A Qualitative Study of the Nurses' Perceptions of their Practice Environments in two Selected Hospitals in Gauteng Province

Abstract

BACKGROUND South Africa, similar to many low- and middle-income countries (LMICs), faces significant human resources for health (HRH) challenges, including an aging workforce, heavy workloads, inadequate staffing, insufficient equipment, and unequal distribution of health professionals between the public and private sectors, as well as between urban and rural areas. While the causes of this crisis are complex, unhealthy work environments are a significant contributing factor. Improving nursing practice environments is essential for addressing these challenges, as healthy environments correlate with increased job satisfaction, retention, and patient care quality. However, research on nurses' practice environments in LMICs, particularly South Africa, is limited, especially qualitative studies utilising the domains of the Practice Environment Scale of the Nursing Work Index (PES-NWI) to gauge nurses' perceptions. METHODOLOGY Therefore, this study explored nurses’ perceptions of their practice environments in both public and private hospitals in Gauteng province. An exploratory qualitative study design was used, and data was collected from April to June 2023. A multi-stage sampling strategy was used to select all categories of nurses from the two selected hospitals in Gauteng to participate in the study. Face-to-face in-depth interviews were conducted with eighteen participants using a semi-structured interview guide. Thematic analysis was done using MAXQDA Plus 2022 software. RESULTS Eighteen nurses were interviewed, exploring eight domains related to their practice environments: participation in hospital affairs, managerial support, foundations for quality care, staffing adequacy, resource availability, team collaboration, staff development, and safety. Contradictory views emerged, with some nurses expressing positive perceptions while others reported negative experiences, particularly regarding involvement in decision-making and managerial support. Participants identified a lack of adequate staffing and resources, with differing views on team collaboration and communication. Facilitators for a positive practice vii environment included in-service training opportunities, resource provision, and supportive management. Barriers included limited professional growth opportunities, excessive workloads, and inadequate resources. To enhance practice environments, participants suggested strategies such as adequate staffing, resource provision, professional development opportunities, recognition, and improved managerial support. CONCLUSION This study highlights the critical need for addressing barriers to create healthier work environments for nurses, ultimately improving patient care quality and workforce stability. Moreover, nurses had solutions for the improvement of their work environments which could be detrimental to the nurse managers and policy makers to improve the nurse work environments as perceived by the people on the ground. Therefore, nurse managers and policy makers should adopt and implement fair and transparent policies for workload distribution and scheduling, ensuring that nurses have a manageable workload and a healthy work-life balance. This could include the involvement of nurses in decision-making pertaining to hospital affairs. Nurses could be given opportunities to be part of the policy formulation where surveys can be distributed to have their views as their involvement would improve the work environment.