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Exploring the planning practices of Planningpractices of
nurse managers in the unit: nurse
managers
a study of nurse managers in
the greater Accra region
Adelaide Maria Ansah Ofei and Yennuten Parima Received 28 August 2021
Research, Education and Administration, College of Health Sciences, Revised 12 November 2021Accepted 22 December 2021
University of Ghana, Accra, Ghana
Gloria Achempim-Ansong
Department of Adult Health, University of Ghana, Accra, Ghana, and
Theresa Barnes
Research, Education and Administration, College of Health Sciences,
University of Ghana, Accra, Ghana
Abstract
Purpose –Nursemanagers’ planning practices are essential to the practice of management in the unit, and the
overall efficiency of the healthcare service delivery. This study aims to explore the planning practices of nurse
managers in the Greater Accra Region, Ghana.
Design/methodology/approach – A descriptive phenomenological design was employed to explore
nurse managers’ planning practices. In total, 15 nurse managers and 47 nurses from 19 primary
and secondary hospitals of the Ghana Health Service and two specialized hospitals in the Greater Accra
Region, Ghana, were involved in the study. Data were collected using semi-structured interview guides and
probes.
Findings –The findings suggested that plans were widely common to all the units of the hospitals and were
considered satisfactory by nurse managers. However, most of these plans were not effectively utilized. Nurse
managers had only fair knowledge about the planning process and were moderately involved and
communicated ideas to colleagues in the process. Furthermore, nurse managers do not frequently share the
vision neither do they even communicate expectations to achieve unit goals and objectives with
subordinates.
Originality/value – The research emphasizes the relevance of planning in healthcare management. It
highlights the management practice of planning in the context of nurse managers and accentuates the values
the healthcare system derives with effective planning practices.
Keywords Planning practices, Nursing manager, Healthcare delivery, Planning, Unit level
Paper type Research paper
Background
Nurses are fundamental to the delivery of quality healthcare since they constitute the
majority of the health workforce (Aitamaa et al., 2016), with nurse managers (NMs)
spearheading activities of nurses within the healthcare setting (Ofei et al., 2019). Hence, as
healthcare becomes increasingly complex, NMs must have knowledge and skills in
management to provide effective and efficient services that guarantee client and staff
satisfaction (Johannessen et al., 2021; Reem et al., 2014). As leaders, NMs use certain
strategies, such as planning, implementation and the evaluation of nursing care according to
required standards (McCauley et al., 2020).
Planning is deciding in advance what you will or will not do in the next minutes, hours,
days, months or years. Planning ensures actualization of goals and objectives, gives meaning Journal of Health Organization and
Management
to work, provides for effective utilization of available resources (personnel, logistics and © Emerald Publishing Limited
1477-7266
facilities). It is cost-effective, based on the past and future and helps reduce the element of DOI 10.1108/JHOM-08-2021-0320
JHOM change and is necessary for effective control. However, with all these numerous benefits of
planning,manyNMs, according toAsamani et al. (2013), do not have any formal plans and are
more comfortable managing their units with informal plans.
Nursing management and administration is organized at three levels: executive, middle/
departmental and the unit. Executive managers are responsible for making organizational
decisions and establishing goals and objectives that affect the entire organization. The middle-
levelmanagers translate the vision andmission for the operational managers, shares resources,
roles and responsibilities of nurses, andmanage thework of unit-levelmanagers. The unit-level
managers manage work at the unit level by planning, organizing, leading, staffing,
implementing and evaluation of staff performance and activities. The focus of the study was
the unit-level managers, the largest group of NMs in Ghana. The researchers purposefully
chose this group of NMs because of the central role they play in the health system.
The crux of this research is to explore the planning practices of NMs that will ensure
efficient use of resources and the creation of a positive workgroup climate.
Literature review
Planning practices in nursing
Bryson et al. (2018) recognized planning as a strategic, deliberative, disciplined effort to create
basic decisions and activities that shape and guide organizations. Planning practices of NMs
have been the focus of studies in recent times due to the immense significance of planning to
the management of the unit. Planning as strategic has increasingly become standard practice
that enables accountability and compliance. Thus, in the study of getting strategic about
strategic planning research, Bryson et al.were able to establish the benefits of planning to the
public sector.
Ofei et al. (2019) employed a quantitative design and found that planning practices at the
unit were quite moderate. Planning in the unit can be formal or informal. With informal
planning, nothing is written down, and there is no or little sharing of vision and goals (Ofei,
2015; Ofei et al., 2019). Formal planning, on the other hand, encompasses definite goals and
objectives covering specific timeframes normally, ranging fromweeks, months or even years,
and it is, therefore, most preferred in nursing management (Ofei et al., 2019). Similarly,
structured planning is essential for the day-to-day administration of healthcare organizations
because of the complex nature of client and stakeholder demands (Ofei, 2015). Furthermore,
formal planning has been recognized for its role in integration and coordination and forms the
basis for both centralizing and decentralizing organizational decision-making (Wolf and
Floyd, 2017, p. 1,755).
Planning process in nursing
Wright (2020) in a study in strategic planning in nursing management highlighted it as a
collaborative process. In the study, strategic planning in today’s world must be led by top
management and include managers and employees from all other departments in the
organization to ensure the improvement of a thorough plan that employees are invested in
implementing. Swedish law (SFS, 2017 as cited in Hansson et al., 2018) required collaborative
planning between healthcare professionals and patients after discharge from the hospital on
how care will proceed. However, Jobe et al. (2020) indicated the collaborative planning process
as a new way of working but challenging for professionals.
George et al. (2018), in their study about cognitive styles, user acceptance and
commitment to strategic plans in public organizations, realized that given a lack of insights
into micro-determinants of strategic planning in public organizations, commitment to
planning is reduced. Whereas, planning team members become committed to strategic
plans because they deem them useful. This indicates that the effectiveness of the
implementation of plans is aligned to how best staff are committed to the plans through Planning
effective communication of the plans to imbibe in them the relevance of the plan to the practices of
organization. nurse
managers
Frequency of planning
The frequency of planning practices is also another concern researchers have investigated.
Ofei et al. (2019) revealed that 59.8% of NMs plan quarterly, while 13.6% plan yearly, and
adequate time was spent in planning for the unit. In a similar study, Ofei (2015) observed that
quarterly plans were more used and time spent on planning for the unit was quite
encouraging. The results of the study further revealed that on average, NMs spent about 40–
59% of their time to plan, and there was a relatively positive correlation between time spent
on planning and the frequency. Also, management practices have a significant influence on
healthcare delivery (Anampiu et al., 2020). Every managerial decision that NMs make
ultimately has either direct or indirect implications on patients, staff and organizational
outcomes; thus, the need to objectively plan for the unit is essential (Ofei et al., 2019).
Content of the plans
The content of plans for a unit can vary significantly from one manager to the other. While in
one unit, plans could focus on the acquisition of human and material resources, others may
give much weight to staff development such as training. For instance, Ofei (2015) found that
planning at the unit level does not adequately address budgeting needs as compared to other
activities such as supervision and acquisition of resources. Similarly, Ofei et al. (2019)
revealed that budgeting for the unit is the least perceived planning practice of NMs. Also,
some critical contents of planning such as staff development and motivation, and their
importance at the unit level have been identified in the literature. Notably, Momanyi et al.
(2016) found a relationship between on-the-job training and the general motivation of health
workers and added that there was unanimous agreement by both health workers and health
service managers as to the influence of training on health workers’ motivation leading to
improved performance. Again, Ahmady and Seidi (2021) emphasized the importance of
supervision at the unit, noting that the ultimate goal of managerial supervision was making
sure that health workers render safe patient care. The results from the quantitative study by
Ofei (2015) depict that training in management, qualification and experience as an NM
account for putting together a written plan. Ofei et al. (2019) found that planning practice at
the unit is significantly predicted by experience as an NM.
Furthermore, organizational factors such as lack of periodic feedback on performance and
prospects for progress, absence of in-service training, job-related refresher programs, good
management and leadership training have been identified as management practices that can
influence overall healthcare delivery (Madlabana and Petersen, 2020; Mboweni and
Makhado, 2017; Musyoka et al., 2016). Studies have also identified medical ethics, clinical
practice, nurse–nurse co-operation, teaching, coaching, assessment and decision-making,
personal and professional development, research, critical thinking and interpersonal
relationships as the most critical factors for management and professional development of
nurses (Gao et al., 2016; Wei et al., 2019).
Use of plans by the unit
George et al. (2018), in an empirical analysis on cognitive styles and user acceptance and
commitment to strategic plans in the public organization, found that strategic plans among
planning team members with planning and creating style are committed to utilizing plans
because they perceive them as useful.
JHOM Conclusion
The findings of the literature show that planning practices of NMs have been less
investigated, with particular attention on the healthcare system of low-middle-income
countries. Drawing inspiration from the few existing studies in this context and taking a
tangent approach, the planning practices of NMs were discussed. More specifically, this
study explores the planning practices of NMs in the Greater Accra Region, Ghana, to describe
NMs’ experiences regarding the planning process.
Methods
Data for this paper are drawn from a larger study about the management practices of NMs
and how managerial characteristics influence the functional practices. A qualitative method
was adopted for this study, with in-depth interviews (with NMs) and focus group discussions
(with nurses).
Research setting and sample
Nurses and NMs working in selected hospitals in the Greater Accra region of Ghana formed
the population of the study. Nurses and NMs from 21 hospitals formed the sampling frame.
Participants in this study were selected via the purposive sampling technique. This meant
that participants were chosen based on their possession of a certain characteristic or criteria
required to be part of the study. Nurseswere chosen as part of the study sample once theymet
the following inclusion criteria: (1) NM recognized by administration as the in-charge of the
unit, (2) professionally registered nurses, (3) participants should have been working in the
hospital for at least six months. Data were collected from 15 in-depth interviews with NMs
and focus group discussions with 47 nurses. Participants were drawn from 19 primary and
secondary hospitals of the Ghana Health Service (GHS) and two specialized hospitals. While
21 NMs were eligible, 15 consented to be part of the study. Primary hospitals included
polyclinics, district, municipal and general hospitals. These settings were chosen because the
researchers wanted to know the planning practices of NMs across the functional levels of the
health system.
Data collection procedure
Data were collected from each hospital, and participants were recruited from the units during
all shifts for fair representation of the dynamics of planning. Discussion for participation was
done in the nurses’ room to avoid interruption of work in the unit. The investigator clarified
the purpose, roles, benefits and risks to the participants. The study team clarified the purpose,
roles, benefits and risks to the participants. Ethical issues relating to research with human
participants were explained and ensured. For instance, participation was purely voluntary,
names and identifying informationwere excluded from the study and pseudonymswere used
to enable confidentiality and anonymity. Participants could ask questions about the study to
allay anxiety, and those keen to participate were recruited by signingwritten consents. Focus
group discussions with 8–10 participants were held in the nurses’ room before or at the end of
shifts. Semi-structured interview guides and probes consisting of questions about planning
practices guided the 60-min tape-recorded interviewswith participants. Data collection lasted
for three months. Ethical clearance was received from the Noguchi Memorial Institute-IRB,
University of Ghana.
Methodological rigor
Methodological rigor was obtained by ensuring trustworthiness, as prescribed by Lincoln
and Guba (1986). Going by the four dimensions criteria (FDC), which are credibility,
dependability, confirmability and transferability (Lincoln and Guba, 1986), trustworthiness
was attained. To achieve credibility, varied interpretations and narrations were obtained Planning
from several participants, with interview sessions being long enough to draw rich details. practices of
Also, the interview protocols had been piloted earlier, to ensure they capture what the nurse
researcher intends to gather to answer the research questions. Also, experienced supervisors
assisted by re-assessing some of the data obtained. Continual review of captured data managers
through member checking ensured that all experiences and events were captured. To ensure
dependability, accuracy and explicit documentation of information given by participants
were validated through a replay of the recorded interviews to the participants. Inaccurate
quotes were altered, further exploration was done and participants confirmed their lived
experiences. Inquiry audit of transcripts and recordings involved scrutiny of data and
supporting documents such as field notes. To maintain reflexivity, researchers ensured
findings reflected the perspectives of participants.
Data analysis
Field notes and audio recordings were transcribed, processed and coded manually using
concurrent content analysis to identify ideas, concepts and to label participants’ words to
maintain the key ideas projected. Transcripts were coded inductively, paying particular
attention to each sentence aswell as listening to the recorded version to identify any trace and
familiarity. After thoughtful listening, cautious reading andmeticulous reflection of the data,
the researchers began to code the relevant words, phrases, sentences and sections. Codes
were cross-checked to ensure consistency and alignment. Subsequently, codes were nested
and categorized to form themes. All data were examined within the various categories and
subcategories to determine definite relationships.
Results
Socio-demographic characteristics of nurses
On the age distribution of the 47 nurses who participated in the study, the majority (42.6%)
were between the ages of 30 and 39 years, while 18 (38.3%) were between 20 and 29 years.
Additionally, 10.6% of the respondents were between 40 and 49 years, while 4(8.5%) were
between 50 and 59 years. Also, 82% were females while the remaining 18% were males.
Furthermore, the majority (45.2%) of the respondents had first degree, while 38.9% were
diploma holders, and the remaining 15.9% were certificate holders.
Socio-demographic characteristics of nurse managers
Out of 15 NMs who participated majority (50.5%) were first degree holders, 34.3% had
masters’ degree while 15.2% had post-basic diploma/certificate. Also, 51.5% were females
and 48.5% were males. Additionally, more than half (52%) have received some form of
training in performance management, whereas 15% have not received any management
training.
Nurse managers and nurses experiences regarding planning practices
The study revealed five broad themes; planning, planning process, the content of plans,
frequency of planning, usage of plans and suggestions for improving planning practices. The
sub-themes and various categories under each are presented in Table A1.
Theme 1: planning
NMs remarked that they do plan for their units, though planning was both formal and
informal. According to them, the plans become a guide for the activities on theward. TheNMs
expressed themselves in this way:
JHOM The plan is not rigid; as and when necessary it is amended because you know we are working with
people and you must respect their views and behaviours as well. So, if you become that rigid, they
would become ugh, let me put it that way; theywill not even respect what youwant to put across so it
is not always that easy (Noble).
The plan is a guide (Robelle).
The in-depth interviews of NMs illustrate that planning is common for all the units because
the nursing administration demands annual reports and budgets from them in some
hospitals. Hence, they are forced to have something put down as plans. Planning, however, is
both formal and informal. Development of plans mostly is done through meetings or durbars
with staff. The minutes of the meeting are taken as plans for the unit. Below are some
comments made by NMs:
During themeeting,we put all our thoughts downand it becomesminutes for themeeting andwe try to
work with it and next time we see how far we have gone with it, or how we have fallen short (Table).
Yeah, we have not put anything down because if I should tell you right now that we write something
down; we know what we are doing but we have not written anything down ugh (Rotelle).
Yes, it is not a written plan per se. What I do is, we have ugh waiting for broad edges; so, like I am
sitting right now, I have the training program for the ward durbar (Google).
Discussions with the focus group depict that planning and plans are widely common to all the
units, though the plans at times are not used. For instance, the participants declared that:
Yes, they have the plan but they do not use it (Toggle).
Yes, they normally paste it on the notice board (Horelle).
Where I am right now, I have not seen any of the plans (Yotelle).
We do not get involved in the plans, so I am thinking if wework in the ward and they have a plan and
they are working by it, they should involve us (Focelle).
Formal and informal planning
The responses of NMs revealed that plans are not always structured, written and placed at
vantage points in the units to remind staff of what they intend to achieve within the period.
Comments from participants included:
Plan should be written to serve as a guide, colleagues should cooperate, and planning should have
specific interval or period for review (Ritelle).
Planning in the unit is not organized but we do plan once in awhile, but it is better if we plan annually
so that performance will be improved (Debelle).
There has to be a well-structured model for every nurse manager to use (Jorelle).
There should be effective planning, implementation, evaluation and review of the plan to ensure the
smooth running of the unit (Griselle).
I want it to be written and placed in every corner for every new person or student nurse to see and
follow every instruction and protocol (Arielle).
Theme 2: the planning process
Planning is done in an ad hoc manner or on-demand as expressed by one NM:
Most of the nursing care is being done on the job because people have worked with long experience
over here, so doing it over and over again; they can dowhatever they are supposed to do even though
they have not been trained. So, I realized after my training that planning was done ad hoc manner, Planning
and when a situation arises, things are done. It is not permanent (Seller). practices of
The development of a vision for the management of the unit was quite interesting. Many of nurse
the NMs have visions or ideas for running their units, but these visions mostly were in managers
thoughts. Out of the 14NMs that the researcher interviewed, only two did not have visions for
managing their units. One had her vision boldly displayed in the unit, whereas the other, the
vision displayed in the unit was from her predecessor. The NMs had their visions in their
thoughts and occasionally shared them with subordinates. Though the vision could be
memorized, it has not been written anywhere; to them, it has been shared infrequently during
ward meetings or durbars, and many of them laughed when asked whether the vision has
been shared. One NM declared that she has never thought about developing a vision for the
unit, and only two of the NMs have genuinely shared their vision with staff. For instance, an
NM at one of the rural district hospitals declared:
To see this unit to be like any other unit in other district hospitals (Groselle).
While other visions given were:
To be the best ward (Belle).
Male involvement in maternal health (Fratelli).
The participants for the focus group declared generally that the units have visions. Only one
out of the lot believes that there would not be any vision for his unit because the nursing units
are dependent on the nursing administration. One also declared that though they have a
vision, it is not written but shared only duringmeetings. Another declared that the visionwas
developed at a meeting during discussion. Only one participant could memorize the vision of
her unit. Two of the participants declared that:
We can’t tell because when we got to the ward, the vision was already laminated and pasted there, so
I think in a way is already been documented but as to whether it was done this year or the previous
year we can’t say (Revelle).
In developing plans, the NMs declared that their plans are developed from goals or objectives
for the department. For instance. one NM stated that:
We write them, then at the end of the quarter, we submit it as the written document being the
quarterly report for the unit; so, we do not set many objectives, maximum four so that when we take
them little by little, then we will have much energy and time to solve them; we can achieve some but
some we do not (Toggle).
Planning in the units as expressed by both the in-depth interviews and focus group are
generally collective. Though some NMs simply plan with just their deputies and later inform
staff during their monthly meetings. The NMs expressed that:
I do it with my nurses, we sit down normally and plan the work for the year, they bring their views
and I also bring mine and we come to conclusion to what should be done. What we have planned last
year and what we have been able to achieve, then we put them together in the plan (Heshelle).
We have meetings every Monday and based on the previous plan, our planning is quarterly; so, we
bring our ideas together on how we can manage the unit better (Jeydelle).
The ideas come and I discuss it with my nurses and when they feel it is laudable, they say ok Aunt
Muna we will try, but if they feel it is not good enough, they ask how are we going to do it and I tell
them we will reach there one day (Forelle).
One NM, however, stated that:
JHOM We sat down and then the needs of the unit are observed and we develop our objectives. Not with all
the staff but withmy deputy, but then it would be communicated to them and they also come upwith
their ideas; which we put in.
For the focus group, these comments were made concerning the planning process:
At our unit, we meet at the beginning of the year with the nurse manager, then we plan for the things
we need.We look around to seewhatwe have; try to seewhich ones are notworking, which other new
ones we will need, and anything we will want to change in the unit. All is documented and a report is
given to the nurse manager who sends it to the matron (Casselle).
Usually formy unit, we do not have anything like we havewritten down something that we are going
to follow, like some strict guidelines butwhen situations come thenwe sit down and discuss as a unit,
how we resolve this. But we do not write it down so if you are not part of the meeting or we do not
communicate anything to you, you would not know (Estelle).
The plan is always a copy work, it is repetitions. They just tell you to re-copy it. So, is just like
somebody is forcing them to do it but we do not know the origins of the plans. Is like one person just
sits down and writes something (Mernelle).
Collective planning
While some NMs acknowledged that the planning process is collective and participatory,
some NMs admitted there is a need to do more descriptions and explanations of decisions
made. Many of the participants asserted that to a large extent there could be increased
involvement of subordinates, and that planning at the unit level should involve all staff, and
even the patients should be encouraged to contribute to planning. Comments such as these
were made:
A memo could be written to all staff to submit their contributions, grievances, and ideas that they
would wish to bring on board to develop the unit (Yubette).
I wish all staff of the unit could actively participate in the planning by being available and making
their opinions known (Dontrelle).
The planning could be done involving other staff in the unit and not just we themanagers alone since
everybody has ideas about how the unit should be (Femalee).
I think we should always involve subordinates when making decisions for the unit and also the
decisions should be written and put on the notice board (Kexelle).
Nurses also showed that they would prefer increased participation in planning activities for
the unit. Nurses proposed that:
The opinion everybody given should be respected and factored in decisions (Edelle).
Involvement of everybody (Parallel).
Staff should be part (Joelle).
Theme 3: content of the plans
The content of the plans as narrated by the NMs ranged from staff annual leave and duty
roster to mostly, logistics, development, review of protocols, training of staff and infection
prevention sparingly. However, maintenance of equipment and staff development were
conspicuously absent in almost all the plans. NMs also acknowledged that plans included
supervision, but thenmostly, the plans for managing units are all about annual leaves. These
comments were expressed by some NMs:
Yes,maybewe only plan for leaves; when is time for leave . . . that one, the book is there, and it is very Planning
effective (Veselle). practices of
Andwhen you are a junior staff, there is no way you can go on leave fromApril going. No, it is for the nurse
senior staff; you have to go from January (Kelle). managers
Staff development
For supervision, I will say Yes but for promotion, I will say No. you have to plan for your promotion
(Quelle).
When it comes to staff in general, the hospital is lacking it, so there is nothing like the development of
staff (RaRatelle).
There is nothing on staff development (Narelle).
When that happens is either a random thing or favouritism (Sorellele).
Maintenance plan
The procurement man comes round so when you have any item spoilt, you go and give it to him, and
somebody will come and repair or will give you a new one and will take the old one (Lovelle).
No, there is nothing of that sort, we wait when it is spoilt, we just fix it (Google).
We do not even know what a maintenance plan is (Noelle).
Wewait till they break down andwe call and they will come and carry it away.When it is not broken
down, we can’t write; when it is not broken down, they do not mind you but when it is broken down,
they take it seriously . . . (Monelle).
Theme 4: frequency of planning for the unit
The majority of the participants have quarterly plans. Interview with some NMs revealed
that they also have yearly plans, but the quarterly plans outnumbered all. For instance, one
NM stated that:
. . .we have a year planner like the year is ending, we have our plan for the next year. . . . so, the year
planner covers the whole year but as the months advance, we assess and reassess because someone
might have put maybe the leave in June but due to some reasons, the one would want to go earlier or
later, so we sit down and then assess, analyze and then . . . (Jarelle).
Theme 5: use of plans by the unit
The use of plans by the unit was quite remarkable, most of the participants acknowledged
that over 60% of the plans put together are utilized by the units, whereas few of the
participants utilized less than 40% of the plans. Comments generated from the NMs
concerning the use of plans were:
. . . so, we ensure, even though you are unable tomeet it 100%, at least wemake some forward. . . . but
it’s more than half so about 60% because we need to encourage, some slack, and some too, have that
enthusiasm so, we are trying.
Like about 50% (Ferelle).
JHOM Theme 6: suggestions for improving planning practices
Participants were generally satisfied with planning in the units; however, some participants,
though satisfied, preferred the process to be more structured and regular. Participants were
also of the view that plans should serve as a guide, should be implemented and reviewed
regularly to ensure their achievement. Below are some comments from participants:
The vision of the unit should be spelt out to staff and involvement of staff in the planning process and
it should be done quarterly to assess performance.
Plan must be specific, measurable, achievable and time-bound (Horelle).
I prefer planning to, . . . be done quarterly in a year and alsowritten and posted on awall where all the
staff can see, to promote easy refreshment of memory (Barelle).
Planning should be done regularly, supervised and regularly reviewed to find out its effectiveness
and to see if set goals have been chiefly achieved (Vozelle).
Planning should be done regularly, supervised, and regularly reviewed to find out its effectiveness
and to see if set goals have been achieved (Tobelle).
The plan should be reviewed at the end of the quarter (Yibelle).
Planning need to be done at least quarterly to enable staff to evaluate their plan in the previous report
(Zellele).
Discussion
Planning practices
This study explored the planning practices of NMs based on the lived experiences of NMs and
nurses in the units. The study found that planning and plans were widely common to all the
units, though most of them are not put into effective use. As noted by some participants, this
is because planning is done to meet administrative purposes such as annual reports, but not
purposely to achieve annual targets. The responses of the NMs further show that they do plan
for their units, although planningwas both formal and informal. In a similar study, Ofei (2015)
observed that, although there were plans at the unit level, the use of the planning process was
not very common. It was revealed that plans are not always structured, written and placed at
vantage points in the units to remind staff of what they intend to achieve within the period.
NMs also reiterated that the plans are not rigid since the nurses were not committed to the
original plans made. By contrast, Ofei (2015) revealed that some sort of planning occurred
among 65%of the participants at the unit level, but thesewritten planswere just a direct copy
of previous plans with modifications in just the dates. This contrasting view could be
attributed to the fact that the study approach varied, the qualitative approach formed the
basis for the quantitative study.While the qualitative sought the reasons behind the planning
practices based on the experiences of the NMs, the quantitative approach gave a general view
on the planning practices. The importance of planning has been acknowledged by many
researchers (Bryson et al., 2018; George et al., 2018; Wolf and Floyd, 2017), and NMs must be
encouraged to make use of their plans.
The study findings revealed that formal planning was moderately done in the units, and
NMs acknowledged that this could be improved. This finding supports a quantitative study
by Ofei (2015) and Ofei et al. (2019) who found that planning practices at the unit were quite
moderate and some units do not plan at all. Also, the responses of the participants in this
study revealed that semi-structured planning is observed during meetings and durbars
where issues encountered are noted and addressed. NMs should, therefore, be urged to plan
so that management in the unit becomes more logical and a basis for evaluating efforts.
Planning process Planning
Additionally, for the planning process, NMs declared that units have visions, and that plans practices of
are developed from the goals or objectives of the unit. However, many participantswere quick nurse
to add that these visions are not written but shared only during meetings. The findings share
similar results with Ofei (2015) that nearly half of the plans at the unit level were not written managers
down. Also, while planning was done collectively at some units, some NMs simply plan with
just their deputies and later inform staff during their monthly meetings. Similarly, Ofei (2015)
revealed that many managers confirmed they have a vision but have only either shared it
with just their deputies, still nursing it in their minds, or have shared it verbally with some
staff. Furthermore, many of the participants in this study expressed that largely the planning
process at the unit level should be all-inclusive. Ofei et al. (2019) also revealed that NMs are
fairly familiar with the planning process; thus, the engagement of all staff in the process can
facilitate commitment, a sense of belonging and team spirit toward a common course.
Content of the plans
The contents of the plan, the nurses asserted are mostly about staff annual leaves, but the
needs of the units are recorded at times. Plans do not include supervision of staff, promotion,
training, the attitude of staff or the mode of organizing patients’ care. Nonetheless, Momanyi
et al. (2016) found a relationship between on-the-job training and the general motivation of
health workers and added that there was an agreement between health workers and health
services managers as to the influence of training on health workers’ motivation leading to
improved performance. Similarly, Ofei et al. (2019) found that planning practice at the unit is
significantly predicted by experience as an NM. Also, Ahmady and Seidi (2021) emphasized
the importance of supervision at the unit, noting that the goal of clinical, educational and
managerial supervision was making sure that health workers render safe patient care.
Indeed, the need for NMs to include the welfare of staff, organizational change and general
well-being of the unit in their plans is imminent.
This study further affirms the findings of Ofei (2015) and Ofei et al. (2019) that planning at
the unit level does not adequately address budgeting needs as compared to other activities
such as supervision and acquisition of resources. This can be attributed to the fact that the
management of nursing in the unit takes account of the day-to-day operations regardless of
the management of culture and management of strategies as observed in strategic
management (Johnson, 1992).
Frequency of planning for the unit
The time spent on planning for the unit is quite encouraging, and quarterly plans are mostly
used by the NMs. The study further observed that, on average, NMs spent about 40–59% of
their time planning. Similarly, Ofei (2015) observed that quarterly plans were more used, and
on averagely, NMs spent about 40–59% of their time to plan, and there was a relatively
positive correlation between the time spent on planning and the frequency. Whereas, Ofei
et al. (2019) revealed that 59.8%of NMs plan quarterly, and thatmajority of them spend about
60–79% of their time in planning. This is recommendable and NMs should be applauded and
urged to continue. Thus, if NMs are encouraged to develop plans with nurses to manage the
units, they would be fairly compelled to utilize them.
Use of the plans
The utilization of plans by the unit was quite remarkable, many of the participants
acknowledged that over half of the plans are utilized. A similar study conducted by Ofei (2015)
found that over 60% of the plans put together by NMs at district and regional hospitals in the
Greater Accra region were utilized. Commitment to the utilization of plans according to George
et al. (2018) in the public sector is about how teams in the workgroup appreciate the plan and
JHOM understand its relevance to the organization. When members of the team perceived the plan to
be useful, then they become committed to the plan. From the study, collective participation in
the planning process was acknowledged; hence, the utilization of plans in the unit may be
because nurses participated in the planning. Participation in the planning process affords
nurses to validate the usefulness of the plan, hence their commitment to its utilization.
Lastly, NMs were fairly satisfied with the planning practices at the units. Many
participants were satisfied with planning in the units but preferred the process to be more
structured, participatory and regular. Plans should serve as a guide, should be implemented
and reviewed regularly to achieve their objective. Planning in the units should be collective
and participatory to ensure commitment. NMs, therefore, should employ a participatory
approach and effective communication to engage all nurses in the planning process to enable
the effective implementation of plans.
Conclusion
The findings of this study suggested that plans were widely common to all the units of the
hospitals and were perceived as satisfactory by NMs. However, most of these plans were not
effectively implemented. The study further showed that the contents of the plans were much
centered on staff annual leaves at the expense of supervision of staff, promotion, training and
other critical issues such as logistics. Furthermore, NMs do not frequently involve and
communicate ideas to colleagues in developing visions for the units. Consequently, the
existing planning practices could be improved by making them more formal and
participatory and widely communicated to all staff to facilitate staff engagement.
Recommendation
Based on the findings from the qualitative analysis of the lived experiences of both nurses and
NMs regarding planning practices, the following recommendations have been made to inform
the effective and efficient development and implementation of planning practices at the unit.
(1) There should be continuous in-service training of NMs to equip them with the
requisite knowledge and skills required to effectively carry out their management
duties in planning at the various units. This will go a long way to fill in existing
managerial lapses and their attendant effect on planning practices at the unit level.
(2) NMs should adopt a formal approach to planning, and ensure that the process involves
all the relevant parties, and the ideas are well communicated and documented.
(3) There should be effective monitoring and supervision of nurses and NMs in ensuring
that planning processes are well taken care of, and not just to meet administrative
demands. This will go a long way to ensuring that planning practices are well
implemented.
(4) The planning process should be well structured and broad to address key issues such
as supervision, training and logistics, as these are critical to the overall performance
of individual units, and largely, the healthcare organization.
Limitations
Few nurses were engaged in the study; this limits the generalizability of the study. While
quantitative data would have made the study more generalizable, the qualitative method
used implies findings cannot be generalized. There were some contrasting outcomes
compared to previous studies, which may be due to the design of the studies, one was
quantitative and the other qualitative. Further investigations need to be carried out to
ascertain the satisfaction of planning at the unit level.
Again, the studywas the foundation for a larger study; thus, probably notmuch inquiry at Planning
this stagewas accomplished. Again, the veracity of the accounts of the participants is difficult practices of
to be ascertained Also, the researcher’s prejudice and biases may have influenced the study. nurse
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Appendix
Theme Sub-theme Categories
Planning Formal and informal planning Written plans
Units have plans
Organized planning
Effective planning
Implementation
Evaluation and review of the plan
Planning process Collective planning Participation in planning activities
Ad hoc or on-demand
Development of a vision
Written vision
Shared vision
Goals or objectives for units
Plan with subordinates
Content of planning Staff development Annual leaves
Promotions
Training
Supervision
Maintenance plan Logistics
Infection prevention
Frequency of planning Quarterly plans
Yearly plans
Usage of plans by the units Plans are put into use
Table A1. Satisfaction with planning practices Satisfaction Satisfied
Lived experiences of Preference More structured and regular
NMs regarding Implemented and reviewed regularly
planning practices Should serve as a guide
Corresponding author
Theresa Barnes can be contacted at: tbarnes@ug.edu.gh
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