The Rise of Outsourcing and Casualisation of Nurses in the Private Hospital Sector

Abstract

The nursing sector occupies a contradictory position within the contemporary healthcare system. Nurses perform essential work that sustains life and ensures the functioning of health institutions, yet many are employed under precarious conditions that undermine their stability, recognition and economic security. This contradiction is particularly evident in South Africa’s private hospital sector, where nursing agencies have become a central mechanism for organising and managing labour. While agency employment offers flexibility for healthcare institutions, it often transfers the risks and insecurities of employment onto nurses through irregular work, income uncertainty and limited employment protections. This paper examines how agency nurses experience and navigates precarious employment within South Africa’s private hospital sector. Drawing on qualitative evidence, it explores nurses’ everyday working conditions and how workplace precarity extends beyond the hospital into the home, shaping family life, financial security and social wellbeing. Rather than treating agency nurses as passive victims of insecure employment, the paper highlights their agency by examining the strategies they employ to negotiate, resist and adapt to precarious conditions. The paper argues that although agency nurses are embedded within exploitative labour relations that prioritise flexibility and cost reduction, they actively create alternative forms of sustenance and survival. These strategies include building informal support networks, diversifying income sources and exercising individual and collective forms of resistance that challenge the constraints imposed by precarious work. By highlighting nurses’ everyday practices of resilience and resistance, the paper contributes to broader debates on labour precarity, agency work and care work. It demonstrates that while precarious employment reproduces insecurity and inequality, agency nurses continue to forge meaningful pathways towards economic survival and collective wellbeing within an increasingly marketised healthcare system.