BUILDING THE MANAGERIAL ROLE OF NURSES IN ANGOLAABSTRACT
Objective: to understand the construction of the managerial function from the perspective of nursing managers in the Angolan hospital context.
Method: this is a descriptive study with a qualitative approach developed with 113 nurse managers from primary, secondary, and tertiary hospitals in Luanda, the capital city of Angola. Data were collected using a semi-structured interview guide, processed using IraMuTeQ software, and analyzed using Descending Hierarchical Classification.
Results: the data utilization rate was 82.08%. The results indicated the formation of six Classes, namely: Class 4 - Academic training of nurses for management; Class 2 - Ascension to the position without prior training; Class 6 - Development of managerial competence; Class 5 - Requirements of nurses for management; Class 3 - Profile necessary for nomination to the managerial function; and Class 1 - Institutional legislation for the nomination of managers.
Conclusion: the way in which the nurse's position is assigned needs to be reviewed with a view to redefining criteria in current institutional legislation, as these criteria are crucial for achieving satisfactory results in the management and nursing care provided to the population. Furthermore, measures aimed at qualification and professional development should be prioritized in order to promote acquiring essential skills for making qualified decisions and achieving measurable results in the management of health services.
DESCRIPTORS:
Nurse; Nursing Management; Hospitals; Nursing Care
RESUMO
Objetivo: compreender a construção da função gerencial na perspectiva de Enfermeiros gestores no contexto hospitalar angolano.
Método: estudo descritivo, de abordagem qualitativa, desenvolvido com 113 enfermeiros gestores de hospitais primário, secundário e terciário de Luanda, capital de Angola. Os dados foram produzidos por meio de um roteiro de entrevista semiestruturado, processados no software IraMuTeQ e analisados pela Classificação Hierárquica Descendente.
Resultados: o índice de aproveitamento dos dados foi de 82,08%. Os resultados indicaram a formação de seis Classes, a saber: Classe 4 - Formação acadêmica do Enfermeiro para a gestão, Classe 2 - Ascensão ao cargo sem capacitação prévia, Classe 6 - Desenvolvimento da competência gerencial, Classe 5 -Requisitos do Enfermeiro para a gestão, Classe 3 - Perfil necessário para Indicação à função gerencial e Classe 1 - Legislação Institucional para indicação de gestores.
Conclusão: a forma como ocorre a atribuição do cargo ao enfermeiro precisa ser revista, com vistas à redefinição de critérios na legislação institucional vigente, pois esses critérios são determinantes para o alcance de resultados satisfatórios na gestão e na assistência de Enfermagem prestada à população. Ademais, devem ser priorizadas medidas voltadas à qualificação e ao desenvolvimento profissional, a fim de favorecer a aquisição de competências indispensáveis à tomada de decisões qualificadas e ao alcance de resultados mensuráveis no âmbito da gestão dos serviços de saúde.
DESCRITORES:
Enfermeiro; Gestão de Enfermagem; Hospitais; Cuidados de Enfermagem
RESUMEN
Objetivo: comprender la construcción de la función gerencial desde la perspectiva de las enfermeras gestoras en el contexto hospitalario angoleño.
Método: estudio descriptivo con enfoque cualitativo, desarrollado con 113 enfermeras gestoras de hospitales de atención primaria, secundaria y terciaria de Luanda, capital de Angola. Los datos se recopilaron mediante una guía de entrevista semiestructurada, se procesaron con el software IraMuTeQ y se analizaron mediante la Clasificación Jerárquica Descendente.
Resultados: la tasa de utilización de datos fue del 82,08 %. Los resultados indicaron la formación de seis clases: Clase 4: Formación académica de la enfermera para la gestión; Clase 2: Ascenso al puesto sin formación previa; Clase 6: Desarrollo de competencias gerenciales; Clase 5: Requisitos de la enfermera para la gestión; Clase 3: Perfil necesario para el nombramiento a la función gerencial; y Clase 1: Legislación institucional para el nombramiento de gerentes.
Conclusión: es necesario revisar la asignación del puesto de enfermera, con el fin de redefinir los criterios de la legislación institucional vigente, ya que estos criterios son cruciales para lograr resultados satisfactorios en la gestión y la atención de enfermería a la población. Además, se deben priorizar las medidas de cualificación y desarrollo profesional para promover la adquisición de habilidades esenciales para la toma de decisiones cualificadas y el logro de resultados medibles en la gestión de los servicios de salud.
DESCRIPTORES:
Enfermera; Gestión de Enfermería; Hospitales; Atención de Enfermería
INTRODUCTION
The current context of the Angolan National Health System (NHS) faces significant challenges and demands, such as the construction of new hospitals with greater technological resources, integration of newly graduated young professionals, both nationally and internationally, and an increasingly demanding society with a high level of legal literacy1-2. The Constitution recognizes health as a fundamental right of the citizen, and it is the State’s obligation to ensure measures, policies, actions and services aimed at promoting, protecting and restoring health from childhood to old age, in any circumstance, including in cases of disability and/or incapacity for work3.
The literature highlights that Nursing management constitutes a strategic pillar for the quality of healthcare. Managerial skills and abilities are crucial for optimizing the coordination of clinical activities and fostering an organizational climate which promotes satisfaction and good performance of the teams. Nursing managers must adopt a critical perspective as the role is multifaceted and highly complex, requiring a diverse repertoire, as well as a strong sense of responsibility in order to achieve effective and efficient care outcomes4-5.
Thus, the NHS lacks nurses with managerial, care, relational, communication and conflict resolution skills, as well as abilities in the use of technologies to lead teams in meeting the needs of the population and in solving recurring problems in hospital units6. From this perspective, training constitutes the basis of the nursing manager’s learning, and should be based on scientific evidence for the performance of their activities7.
Although it is the organization’s responsibility to promote training and development of professional managers, it also has the prerogative of self-qualification. This imperative constitutes a competitive advantage in a context that demands mastery of normative and regulatory frameworks so that the ability to interact effectively with multidisciplinary teams becomes a success factor, reinforcing the importance of continuously pursuing improvement as an essential strategy for professional relevance8.
In view of the above, and highlighting the relevance of the training process and the dynamics of building the management function in nursing professional practice, this study aimed to understand the construction of the managerial function from the perspective of the professional in the Angolan hospital context.
METHOD
This is a qualitative, exploratory-descriptive study guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) in order to ensure methodological rigor9. No Artificial Intelligence (AI) tools were used in this study.
The researchers involved in this investigation had mastery of the method and the subject matter, and presented no conflicts of interest. In addition, they did not have an employment relationship with the participating hospitals, which minimized possible biases of influence. The relationship between researcher and participant was limited to the moment of the interview, without interfering in the work dynamics.
The study was conducted in Luanda, the capital of Angola, in 12 hospitals, between February and April 2025. A total of 113 nurses who held positions as Nursing Director, Head Nurses of Service, and Supervisors for at least one year participated. Those who were absent from their duties during the data collection period, either due to vacation or leave, were excluded. According to the functions performed, it was the responsibility of the Nursing Director to direct, guide, coordinate, and lead the hospital’s nursing services; the Head Nurse of Service performed the same functions, including nursing care in their area; and the supervisor assisted the Nursing Director in outpatient consultations and hospitalizations.
Non-probabilistic convenience sampling was used to recruit the participants. The interviewees participated by invitation from the researcher at the research site, at which time they were informed about the study objectives, the voluntary nature of their participation, and the need to sign the Informed Consent Form.
The data were obtained from an instrument divided into two parts: the first aimed at characterizing the sociodemographic and occupational characteristics of the participants; the second consisted of a semi-structured interview guide, applied in person, on dates and times previously scheduled according to the interviewee’s availability. Permission was requested to record the interviews in audio using a smartphone, with identification by codes (p1, p2, p3...p113) in order to maintain anonymity of the participants. A pilot test was conducted with five participants to verify the suitability of the questions in the script to the study objectives. The adjustments resulting from the pilot test were only semantic, without altering the content of the questions.
The sociodemographic and occupational characterization data were submitted to descriptive analysis. The textual corpus of the transcribed interviews was processed with support of the IRaMuTeQ software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) and analyzed using Descending Hierarchical Classification (DHC). Text Segments (TS) are classified in this analysis method according to the vocabularies which originate TS classes with similarities grouped by repeated chi-squared tests10.
The project was submitted for approval to hospitals in Luanda (Angola) and subsequently approved by the Ethics Committee of the Angolan Ministry of Health (CEMS), as established by Presidential Decree No. 177/19 of May 22, respecting all ethical principles related to research with human beings11.
RESULTS
The research conducted in Luanda included 113 nurse managers. Of these, 25.6% (n=29) worked in primary level hospitals, 40.7% (n=46) in secondary level hospitals, and 33.3% (n=38) in tertiary level hospitals. Most participants were over 48 years old (N=55; 48.6%), were women (n=88; 77.8%), had a degree (n=100; 88.4%), and did not have additional training in leadership or hospital management (n=37; 32.7%). Regarding professional experience, 47 (41.5%) had more than 21 years of experience, and 91 (80.5%) had been in their positions for between one and five years.
The textual corpus consisted of 113 interviews, totaling 413 TS. The analysis identified 1,092 distinct forms, with 13,884 occurrences, of which 812 correspond to lemmas (reduced forms), 727 to active forms, and 75 to supplementary forms. In turn, 339 Elementary Context Units (ECUs) were classified, with a success rate of 82.08%. The DHC resulted in six thematic classes, organized into three analytical axes. These axes express critical dimensions of the inadequate profile of nursing managers, reflecting deficiencies related to specific training, informal appointment criteria, and the absence of normative guidelines to guide exercise of the managerial function (Figure 1).
Vertical dendrogram resulting from Descending Hierarchical Classification. Luanda, Angola, 2025.
Class 4 - academic training of nurses for management
Class 4 represented 17.05% of the ECUs and included discourses which recognize a degree in Nursing as the main, and in many cases the only, training foundation for the exercise of managerial functions. The lexical field of the class was composed of terms such as discipline, administration, course, degree, base, management, leadership, and knowledge. These words highlight the centrality of university education, especially the discipline of Nursing Administration, as initial theoretical support for performing leadership positions. The following excerpts illustrate the tension between knowledge acquired in training and the demands of professional practice:
[...] Training is important for developing activities delegated by management, understanding the hospital’s structure, and knowing how to interact with patients’ families (p16).
[...] the Nursing Administration course helped me understand the functions of leadership, but I lack preparation to deal with people, conflicts, and the management of the service as a whole (p18).
[...] the undergraduate course taught some principles, but leadership is different. Practice demands much more than what we saw in university (p15).
Class 2 - ascension to the position without prior training
Class 2 accounted for 16.52% of the ECUs in the corpus and emphatically expressed the absence of specific management training among nurses holding managerial positions. The predominant lexical field consisted of terms such as training, assume, management, before, course, responsibility, learn, important, and empower, which highlighted the recurring reality of professionals appointed without any prior technical-training preparation. The following excerpts were selected for their representativeness and coherence with the thematic core of the class:
[...] the responsibility was suddenly assigned by management and there was no time for a specific course (p28).
[...] we came from university and to be a manager, training is essential. Most of us come without specific preparation for management (p15).
[...] I didn’t have formal training, I only sought knowledge after I was already in the position. I learned everything in practice and through mistakes (p30).
Class 6 - development of managerial competence
Class 6 represented 16.52% of the ECUs and expressed a recurring pattern among the head nurses of the hospitals investigated: management learning occurs after entering the position and stems from practical experience, without prior preparation. The terms with the highest statistical association value included practice, experience, acting, applying, organizing, learning, and life experience, indicating that managerial competence has been built empirically and reactively. The following excerpts illustrate this informal learning:
[...] I develop my activities based on what I learned in my undergraduate degree, especially in the Nursing Administration discipline. Practical training was acquired in the day-to-day work of the service (p37).
[...] I learned from the team. I took the position without wanting to, without training. I came to understand how to lead from my interaction with the professionals (p38).
[...] I never had a management course. What I know is from my experience in the Medicine service. Today I apply this to my new role (p41).
Class 5 - requirements of nurses for management
Class 5 represented 17.99% of the ECUs and showed that the selection and legitimation criteria for the head nurse are strongly anchored in personal and behavioral attributes, often dissociated from technical-managerial skills. The vocabulary most associated with the class included requirement, example, reference, posture, responsibility, humility, empathy, and communication, suggesting a representation of leadership as an expression of ethical and moral conduct, rather than as a specialized technical function. Some excerpts which illustrate this profile construction are presented below:
[...] the prerequisites include being a humanist, a nurse, having empathy, patience, love for the profession, and being a reference. Nominations are made by management (p4).
[...] the position was assigned to me because I am a reference in the area. I never had specific training, but I always stood out for my behavior with the team (p30).
[...] being a nurse, having a spirit of leadership, empathy, communication, and knowing how to deal with people. That’s what they look for when nominating someone (p22).
Class 3 - profile necessary for nomination to the managerial function
Class 3 represented 17.76% of the ECUs and made it clear that most head nurses assume leadership positions through informal nomination processes, generally motivated by institutional gaps and the absence of qualified professionals. The terms with the strongest statistical association in this class included nomination, scarcity, reference, technician, profile, recognition, sector, and education, composing a vocabulary that points to a nomination system based more on organizational convenience than on technical-training criteria. The following excerpts illustrate these conditions of precarious access:
[...] it was due to scarcity. They already considered me a reference in the unit, and they appointed me without any prior preparation (p47).
[...] I assumed the position by nomination from management. There was no technical criterion, it was because I was already leading the team informally (p30).
[...] I was working as a technician due to a lack of nurses and was called to be a head nurse. Today I lead an entire sector without having been prepared for it (p61).
Class 1 - institutional legislation for the nomination of managers
Class 1 represented 14.16% of the ECUs and highlighted one of the central aspects of the fragility of the identified managerial profile: the non-existence or inaccessibility of institutional regulations governing the exercise of the head nurse function. The words with the highest statistical association included statute, document, legal, guidance, code, law, ethics, organizational chart, and regime, indicating the participants’ concern with the absence of formal and structured guidelines. This perception is illustrated by the following statements:
[...] I was never given guidance on exactly what I should do as a head nurse. There was no document, no conversation. They just said: now it’s your turn (p24).
[...] the organizational chart exists, but it doesn’t reach us. The management protocols are not shared with the head nurses (p48).
[...] I've heard of a code of ethics and a statute, but I’ve never seen these documents. Things work through experience, not through rules (p41).
DISCUSSION
The speeches highlighted the importance of training nurse managers for developing activities which involve understanding the hospital’s organizational structure, as well as interpersonal relationships with family members, patients, and other professionals. It is worth noting that nurses with management knowledge are able to inspire teams, optimize processes, and contribute to an organizational culture based on innovation and the inclusion of team members in decision-making12.
However, there is a lack of specific prior training which provides fundamental knowledge about management, being essential for the sustainability and consolidation of the nurse’s managerial role in Angola. Thus, professionals stated that they perform their activities based on knowledge acquired during their undergraduate studies and in daily practice, which does not always correspond to the demands and expectations of the organizations13-15.
This insufficient knowledge generates inefficiency and limitations in their performance of functions, causing barriers in guidance of team members, functional instability, and consequently compromising the achievement of institutional objectives16. The need for organizations to invest in the development, improvement, and qualification of management professionals is highlighted, contributing to more engaging and innovative environments, as well as to the continuous improvement of the NHS12,15,17.
Limitations in the construction of the nurse’s managerial function in the Angolan context due to a lack of preparation, training, and qualification for the full exercise of this function can compromise the effectiveness, efficiency, and efficacy of the work performed, in addition to promoting dissatisfaction among subordinates and is reflected in unsatisfactory care quality1. This is not a reality exclusive to Angola. Problems related to management (18.1%) and human resource management (11%) stood out among the main problems identified in the context of the Unified Health System (O Sistema Único de Saúde - SUS) in Brazil18.
The managerial function of health services requires qualified professionals with essential attributes such as management competence, leadership, communication, interpersonal skills, and ethical values which favor the appropriate use of technological resources and increased problem-solving capacity in the National Health Service (NHS) and its coverage areas, in accordance with the competencies assigned by Presidential Decree No. 260/10, of November 192.
Therefore, it is relevant to state that preparing nurses for the managerial function must be treated with responsibility and discernment, especially when compared to other knowledge areas, considering that the managerial dimension of care receives little or no investment19. A properly prepared nursing manager energizes activities, promotes care quality, optimizes operational costs, reduces resource waste, and ensures compliance with established standards and protocols20-21. It was observed in the participants’ statements that management experiences differ from those of care, and so it is imperative to train professionals for the appropriate use of management tools.
Regarding the prerequisites for the assignment of the nursing manager role, participants highlighted the importance of being humanistic, having empathy, patience, love for the profession, and being a reference in the service. However, these criteria reveal a superficial assignment, falling short of the competencies required for the position. In addition, it was reported that assignment of the role occurs by convenience through nominations from the hospital management. Although this nomination model is recognized by law, it can favor personal interests, compromise the manager’s autonomy, and weaken the bond with other professionals8,19.
This reflects the freedom that hospital directors have to choose a nurse to occupy positions such as Nursing Director, Head Nurse of Service, or Supervisor, in light of Presidential Decree No. 260/10, of November 192. Thus, the general director in most Angolan hospitals is a doctor, who usually chooses the nurse who suits him best, without considering scientific and technical knowledge as a prerequisite for the managerial role.
Selecting nursing managers without valuing merit principles can result in appointing professionals lacking technical, behavioral, or administrative competence, as well as a lack of mastery of institutional documents and protocols. Thus, a meritocratic system strengthens the feeling of organizational justice, promotes equity, and consolidates trust relationships within institutions22.
Allocating management positions based on convenience is common in Angola, stemming from Presidential Decree No. 260/10, of November 192. This practice of appointing professionals without proper preparation compromises continuity of projects and the effectiveness of changes implemented in the sector, raising questions about their real contribution to the organizations. Are changes that actually add value being promoted? Is there continuity in the projects? Is there accountability on the part of these managers? Do the transformations meet the current context of the NHS? Are they necessary? It is plausible to assume that the answers to these questions are negative, which highlights the urgency of future investigations on the subject.
Normative documents and institutional protocols guide the actions of managers and health professionals regarding administrative procedures15. However, the lack of knowledge of these instruments by the nurses who participated in this study highlights the need for immediate training measures, as this gap can violate administrative principles, hinder achievement of the objectives of the NHS and weaken the relationships between managers and subordinates, compromising the care provided to patients.
The nursing managers interviewed stated that they had heard about the code of ethics and the professional statute, but had never read them. This situation represents a risk to the profession, since the nursing manager must know the legal bases that underpin their practice, such as the Code of Ethics and Deontology of Nursing, established by Presidential Decree No. 178/18, of August 6, which provides for the legal regime of Nursing professionals in Angola23.
These documents are essential because they define the guidelines that govern the competencies of nursing professionals, regardless of academic level. It is concerning that a nursing manager, responsible for the team and the quality of care provided, does not master the legal documents governing the profession, thus violating Chapter III - Responsibilities, Article 8, paragraph C, of the Code of Ethics and Deontology of Nursing Professionals in Angola24.
Lastly, it is urgent to review the model for assigning the role of nursing manager established by the aforementioned decree2 in Luanda (Angola). This model delegated specific responsibilities to professionals without adequate technical and managerial skills, which weakens the category, harms interpersonal relationships within teams, and compromises the quality of care provided to patients.
CONCLUSION
Construction of the nurse’s managerial role is based on the need for specific training, given that most of those who assume the position do not receive prior training and usually acquire learning through day-to-day experiences, meaning after entering the position. Furthermore, this limitation is associated with appointment by convenience, in most cases supported by presidential decree. It is also noteworthy that many professionals are unaware of the normative documents which guide performance of the managerial role, which can directly impact relationships with other professionals, families, and users of the National Health Service.
The way in which the nurse is assigned the position needs to be reviewed, with the aim of redefining the criteria provided for in current institutional legislation, as these factors are decisive for achieving good results in management and in the quality of nursing care provided to the population. In addition, measures aimed at qualification and professional development should be prioritized, favoring acquisition of essential skills for informed decision-making and achieving measurable results in health service management.
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» https://files.ordenfa.org/legislacao/DR-II-Se%CC%81rie-1792016-Deliberac%CC%A7a%CC%83o-n.%C2%BA-122016-Co%CC%81digo-de-E%CC%81tica-e-Deontologia-dos-Profissionais-de-Enfermagem.pdf
NOTES
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ORIGIN OF THE ARTICLE
Post-Doctoral Internship in Nursing of the Postgraduate Program in Nursing of the Universidade Federal do Piauí, 2025.
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FUNDING INFORMATION
Provided by the Ministério da Saúde de Angola (MINSA).
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Research Ethics Committee of Angola, opinion no. 013/CEMS/2025, Certificate of Presentation for Ethical Review on February 10, 2025.
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TRANSLATED BY
Christopher J. Quinn.
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DATA AVAILABILITY
The dataset that supports the results of this study is not publicly available.
The dataset that supports the results of this study is not publicly available.
Source: IRaMuTeQ (2025).