Structured leadership succession planning is vital for maintaining management continuity in healthcare; however, such frameworks are frequently absent within the South African public hospital sector.
The purpose of this study was to determine the perceptions and experiences of leadership succession planning for registered professional nurses in Mangaung district, Free State province.
Although structured leadership transitions are vital, succession planning within public healthcare sectors continues to be predominantly informal, ad hoc and detached from organisational policy.
A qualitative research design was employed using in-depth unstructured interviews. Data were collected from 20 participants in Mangaung district and analysed using Braun and Clarke thematic analysis.
The results revealed that leadership development is commonly perceived as a secret administrative task rather than a shared professional practice.
The findings support the need to consider succession planning that incorporates mentorship, knowledge transfer and effective communication, in line with the transformational leadership principles and best practices.
This study highlighted that a clear policy-driven succession planning is essential to enhance human resource practices, foster nurse leadership and ensure the long-term success of public health system reforms in South Africa.
Globally, literature widely positions succession planning as a cornerstone of organisational endurance, yet systemic vulnerabilities like poorly defined career trajectories, inadequate mentorship and uneven career advancements remain prevalent (Groves,
In South Africa, these broader struggles collide with acute local vulnerabilities within the public health sector, such as staffing deficits, overwhelming patient numbers and policy execution failures. Recent studies emphasise that the absence of formalised competency frameworks, exacerbated by an ageing workforce nearing retirement and the ongoing emigration of professional nurses threatens stability, particularly in the Free State province (Motlhaole et al.,
While macro-level nursing shortages and broad leadership frameworks are well established in South Africa, there remains a significant empirical gap concerning frontline nurses’ perspectives and the institutional barriers that hinder succession planning in local public hospitals (Du Plessis,
This study is particularly relevant in the Mangaung District of the Free State Province, a key healthcare hub serving vulnerable populations, where the growing demand for nurse managers means that inadequate succession planning directly threatens patient care and hospital operations. By examining the specific barriers and perceptions within a selected public hospital, the research provides context-specific insights to support policymakers and administrators in shifting from reactive crisis appointments towards a sustainable, resilient nursing leadership model (Maroga et al.,
The purpose of this study was to determine the perceptions and experiences of leadership succession planning for registered professional nurses in Mangaung district, Free State province.
The objectives of this study were:
To explore the current state of leadership succession planning in Mangaung district, Free State province.
To describe perceptions of leadership succession planning in Mangaung district, Free State province.
To fully grasp the operational bottlenecks of succession planning in healthcare, it is necessary to first trace its theoretical evolution. Early organisational scholarship largely framed succession planning as a reactive administrative tool designed to fill vacancies. In contrast, contemporary nursing literature conceptualises succession planning through multiple, overlapping thematic perspectives that emphasise leadership development, institutional continuity and strategic alignment.
A comparative analysis of the primary definitive frameworks within the recent 5-year cycle.
| Dimension and theme | Sources | Core theoretical focus | Critical analytical limitation |
|---|---|---|---|
| Systematic and strategic capital alignment perspective | Schweitzer and Graebe ( |
Emphasises long-term organisational agility by aligning talent pipelines with shifting institutional visions | Often overestimates bureaucratic flexibility and neglects the realities of resource constrained public healthcare. |
| Transactional competency and identification approach | Tyler ( |
Applies behavioural economics to audit workforce skills and identify leadership traits | It risks reducing leadership potential to static, algorithmic checklists. |
| Institutional memory and knowledge transfer dimension | De Gruyter ( |
Underscores gerontological and cultural continuity through deliberate preservation of institutional knowledge | It can entrench outdated practices and assumes older generations have both the time and willingness to mentor. |
| Structured market and career pathway model | Atwood ( |
Focuses on visible career trajectories to enhance retention and competitiveness | Reliance on predictable organisational structures falters in chaotic, high turnover public health systems. |
Note: Please see the full reference list of this article Motlhaole, L.G., Luhalima, T.R., & Mudzweda, A.D. (2026). Succession planning in nurses leadership: Perceptions from a public hospital in Mangaung district, Free State province.
Synthesising these definitional boundaries reveals a profound theoretical divergence between macro-strategic models (Schweitzer & Graebe,
This friction is further mirrored chronologically. De Gruyter’s (
Ultimately, the fundamental flaw across this entire definitional spectrum is the naive presumption of structural equilibrium. These models operate on the idealist premise that healthcare facilities enjoy ample administrative capacity, fiscal predictability and staffing surpluses. By disregarding the volatile, chaotic realities of overextended and underfunded public health systems, these conceptual frameworks remain largely academic abstractions isolated from clinical practice.
Research from 2020 to 2025 highlights a persistent disconnect: healthcare organisations universally acknowledge the value of succession planning, yet its practical application is highly inconsistent. This implementation gap can be analysed through a critique of distinct operational pillars:
Martin and O’Shea (
Integrated succession planning models, championed by organisations such as the American Organization for Nursing Leadership (AONL), emphasise mentoring, experiential learning and alignment with institutional values (AONL Workforce Committee,
Bell (
An alignment between the succession plan, organisational strategy and organisational values is crucial for the effective implementation of the succession plan (Feldman,
A critical shortcoming in succession planning research is its reliance on macro-level, urban or international data, which fails to capture the realities of localised, resource-constrained public healthcare environments. The unique challenges faced by public institutions such as rigid civil service structures, politically influenced appointments, local labour dynamics and severe provincial budget constraints are largely absent from mainstream scholarship. This omission creates a void in understanding how succession planning operates within the fragile infrastructures of public hospitals.
There is therefore an urgent need for localised research that moves beyond broad descriptive accounts and instead analytically investigates how frontline registered professional nurses in highly burdened regional hubs, such as the Mangaung district, experience and navigate systemic barriers. By focusing on the lived realities of nurses in these contexts, succession planning can be reframed from an abstract corporate ideal into a practical, resilient framework tailored to the demands of public healthcare. Bridging this gap is essential for developing succession strategies that are not only theoretically sound, but also operationally viable in resource-constrained environments.
A qualitative exploratory-descriptive design was applied in this study to get a deeper understanding from the participants. An exploratory design was essential in probing the fragmented nature of South African healthcare succession (Hunter et al.,
The study was guided by an interpretive paradigm, as the researcher sought to understand the perceptions, lived experiences and understanding of succession planning among professional nurses in the selected public hospital.
The study was conducted in Mangaung district, in the Free State province of South Africa. It is the second-least populated province in South Africa. The district encompasses both urban and rural areas, with the province serving as the provincial capital and primarily an urban hub. It is diverse, with multiple languages being spoken. Services are rendered through a network of primary healthcare centres and community healthcare centres, and through a referral system between two hospitals. Despite this, the institution faces chronic staff shortages, operational injustices and delayed service delivery.
The researchers served as instruments by conducting interviews while observing participants’ interactions and behaviours. This approach enabled the researcher to describe participants’ reactions to the research questions. The researcher mitigated bias through peer debriefing by engaging experts and peers in the field about the study’s outcomes, using a journal to record their own judgements, expectations and experiences throughout the study, and encouraging participants to detail their understanding without hesitation.
The study population included all registered professional nurses in different units who are registered with the South African Nursing Council. The target population was registered professional nurses with more than 5 years of clinical experience, leadership skills and qualifications that warrant them for leadership positions in the selected public hospital. The intended sample size was 20 participants who are permanently employed in the institution, however sample size determined by data saturation. Data saturation was reached with Participant 13; the number was stretched to 20 due to the willingness of the participants, and with the hope that new information may suffice during the interviewing stage. A non-probability purposive sampling was used to identify registered professional nurses in the selected healthcare facilities.
Interested participants were given an information sheet detailing the study’s process, purpose and the information was explained. Participants signed informed consent, and appointments were made for interviews. The interviews were conducted in participants’ respective units due to staff shortages, during which participants were unable to leave their stations, while others were conducted in a selected office with a ‘do not disturb’ sign on the door. Interviews lasted between 15 min and 30 min per participant. The following central question was asked: ‘How do you view leadership succession planning in your hospital, and what challenges or opportunities do you see in implementing it?’ Data were collected from November 2025 to January 2026. The research question was broken into two parts, as the researcher observed during the pretest phase that participants only focused on the challenges and their views on leadership succession planning in this institution. Interested participants were given information sheet detailing the study’s process, purpose and the same information sheet was explained for clarity purposes.
An audio tape recorder was used and included in the information sheet. The purpose of recording was to capture the interviews as raw as they came and later transcribe them for analysis. Additionally, field notes were taken to complement the interviews.
The qualitative data were analysed using Braun and Clarke’s (
The study ensured methodological rigour by meeting four key qualitative criteria: credibility was achieved through member checking by having participants verify data accuracy and prolonged engagement, whereby the researcher spent extended time with them during day and night shifts interacting with participants and later reflected on their experiences off record. Dependability was maintained through a detailed audit trail tracking all research and analytic steps. Transferability was supported by using purposive sampling to gather diverse nursing perspectives and providing a thick description of the setting for future context comparison. Confirmability was secured by archiving transcripts, recordings and field notes to ensure findings were data-driven rather than biased.
Ethical clearance was obtained from the University of Venda Research Ethics Committee (FHS/25/PDC/07/204). Permission was granted from the Free State Department of Health (Bophelo House) and the selected public hospital in Mangaung District. Participants aged 18 years or older signed the informed consent forms. All participants were reminded that the interviews were confidential, allowing them to speak freely and to withdraw from the study without giving a reason. Codes were used to hide and protect participants’ identities. Confidentiality was maintained by storing signed informed consent forms in a secure location with limited access by the researcher.
The study cohort comprised 20 participants, predominantly female registered professional nurses (
Demographic profile of participants (
| Demographic variable | Category | |
|---|---|---|
| Gender | Male | 2 |
| Female | 18 | |
| Age group (years) | 30–39 | 5 |
| 40–49 | 7 | |
| 50–59 | 6 | |
| 60–69 | 2 | |
| Clinical experience (years) | 5–14 | 4 |
| 15–29 | 14 | |
| 30+ | 2 |
Transcript analysis revealed one overarching theme, an institutional void in structured succession planning-supported by three sub-themes. These deficits manifested structurally through informality and stagnation, communicatively through ambiguity and information asymmetry and behaviourally through reliance on temporary ‘acting’ roles. Collectively, the findings highlight how the absence of strategic succession governance fosters short-term fixes that undermine workforce stability and transformational leadership.
Summary of theme and sub-themes.
| Theme | Sub-themes |
|---|---|
| Perceptions and systemic architecture of succession planning | Absence of formal or standardised structures Reactive gap-filling and the cycle of ‘Acting’ roles Misalignment of definitions and communication gaps |
Participants stated that they are frustrated by the unstructured environment, which promotes stagnation, in which nurses perform the same clinical tasks without any indication of future development or preparation to become leaders. This feeling is reflected in the following excerpts:
‘And the answer is no. We don’t have any succession plans in our institution.’ (Participant 5, 38, Male, Registered Professional Nurse)
‘I find that there are no proper structures in place to ensure leadership continuity. There is no HR-managed system where a manager formally identifies two or three mentees among registered professional nurses … So overall, the system is too informal. There is no structure.’ (Participant 11, 37, Female, Registered Professional Nurse)
‘We come to work, we do our duties, and that’s it. There is no structured way of saying, “You are being prepared for management.”’ (Participant 15, 33, Female, Registered Professional Nurse)
Nonetheless, participants had noted that they received little guidance and mentorship and lacked communication on leadership opportunities. These issues are further depicted in the next quotes:
‘Um, my view is, uh, that normally a succession planning is done within the, the premises. So normally you find the, the manager already, already having one or two people that they are already training.’ (Participant 6, 49, Female, Registered Professional Nurse)
‘It’s no longer about who qualifies or performs well; it’s about who is recommended.’ (Participant 3, 52, Male, Registered Profession Nurse)
‘I do not think leadership succession planning is well established here. There is no clear structure that identifies potential leaders among registered professional nurses or prepares them for management roles.’ (Participant 13, 34, Female, Registered Professional Nurse)
Acting appointments were described as informal, unsupported and rotational, with minimal learning, mentorship and accountability. This goes against best-practice advice, which states that acting roles must be part of a formal leadership pipeline that incorporates coaching, feedback and increased responsibility. The lack of these components restricts the developmental worth of acting positions and compromises their contribution to training future nurse leaders.
The excerpts that follow indicate the disjointed and haphazard character of acting appointments in the institution:
‘Instead of them appointing somebody, there are candidates for the post, ne. They’ll keep on inviting people to come and act. They act for a certain period, and then once that period is over, they change to another person and whatnot. Okay. So, they, they, they always get people that are acting to act on the post.’ (Participant 7, 55, Female, Register Professional Nurse)
‘Sometimes you may be asked to act as an in-charge when the unit manager is not around, but that is not succession planning. That is just filling a gap for the day. There is no mentorship, no coaching, no follow-up. You are just expected to make sure the ward runs, and when the manager comes back, everything goes back to normal.’ (Participant 15, 33, Female, Registered Professional Nurse)
‘An acting appointment letter was issued without informing her. She only found out when she came on duty in the evening after working a night shift. An ENA handed her the letter and said, “The OPM asked me to give you this.” It was not her position, and no one took responsibility for the poor communication.’ (Participant 11, 37, Female, Registered Professional Nurse)
The performing roles were viewed as symbolic rather than substantive, and some participants considered them a way to postpone permanent assignments or evade financial obligations. The lack of a long-term leadership plan supports what the literature identifies as a significant obstacle to successful succession planning. Image is supported by reports of passive managerial opposition and the absence of policy action:
‘Everything happens unexpectedly. One day you hear that someone is retiring, and the next thing, someone new is appointed, often from outside. Another challenge is lack of policy implementation. Policies exist on paper, but they are not practiced.’ (Participant 16, 60, Female, Registered Professional Nurse)
‘Occasionally, nurses are asked to act as unit managers when someone is away, but there’s no mentorship or guidance. Acting roles are temporary and do not provide meaningful development.’ (Participant 20, 44, Female, Registered Professional Nurse)
‘After repeating the suggestion multiple times with no change, I realised this was passive resistance. He took the template, displayed it on the notice board, but no action followed. The dysfunction continued.’ (Participant 11, 37, Female, Registered Professional Nurse)
Only few participants (7 of 20) reported limited knowledge or perceived communication failures in the process by which the hospital develops future leaders. This theme implies that the current state of succession planning is defined by a lack of connection between the administrative will and frontline consciousness. It is noted that a lack of communication and transparency negatively affects successful succession planning. Some registered professional nurses were even unaware of the term, and it had to be defined live during interviews, indicating that the concept of succession planning has not been properly socialised by management in the clinical setting.
The subsequent quotes reflect the confusion and apparent obscurity of the planning process in the first place:
‘Mmmh, I don’t know actually how I’ll answer that question. Leadership … I think in [
‘No, most of the thing, they don’t, ehh, I don’t know about the succession planning. And most of the things they … They are what. I don’t reveal anything to us.’ (Participant 2, 57, Female, Registered Professional Nurse)
‘I want clarity of succession planning. What is it all about?’ (Participant 4, 39, Female, Registered Professional Nurse)
The reluctance and straightforward demands to define underlines a clear communication gap, whereas certain answers describe it as a conscious refusal by management to provide information. The lack of these components highlights a failure of correspondence between leadership ideals and practice.
This misalignment and structural invisibility of leadership planning are reflected in the quotes below:
‘Oh, it is usually done in the office. Some units have shift leaders for patient care only, not for office work.’ (Participant 10, 57, Female, Registered Professional Nurse)
‘In nursing, everything we do is based on handover – moving from one shift to another – so that the transition is smooth, routine, and systematic. However, in terms of leadership, the problem is that there are many factors outside the bounds of professionalism.’ (Participant 11, 37, Female, Registered Professional Nurse)
‘If it exists, it is not clearly communicated to registered professional nurses. Most of us do not understand how leadership positions are planned or how people are prepared for them.’ (Participant 12, 43, Female, Registered Professional Nurse)
The study reveals a pervasive absence of standardised succession planning within the institution, with 19 of 20 participants confirming that leadership structures are either missing or poorly defined. Career advancement is perceived as erratic and unattainable because development remains ad hoc and dependent on individual managers rather than formal Human Resource (HR)-driven systems. This lack of structure mirrors global findings that public healthcare organisations often fail to implement succession planning despite recognising its importance (Martin & O’Shea,
In the South African context, these results underscore systemic challenges within the public health sector. As noted by Chun and Evans (
The data also highlight a failure to embody transformational leadership principles, particularly individualised guidance and clear career pathways (Broome,
The study shows that succession planning in the institution has been reduced to short-term crisis management, with leadership continuity dependent on repetitive acting appointments rather than structured mentorship or talent development. Twelve participants confirmed that these roles functioned as temporary stopgaps, lacking oversight, feedback and learning objectives, which fostered exclusion and disengagement among nurses.
This pattern reflects Karthik’s (
In the South African context, these findings resonate with systemic challenges in the public health sector. National frameworks such as the National Development Plan (NDP 2030) and the Human Resources for Health Strategy (2012/2013–2016/2017) stress the importance of structured leadership pipelines to ensure service delivery and sustainability. Yet, implementation remains fragmented, weakened by chronic resource constraints, high staff turnover and politicised appointments. The notion is not in par with the Office of Health Standards Compliance (OHSC) criteria which penalises leadership instability and weak operational management.
Ultimately, the institution’s dependence on reactive acting roles perpetuates stagnation, erodes trust and prevents the development of a sustainable nursing leadership pipeline. This governance vacuum compromises organisational resilience, restricts knowledge transfer and obstructs professional advancement, leaving the facility ill-prepared to cultivate the next generation of nurse leaders.
The study highlights a profound conceptual ambiguity surrounding leadership succession planning in the facility. Only 35% of participants demonstrated any familiarity with succession mechanisms, with several requiring definitions during interviews. This lack of awareness reveals that succession frameworks are excluded from daily professional discourse and disconnected from frontline clinical practice, creating a significant communication gap between administrators and staff.
These findings align with prior scholarship emphasising that communication deficits and operational opacity undermine succession planning (Hafnidah et al.,
The reliance on informal promotion practices also echoes documented patterns of favouritism and marginalisation, diverging from best-practice guidelines that call for formal mentorship and structured communication (AONL Workforce Committee,
Given the high rates of staff retirement, turnover and the demanding healthcare system, these findings have several implications:
In the absence of standardised succession frameworks, nepotism and unequal promotional opportunities flourish, which directly damages employee morale and compromises staff retention.
The systemic lack of deliberate pathways and professional mentorship stalls the development of a future leadership cohort, intensifying employee burnout and accelerating turnover rates.
With the ongoing transition towards National Health Insurance (NHI) in South Africa, healthcare organisations are required to satisfy the strict criteria of the OHSC; however, leadership volatility and deficient succession frameworks threaten institutional accreditation, clinical safety and the execution of these healthcare reforms.
Implementing deliberate succession management founded upon open communication, career mentorship and structural policy compliance provides a vital mechanism to disrupt crisis-driven temporary staffing, reinforce the nursing leadership pipeline and secure long-term organisational continuity within under-resourced public health institutions.
Strategic succession planning facilitates seamless leadership handovers, ensuring uninterrupted patient care. By proactively identifying successors, healthcare facilities can eliminate management gaps during executive departures and strengthen their overall stability in the face of staffing shortages. Furthermore, by establishing defined career trajectories, organisations can decrease their dependence on temporary ‘acting’ positions, which rarely provide meaningful professional growth. This approach not only curbs turnover and burnout, but also bolsters retention by providing nursing staff with tangible, motivating advancement opportunities.
The study explored succession planning among registered professional nurses at a public hospital in the Mangaung district, Free State, and offers four key recommendations tailored to South Africa’s public health sector realities:
Formulate transparent, merit-based policies aligned with Chapter 4 of the Public Service Regulations to eliminate favouritism and bridge the policy-to-practice gap.
Embed cost-effective leadership mentoring into existing clinical supervisory roles to encourage knowledge transfer without placing an extra financial burden on the facility.
Dismantle bureaucratic administrative silos to ensure frontline nursing staff are openly informed about leadership opportunities and planning processes.
Create clear professional advancement maps using low-cost, in-service modules and nursing college partnerships to prepare eligible nurses for future management positions.
Despite it’s contribution, this study also has limitations:
The researcher’s active role in data collection and thematic analysis may have introduced subjectivity, despite the rigorous use of reflexivity.
Being confined to one public healthcare facility limits the generalisability of the findings to other hospitals or provinces.
Conducting interviews in Sotho/Tswana and translating them into English introduces the risk of losing subtle cultural idioms or semantic meanings.
Power Rigid workplace hierarchies may have caused some participants to temper their responses due to fear of professional reprisal or authority differences.
The study revealed that the facility relies on reactive, crisis-driven replacement planning rather than structured succession pathways, which alienates nurses and lowers morale. This problem stems from a disconnect between administrative policy and clinical practice, leaving leadership opportunities hidden and opaque. To protect patient care quality and combat severe nurse turnover, the institution must immediately pivot from short-term gap-filling to a transparent talent pipeline rooted in standardised guidelines, open communication and embedded mentorship.
The authors would like to express their sincere appreciation to the study participants.
The research presented in this article formed part of Lebogang Godfrey Motlhaole’s postgraduate studies and was originally conducted as part of their MCur titled: ‘Leadership Succession Planning for Registered Professional Nurses in a Selected Public Hospital in Mangaung District, Free State Province’, submitted to the Faculty of Health Sciences, Department of Nursing Sciences, University of Venda in 2026, under the supervision of Takalani R. Luhalima and Aluwani D. Mudzweda. The article was submitted in partial fulfilment of the requirement for the Masters in Nursing Science degree. The manuscript has since been revised and adapted for journal publication. The original thesis has not been published.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Lebogang G. Motlhaole: Conceptualisation, Data curation, Investigation, Methodology, Visualisation, Writing – original draft. Takalani R. Luhalima: Conceptualisation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing. Aluwani D. Mudzweda: Formal analysis, Writing – original draft, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication and take responsibility for the integrity of its findings.
The data that support the findings of this study are available from the corresponding author, Lebogang G. Motlhaole, upon reasonable request.
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.