The challenges in leadership roles hinder the rendering of quality primary healthcare service in the mines. Mining, the heart of the South African economy, requires good health to its personnel to carry out operations. However, nurse managers, the leaders in a mining primary healthcare setting experience difficulties in their leadership roles.
The aim of this study was to explore and describe the challenges in leadership roles experienced by nurse managers in a mining primary healthcare setting in South Africa.
The study was conducted in a mining primary healthcare setting in West Rand, Gauteng province, South Africa. A qualitative, exploratory, descriptive design that is contextual in nature, using a phenomenological approach, was adopted. Data from nurse managers in the mine were collected and data saturation was reached by the seventh participant. The study followed Giorgi’s four stages of the phenomenological descriptive data analysis. An expert independent coder in qualitative research coded the data, and consensus on the findings was reached with the researcher.
Three subthemes emerged from the study: mining management and unions interfere with nurse managers’ leadership roles, incongruent mining primary healthcare policies and communication gap between nurse managers and mining management.
The triangulation of nurse managers, mining management and unions requires a collective fusion to directly tackle the challenges in leadership roles in mining primary healthcare.
Challenges in leadership roles affect the quality of primary healthcare service rendered in the mining industry (Britton
Nurse managers are part of mine workers who are employed to lead in a mining primary healthcare setting. If health problems of mine workers are not managed at primary healthcare level, this will result in an increase in hospital stay and long sick leaves, and the worker’s performance then will be affected, thus reducing the mining production. The management role of a nurse manager in a primary healthcare setting is to ensure that the resources required to execute daily activities are available, safe and fairly distributed. There are challenges in leadership roles experienced by nurse managers that affect the effectiveness of their leadership. The leadership role of a nurse manager is to inspire and empower the followers during the execution of daily activities in order to achieve a specific goal (Al-Dossary
Leadership roles direct nurse managers to focus on collectively achieving the vision of a mining primary healthcare setting (Jooste & Hamani
Nurse managers face challenges in leadership roles in a mining primary healthcare setting in South Africa. Banaeianjahromi and Smolander (
Leadership roles in a primary healthcare setting assist nurse managers to facilitate the process of ensuring that health users receive appropriate assessment, treatment and care timely (Booysen, Jooste & Sibiya
The South African Department of Health is transitioning to National Health Insurance to mitigate the challenges in leadership roles (South African National Health Insurance Bill
The activities mentioned in the statement above will contribute to ensure that the SDG number 8 – ‘decent work and economic growth’ – is achieved (WHO
The challenges in leadership roles in primary healthcare can be resolved by transferring enthusiasm, empowerment, assertiveness and building relationships (Jooste
Mining primary healthcare setting has its own leadership roles dynamics and it includes dealing with different stakeholders simultaneously to ensure that the objectives of the organisation are achieved. The collective objectives ensure that mine workers are healthy, safe and productive to sustain the business, and thus contribute significantly to the economy of the country (Froneman
In their studies in mining primary healthcare settings, Jooste and Hamani (
From the background, it is clear that nurse managers are leaders in a mining primary healthcare setting. However, in a specific mining primary healthcare setting in South Africa, the researcher has observed that the nurse managers experience challenges in their leadership roles. On execution of leadership roles, nurse managers experience the interference from the mining management and unions. Nurse managers are told what to do and how to do it, rather than being allowed and emancipated to lead as experts in primary healthcare. It is not the obligation of the mining management and unions to lead in a primary healthcare setting as it requires specific operational skills that they do not have (The South African Human Resource for Health, 2012/2013–2016/2017). Sherman (
The purpose of this study was to explore and describe the challenges in leadership roles experienced by nurse managers in a mining primary healthcare setting in South Africa.
The study was conducted in a mining primary healthcare setting in West Rand, Gauteng province. West Rand is a gold and uranium mining area, and primary healthcare services are offered in house by some of the mining organisations, and hence nurse managers are mine employees. In this mining organisation, comprehensive primary healthcare services are provided. These services include primary healthcare emergencies, tuberculosis management, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) management, family planning, and medical and surgical services managed at primary healthcare level. Nurse managers are responsible for eight mining primary healthcare clinics. There are 15 nurse managers employed in this mining primary healthcare setting, with about 45 nursing staff members reporting to them, providing services to about 17 000 mine workers.
A qualitative, exploratory, descriptive design that is contextual in nature, using a descriptive phenomenological approach, was adopted in this study to explore and describe the challenges in leadership roles experienced by nurse managers in a mining primary healthcare setting in South Africa (Creswell & Creswell
The target population in this study were nurse managers from a mining primary healthcare setting in West Rand, Gauteng province, South Africa. These nurse managers were selected because they were more informative about the phenomena and were willing to share their experiences (Polit & Beck
Inclusion criteria for this study were as follows: nurse managers working in this mining primary healthcare setting with more than one year of experience and willing to participate. These nurse managers had to be registered with the South African Nursing Council as professional nurses and nurse administrators. Nurse managers with less than one year of experience in a mining primary healthcare setting, and who were not working in primary healthcare such as occupational health nurse managers, were excluded from the study.
In-depth individual descriptive phenomenological, semi-structured interviews were conducted to collect data from the participants in their workplace between September and December 2017. The information session on the study was held to recruit the participants, and the consent forms to participate in the study and of audio recordings were completed afterwards by the participants who were willing to participate. Arrangements on time, date and venue for the interviews were made with the participants according to their work schedule and interviews were held in their offices. The researcher was a case manager in this mining primary healthcare service during the study, reporting to the head of case management. The head of case management was reporting to the nurse managers, and, therefore, there was no close relationship between the researcher and the participants. The experiences of the participants were transcribed as described by them (Gray, Grove & Sutherland
Giorgi’s four stages of the descriptive phenomenological data analysis were employed in this study (Holloway & Gavin
Lincoln, Lynham and Guba’s (
Dhai and McQuoid-Mason’s (
Seven participants were interviewed, and the findings that emanated are presented below. The demographics of the participants are presented in
Participants’ demographics.
| 7 | |
| Race | White 1, African 6 |
| Gender | Women 3, Men 4 |
| Age range | 38–60 years |
Three themes emerged as challenges in leadership roles experienced by the nurse managers, namely, mining management and unions interfere with nurse managers’ leadership roles, incongruent mining primary healthcare policies and communication gap between the nurse managers and mining management.
The participants mentioned that the mining management and unions interfere with the execution of their leadership roles, and their activities are influenced by the management and unions. This statement is confirmed by the following quotations from the participants:
‘You know one experience that the mining management don’t get informed from the operations to say these are the challenges that we sit with; they just sit at the strategic level making decisions for us, interfering with primary healthcare activities.’ [
‘You also experience a challenge of dealing with the demanding unions, who are interfering with what is happening at primary healthcare.’ (Participant 7, Male, 59 years)
Another participant mentioned that:
‘I think because we [
Most of the participants mentioned that their experiences involve the challenge of using mining primary healthcare policies that are outdated, and not relevant for the practice. Confirming this are the following quotations from the participants:
‘My experience is that we have to use old policies that are no longer relevant for the setting.’ (Participant 2, Female, 60 years)
‘You are on board leading, but the policy is not recognizing you and it is irrelevant for the practice.’ (Participant 3, Female, 57 years)
One participant alluded that:
‘Our biggest challenge are the old rules and policies that govern you … and we need to function within them.’ [
Nurse managers alluded that there is a challenge of communication gap that affects the execution of their leadership roles. The communication gap is between the nurse managers and mining management. Other participants mentioned that there is a lack of open and honest communication in mining primary healthcare setting. This is affirmed by the following quotations:
‘I think a bit of gap that we have at this stage that we experience as a challenge, it’s communication.’ (Participant 2, Female, 60 years)
‘I have experienced that there is no open and honest communication here.’ [
Another participant echoed that they experience absence of equity in communication sharing and that information is also disclosed to them at a later stage:
‘You get that the person you report to didn’t disclose everything, and they only disclose it at a very late stage.’ [
The findings of this study revealed that one of the challenges experienced is that the mining management and unions interfere with the nurse managers’ leadership roles. The mining management should avoid interfering with operational activities by ensuring that the strategic goals are congruent to the operational goals (Jooste
Furthermore, it was also noted by the participants that they experience a challenge of a mining environment that is highly unionised and that the unions are demanding, instead of engaging. Unions should not be demanding towards nurse managers but instead they should engage on developing a culture of facilitating effective corporate interaction to manage leadership roles challenges in a mining primary healthcare setting (Fortunato, Gigliotti & Rubben
Nurse managers also alluded that they experience a challenge of incongruent mining primary healthcare policies. The available policies are old and no longer relevant for the mining primary healthcare practice today, and hence these policies do not recognise nurse managers as leaders. Lawlis, Knox and Jamieson (
Other participants alluded that mining primary healthcare policies governing them are old and do not recognise them as leaders. Leaders who are not recognised by the existing policies that are guiding the practice feel devalued and discouraged, and this affects the performance of the organisation (Veronesi, Kirkpatrick & Altanlar
Nurse managers posit that there is a communication gap between them and the mining management, and this gap affects the execution of their leadership roles. Communication gap makes it difficult to set common goals and achieve a shared understanding, and this put the organisation at risk of personnel’s distrust, lack of innovation and loss of competitive edge (Banaeianjahromi & Smolander,
Participants further stated that there is no open and honest communication in the mining primary healthcare setting, and that communication of information is not released simultaneously to all stakeholders. The union members receive information before the nurse managers receive it from the mining management; by the time nurse managers are discussing the issues with the nursing personnel, these issues are already known to the nursing personnel. Woodward, More and Van Der Heyden (
This study is contextual in nature, limiting the generalisation of the study to other mining primary healthcare services. The researcher experienced that there is limited literature on mining primary healthcare, and it was therefore challenging to provide dense description of data within this setting for integration with relevant literature. Some of the participants were scared to provide more details on their leadership roles’ experiences in the mining primary healthcare setting.
Nurse managers in mining primary healthcare settings can implement the findings of this study to approach and resolve their leadership roles challenges. The challenges identified from this study can be used for the personal and professional development of nurse managers in mining primary healthcare settings.
Nurse managers are leaders in a mining primary healthcare setting but they are experiencing challenges in leadership roles. The mining management and unions are interfering with their leadership roles, and existing primary healthcare policies are incongruent to the leadership roles of nurse managers. The other challenge is that there is a communication gap between the nurse managers and mining management.
Challenges in leadership roles experienced by nurse managers should be identified and resolved collectively by all the relevant stakeholders in a mining primary healthcare setting to improve practice (Jooste
The author thanks all the participants for providing dense data on the studied phenomenon and also thanks his research supervisors Dr H. Ally and Mrs E.M. Nkosi from the University of Johannesburg.
The author declares that there was no personal or financial interest that influenced him in writing this article.
I declare that I am the sole author of this research article.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the author only and do not necessarily reflect the official policy or position of any affiliated agency of the author.