Unit nurse managers in Malawi experience many challenges in the course of performing their
roles. This affects their performance and service delivery including the quality of nursing care to
patients. This study was conducted to determine the factors that hindered performance of unit
managers in relation to expected quality of nursing services at two referral facilities (Kamuzu and
Queen Elizabeth Central hospitals) in Malawi. These two central hospitals have the same structural
settings and both offer specialized tertiary health services. A quantitative descriptive design
was used to guide the planning and implementation of the study. Purposive sampling was used to
select the two major hospitals in Malawi and all available 37 unit nurse managers during the time
of the study at the two hospitals participated in the study. Data were collected using semi-structured
questionnaires after seeking consent from the participants and were analyzed using SPSS
version 16.0. The major roles identified by the unit managers were supervision (75.6%, n = 28)
and coordination (70.3%, n = 26). Other roles such as team leader, liaison officer, research allocator,
monitor and facilitator were rated by very few participants. Findings of the study showed that
performance of unit nurse managers was affected by inadequate material (86.4%, n = 32) and
human resources (94.5%, n = 35) and lack of managerial skills (5.4%, n = 2). In addition, the unit
managers perceived their role to be stressful (38.9%, n = 14) and challenging (47.2%, n = 17).
Therefore, there is a need to provide adequate material and human resources to the wards of the
two central hospitals to enable the unit managers perform their duties efficiently.