Challenges faced in rural hospitals: the experiences of nurse managers in Uganda

Aim: The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. Background: The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. Methods: This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. Results: Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: ‘Numbers do matter’; ‘I cannot access them when I need them at work’; ‘Challenges in dealing with negative attitudes’; and ‘Questioning own ability to manage health services’. Discussion: Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. Conclusion: Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. Implications for nursing policy: It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development.