Research on the State of Nursing (RESON)


Nurses are often referred to as “the backbone of the health system” because of their majority numbers compared to other health professional categories. They are also often the first point of call for communities in different geographical settings. Although there is universal agreement on the centrality of nursing to health maintenance and health system developments, there are sharp disagreements amongst policy makers, researchers and nurses themselves on the reasons for and solutions to the nursing crisis. This research project explored the state of nursing policies, practice and management in South Africa. It was a four-year research programme, funded by Atlantic Philanthropies, to develop and strengthen the research evidence for improved nursing policy development and practice.


Three research areas focused on nursing policy analysis; examining changing patterns of nursing practice with a focus on the casualisation of nursing; and nursing supervision and management. The themes of policy engagement and dialogue facilitation, and capacity building cut across the research endeavour.

Policy analysis: Using a contemporary policy analysis framework, this component was an in-depth analysis of nursing policy initiatives with the goal of deepening understanding around critical factors which influence nursing policy development and implementation, with recommendations on improving policy processes.

Changing patterns of nursing practice: This research analysed agency nursing and moonlighting and their health systems consequences. The study has had a major impact on policy in South Africa.

Nursing management and supervision: This study examined the relationship between the quality of care and the quality of nursing unit management in hospitals, and between the quality of care and the quality of PHC facility management.


An integral part of this project was to engage with expert stakeholders through an advisory committee to initiate dialogue, impart information, encourage input and support. The advisory committee comprised a cross-section of key nursing stakeholders representing academia, nursing practice (private and government), statutory and nursing organisations, and policy-makers.

Capacity development

The project has provided opportunities to develop capacity in human resources research among health system researchers and academics, leading to several higher degrees. It has also provided a platform to facilitate and strengthen networking between existing researchers.


Ditlopo P, Blaauw D, Rispel, LC, Thomas S, Bidwell P. (2013) Policy implementation and financial incentives for nurses in South Africa: a case study on the occupation specific dispensation. Glob Health Action 2013, 6: 19289 -

Munyewende P, Rispel LC, Chirwa T. Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces. Human Resources for Health 2014, 12:27 doi:10.1186/1478-4491-12-27.

Rispel LC, Blaauw D, Chirwa T, de Wet K. (2014) Factors influencing agency nursing and moonlighting among nurses in South Africa.Glob Health Action;7:23585.

Van Zyl G, Christofides N. International Nurses Day and press coverage in South Africa. International Nursing Review, 61(2): 186-193. June 2014 DOI: 10.1111/inr.12101

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