Essential managerial attributes of the nowadays nursing service manager in the South African context

Nursing service managers need certain essential manage­ rial attributes in taking the lead in effective management of the nowadays health care organisations in South Africa. Major changes in restructuring and human resources plan­ ning are taking place through transformation of health serv­ ices and specific managerial attributes are needed in this scenario. Without nursing service managers with the nec­ essary managerial attributes, change in the health care en­ vironment will be hampered and planning, organising, di­ recting and control o f the delivering of quality care will be negatively influenced. The research problem was addressed in the following ques­ tion that guided the study: Which essential attributes/ characteristics should a nursing service manager possess to run a health care service effectively? It was unclear what the opinions of all level of nurse managers were re­ garding the necessary managerial attributes the health serv­ ices manager currently need to run the current health care services effectively. This study aimed at highlighting the necessary attributes of the nowadays nursing service manager in running a health care institution in the current health care environ­ ment of South Africa. Purposive sampling was done and forty-five functional, middle and top-level managers regis­ tered for a second year degree course in Health Services Management at a South African university participated in the study. The findings indicated important managerial and leadership attributes, which the current nursing service manager should possess. This article will only discuss the important managerial attributes needed. A conceptual framework came to the fore according to which an example of a self-evaluation instrument was compiled for nursing service managers for future use. The results of the data analysis indicated that the nursing service manager should promote good interpersonal rela­ tionships w ith colleagues, subordinates and patients through the attributes of openness, being inviting and empowering behavior. The purpose of this article is to make nursing service managers more aware of the necessary at­ tributes they should possess and should develop to man­ age nursing services more effectively. Abstrak V erpleegdiensbestuurders benodig sekere essensiële bestuurskwaliteite om in die hedendaagse gesondheidsorgorganisasies in Suid-Afrika die leiding te neem in effektiewe bestuur. Groot veranderinge in herstrukturering en h e rs tru k tu re r in g v ind d eu r tra n sfo rm a s ie in gesondheidsdienste plaas en spesifieke bestuursvaardighede is nodig om hierdie scenario te hanteer. Sonder verpleegbestuurders met die nodige bestuurskwaliteite, sal veranderinge in die gesondheidsorgomgewing gestrem word en beplanning, organisering, leiding en beheer van die lewering van gehaltesorg sal negatief bei'nvloed word. Die navorsingsprobleem is deur die volgende vraag aangespreek wat die studie gerig het: Watter essensiële kenm erke behoort ‘n verpleegdiensbestuurder oor te beskik om ‘n gesondheidsdiens effektief te bestuur? Dit was o n d u id e lik w at d ie m en ings van a lle v lakke v e rp le e g b e s tu u rd e rs w as aan g aan d e d ie nod ige bestuurskwaliteite wat die hedendaagse verpleegdiens­ bestuurder benodig om die huidige gesondheidsdienste effektief te bedryf. Hierdie studie was daarop gemik om die nodige kwaliteite van die hedendaagse verpleegdiensbestuurder in bestuur van ‘n gesondheidsorg instansie in die hedendaagse gesondheidsorgomgewing van Suid-Afrika te beklemtoon. Doelbewuste streekproefneming is gedoen en vyf-enveertig funksionele, middel en topvlakbestuurders wie vir ‘n tweedejaarsgraadkursus in Gesondheiddiensbestuur aan ‘n Suid-Afrikaanse universiteit geregistreer was het in die studie deelgeneem. Die bevindinge het op belangrike bestuurs-en le ierskapskw alite ite gedui w aaroor die hedendaagse verpleegdiensbestuurder behoort te beskik. Hierdie artikel sal slegs die belangrike bestuurskwaliteite wat benodig word aanspreek. ‘n Konseptuele raamwerk het na vore gekom waarvolgens ‘n voorbeeld van ‘n selfevalueringsinstrument ontwerp is vir verpleegdiens­ bestuurders vir toekomstige gebruik. Die resultate van die data-analise het daarop gedui dat die v e rp le e g d ie n sb e s tu u rd e r go e ie in te rp e rso o n lik e verhoudinge met kollegas, ondergeskiktes en pasiënte behoort te bevorder deur die kenmerke van openheid, uitnodigende gedrag en bemagtigende gedrag. Die doel van hierdie artikel is om verpleegdiensbestuurders meer bewus te maak van die essensiële kwaliteite waaroor hulle behoort te beskik en moet ontwikkel om gesondheidsdienste meer effektief te bestuur. 19 Curationis August 2003 Introduction and background The nowadays nursing service manager needs certain mana­ gerial attributes to promote quality nursing care and staff sat­ isfaction, and to implement health legislations effectively in their services. The South African health summit of 2001, fo­ cuses on reaching out for better health for all. This document outlines key issues in developing an equitable, efficient, co­ herent and high quality health quality health system in South Africa. One requirement is to meet the goal o f equity and the nursing services manager should use the resources available within the public and private sector for the benefit of the whole population (Health summit 2001:32). On the other hand the National patients’ rights charter (1997) outlines the patient’s rights in the national health care setting. Among others it stipulate that every patient has the right to a healthy and safe environment, participation in decision-making on matters af­ fecting their health, health information on for example how best to use services, continuity of care, and the right to complain about health services. The charter holds different challenges for the nursing service manager. The eight principles for transforming public service delivery the Batho Pele principleshave been identified by the Depart­ ment of Public Service and Administration (1997). Putting these principles of Batho Pele into practice is another challenge facing the nursing service manager in the South Af­ rican public sector. Consultation will give citizens the opportu­ nity of influencing decisions about services rendered to them and foster a more participative relationship between for exam­ ple the nurse, doctor and the patient. Patients should be told what level and quality of service they would be receiving so that they are aware of what to expect. Services should be pro­ vided economically and efficiently in order to give patients the best possible value for money. In this scenario the nursing service manager has to display several attributes in her role along with other members of the multi-disciplinary team to adequately address the health care needs of the community. Certain attributes are essential for a nursing service manager in charge of a health care service who must manage resources in the delivering of health care and therefore also promoting the current health care situation in South Africa. This article will only address the managerial attributes needed by the nurs­ ing service manager to run a health care institution effec­ tively. M anagem ent and leadership Management is often equated with leadership. However, lead­ ing differs significantly from managing. Leadership is human communication whereas a leader exerts influence over others, modify their attitudes and behaviors in order to reach group goals and needs. M anagement on the other hand recalls the terms status quo, stability, harmony, maintenance and con­ stancy. Both management and leadership are important in the daily functioning of an organization but key differences exist between these two terms. Managers tend to rely on systems, while leaders tend to rely on people. Managers tend to think of the everyday problems they are faced with in their planning, whereas leaders are more concerned with long-term or strategic planning. Managers thus focus on getting things done and react to everyday pressures and events, while leaders re concerned with the future. Lead­ ers develop a vision of the future and a strategy to get there (Booyens 1998:418). In their role interpretations, managers differ from leaders. Ac­ cording to Swansburg (1996:435) the manager is a problemso lv e r w ho su cceed s b ecau se o f p e rs is te n c e , to u g h ­ mindedness, hard work, intelligence, analytical ability, and tol­ erance and good will. Managers focus on results, analysis of failure, and tasks. They emphasize control, decision making and decision analysis. Management is a conglomerate of attributes that when used effectively “get things done” through people. It is about disci­ pline, methodology, and right and wrong (Flarey 1997:8).

The research problem was addressed in the following ques tion that guided the study: Which essential attributes/ characteristics should a nursing service m anager possess to run a health care service effectively?It was unclear what the opinions o f all level of nurse managers were re garding the necessary managerial attributes the health serv ices manager currently need to run the current health care services effectively.
This study aimed at highlighting the necessary attributes o f the nowadays nursing service m anager in running a health care institution in the current health care environ ment o f South Africa.Purposive sampling was done and forty-five functional, middle and top-level managers regis tered for a second year degree course in Health Services M anagement at a South African university participated in the study.The findings indicated important managerial and leadership attributes, which the current nursing service manager should possess.This article will only discuss the im portant m anagerial attributes needed.A conceptual framework came to the fore according to which an example o f a self-evaluation instrument was com piled for nursing service managers for future use.
The results o f the data analysis indicated that the nursing service manager should prom ote good interpersonal rela tion sh ip s w ith colleag u es, su b o rd in ates and patients through the attributes o f openness, being inviting and empowering behavior.The purpose of this article is to make nursing service managers more aware o f the necessary at tributes they should possess and should develop to man age nursing services more effectively.

Abstrak
V erpleegdiensbestuurders benodig sekere essensiële bestuurskwaliteite om in die hedendaagse gesondheidsorgorganisasies in Suid-A frika die leiding te neem in effektiewe bestuur.Groot veranderinge in herstrukturering en h e rs tru k tu r e r in g v in d d e u r tra n s fo rm a s ie in gesondheidsdienste plaas en spesifieke bestuursvaardighede is nodig om hierdie scenario te hanteer.Sonder verpleegbestuurders met die nodige bestuurskwaliteite, sal veranderinge in die gesondheidsorgomgewing gestrem word en beplanning, organisering, leiding en beheer van die lewering van gehaltesorg sal negatief bei'nvloed word.Die navorsingsprobleem is deur die volgende vraag aangespreek w at die studie gerig het: W atter essensiële kenm erke behoort 'n verpleegdiensbestuurder oor te beskik om 'n gesondheidsdiens effektief te bestuur?Dit w as o n d u id e lik w at d ie m e n in g s van a lle v la k k e v e rp le e g b e s tu u r d e rs w as a a n g a a n d e d ie n o d ig e bestuurskw aliteite wat die hedendaagse verpleegdiens bestuurder benodig om die huidige gesondheidsdienste effektief te bedryf.
Hierdie studie was daarop gemik om die nodige kwaliteite van die hedendaagse verpleegdiensbestuurder in bestuur van 'n g eso n d h e id so rg in stan sie in die hedendaagse gesondheidsorgomgewing van Suid-Afrika te beklemtoon.D oelbew uste streekproefnem ing is gedoen en vyf-enveertig funksionele, middel en topvlakbestuurders wie vir 'n tw eedejaarsgraadkursus in G esondheiddiensbestuur aan 'n Suid-Afrikaanse universiteit geregistreer was het in die studie deelgeneem.Die bevindinge het op belangrike b estu u rs-en le iersk a p sk w a lite ite gedui w a aro o r die hedendaagse verpleegdiensbestuurder behoort te beskik.Hierdie artikel sal slegs die belangrike bestuurskwaliteite wat benodig word aanspreek.'n Konseptuele raamwerk het na vore gekom w aarvolgens 'n voorbeeld van 'n selfevalueringsinstrum ent ontw erp is vir verpleegdiens bestuurders vir toekomstige gebruik.Die resultate van die data-analise het daarop gedui dat die v e r p le e g d ie n s b e s tu u rd e r g o e ie in te rp e rs o o n lik e verhoudinge m et kollegas, ondergeskiktes en pasiënte behoort te bevorder deur die kenmerke van openheid, uitnodigende gedrag en bemagtigende gedrag.Die doel van hierdie artikel is om verpleegdiensbestuurders meer bewus te maak van die essensiële kwaliteite waaroor hulle behoort te beskik en m oet ontwikkel om gesondheidsdienste meer effektief te bestuur.

Introduction and background
The nowadays nursing service m anager needs certain mana gerial attributes to promote quality nursing care and staff sat isfaction, and to implem ent health legislations effectively in their services.The South African health summit o f 2001, fo cuses on reaching out for better health for all.This document outlines key issues in developing an equitable, efficient, co herent and high quality health quality health system in South Africa.One requirem ent is to meet the goal o f equity and the nursing services m anager should use the resources available within the public and private sector for the benefit o f the whole population (Health summit 2001:32).On the other hand the National patients' rights charter (1997) outlines the patient's rights in the national health care setting.Among others it stipulate that every patient has the right to a healthy and safe environment, participation in decision-making on matters af fecting their health, health information on for example how best to use services, continuity o f care, and the right to complain about health services.The charter holds different challenges for the nursing service manager.
The eight principles for transform ing public service deliverythe Batho Pele principles-have been identified by the D epart ment of Public Service and Administration (1997).Putting these principles of Batho Pele into practice is another challenge facing the nursing service m anager in the South Af rican public sector.Consultation will give citizens the opportu nity of influencing decisions about services rendered to them and foster a more participative relationship between for exam ple the nurse, doctor and the patient.Patients should be told what level and quality o f service they would be receiving so that they are aware o f what to expect.Services should be pro vided economically and efficiently in order to give patients the best possible value for money.
In this scenario the nursing service m anager has to display several attributes in her role along with other members o f the multi-disciplinary team to adequately address the health care needs o f the community.
Certain attributes are essential for a nursing service manager in charge of a health care service who m ust manage resources in the delivering of health care and therefore also prom oting the current health care situation in South Africa.This article will only address the m anagerial attributes needed by the nurs ing service m anager to run a health care institution effec tively.

Managem ent and leadership
M anagem ent is often equated with leadership.However, lead ing differs significantly from managing.Leadership is human com m unication whereas a leader exerts influence over others, modify their attitudes and behaviors in order to reach group goals and needs.M anagem ent on the other hand recalls the term s status quo, stability, harmony, m aintenance and con stancy.Both management and leadership are important in the daily functioning o f an organization but key differences exist between these two terms.Managers tend to rely on systems, while leaders tend to rely on people.M anagers tend to think o f the everyday problems they are faced with in their planning, whereas leaders are more concerned with long-term or strategic planning.Managers thus focus on getting things done and react to everyday pressures and events, while leaders re concerned with the future.Lead ers develop a vision o f the future and a strategy to get there (Booyens 1998:418).
In their role interpretations, managers differ from leaders.Ac cording to Swansburg (1996:435) the m anager is a problems o lv e r w ho s u c c e e d s b e c a u se o f p e rs is te n c e , to u g h mindedness, hard work, intelligence, analytical ability, and tol erance and good will.M anagers focus on results, analysis of failure, and tasks.They emphasize control, decision making and decision analysis.
M anagem ent is a conglomerate o f attributes that when used effectively "get things done" through people.It is about disci pline, methodology, and right and wrong (Flarey 1997:8).

Problem statement
Pressures for change in health care delivery make the move from bureaucratic management to effective democratic man agement and leadership essential.Several debates have also taken place on the need for a nursing service m anager to pos sess certain leadership and managerial attributes.The need for the developm ent o f an appropriate framework of a managerleader, that will ensure that nursing service managers play a pivotal role in effective managem ent o f a health care service, was identified.The research question that guided the study entailed the following: Which essential attributes/character istics should a nursing service manager possess to run a health care service effectively?

Objectives of the study
The objectives for the study were as follow:

•
To explore and describe how informants viewed the essential managerial characteristics of an effective nurs ing manager in health services, based on their personal experiences in nursing m anagement practice

•
To explore and describe how informants viewed the essential leadership characteristics of an effective nurs ing m anager in health services, based on their personal experiences in nursing management practice

•
To establish a conceptual framework outlining the es sential characteristics o f a nursing service m anager • To draw a profile o f an effective nursing service man ager in the South African context.From this profile guide lines for addressing the professional developm ent of m anagers could be drawn as well as a schedule to be used in selection com m ittees for managers in health services.
The overall aim of the study was to determ ine the essential attributes o f the nursing service m anager in running a current health care service effectively.This article will focus on the first and third objectives as m en tioned.

Assum ptions
The approach to management in this paper takes the perspec tive that • management and leadership are related but are not the same; • leadership can not replace management; and • there is a time to lead and a time to manage.It was further assumed that personal experiences of informants are sources of knowledge.

Health care service
The term refers to any health care setting such as a clinic or hospital that deliver health care services to patients on a 24hour basis.

Nursing service manager
Managers are m aintenance thinkers.Their goal is to make sure that things runs right, efficiently, and with as few problems as possible, to maintain the status quo (Kerfoot 1998:173-174).In this discussion the term "m anager" will also refer to a nursing service manager in a top-level m anagem ent position held by a professional nurse in charge o f a health care service or clinic.

M anagem ent
M anagement is a set o f attributes.Practice o f these attributes leads to greater levels o f perfection (Flarey 1997:8-9).This defi nition is applicable to the study.

Attribute
The Oxford advanced learners dictionary o f current English (1986) defines the word "attribute" as a quality looked upon as naturally or necessary belonging to a person.In this study "attributes" will refer to the qualities and attributes of the nurs ing service m anager in a top-level m anagem ent position.The word "characteristic" will be viewed as synonym ous with the term "attribute".

Effectiveness
This term refers to "having an effect, able to bring about the result intented" (Hornby 1986:277).In this study the term "ef fectiveness" refers to bring about the expected result, namely quality o f nursing care.

Research design and method
A qualitative, exploratory, descriptive and contextual research design was utilised (Bums & Grove 1993:28-29).The researcher worked inductively to explore and describe participants' views on which essential characteristics a nursing service m anager should have in running their health service effectively.

D ata collection
Unstructured data collection was done by means o f narrative sketches.Participants were asked to share information based on their experiences in practice on how they viewed "the ef fective nurse m anager in charge o f a health care service" who is needed in current health services in South Africa.A ccord ing to Gadow (1996:8) any description o f a situation can be viewed as a narrative.Within the context o f this study narra tive sketches were aimed at revealing the views o f students regarding what characteristics a nurse m anager has to possess in running a nursing service effectively, based on their nursing m anagement experiences in nursing practice.

Population and sampling
A population o f two hundred and twenty five professional nurses representing functional, middle and top level m anage ment, were registered as second or third year students for the course in Health Services M anagement II at a South Africa university.They attended practica workshops for this course, in the first semester of 2001, at different regional offices of the University in South Africa in Durban, Cape Town, Pietersburg, Bloemfontein and Port Elizabeth.Purposive sampling was used and the criteria o f being a third year student was set to be selected as a participant.A sample size o f 45 students com plied to this criteria and were selected to answer the research question.Data saturation occured.

M easure to ensure trustw orthiness
Trustworthiness was ensured according to the four principles related to cred ib ility , tran sfe ra b ility , d ep e n d ab ility and confirmability (Babbie and Mouton 2001:276).Credibility was ensured through student's engagement in m anagement situa tion in their own nursing practice.Consensus betw een the researcher and an external coder, an expert in qualitative data analysis, was reached with regard to the categories derived from the data collected.Follow-up interviews will be conducted with nurse managers to validate the essential characteristics of a nursing manager.Furtherm ore a thorough literature review was conducted and the data analysis brought forward known concepts o f nursing management.
Transferability was established by research findings obtained from participants represented functional, middle and top level nurse m anagement positions in health clinics and hospitals in South Africa.The conceptual fram ework arrived at was dis cussed by an expert group of managers for in-depth discus sions o f interpretations o f research findings.T hey ju d g ed whether the findings could be applied in their own contexts and in their health care situations.
The establishm ent o f an audit trail, enhanced the dependabil ity o f this study.
To enhance confirmability, the researcher established an audit trail, by importing the narrative sketches into a qualitative dataanalysis programme, namely QSR NUD*IST 4.0.The data analy sis is available in printed format.The raw data, the coded data and the researcher's interpretations were scrutinized by a col league as expert in qualitative data analysis.No major discrep ancies w ere identified betw een the researcher and experts' analysis o f the data.
M eaning in context was arrived at because participants aired their views o f their experiences in the nursing m anagem ent practice.During the group discussions preceding the enquiry, the question stated in the study addressed their experience regarding their nursing service manager.On the other hand the group discussions covered the curricula on the role o f the unit manager.The research project was not aimed at evaluating any outcomes related to the group discussion.
Narrative sketches were written repeatedly in different centra in South A frica until no new data emerged, data saturation took place.

D ata analysis
The QSR NUD*IST program was used for the qualitative analy sis (ordering) o f data.The following steps according to the protocol of Tesch (inC resw ell 1994:155) were followed bythe researcher in the data analysis:

•
The researcher read through all the sketches to form an idea o f the profile o f a nursing service manager; • The researcher thought about the underlying meanings and wrote notes in the margin; • All similar topics were clustered together under major topics; • Coding was done; • The most descriptive wordings for topics were turned into categories.
As the researcher followed the steps of the data analysis, a research assistant was of help in processing the data into the QSR NUD*IST program.
The researcher interpreted the results to elicit the meanings that em erged from the data.This enabled the researcher to identify and describe the characteristics o f the nursing service m anager from the point o f view o f participants.M ain catego ries of management and leadership characteristics emerged from the data obtained from nursing service managers of which the leadership characteristic appeared to be the m ost prom inent category.This category will not be discussed in this article.However, the main leadership category indicated that the char acteristics needed for good interpersonal relationships, knowl edge, m otivation, participative m anagement, guidance, acting as a change agent, conflict m anagem ent and problem solving.
Findings were supported by a literature review, which was done after the data collection.

Ethical measures
Strict ethical measures were ad hered to during this research.
Students attending the group discussions o f health services m anagement were asked to vol untary participate in the project only after their group discus sions were com pleted, so that participants did not feel intim i dated to participate.Participants could withdraw in any stage of participation.Students were en sured of confidentiality and ano nymity as well as of the benefits o f the study.All students regis tered for the course will have access to the results of the study (DENOSA 1998:1-7).

Attributes contributing to an effective nursing service manager
Participants expressed specific and clear elements that could enhance the role o f the nursing service m anager creating an effective workplace towards fulfilling institutional goals (fig ure 1).These elements were also an indication o f what the needs o f nursing service managers are in terms of in-service training needs.

A planner
An informant wrote, "plan first o f a i r and commenced by stating, "planning is the first cornerstone o f running a serv ice" .Higher-level m anagers spend more time in the planning function than lower level managers (Quible 2001:175).Other participants stated that the m anager should "have attributes regarding good p la n n in g " and "knowledge and attributes about planning o f work".
Participants highlighted the scope o f planning, the how to plan and the goal o f planning as a managerial tool (figure 2).The aspects outlined by members as important for the scope o f planning are "for services", "o f all activities in the unit" and through financial planning.Participants commented that "she try to economize and not to be wasteful" and "budget and prom ote economical welfare" .The budget is based on the aims and objectives of the service (M uller 1998:228).
The how o f planning was described as "purposeful", and through "managem ent of objectives" .A participant stated that "putting a plan into action by identifying problems and making decisions" is essential for planning effectively.M anagers are generally responsible for ensuring that planning efforts are consistent with the organisation's vision statement, namely how the organization gets where it wants to go (Quible 2001:175).The goal o f planning was identified by a participant as "to

Budgeting and economicaf welfare
To give direction plan work so as to give direction" .The mission of an organiza tion is the reason for the organisation's being (Quible 2001:175) From the above it is clear that an effective nursing service manager should determine the goals o f the organization and the means o f achieving them.

An organiser
A participant viewed the manager as a "good organiser" and other comments of participants like "able to co-ordinate well", "well developed organising abilities", "organisational at trib u te s" , and "o rg a n isa tional qualities" outlined the managerial function o f or ganising.The o rg an izin g function thus involves the developm ent o f an environ ment in which subordinates can be productive and effi cient.
Muller (1998:133) states that organization is the orderly structuring o f functions or responsibilities in order to ensure the smooth running o f a c tiv itie s .In fo rm a n ts mainly indicated the w ho/ what, how and why o f the managerial function organiz ing (figure 3).
They worded it that the m an ager should organise "her own work", "coordinate her work" and " should be o rg an ised ".M embers further indicated that the effective m anager should have the characteristic to or ganise "the work unit" and "be able to co-ordinate all activities in the unit" .An effective man ager should "be able to organ ise staff effectively" as well as "other staff members and col leagues".T his indicated that the m anager should be able to organise her ow n and others work activities.The role o f the m anager in relation with other mem bers o f the m ulti-discipli nary team was underlined in the wording "she must be able to co-ordinate w ith other p ara medical staff e.g.x-rays, labo ratory staff, doctors and thera pist".Coordination is a process to combine different activities in order to achieve unity in goal achievement (Muller 1998:183).
Participants expressed that the four concepts o f "know ledge able about the organisational structure", "delegation", "time management", conflict management, problem solving and "eq uity" indicate the "how" o f organising.
The characteristic o f the manager, to be know ledgeable about the organisational structure, came to the fore in the suggestion of a participant that "effective utilization o f resources" is es sential.

CONFLICT HANDLER
The concept o f delegation was em phasized by participants who specifically stated that the obligation of the m anager is to be able "to delegate to staff according to their scope of prac tice" and " not to give out orders and relax.It was further written, "she is to do a follow up on what she has delegated her subordinates on" .
The concept o f tim e m anagem ent was highlighted by the phrases " com plete her own duties on tim e", "be able to utilize time effectively" and "observant, to notice change in time to take corrective measures" .A direct quote that supports the im p o rta n c e o f th e c o n c e p t tim e m a n a g e m e n t re ad s as follow s:"In practice I found being a m anager attending a lot of meetings, doing a lot o f administrative work, did nothing for the m orale and productivity of the unit" .The nursing service m anager should effectively plan and schedule work time to ensure that the most im portant work is com pleted and that sufficient time is left for unexpected em ergencies that may oc cur (Booyens 1998:289).
running o f the service" .
The nursing service m anager should possess the character istic to be able to handle con flict effectively (figure 4).Differ ent strategies to m anage and prevent conflict in the work situ ation were suggested by partici pants, as the following quotes indicate: "must be able to handle conflict without taking anyone's side", (This strategy indicates objec tivity on the part o f thé nursing service manager.)Stressful situ ations can lead to conflict and participants suggested the nurs ing service m anager should be able to "defuse stressful situa tions before they become conflict situations", and "take criti cism", "handle stress" and "develop the mind by being willing to learn from sta ff'.The positive side o f conflict was pointed out.A participant concluded that the m anager should be "able to work with and direct different personalities effectively".Sev eral measures such as increased self-awareness, regular vaca tions, and outside interests can assist the m anager to lesson the effect of conflict and stressors in the workplace (Booyens 1998:149).
Informants added the following on the value of being a prob lem solver (figure 5) as a skill o f an effective nursing service manager: "must be able to solve problems, which is based on knowledge and attributes" .
Giving subordinates the opportunity to solve their own prob lems was emphasized.A participant stated: ''Promote problem solving by subordinates, do not solve problems for them " .
The concept equity was highlighted by the com m ent "should give all individuals equal opportunities in everything, for ex ample promotion, performing o f tasks" and "no favoritism " .An informant stated "favoritism should not be practiced be cause other em ployees would be left out" .Why should the m anager have characteristics to organise the work activities?Participants expressed the needs to "be able to organise the unit to prevent chaos" and "responsibility for the day to day

FIGURE 5: ATTRIBUTES OF A PROBLEM SOLVER •PROMOTE INDEPENDANT PROBLEM SOLVING •BE IMPARTIAL •LISTEN CAREFULLY •HELPER •PREVENT PROBLEMS
The attributes of being impartial and listening to subordinates during problem solving came to the fore.An informant wrote: "W hen ever there is a problem in a unit, she must not take sides.She has to listen to both parties when solving the prob lem." The nursing service manager is seen as the helper in solving problem s as highlighted in the following quotes: "she should be an assertive person but staff should be able to can come to her with their problems and concerns", and "be able to correct m istakes" .Some participants indicated the option of the nursing manager to prevent problem s in the service and stated: "anticipate problem s or take action to prevent them " , and "able to handle stress".

Hum an resource officer
The managerial concept o f staff ing was least addressed by par ticipants (figure 6).A m em ber in-

Director/guide
The nursing manager being a guide for and supporter of staff members was identified as an essential ingredient o f other at tributes of the nursing service manager (figure 7).O f the vari ous responsibilities o f managers, directing subordinates is likely the most demanding and time-consuming aspect of their jobs (Quible 2001:176).Participants wrote that the nursing serv ice manager should "be able to guide and advise sta ff', "should be able to guide and direct s ta ff' and "should support staff in experiences they have" .A participant stated that the nursing service manager "should guide her/his staff in relation to their jobs" .This indicates a definite relationship between the nurs ing service manager being a guide and the managerial task of staffing.

Controller
A participant identified the characteristic of the nursing serv ice manager as a controller (figure 8), as "to be able to apply and maintain control".Participants outlined the following con cepts related to a controller: "should be able to control" "abil ity to supervise", "other than del egating she should be able to su pervise" "budget orientated", infec tion control attributes" .The man ager as controller is thus described as a(n) supervisor, evaluator, infec tion controller, and cost container.
Participants described that for the nursing service m anager to effec tively run a health care service she/ he should have the attributes to manage the what, how and why of controlling the different activities in the service.
On what the manager should control informants stated "effec tive control o f staff m em bers and equipm ent" , "evaluate whether objectives o f plans were met" .Control is a m anage ment activity whereby the m anager checks whether the set objectives have been achieved (M uller 1998:134).
From the data analysis it became apparent that how the m an ager should exercise control was rooted in the concepts of authority, discipline and being punctual.
Regarding the concept "authority" a participant stated "she must be able to exercise authority and be able to know when to exercise authority and when not to" .Authority is the power given to the manager because o f the top position she holds.Authority also comes from perceptions that she is ethical, ju d i cious, fair, and trustworthy (Dienemann 1998:4 11-412).
The concept "discipline" came to the fore by participants who commented that the m anager should "set rules and all must obey to them ", "apply and maintain discipline and control", and "be able to take disciplinary steps" .A participant wrote, "she must be strict when needed, firm but friendly" .Another m ember stated, "live up to standards what is expected o f a nurse-in-charge executive".It should be remembered that stand ards o f perform ance are not static but they should reflect changes in the profession and society (Dienem ann 1998:17-18).
The characteristic o f being punctual was highlighted by the following quotes: " re sponsibility that certain things are handed in on certain times", "staff members should obtain feedback on a monthly or weekly basis with regard to their ward perform ances" .
The main reason (why) that the nursing service m anager should be a controller of quality patient care was expressed in the following wording: "able to meet client's needs" .This is the ultim ate goal for pro viding quality nursing care.
Controlling is an ongoing process to com pare present perform ances with pre-estab lished perform ance standards.The nursing service m anager should include the con trol actions o f quality assurance, produc- The conceptual framework serves as departure for drawing a profile of an effective nursing service manager in the context of health services in South Africa.The manager with an effective profile and adequate attributes will be able to boost the moral of staff and promote quality nursing care.

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The profile o f the nursing service m anager could be set out in the format o f a self-evaluation instrument (table 1).Each nursing service manager could identify her own shortcomings.The profile o f the nursing service man ager could thus assist in determ ining im portant issues to be addressed in staff developm ent programs for all nurse managers.

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The complete profile/conceptual framework could be to be used in the form at o f a selection tool in selection com mittees specifically for nursing service managers, focusing on essential managerial attributes needed in health services.

Lim itations
There was a limitation to this study that should be noted.The fact that the participants did not elaborate on the concept of "staffing" should be further investigated.

FIGURE
FIGURE 4: ATTRIBUTES OF A CONFLICT HANDLER

FIGURE
FIGURE 6: COMPONENT: STAFFING 39. life up to the expectations o f subordinates 40.am punctual when expecting that certain documents should be handed in on certain times 41.ensure that staff members obtain feedback on a monthly basis with regard to their ward perform ances" .NAUDE, M , M EY ER, S & V A N N IE K E R K ,S 2001:Thenurs ing unit manager.A comprehensive guide.Kwazulu-Natal: Heinemann.Q U IB L E , Z K 2001: Adm inistrative office management.An introduction.7th edition.New Yersey: Prentice Hall.SW A N SBU RG , R C 1996: M anagem ent and leadership for nurse managers.2nd edition.Boston: Jones and Bartlett.

Table 1 :
A self-evaluation instrum ent with exam ples of attributes needed to be an effective nursing service m anager

as the nursing service manager
1. believe that planning is the first cornerstone o f running a service effectively 2. am involved in the planning of activities for the service 3. focus on the economical welfare of the service 4. am an active mem ber o f the budget committee o f the institution 5. believe planning should be purposeful 6. run the service through m anagem ent by objectives 7. usually put a plan into action by first identifying problems and then making decisions 8. ensure that planning efforts are consistent with the vision of the service 9. plan work to give subordinates direction 10. participate actively in setting the goals o f the organization able to organize my own work activities effectively 12. coordinate activities with other members of the multi-disciplinary team 13. utilize resources effectively 14. am know ledgeable o f the organizational structure 15. am obliged to delegate tasks to staff members according to their scope o f practice 16. am able to utilize time effectively 17. am able to complete managerial tasks in time 18. give all individuals equal opportunities in everything, for example promotion, performance of tasks 19.am able to handle conflict without taking anyone's side 20.defuse stressful situations before they become conflict situations 21. am able to work with different personalities effectively 22. give subordinates the opportunity to solve their own problems 23.listen to both parties when solving a problem 24.experience it that staff come to me with their problems and concerns 25. am able to handle stress in my daily tasks

A HUMAN RESOURCE OFFICER -1 as the nursing service manager 1 2 3 4 26
. utilize staff effectively 27.prom ote harmony in the unit 28.prom ote staff developm ent opportunities in the institution 29.am involved in active recruitm ent o f nursing staff 30.act as a motivator for retainm ent of staff whether objectives o f plans were met in the service 35.am able to exercise authority over staff and equipment 36.am in control of infection control in the institution 37. set rules and all nursing staff obey them 38.am strict and firm when needed