A tale of two systems--nurses practice environment, well being, perceived quality of care and patient safety in private and public hospitals in South Africa: a questionnaire survey

Objective: To examine the practice environment, nurse reported quality of care and patient safety, and nurse workforce outcomes in medical and surgical units in private and public hospitals in South Africa (SA), and determine the association of modifiable features of the hospital such as the practice environment and patient to nurse workloads on these outcomes.

Design: Cross-sectional survey of nurses.

Setting and participants: Nurses were surveyed in medical and surgical units of 55 private hospitals and 7 public national referral hospitals in SA. A total of 1187 nurses completed the survey.

Measurements: Practice environment, patient to nurse workloads, nurse reported quality of care and patient safety, and nurse workforce outcomes including burnout, job satisfaction and intention to leave.

Results: On a national level, more than half, 54.4% (634/1166) of nurses intend to leave their hospital within the next year due to job dissatisfaction and 52.3% (600/1148) rate their practice environment as poor or fair, while almost half, 45.8% (538/1174) report high levels of burnout and 44.9% (517/1152) are not confident that management will resolve patient problems. Public hospital nurses report more negative outcomes than private hospital nurses. Some 71% (320/451) of public hospital nurses rate their practice environment as poor/fair, 62.9% (281/447) are not confident management will resolve patient problems, and 59% (272/461) intend to leave their hospital within the next year due to job dissatisfaction. On a national level, more favourable practice environments are significantly associated with more positive nurse reported quality of care, and nurse workforce outcomes. This is true for private and public hospitals. Patient to nurse workloads are also significantly associated with more positive nurse reported quality of care and patient safety, and nurse workforce outcomes, but primarily in public hospitals.

Conclusions: Improving the practice environment, including patient to nurse ratios holds promise for retaining a qualified and committed nurse workforce and may benefit patients in terms of better quality care.