Do nurses make better hospital managers compared to doctors?

Hospitals, for a long time run on a hierarchical basis, are increasingly facing scrutiny on how to improve their operations, patients’ safety and ultimately, financial wellbeing. One of the friction points being the never-ending and quite emotive debate on the roles various cadres should play in management of hospitals. Debate so far, centres on whom between nurses and doctors, make better managers.

In public hospitals in particular, historically, doctors as the senior-most trained cadre, have always felt the right to be at the helm of hospital management. Nurses on the other hand, believe that as the cadre with intimate contact time with patients, their knowledge of the day to day workings of hospitals is unsurpassed. As such, it imbues them with an added advantage over the other cadres.

An analysis of hospitals in the country reveals that while nurses play management roles at the lower level health facilities (dispensaries and health centers), at higher levels, doctors call the shots. One of the arguments fronted by nurses is that given the short periods spent by doctors in the hospitals, it is hard for them to notice the needs and challenges facing their workplaces and patients.

Among Kenyan public hospitals, this assertion may be true. On average, nurses spend more time at the hospital than doctors. A World Bank study on health worker absence in public hospitals Provider Absence Surveys in Education and Health, suggests that doctors may be more likely to miss work compared to lower cadres. For senior doctors, even much higher absence rates occur. Yet this latter group is often at the helm of leadership, based on hierarchy.

As an undergraduate medical student, in an attempt to lower this absenteeism, the training hospital management decreed that no patient ward rounds would commence unless consultants were present. Needless to say, after several missed ward rounds occasioned by consultants’ no-shows, the decision was scrapped.

Across the five key pillars of hospital management: patient safety, staff cohesion, quality improvement, research culture and financial well-being, active hands-on guidance is necessary. There has been a link between management absence and performance of hospital institutions.

One of the opinions against nurses taking the helm has been their relatively shorter and lighter medical training compared to doctors. Critics of this viewpoint, however, argue that in terms of hospital management, both cadres are at a loss and on equal footing. A suggestion is that they all need extra training on hospital management, governance, productivity measurement and improvement.

Locally, nurses, have commendably evolved a Bachelor of Science degree in nursing that is envisaged to train those keen on management roles. Doctors and nurses are also taking up healthcare management MBAs. Let us not forget that individual capabilities regardless of cadre, is a crucial ingredient of good leadership.