furtherm ore jeopardize the level o f productivity in an organization, as quotations may expire before authorization can be effected, and there are no standing orders for the cam pus to apply in cases o f em ergency and this has a negative im pact on academic activities.The findings reflected that nurse educa tors (and adm inistrators) spent consid erable time executing duties, the end prod uct o f which was not achievable, for in stance accessing the required resources and services.In this instance, the re searcher believes that achievem ent o f a goal is essential for healthy personal m o tiv a tio n .W ood, W allace & Z effan e (2001:142) confirm that motivation is the basic source of pow er behind hum an be haviour.
The findings also reflected as problem atic was the poor communication between the college and the individual campuses.Participants said: "Inform ation is not relayed to the p eo p le on tim e as a resu lt dead lin es on budget issues are not m e t"; "There is p o o r com m unication; a lot o f information does not reach us.There are no regular sta ff meetings, and there are things th a t skip us w ithout being in fo rm e d about them." "Things discussed at meetings are never im plem ented because before such is im plem ented, there is yet another change ".These statements show that staff m em bers on campuses are not given inform a tion about activities taking place and they are not given adequate tim e to think about where inputs have to be made.Gerber & Nel (1998:345) view communi cation and com m unication channels as essential for the survival o f any organi zation as they assist with the establish m ent o f relationships betw een individu als, particularly when a specific goal such as rationalisation has to be attained.N urse educators expressed the feeling that decisions were imposed on them.The findings in this study reflected the fact that m ost nurse educators, particularly those lower in the hierarchy, felt that they had not been m ade part o f the rationali sation process, and that they had not been actively involved.Instead it was seen as a top-dow n approach where de cisions were im posed on them through bureaucracy.

"The departm ent decides we implement th a t' s it because everything is fo r us with out us. " "We fin d ourselves to be implementers o f decisions taken elsew here."
Statem ents sim ilar to those quoted were highlighted by six participants, that in the researcher's view, were an indication of the dissatisfaction caused by the way in w h ich ad m in istrativ e decisions w ere taken at higher levels.
M ost participants interview ed revealed that the bureaucracy introduced deci sions at tim es that were based on trial and error and they cited exam ples such as exam ination setting and marking, to m ention but a few: "...e v e r y th in g is tria l a n d e rro r a p proach when som ething is seen as not fu n ctio n a l it is replaced by something else." "We do not even give input as to whether decision can work or not, this hampers progress." F indings revealed that these im posed decisions m ade nurse educators feel al ienated in the process.A lienation, ac cording to Coetzee (1991:32), contributes to a feeling o f w orthlessness, purpose lessness and lack o f norms that can re sult in a state o f anomie and can ham per the integration process.Coetzee (1991:19) argues that integration should aim at maintaining harmony among the compo nents o f the system, to elim inate distur bance, and to ensure the coherence and solidarity o f the system.To ensure that tension is reduced in the process of ra tionalisation, the author suggests that actions should be geared towards moti vating those directly affected by change (in this case all levels o f hierarchy) to participate actively towards rationalisa tion, which is the ultim ate goal.
Research (Teng-Zeng, 2005:4) describes rationalisation (transform ation) within the context o f government policy (White Paper on Higher Education 1997:7) as part o f the broader process o f South A frica's political, economic and social transition, the challenge o f which is to redress past inequalities and m eet pressing national needs.R esearch further confirm s that rationalisation can never be perfect at the same time, but that a m ajor aspect of ra tionalisation is the merging o f campuses into a single college and establishing a new nursing education institution in the province w hich utilizes a single curricu lum.To ensure integration (merger) re search (Teng-Zeng 2005:5) has shown the following requirements, am ong others: • increased and broadened partici pation to overcome a historically determ ined pattern o f inequality and inefficiency; • co-operation and partnership in governance among stakeholders to create and enable environment and culture that are sensitive to the needs o f people.Based on the findings o f the report, the researcher believes that the same could be relevant for the purpose o f rationalis ing nursing education.N urse educators as m ulti-dim ensional beings, as argued by Bruce (1996:48), are capable o f adapting to changing envi ronments if given space and time to do so, and the opposite o f this can also be true.The researcher's view is that should this state o f affairs be allowed to persist, it could im pact negatively on organiza tional culture, behaviour and productiv ity.

Dissatisfaction amongst nurse educators on issues related to operational level.
Nurse educators expressed their views with regard to perform ance o f tasks at the operational level, which is where com mitment to change is desired.The fol lowing subcategories explain this dim en sion.

Ineffective management of campus activities which leads to ineffective teaching due to:
• Increased workload on deputy managers All participants raised a sim ilar concern about the fact that campus vice-princi pals and heads o f departm ent w ere fre quently not available at their workplaces.This was highlighted by the following direct quotation: "In m any in stances campus vice-principals are not fo u n d in their cam puses due to m eetings which are conducted +200 km away fro m their ca m p u se s" and "there are too m any meetings especially fo r the h e a d s".The frequent unavailability o f the vice-prin cipals aggravated the delays, particularly when certain adm inistrative decisions with financial implications had to be made.Wood et al. (2001:114} confirm that una vailability o f a campus manager on a con tinual basis may have an im pact on the culture and behaviour within an organi zation and may portray ineffective lead ership which could increase stress lev els in the process.The findings reflected increased w ork loads on deputy m anagers and others who had to m anage the cam pus in the absence o f the manager.Participants in dicated the following: "This overloads the deputy m anagers who in other cam puses manage the campus in the absence o f the vice p rin cip a l" and "we remain overloaded with our work and theirs".

•
Lack o f resources During interviews, it was found out that lack o f resources, both m aterial and hu man, created a challenge and this was linked to the increased w orkload and in effective m anagem ent o f cam pus activi ties.M ost participants highlighted this; "Lack o f tra n sp o rt f o r each tu to r to render services as cars are shared by all campus departments" and "very old cars are used.......... and this poses a threat to our lives as m ost o f them are not 100% roadworthy " Participants revealed that they also be came exhausted and this was expressed as follows: Finally when I reach my des tination I am already fin ish ed ..., tired." Based on these statem ents it was evi dent that lack o f resources m ight im pact negatively on the teaching function and it made nurse educators' situation hope less, as their safety was not considered or guaranteed, whereas the C onstitution o f South A frica (A ct no.108 o f 1996) spells out that all hum an beings have the right to protection.
The findings revealed that shortage o f staff was another challenge w hich nega tively affected the pace at w hich tasks were executed.The following statements by m ost o f the participants were evidence o f the shortage o f hum an resources: "....tutors teaches both theory and p ra c tic e " and "...those who leave are not replaced; there is sta ff shortage"."Groups are too large com pared to the num ber o f tutors available to teach" and besides that there are no video cassettes fo r sim ulating procedures before expo sure o f students to clinical settings." There is a direct link that exists betw een shortage o f hum an resources and in creased workload, and as a result this might retard the process o f rationaliza tion.
Abedian, Strachan, and Ajam (2003:153) argue that hum an resources are an im portant source o f labour in any organiza tion.This statem ent m eans that w hen rationalisation is envisaged, it is im pera tive that m anagers consider this aspect so that m anageable workloads can be al located as indicated in Searle and Pera (1995:198).Participants verbalized the challenge o f having to deal with large groups.This also posed problems in clini cal facilities as they had to spend a speci fied period o f time with each student.The num ber o f students allocated to each clinical area had an influence on guid ance and supervision.If the group was too large, it becam e difficult for nurse educators to teach.Research conducted by (D avhana-M aselesele, Tj allinks & N o rv al, 2001:7) has show n th a t the num ber o f students allocated to any clini cal area should be controlled so as to a v o id o v e rc ro w d in g .G ib b o n an d Kendrick (1996:52) confirm that over crowding makes teaching and learning en v iro n m ents co u n terp ro d u ctiv e and recommend a maximum of 15 students per tutor.This was not the case in this in stance.This notion suggests that theo retical learning should take account o f the realities o f the practical situation, or else students w ould be encouraged to memorise -a practice that makes it diffi cult for students to integrate theory with practice.For instance, students are less likely to develop em pathy and good working relationships with patients when their education has been largely memorization-based.The large groups that nurse educators talked about w as confirm ed w hen the available data in nursing cam pus regis ters was studied, and it was found that in a classroom setting one nurse educator was available for +200 students instead of 30 (Gibbon & Kendrick, 1996:53).

Dissatisfaction amongst nurse educators on issues related to human level.
Nurse educators expressed hum an, per sonal feelings relating to the rationalisa tion.The researcher viewed the expres sion o f feelings as therapy in itself.This is e x p la in e d by th e fo llo w in g subcategories.

•
Confusion Research found that nurse educators ex perienced confusion during the process of rationalisation.In the researcher's view the source o f confusion was three-fold, nam ely, ed u c atio n a l philosophy, b u reaucracy and increased workload.The following quotation is evidence o f con fusion: "Each university brought its own e d u c a tio n a l p h ilo so p h y , a n d it a p peared as i f none o f them was ready to compromise and this confused college sta ff further." "Today you are told this and tom orrow that, I 'm telling you people become con fu s e d " and "even tests get lost sometimes -its confusion." Based on this quotation it appeared that the university consortium , w hose aim was to guard standards, did not com pare their similarities and differences and reach consensus on dealing with the process.N urse educators from different b ack grounds becam e confused in the proc ess while they attem pted to m ake ration alisation a reality.In this instance it might destroy the self-im age, self-respect and self-confidence o f nurse educators and even affect their m ental health.and now placem ent is quite differ ent fro m likes " and "there is a lot o f pres su re on the ju g u la r vein.O ne has a specialty which one has w orked hard fo r; but you fin d yo u rself p laced in a dif fe re n t area fro m where you have special ized on, " (Shaking Shoulders).
It becam e apparent that some nurse edu cators had been approached by others, as suggested by the m anagem ent, to join the nursing education system from the nursing service, and now they felt inse cure and unsure o f what was to come next.Jansen (2003:364) asserts that o f all hum an experiences, fear is the most trou blesom e.Perhaps one other factor con tributing to frustration was that they were not placed acco rd in g to th e ir p re fe r ences.This situation might be coupled with disbelief in response to a situation with which they dealt in their professional lives.
One participant stated that, "One enjoys teaching m idwifery because one has a specialty on that a nd not B N S or GNS stuff."A survey o f nursing education in Africa w ith regard to hum an resource crises (University of N atal, 2000) revealed that subjects were often not taught by sub je c t specialists, and that this often led to a practice where students in many nurs ing schools learned by rote, with little opportunity fo r them to question and explore.

•
Stress, anger and frustration A nger often erupted during interviews and som e participants expressed their increasin g need to leave the system , "hm m m .......... is ju s t that those doors have not opened yet, "(implying other employ m ent options) a n d that is why other nurse educators have left the campus and jo in e d flo o r crossing practices" (re ferring to some going back to nursing services).
In the literature Johnson (1997:330) con firm s that anger is a strong defensive em otion that signals that the person feels frustrated, thw arted, uncertain, confused and under attack.
The findings revealed a feeling o f frus tration which m anifested itself in a state o f confusion, stress and anger.Partici pants felt that they had no future in nurs ing education as their presence, in their view, was not valued.These direct quo tations confirm the statement: "Tutors are frustrated, there is no fu tu re in nursing education " and "I 'm frustrated, tutors are not listened to." H ughes (2002:503) believes that when there is an obstacle in interaction, even a very sim ple request can turn into an ar gument.B ased on the cited quotations, Louw (1999:52) agrees that when the balance o f personality is disturbed, by any other fru stra te d m o tiv a tio n s, the urge for hom eostasis will drive nurse educators to seek alternative satisfaction through fight and flight compromises.
• D eteriorating nursing standards Perhaps the other factor contributing to frustration-related em otion w as when p a rtic ip a n ts w itn e sse d d e te rio ra tin g nursing standards.They were o f the opinion that the course as stipulated by the SANC (Regulation 425 o f February 1985 as amended) was no lo n g e r integ rated , as levels w ere taught at different campuses.Students ro tated am ong three cam puses to be taught subjects of the same course be cause cam puses no longer taught stu dents from first to fourth level.Nurse educators expressed their desire to teach students all aspects o f the four-year in tegrated course to ensure coordination betw een what students learnt in classes and w hat they did in clinical rotations.All participants interviewed directly and indirectly verbalized that nursing stand ards were deteriorating.
The following quotations by four partici pants confirm ed the statem ent: "I am w o rrie d a b o u t sta n d a rd s, they have d ro p p ed " and "with rationalised levels, where is continuity?"The research revealed that nurse educa tors supported change, but their view was that it should not com prom ise standards.This statem ent indicated passion for the profession.They expressed the need to feel proud o f the end product.The fol lowing quotations highlighted this: "One test in fourth-year subjects p er campus to m e is out " and "one m ust be proud o f the end p ro d u ct." "....w ith poverty al leviation, points (selection criteria fo r new students) w ent down fro m 30 to 16, some do not have matric exemption -lan guage is a problem " (im plied problems w ith English as the m edium o f instruc tion during nurse training) and "nursing education is politically defined, it does not belong to the profession." • N ot cared for and lack o f support The researcher discovered that most par ticipants raised this concern in one way or another.The researcher's assumption on this aspect was that coupled with pre vious concerns, it might be costly to the econom y and dangerous to patients if standards rem ained compromised.M ost participants were o f the opinion that they were not cared about or loved and deliberate exclusion from m ost deci sions in relation to rationalization made them feel discrim inated against.Partici pants said, "N o one cared f o r us or showed love, that you are something and you are m aking a contribution", and "surely nobody cares".
A survey in Zambia (1995Zambia ( -1997) ) showed that a powerful tool to direct staff and to keep morale high during a period o f re form is when they feel a sense of pride in what they do.This somehow makes them feel they are making an important contri bution to im proving the nursing educa tion system and this is not what is hap pening in South Africa.Louw (1999:54) suggests the concept of love as the relationship with members who share reciprocal trust within the cy cle of work, and if such concept is under mined it may result in isolation.The same could be true in the situation of nurse educators.
Related to the concept is M aslow 's hier archy of needs (Louw, 1998:65) when love and belonging needs are unmet, individu als feel rejected, friendless and aban doned by their own colleagues, and the consequences may be that they leave the profession or perform at less than opti mal levels that is burnout and stress sets in.The presence o f support is therapeu tic and absence thereof is demoralizing and demotivating.Participants strongly believed that the bureaucracy could still assist nurse educators regarding this aspect.The following discussion indicates how this theme was identified.The most common need that participants expressed was for proper planning.They described planning as an im portant tool in any administration.In their view the rationalization was not planned, and they were not made part of the process.Direct quotations highlighted the follow ing: "Planning h m ...... planning, strategic.... (show o f hands, movement) plan accom modation classes and residences, plan m anpower........... hm ...hum an resource, I can go on and on and I d o n 't want to do that." The follow ing subcategory described how planning should be conducted dur ing the process of rationalization, namely: Nurse educators expressed the need to participate actively and be consulted in the planning process Nurse educators expressed the need to get involved actively in all matters and not be surprised in the process.During their participatory role, they expressed the need for process evaluation and fe e d back m echanism s to see if there is any progress made or not.M ost p articip an ts in d icated directly: "C onsult....don't surprise people." In the researcher's opinion this quota tion alone was an indication o f the need for participatory management.The report of a survey in Zambia (The Health Sector Human Resource Crisis in Africa, 2003:35) revealed that regular consultation and sharing o f information betw een m anage ment and staff representatives was not the norm, since inform ation was often seen as a source of pow er for m anagers, and thus they m issed opportunities to gain staff understanding and support.
In the light o f this statem ent it became clear that nurse educators yearned for identity.Le Francios (2001:511) relates the term identity to Erickson's w ords "that to experience wholeness, people (nurse educators) m ust feel progressive conti nuity between that which had com e to be in the long years o f their profession and that which prom ises to be in the an ticipated future."This notion suggests that bureaucracy is capable o f providing a platform for nurse educators to partici pate and be consulted and becom e part of the future of nursing education.
Participants spoke strongly on the as pect o f evaluation and feedback.They believed that rationalisation as a proc ess should be evaluated.M ost partici pants verbalized this need w hen they said, "D o n 't you som etim es need to look at where you come from , where you are and how you arrived where you are?" "Evaluation is important; you c a n 't ju s t start up a thing and leave it to continue without follow ing it up." Findings revealed that evaluation was and had always been a benchm ark in any project m anagem ent, to check w hat had worked and what had not w orked and why.
Another need which participants wanted to see addressed was feedback.The re searcher found that evaluation and feed back were inseparable.This need was highlighted when they said, "F eedback is very im p o rta n t a t any workplace " and "I can tell you, there is no feedback." Based on this statem ent the researcher believes that evaluation and feedback are essential to com plete the cycle o f ration a lis a tio n as s u g g e s te d by F is h e r (1986:143), to provide the amount of qual ity dem anded by the situation.

Nurse educators expressed the need for maintaining professional standards.
During the interview s it was apparent that participants w ere sensitive to and critical about professional standards.They felt that they should be m aintained and they expressed that bureaucracy was becom ing au to cratic on professio n al matters.
During interviews participants showed that they felt they were experts in their profession and that they deserved re spect.Four o f the participants literally said, "P o liticians m u st leave p r o fe s sional matters to the profession itself." The report on the survey in Zam bia (The Health Sector Human Resource Crisis in Africa, 2003:33) revealed that in Zambia, se le c tio n o f tra in e e s w as b e in g professionalised and made com petitive, and that everyone wishing to be consid ered for training applied, and the com m ittee did the selection based on the country's priorities for training and the perform ance o f the applicants.The re port further em phasized that the fact that politicization o f personnel recruitm ent and appointment diluted the professional civil services, o f which nursing educa tion formed part.Based on this report the research er believes that this practice could still be taking place in this country, particularly in this province.It is there fore important to develop guidelines to decision makers regarding rationalization o f nursing education institutions so as to retain nurse educators by addressing their needs.

Guidelines
The guidelines are based on the themes that emerged during the interviews.The following guidelines are suggested for use by decision m akers on rationaliza tion process o f the nursing education institutions:

Guidelines relating to administrative, operational and human related responsibilities
During the interviews nurse educators expressed dissatisfaction in several ad m inistrative, operational and human ar eas.The concerns em anated from tasks that had been centralized at a single cen tre which in the process created deficien cies in service delivery.The researcher suggests a "decentralized m o d el".
The decentralized model means that each section o f the system has to establish, enhance and improve its service deliv ery capacity.The model has advantages such as: • D evolving pow er to institutions at operational level (i.e. the cam pus).The rationale behind this is the principle that certain decision--making powers and authority should be delegated to the low er sustainable m anagem ent based on policies to guide such opera tions.To decentralize also calls for measuring of perform ance at lower levels.• Institutional staff enjoys greater authority; they can be m otivated to achieve higher levels o f perform ance in their departm ents.
• Channels of communication are shortened and potential comm unication problems are reduced.
• M anagers are responsible for sm aller units.Their knowledge is more intim ate and they are able to identify and solve problem s quickly and effec tively.
The m odel that could be used to reduce the concentration o f adm inistration at central level and transfer pow er to local authority to make rationalization a reality is discussed in the paragraph that fol lows:

Participatory model
This m odel suggests that both m anag ers and nurse educators take part and express their opinions or ideas to reach their full potential.Participation em pow ers stakeholders to take responsibility for making rationalization a reality.The model suggests the breaking o f the m onopoly o f know ledge by allowing in volvem ent, encounter and dialogue, as Groenew ald and M cK ay (1990:137) put it.Participation allows for critical think ing on, for example, how to make the most o f lim ited resources and w hat it is that different stakeholders can do best to im prove activities at operational level and that could reduce the stress and frustra tion among human beings.The researcher view s participation as the best remedy as it helps in making inform ed decisions.It m ay suggest a shift in leadership style tow ards participatory management.

Guidelines relating to nurse educators' specific needs
These guidelines are directed at assist ing nurse educators to identify with the process so that they no longer regard them selves as worthless.The guidelines will assist in planning and where to get expert know ledge in the process.The guidelines are discussed below:

Collaborative model
The collaborative m odel allows different viewpoints to be integrated through cog nitive participation.This model allows room for engagem ent so that innovative ideas can be translated into programme actions.It is the belief o f hum anist theo rists (Rom m , 1990:116) that to promote corporate im age, managers (both at cen tral and operational levels) should for m ulate policy guidelines which form the point o f departure o f a process, which can be evaluated.
The researcher believes that these dy nam ics can be infused by m aking use of the following criteria which spring from a hum anist theoretical standpoint (Romm, 1990:116).
• Creating awareness (Groenewald & McKay, 1990:100) say the need for ra tionalization should draw all members concerned to work to gether, so that they m ake com m on cause and strengthen group solidarity.Creating awareness also implies plan ning together from the onset.This criterion creates an opportunity for the free flow of information.
• Creating participation implies that the need for rationalization should evoke cognitive participation by all those in volved and affected by the process.The criterion allows for a shift from a technocratic to a participatory approach and leadership.Groenew ald and McKay (1990:137) argue that plans which do not accom m odate different view points can be evaluated as dehumanizing, hence the need to consider hum an potential towards the process.
Through creative participation, task com m ittees can be established, for example task team s to work on: • needs analysis -to look at re sources available and how to m ake the m ost of them; • conducting m eetings and engaging stakeholders in dialogue, verifying the felt and unfelt needs; • developing questionnaires -so that issues about rationalisation can be verified; • form ulating policy guidelines and protocols as yardsticks for the process and setting targets; • action design -involving how well plans should be transform ed into actions to achieve the desired goal; • establishing a standard assess m ent tool or im pact analysis which can be given to campus students to assess their p rogressin core subjects o f the uniform curriculum based on rationalisation; • process evaluation/perform ance analysis -to look at the outcom es, challenges and gaps and w hat should be done to m eet the desired outcom es or rem edy the situation; • holding feedback m eetings to keep people informed about the whole process.
Adopting a reflexive attitude is another criterion which suggests that all arrange m ents o f the ra tio n a lisa tio n process sh o u ld be su b jec ted to co n sta n t reevaluation; that is, being strategic and detecting the "good n e w s" and "bad n ew s" in the process.• Encourage open expression of feeling so that a feeling of being degraded could be avoided.
• O ffer support to nurse educa tors so that they do not feel iso lated, "seeing how to fin ish " in the process.Perhaps expression o f appreciation for the efforts put into the process o f rationalisation could boost the morale of those who feel ne glected.
• Set targets and goals w hich are achievable.Perhaps one thing at a tim e would do.The researcher believes that ratio nalisation which is revolution ary tends to have m ore nega tive im pact than the one which is evolutionary in nature.
• Provide feedback sessions, where updated inform ation about rationalisation could be com m unicated, to take every one on board regarding the progress made thus far, e.g.strengths and weaknesses, and allow participation in the way forward

Limitations
The study was lim ited to one cam pus only where rationalisation had taken and w as still tak in g place.F u rth er study should exam ine larger samples from dif ferent ethnic backgrounds where ration alisation is taking place.

Recommendations
The recom m endations from this study will be made w ith specific reference to nursing education and further research.

Nursing education
It

Concluding remarks
In this study the researcher found that nurse educators expressed dissatisfac tion with regard to rationalisation of nurs ing education as regards adm inistrative, operational and hum an dim ensions.In their view, the centralisation o f tasks de lays service delivery w hich negatively impact on m anagem ent and create con fusion.N urse educators expressed the need for proper planning which involves active participation and m aintenance o f p ro fe ssio n a l s ta n d a rd s.F in a lly , the guidelines derived would be o f assist ance for future researchers.

•
poor com m unication which leads to the im position o f deci sions on nurse educators without their in volvement.Moja, M uller & Cloete (1996:149) cited the disadvantages with regard to the cen tralisation o f tasks as follows:

•
Fear and uncertainty Some participants expressed feelings o f fear and uncertainty which the researcher found to be troublesom e.The follow ing quotations are evidence o f fear and un certainty: "A t least we are not m oved away t o ........ (nam e o f place), but I d o n 't know fo r how lo n g " and "you know o f ............. (name o f place) issue, it is a burn ing issue." e d u c a to rs e x p re sse d sp ecific needs regarding rationalisation; this was supported by the following categories: Nurse educators expressed the need for proper planning.
Abedian et al. (2003:104)  cited the advan tages o f the m odel as follows: ABEDIAN, I; STRACHAN, B & AJAM , T. 2003: Transformation in action: budg eting for health service delivery.Univer sity o f Cape Town: Cape Town Press.A F R IC A N N A T IO N A L C O N G R E S S. 1994(a): A National health plan for South Africa.Maseru: Bahr M apping and Print ing.A F R IC A N N A T IO N A L C O N G R E SS .1994(b): The reconstruction and devel o p m e n t p ro g ra m m e .Jo h a n n e sb u rg : Umanyano.B R IN K , P J & W O O D , M J. 1994: Basic steps in planning research.4th ed.Bos ton MA: Jones and Bartlett.B R U C E , J 1996: N ursing news: trans form ation o f education and training in South Africa.Antecedents to NQF. O c tober, P, 48-51.Witwatersrand: South Af rica.C O E T Z E E , J K 1991: Development is for people.Johannesburg: Mac Millan.C R E S W E L L , J W 1994: Research de sign: q u alitative and quantitative ap proaches.Thousand Oaks: Sage.D A V H A N A -M A S E L E S E L E , M ; T JA L L IN K S,JE & N O R V A L ,M S2001: Problems in integrating theory with prac tice in selected clinical nursing situations.Curationis.November (4-9) D E M O C R A TIC NURSING ASSOCIA T IO N OS SO U TH A FR IC A , 19% : Ethi c a l S ta n d a rd s fo r n u rse s.P re to ria : DENOSA DEPARTMENT O F EDUCATION.1997: W hite Paper on H igher Education-pro gramme for higher education transforma tion.Pretoria: South Africa.D E P A R T M E N T O F H E A L T H , 1997: W hite Paper for the transform ation of health system in South Africa.Govern ment Gazette no.1790.Pretoria South Af rica.D E P A R T M E N T O F JU S T IC E AND CONSTITUTIONALDEVELOPMENT, 2004: M inim um standards on services.Republic o f South Africa.D E V O S, AS 1998: Research at grass roots.W estern Cape: JL van Schaik: Pre toria.E G A N , G 1986: The skilled helper: A sys tem atic approach o f effective helping.Pacific Grove: Brooks/Cole publishing company.F IS H E R , E 1986: Psychology for nurses and health team.Cape Town: Juta & Co, O N , C & K E N D R IC K , K 1996: Practical conflicts.Nursing T im es.92 (l):50-52.GROENEW ALD, D & MCKAY, V 1990: The small business development project: h u m an ist strategy?In Sociology and Society: Humanist Profile.Johannesburg: Southern H U G H E S , L 2002: Paving pathways.Australia: Wadsworth.JA N S E N , J D 2003: On the state o f South A frican Universities: South A fri can Journal o f Higher education.17(3):9-12.JO H N SO N , D W 1997: Reaching out: In terpersonal effectiveness and self actu alization.Boston: Allyn & Bacon.L E FR A N C IO S, G R 2001: An introduc tion to child and adolescent development.Australia: Wadsworth.LINCOLN, YS & GUBA, EG 1985: Natu ralistic enquiry.Los Angeles: Sage.LOUW , DA. 1999: Human development.Pretoria: Kagiso Publishers.M OU TON, J & M ARAIS, H C 1990: Ba sic concepts in m ethodology o f social science.Pretoria: Human Science R e search Council.M O JA , T; M U L L E R , J & C L O E T E , N 1996: Towards new form o f regulation in Higher Education: the case o f South Af rica.Higher Education 32:129-155.NATIONAL ASSEMBLY F O R WALES 2000: Creating the potential: A plan for e d u c a tio n .A v a ila b le from www.nmc.uk.orgPOGGENPOEL,M &M YBURGH,CPH.1998: Dim ension o f the research proc ess.Publication.P O L IT , D F & H U N G L E R , BP. 1991: Nursing research, Principles and meth ods.Durban: Butterworth, LTD.R O M M , N 1990: Berger's conception of developm ent: a hum anist argum ent in sociology and society: a hum anist pro file.Johannesburg: Southern.S E A R L E , C & P E R A , S 1995: Profes sional and Practice: A South African per spective.Durban: Butterworth Ltd.SO U TH A FR IC A N N URSING COU N C IL , 1985: Regulations relating to the approval of minimum requirements for the education and training o f a nurse (gen eral, psychiatric and community) and mid wifery leading to registration (Reg.42522

Theme 1: Nurse Educators expressed dissatisfaction in several areas relating to nursing education Dissatisfaction
am ongst nurse educators was expressed in different dimensions as supported by the following categories: