International Journal of Nursing Practice 2010; 16: 545–554

RESEARCH PAPER

Towards a competency-based framework for

nursing management education ijn_1880 545..554

Rubin Pillay PhD MBChB MBA MSc BScHon

Professor, School of Entrepreneurship, Spears School of Business, Oklahoma State University, Oklahoma, USA

Accepted for publication July 2010

Pillay R. International Journal of Nursing Practice 2010; 16: 545–554

Towards a competency-based framework for nursing management education

Defining a competency-based model for nursing management development will help to establish core competencies for
nursing managers which will not only strengthen their practice and provide further learning and development opportu-
nities, but will also provide the basis to focus training and professional development efforts. This paper identifies the
competencies important for effective nursing management in the public and private health sectors. A total of 420 senior
nursing managers in South Africa were surveyed using a self-administered questionnaire. Respondents had to rate the
importance of 51 competency items as it pertains to effective nursing management. Self-management, controlling,
health/clinical, organizing, people management, planning and ethical/legal competencies were found the most valuable
for optimal nursing management. These findings reflect the reality of the nursing management milieu and will be useful
in the design and delivery of management development programmes aimed at enhancing nursing management capacity.
Key words: management education, nurse managers, nursing management, SCHOPPE.

INTRODUCTION improving our nursing management capacity so that we

If skilled health personnel are the key input into any health
system, then the nursing profession surely forms the core
of this group. This is particularly so for countries like
South Africa, and indeed most of the developing world,
which have embraced the primary health-care approach
that places nurses at the epicentre of health delivery. Poor
management of nurses and nurse discontentment with
their managers1 therefore has the potential to undermine
health-care delivery in South Africa as well as our ability
to improve our responsiveness and upscale interventions
to meet health goals such as the Millennium Development
Goals. The key to reducing the burden of disease and
achieving these goals is therefore partly dependant on
Correspondence: Rubin Pillay, School of Entrepreneurship, 343 Spears
School of Business, Oklahoma State University, Stillwater, 74078,
Oklahoma, USA. Email: rubin.pillay@okstate.edu
are able to harness and maximize the limited resources
available to us.2,3
Addressing the gap between what the primary health-
care approach espouses and the reality experienced by the
majority of South Africans requires nursing managers to
combine leadership, entrepreneurial and administrative
skills to meet the challenges that the changing socio-
political, economic and technological landscape presents,
as well as the expectations of patients, health profession-
als, politicians and the public. This is especially so as the
stereotypical role of nurse managers has evolved from the
autocratic matron role to a pivotal position within
health service organizations which requires a broader
understanding of health and social systems as well as astute
management and leadership capabilities to ensure effec-
tive, efficient and equitable health-care delivery and the
future sustainability of the organizations they serve. Con-
sistent with this goal, it is imperative that we endow our

doi:10.1111/j.1440-172X.2010.01880.x © 2010 Blackwell Publishing Asia Pty Ltd

546
nursing managers with the requisite skills with which to
improve clinical care and the delivery of health services in
South Africa.
Identifying and assessing competencies is a vital precur-
sor to improving professional development and the align-
ment of individual development with the needs of an
organization or profession.4,5 Managerial competencies
are ‘sets of knowledge, skills, and attitudes that affect a
major part of one’s job, correlate with performance on
the job, can be measured against well-accepted standards
and can be improved by training and development’.6
Defining a competency model for nursing management
development will therefore help to establish competen-
cies for nursing managers which will not only strengthen
their practice but will allow one to identify the gaps
between current skills levels and the skills required which
will provide the basis to focus training and development
opportunities.6–8
Although the competency-based approach to profes-
sional development has its origins in the Scientific Man-
agement era when Taylor emphasized the importance of
task analysis and work flows, it gained prominence after
the success of the outcome based educational approach
of the 1980s. It was subsequently widely embraced to
facilitate educational and professional development ini-
tiatives.4 It entails defining, teaching and assessing com-
petencies and focuses on the ability of students to apply
their knowledge and skills as opposed to just acquiring
knowledge.9 It supersedes the traditional approach to
management education where educators determine the
content without necessarily reflecting on the workplace
or broader context needs, teach using a didactic
approach, and then assess to evaluate if the content was
learned. The competency-based approach integrates
theory and practice, uses a combination of didactic and
interactive approaches which encompasses case based
and experiential learning and starts by determining what
the job entails before determining learning objectives.10
Appropriate programmes based on the personal needs
and experiences of nursing managers can then be put in
place to train managers to provide leadership and to
ensure a sustainable improvement in the work context of
nurses and thence on the quality of care and health of the
communities their organizations serve.11 This situated
model of learning is especially relevant to developing
new professions as it derives authenticity and relevance
by being conceptualized, designed and delivered in
context.12
© 2010 Blackwell Publishing Asia Pty Ltd
R Pillay
This approach has been found to be beneficial as it
facilitates communication across institutions and pro-
gramme lines, career growth across health professions and
career stages, the development of standards for best prac-
tice, clarity of learning direction for faculty and students,
and opportunities for self-assessments of performance by
faculty, self and peers.7,9,11,13–15 Specific human resource
management (HRM) benefits include improved selection,
training and development, appraisal and succession plan-
ning as it clarifies the skills and knowledge characteristics
required for the role.6
The business and general management literature advo-
cates that all managers, irrespective of where or what
they manage, need to develop several competencies that
will enable them to perform the functions of planning,
organizing, leading and controlling effectively and effi-
ciently.14,16 Planning involves defining goals and mapping
out ways to reach them; organizing entails arranging and
coordinating human, material and information resources
aimed at achieving desired goals; leading involves moti-
vating others to achieve organizational goals and control-
ling involves measuring performance and monitoring
progress relative to objectives
Protagonists for a specific health management model,
however, believe that health managers require additional
competencies due to the uniqueness of the health environ-
ment. The National Centre for Healthcare Leadership
(NCHL)7 defined three domains—transformation (strate-
gic), execution (organizing and controlling) and people
(leadership)—comprising 26 competencies which encap-
sulates health management today. Shewchuck et al.11 iden-
tified health-care operations, a patient focus, financial/
economic, legal/ethical and medical relationships, in
descending order of importance, as domains important
for competent health-care executives. This was preceded
by the American College of Preventive Medicine who
defined a list of health management competencies and
performance indicators related to the delivery of health
care, financial management, organizational management,
and legal and ethical considerations to assist in the devel-
opment of training programmes in medical manage-
ment.17 Competencies related specifically to health care,
including clinical preventive skills, were rated highly
by American medical directors, relative to generic
management competencies18 while similar studies in the
UK, also identified financial, medical and people related
skills as the most important for inclusion in management
development programmes for hospital managers.19,20
Nursing management competencies
Hospital managers in South Africa felt that people
management and self-management skills were the most
valuable for the efficient and effective management of
hospitals, followed by ‘hard management skills’ and skills
related to the ability to think strategically. Specific skills
or knowledge related to health-care delivery were per-
ceived to be least important.21
The literature pertaining specifically to nursing man-
agement is relatively sparse and focuses predominantly
on developed nations, with none differentiating between
public and private sectors. The general consensus does,
however, support the general management and health
management literature as described above.22–27 The
American Organisation of Nurse Executives26 defined
nurse management functions as including management of
care delivery, personnel development, management of
human, fiscal and other resources, strategic planning,
compliance with regulatory and professional standards
and fostering of interdisciplinary, collaborative relation-
ships. Lin et al.22 defined four factors related to HRM,
operations management, planning, and material and
environment management. They demonstrated that these
managerial activities, and therefore competencies,
required varied according to the level of the nurse man-
agers with top and middle managers more focused on
HRM and planning, and supervisors more on materials
management. The HRM and leadership skills were also
found to be the most important by Mathena,24 Orovio-
goicoechea25 and Chase.27
Although specific clinical or health delivery skills were
not found to be an essential prerequisite for nursing
managers28–30 some authors still found them to be useful
in managing nursing services.27,31,32 Mathena23 also found
that the ability to balance work and home life and other
self-management skills were also important to succeed as
a nurse manager while many authors also acknowledge
the importance of being able to confront ethical issues
especially as there will be an increasing need to allocate
resources parsimoniously.33,34
Given that nursing managers are central to overcoming
the challenges facing health delivery in South Africa, there
has been a paucity of research in the health management
literature that systematically specifies and assesses which
competencies were important to improve leadership and
leadership development among nursing managers. The
primary objective of this paper was to identify the skills and
competencies that were perceived to be important for
effective nursing management in South Africa. Secondly, in
547
view of the dominant roles that both the public and private
sectors played in health care in South Africa, it compared
and contrasted the requisite competencies for nursing
managers in the public sector with those in the private
sector. Finally, nurse managers’ perceptions regarding
their need for further management development and the
appropriateness of nurses in management were sought. It is
hoped that the information gleaned will help in the con-
ceptualization, design and delivery of appropriate and
pedagogically sound programmes aimed at enhancing man-
agement and leadership capacity among nursing managers
in South Africa and other developing nations.
METHODOLOGY
Data for this study came from a cross-sectional survey of
senior nursing managers in the public and private sectors
in South Africa, using a self-administered questionnaire.
The survey was conducted among heads of nursing of
public hospitals in six of the provinces in South Africa (3
provinces did not respond to the call to participate) as
well as of private hospitals registered with the Hospital
Association of South Africa, which represents 94% of
private hospitals in the country. The sample comprised
215 public sector managers and 205 private sector
managers.
The survey instrument was designed by the author
and comprised a specially developed and pre-tested
questionnaire comprising two parts. Part one included
bio-demographic attributes and exposure to health man-
agement training. In part two, respondents had to rate the
importance of a list of 51 management competency items
on a Likert type scale ranging from 1 (not important) to 5
(very important), as it pertains to effective nursing man-
agement (see Table 1).These competencies were derived
from the literature,7,11,17–27,35,36 and several other stake-
holders with an interest in health management.
Questionnaires were mailed in October 2007 and non-
responders were sent questionnaires 4 and 8 weeks
later. Data collection was terminated 6 weeks after the
final mailing. The results of a sample of primary non-
responders were compared to that of the primary
responders to assess non-response bias. Data for indi-
vidual variables were summarized using frequency distri-
butions and focused on the central tendency (mean) and
the dispersion (standard deviation). Factor analysis using
principal components analysis was used to extract factors
from the 51 competency items. The Eigenvalue rule was
used to determine the number of factors to be extracted.
© 2010 Blackwell Publishing Asia Pty Ltd
548 R Pillay

Table 1 List of management competencies important for nursing Item selection for the factors was based on the psycho-
management metric quality as well as the conceptual appropriateness of
the item as determined by the researcher.37 Reliability of
Competencies
scales was estimated by assessing the internal consistency
of the scales using Cronbach’s alpha. Relationships
1 Use of tools to standardize patient management between variables were analysed using chi-square tests for
2 Evaluating medical necessity and effectiveness of products or interventions
categorical variables and one-way analysis of variance for
3 Planning and implementation of health promotion programmes
4 Use of epidemiological data quantifiable variables.
5 Assessing the impact of health services delivery on health of population
6 Delivery of primary preventive services RESULTS
7 Integration of nursing services with district health system
Questionnaires were returned from 94 of 202 valid
8 Delivery of curative services
9 Nursing standard and guideline setting
addresses of public sector managers and 77 of 190 valid
10 Planning programmes addresses of private sector managers. This represents a
11 Creating a vision for the hospital total response rate of 44.64% and a response rate of
12 Planning further needs and developments 46.53% and 40.53% from the public and private sectors,
13 Developing organizational goals
14 Preparing of a strategic plan
respectively. Four respondents indicated that they
15 Implementing doctors’ orders worked in both sectors and although they were included
16 Budgeting in the total analyses, they were excluded from the sectoral
17 Controlling and allocating financial resources analysis. There were no significant differences between
18 Using management information system
primary respondents and the sample of primary non-
19 Using health service technology
20 Using human resource management principles appropriately
respondents in terms of demographics, institutional char-
21 Human resource planning acteristics and ratings of competencies.
22 Managing personnel As shown in Table 2, most public sector respondents
23 Planning nursing training were female (95.6%), older than 50 years of age (63%)
24 Planning of resources
25 Structure health service organization
and have been in their current positions for less than 5
26 Managing teams years (39.8%). Private sector respondents were also pre-
27 Communicating organizational goals dominantly female (93.5%), between the ages of 35 and
28 Motivating employees 50 (50%), with the majority (40.3%) having been in their
29 Managing conflicts
positions for less than 5 years.
30 Managing workforce diversity
31 Labour relations Close to a 100% in both groups reporting having
32 Setting organizational culture nursing as their primary formal qualification. Formal
33 Measuring of organizational performance training in health management, in the form of a certificate,
34 Assessing the quality of care
diploma or degree was higher among public sector man-
35 Assessing patient satisfaction
36 Providing feedback to patients and staff
agers (94.7%), relative to their private sector colleagues
37 Evaluating health service delivery programmes (80.5%). Both groups reported equally high levels of
38 Evaluating financial performance informal training in health management (around 90%).
39 Implementing health quality improvement systems These included mentoring, in-service training and non-
40 Managing of nursing quality
41 Managing of environmental safety and sanitation
certified programmes. Almost 70% of public sector man-
42 Identification and analysis of an ethical issue in a health-care setting agers reported an intention to pursue further training in
43 Identification and analysis of an liability issue in a health-care setting health management but less than 56% of private sector
44 Labour-related legislation managers expressed this intent.
45 Health-related legislation
Factor analysis combined with selection of items based
46 Learning from experiences
47 Time management
on conceptual appropriateness, on the 51 competency
48 Acting independently items listed in Table 1 yielded seven factors, all with
49 Awareness of personal strengths and weaknesses Cronbach’s alpha greater than 0.7. The reconstituted
50 Balancing work and life issues scales are presented in Table 3.
51 Self-development
Self-management skills included items pertaining to
awareness of ones strengths and weaknesses as well as

© 2010 Blackwell Publishing Asia Pty Ltd

Nursing management competencies 549

Table 2 Respondent characteristics

Public (N = 94) All (N = 175) Private (N = 77)

Frequency Valid (%) Frequency Valid (%) Frequency Valid (%)

Response rate 94 43.72 175 41.67 77 37.56

Gender
Male 4 4.3 9 5.2 5 6.5
Female 89 95.7 165 94.8 72 93.5
Total 93 100 174 100 77 100
Age (years)
< 35 0 0 6 3.5 6 7.9
35–50 34 37 73 42.4 38 50
> 50 58 63 93 54.1 32 42.1
Total 92 100 172 100 76 100
Number of years in current position
<5 37 39.8 69 39.7 31 40.3
5–10 32 34.4 58 33.3 25 32.5
> 10 24 25.8 47 27 21 27.3
Total 93 100 174 100 77 100
Primary formal qualification
Nursing 73 77.7 128 73.1 53 68.8
Other 1 1.1 2 0.6 1 1.3
More than one qualification 20 21.3 45 25.7 23 29.9
Total 94 100 175 100 77 100
Formal/certified training in HCM
None 5 5.3 21 12 15 19.5
Certificate 7 7.4 15 8.6 8 10.4
Diploma 27 28.7 50 28.6 22 28.6
Degree 34 36.2 53 30.3 19 24.7
Other 3 3.2 7 4 4 5.2
More than one qualification 18 19.1 29 16.6 9 11.7
Total 94 100 175 100 77 100
Informal training in HCM
None 11 11.7 18 10.3 7 9.1
Mentoring 2 2.1 6 3.4 3 3.9
Non certified courses 3 3.2 6 3.4 3 3.9
In-service training (workshops, seminars) 50 53.2 79 45.1 27 35.1
Other 1 1.1 2 1.1 1 1.3
More than one qualification 27 28.7 64 36.6 36 46.8
Total 94 100 175 100 77 100
Intention to attend training
Yes 65 69.1 111 63.4 43 55.8
No 29 30.9 64 36.6 34 44.2
Total 94 100 175 100 77 100

HCM, Health Care Management.

© 2010 Blackwell Publishing Asia Pty Ltd

550 R Pillay

one’s ability to take responsibility for one’s life at work
and beyond but the ‘controlling’ factor comprised items
pertaining to monitoring and evaluation of the effective-
ness and efficiency of processes and outcomes within their
organizations. Items in the ‘health/clinical related skills’
factor pertain to clinical and public health skills important
in health management. ‘Organizing skills’ or core man-
agement functions included functions such as finance,
human resources and information technology. People
management skills included the ability to motivate
employees, be a team player, to work with people from
different backgrounds, resolve conflicts, delegate tasks
and share information. ‘Planning skills’ included items
pertaining to creating a vision and preparing strategic
plans as well as skills relating to needs assessment and
programme planning based on an understanding of what is
happening inside and outside the organizations but the
‘ethical/legal’ factor comprised items relating to under-
standing the legislative environment and medical ethics.
Noting that means could potentially range from 1 (not
important) to 5 (very important), nurse managers, as a
group, rated all competencies as being important with the
controlling function being ranked as the most important
(4.606) followed by the people management function
(4.573) and self-management (4.544). Specific health
delivery (4.345) and ethical/legal competencies (4.506)
were ranked as being relatively less important (see
Table 3). Both public and private sector managers rated
competencies related to controlling and people manage-
ment highest and specific health delivery skills lowest (see
Table 4). Bivariate analyses demonstrated that there was
no significant difference in how managers from the differ-
ent sectors rated the importance of all the competencies,
except for health/clinical skills which was perceived to
significantly more important by public sector managers
(F = 7.593, P = 0.001).
Univariate analysis of items pertaining to the need for
further management development and the appropriate-
ness of nurses in management showed that more than 90%
of nurse managers felt that they can benefit from a greater
understanding of the principles of management and that
specialized management training was advisable for nurse

Table 3 Reliability of management competency scales

Management competency variable N N of items Cronbach’s alpha

Self-Management (46,47,48,49,50,51)* 173 6 0.82

Controlling (33,34,35,36,37,38,39,40,41)* 173 9 0.93
Health/Clinical skills (1,2,3,4,5,6,7,8,9)* 171 9 0.889
Organizing (16,17,18,19,20,21,22,23,24,25)* 170 10 0.923
People Management (26,27,28,29,30,31,32)* 172 7 0.886
Planning (10,11,12,13,14,15)* 172 6 0.878
Ethical/Legal Skills (42,43,44,45)* 173 4 0.801

* Items from Table 1.

Table 4 Ratings of competencies (mean values for total sample, public and private sectors)

Competency variable Total sample Public sector Private sector

Self-management 4.543 4.580 4.517

Controlling 4.606 4.644 4.579
Health-care/clinical skills 4.347 4.511 4.159
Organizing 4.530 4.601 4.466
People management 4.573 4.624 4.533
Planning 4.530 4.563 4.505
Ethical/legal skills 4.505 4.550 4.468

© 2010 Blackwell Publishing Asia Pty Ltd

Nursing management competencies
managers. More than 80% felt that they required further
training as well as coaching and mentoring. Although 60%
of managers felt that nurses are not trained as managers
and 57.5% felt that nursing does not prepare nurses to
manage health, more than 85% felt that it was important
that nurse managers have a nursing background and 75%
felt that integrating nurses into management was a key
factor for successful nursing management.
DISCUSSION
Although response rates of self-administered question-
naires in nursing management differ greatly and tend to be
much higher in localized studies,24,27 ours compares
favourably to the 33.9% obtained by Lin et al.22 in their
nationwide study. However, the similarity in responses
between respondents and a sample of primary non-
responders suggests that non response bias was minimal
and the sample was therefore representative of all nursing
managers in South Africa.
The relatively high ranking of the importance of all of
the competencies validates the relevance of the measures
used for the study and underscores the importance of
theses competencies for effective, efficient and sustainable
nursing management. Results from the survey demon-
strated that nursing managers as a group felt that the
controlling, people management and self-management
skills were the most valuable for optimal nursing manage-
ment, followed by planning and organizing, but ethical/
legal competencies and specific health /clinical related
skills were relatively least important.
The controlling competency includes mainly assess-
ment and measuring skills of organizational and financial
performance, health quality systems and nursing quality
management. The NCHL7 includes these skills in the
execution domain termed accountability, which is defined
as ‘the ability to hold people accountable to standards of
performance or ensure compliance using the power of
one’s position or force of personality appropriately and
effectively, with the long-term of the organization in
mind’. This finding suggests that nursing management is
primarily about monitoring and evaluating the optimal
utilization of resources as well as ensuring that goals are
met. Although this implies a predominantly task orienta-
tion and a production focus, it leads to high performance
and effectiveness provided it is combined with a strong
people orientation,38,39 which was also ranked highly.
The high ranking of the people management compe-
tency is congruent with other studies4,21,22,24,27,40 and rein-
551
forces the fact that health care is a human system and that
a transformational approach41 coupled with team work are
critical success factors in the management of health.42 The
findings also underscore the importance of transforma-
tional leadership skills in a profession characterized by
staff shortages, high turnover and recruitment and reten-
tion difficulties. Nurse managers also play a critical role in
achieving transformation objectives and they have to
embrace as well as implement principles of diversity,
inclusiveness, equality and affirmative action. In addition,
nurses are becoming increasingly more empowered and
vocal with regards to employment conditions as well as
other social justice issues, as evidenced by recent indus-
trial action and support of social activist groups. All of
these require astute leadership, team and conflict manage-
ment skills. Enhancing skills in people management will
also contribute substantially in helping to reconceptualize
health service provision towards becoming more patient
cantered which requires that managers move their com-
petency focus from being more administration inclined to
being leaders and change agents.43
The high value placed on ‘self-management skills’ sug-
gests that managers feel that there is an intrinsic link
between personal and career effectiveness. This supports
the findings of Allen15 and also validates modern
approaches to management and leadership development
which focus not only on enhancing cognitive ability but
on emotional intelligence and spiritual intelligence as
well.44,45 Leadership by integrity, self-confidence, and
self-awareness allows one to be ‘appreciative of the
nuances of situations confronting you, avoid rushed judg-
ments, size up opportunities, capitalize on your personal
strengths avoid situations in which you are likely to fail,
and influence other people’.46 Being able to prioritize
work and life issues and finding ways to balance them
might be one of the most difficult challenges managers’
face.47 Coaching and mentoring are therefore important
tools to provide managers with the knowledge, skills and
mindset to develop as individuals and leaders.45
The relatively low ranking accorded to the importance
of planning is of concern considering that the general
health environment is a highly dynamic one and a key
competency for transformational nursing managers is the
ability to be visionary and see the organization in a more
global context, plan ahead, as well design, implement and
monitor programmes.48 This is particularly so, as we
move towards decentralized health systems that place
nurses at the epicentre of care delivery as espoused by the
© 2010 Blackwell Publishing Asia Pty Ltd
552
primary health-care approach. This finding might there-
fore imply that the decentralization and the devolution of
power that is much talked about is perhaps just a cliché of
policy makers and administrators. Senior nurse managers,
such as those surveyed, need to be made an intrinsic part
of the planning process and will therefore need to become
familiar with how socio-political, economic, technologi-
cal and other external and internal contingencies influence
and constrain the provision of care.
Although competencies pertaining to managing legal
and ethical issues in the workplace were ranked rela-
tively lowly they were regarded as being very important.
Given that nursing is a moral enterprise operating in an
increasingly litigious environment, and that nurse man-
agers will increasingly have to deal with more questions
like the allocation of limited resources, the use of
advanced technology, an ageing population and an
increase in behaviour related problems, it is important
that they appreciate the importance of, and equip them-
selves to perform their functions in a ethically and
legally defensible manner.33,49–51 In addition, as the
political landscapes of nations change and policymakers
continue to seek better solutions to their health-care
challenges, nurse managers need to be cognisant of the
evolving regulatory environment, especially as it pertains
to labour practices and the health sector.
The finding that specific clinical/health related skills
were perceived to be least important supports those of
similar studies 4,21,22 and underscores the assertion of
Lin et al.22 and Katz52 that technical competence is only
important at operational level while human and concep-
tual skills become more important for senior managers.
Given that > 99% of managers were nurses and that
management positions appear to be predicated on clini-
cal experience, these findings lead one to challenge the
rationality of having nurses in senior management posi-
tions. Because clinical competencies are not regarded as
being an essential prerequisite for nursing managers,28–30
consideration should therefore be given to appointing
trained generalist managers or creating management
career paths or specializations for aspirant nurse manag-
ers who happen to be nurses. The fact that the over-
whelming majority of respondents felt that a nursing
background was important for nursing management
and that they should not be precluded from managing
themselves despite not being trained as managers,
suggests that the latter approach warrants further
investigation.
© 2010 Blackwell Publishing Asia Pty Ltd
R Pillay
The finding that public and private health managers
rated the importance of the competencies similarly sug-
gests that managers in both the sectors require similar
skills sets for optimal performance. This contradicts the
commonly held view that there were distinct differences
between sectors which required different competencies.
Public sector managers did, however, rank the organizing
competencies—the hard management skills—as being
third most important as opposed to the sixth most impor-
tant ranking by the private sector. This suggests that
despite being senior managers, managers in the public
sector still perceived a need for hard management skills as
they perhaps had a greater operational responsibility and
oversight role over limited resources.
Although this study has important theoretical and prac-
tical relevance for the improvement of nursing manage-
ment development, there were limitations that need to be
acknowledged. The ranking of these competencies by
managers was purely subjective and was not externally
validated. It might have been influenced by the respon-
dents lack of knowledge with the topic and therefore a
lack of confidence in being able to rate the items. The
competencies listed might also not have fully reflected the
scope of nursing management.
In conclusion, as nursing managers have been identi-
fied as being pivotal to overcoming the health challenges
that we face, it is crucial that we endow them with
appropriate and relevant skills to enable them to meet
these challenges. This research provides valuable infor-
mation for those responsible for the professional devel-
opment of health-care managers. Self-management,
controlling, health/clinical skills, organizing, people
management, planning and ethical/legal competencies
have been identified as important for nursing manage-
ment in both the public and the private sectors. These
findings reflect the reality of the local health service
environment and the needs of nursing managers and will
be useful in the conceptualization, design and delivery of
health management programmes aimed at enhancing
current and future management and leadership capacity
in the health sector in South Africa and the rest of the
developing world.
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