Nurses In South Africa Research Articles

Facilitating psychiatric nurses’ advocacy for mental healthcare users’ human rights in a primary healthcare setting: a conceptual framework

BackgroundEven though human rights advocacy is a part of mental health care, psychiatric nurses in South Africa’s primary healthcare (PHC) setting face substantial challenges when advocating for the rights of mental health care users (MHCUs). The study aimed to develop a conceptual framework to facilitate psychiatric nurses’ advocacy for mental healthcare users’ human rights in a PHC setting.MethodsA qualitative, exploratory, descriptive, and contextual design was used to investigate the psychiatric nurses’ experiences advocating for MHCUs’ human rights in a PHC setting. Three phases were followed: the empirical phase, the classification of concepts, and a development phase. Following the empirical phase, a conceptual framework was developed to facilitate psychiatric nurses’ advocacy for MHCUs human rights in a PHC setting.ResultsThree themes were derived from focus group interviews with psychiatric nurses in the empirical phase. These themes yielded the central concept as ‘the facilitation of empowerment’ of psychiatric nurses in advocating for MHCUs’ human rights. The central concepts were also classified. A conceptual framework was developed that included the relationship, working and termination phases.ConclusionThe study described the development of a conceptual framework to facilitate psychiatric nurses’ advocacy for mental healthcare users’ human rights in a PHC setting. Psychiatric nurses play a key role in advocating for the human rights of MHCUs. This task is important and should be implemented from the government to the societal level, including all stakeholders.

Coping in crisis: The role of sense of coherence, life satisfaction, and resilience in the relationship between depression, social support, fear of COVID-19, and perceived vulnerability to disease among nurses in South Africa

In the context of the formidable challenges posed by the COVID-19 pandemic, healthcare professionals coped in various ways. This cross-sectional survey study sought to examine the protective role of satisfaction with life, sense of coherence, and resilience in the relationship between depression, social support, fear of COVID-19, and perceived vulnerability to disease among nurses in South Africa. Participants were a convenience sample of nurses ( n = 264) working at four South African hospitals in the Western Cape. Data were collected by means of an electronic survey and analysed using structural equation modelling. Participants completed a comprehensive battery of psychological measures. We found that while higher levels of fear of COVID-19 robustly predicted depressive symptomology among nurses, factors such as sense of coherence, and social support emerged as protective resources. These protective factors have the potential to alleviate the mental health impacts of pandemic-related stressors among nurses.

Impact of burnout on depression among nurses at a private hospital in Johannesburg, South Africa.

Burnout is a syndrome that is understood as emanating from chronic workplace stressors that have not been managed successfully. Little is known about the causes of burnout among nurses in South Africa. The study aimed to determine the prevalence of burnout and its impact on depression and assess the relationship between burnout and depression among nurses at a Johannesburg private hospital. Nurses at a private hospital in Johannesburg were asked about their exposure to depression and burnout using a closed-ended questionnaire as part of a quantitative, cross-sectional study design. Ap-value 0.05 was considered statistically significant. The respondents were selected using the simple-random sampling method. The collected data were analysed using IBM-SPSS version 28. The study involved 112 nurses, of whom 95 (84.8%) were females. Most of the nurses, that is, 56 (50.0%) were registered nurses. Emotional exhaustion (p= 0.001) and depersonalisation (p= 0.001) were significantly associated with depression. Work experience (p= 0.001) and depersonalisation (p= 0.002) had an impact on depression. The study revealed a high prevalence of burnout among nurses at a Johannesburg private hospital. The study found that depression was significantly associated with emotional exhaustion and depersonalisation. The study also found that work experience and depersonalisation have an impact on depression.Contribution:The study's recommendations can help mitigate burnout and improve the well-being of nurses, ultimately enhancing the quality of healthcare services provided at the hospital.

Stirring the Forensic Nursing Pot in South Africa

This is a brief summary of forensic nursing in South Africa and the development of a forensic nursing specialization.

Student nurse perceptions of family nursing practices in South Africa: A descriptive survey.

Family nursing practices (FNPs) are gaining momentum in global literature, but the available research has targeted qualified nursing professionals. There are limited studies exploring this phenomenon in undergraduate student nurses in South Africa. The study aimed at exploring the undergraduate student nurse perceptions of FNPs. The study was conducted at a selected university in KwaZulu-Natal, South Africa. A descriptive survey design was used to purposively select undergraduate nursing students. The Family Nursing Practice Scale (FNPS) was used to collect data online. Descriptive and inferential statistics were used to analyse quantitative data. Open ended questions were analysed using content analysis. Out of 154 participants, 77 responded to the questionnaire, translating to a response rate of 50%. Compared with other studies in literature, student nurses rated their overall FNP as being low (M = 3.43, s.d. = 0.99). A further descriptive analysis revealed better FNPs (2.97) for 3rd year compared to 2nd year (3.90) nursing students with significance differences in the means (p < 0.0001). While family conflict, maintaining confidentiality, ill prepared and absent family were challenges experienced in FNP, advantages included obtaining detailed information, ability to plan individualised care and enhanced student nurse-family relationship. A lower critical practice appraisal and lower perceptions of interaction and reciprocity in the nurse-family relationship were identified. There is need for an inclusive curriculum that promotes and advocates for family nursing within the undergraduate programme. This study highlights the importance of teaching family nursing to undergraduate student nurses.

A knowledge retention strategy for professional nurses in South Africa

This paper explores the existing knowledge retention strategies for professional nurses at Philadelphia hospital, in South Africa, located in one of the previously disadvantaged district municipalities in the country and it develops a strategy for retaining nurses. Design/Methodology/Approach: The study adopted a qualitative research approach and a case-study design. Semi-structured interviews were used to solicit in-depth understanding of the current knowledge retention practices. Out of the 90 professional nurses at Philadelphia hospital, 20 were purposively interviewed to a point of saturation. Data was analysed thematically. Findings: A knowledge retention strategy was developed. It calls for a knowledge retention policy; awareness training programmes; reward systems for effectively encouraging professional nurses to participate in knowledge retention practices; programmes for recovering lost knowledge and conducting knowledge audits. The strategy contributes to the existing body of knowledge-on-knowledge retention in the health care sector. The article is part of the findings from the authors master's dissertation. Conclusion: The loss of critical nursing knowledge remains a challenge in South Africa and to the rest of the globe, as highly skilled and experienced nurses migrate from place to place in search of greener pastures, hence this has affected patient care. Although the country has engaged in several efforts such as educating and training nurses, its knowledge retention strategies have not been prioritised in the country. Limitations: This paper focuses on knowledge retention practices in the nursing profession, which is only one part of the health sector in the former disadvantaged province. It is a qualitative study performed in one out of the nine provinces in South Africa. There is a dire need for a quantitative study, which will explore knowledge retention amongst nurses in the country and the health sector as a whole

Knowledge and attitudes of HIV pre-exposure prophylaxis among nurses in South Africa.

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) has shown efficacy and effectiveness in populations who practise high-risk sexual activity. Nurses' knowledge and positive attitudes enhance PrEP implementation. This study aimed to investigate the knowledge of and attitudes towards PrEP among nurses in primary health care facilities. The study was conducted in 10 health facilities that offer comprehensive services in Tshwane, South Africa. A cross-sectional survey assessed the knowledge of and attitudes towards PrEP among 114 nurses. Univariate, bivariate and logistic regressions were performed to estimate odds ratios and to determine whether age, sex and education had an association with the knowledge and attitudes. Majority of the study sample consisted of female nurses (92.1%), and most respondents (68%) had moderate PrEP knowledge. Logistic regression showed that age and education were not associated with high level of knowledge. Pre-exposure prophylaxis was viewed negatively by 84.5% of the respondents. The odds of positive attitudes towards PrEP were 1.92 times higher among males than females (95% CI 0.54-6.83) and 1.24 times higher among nurses who had bachelor's degree than diploma holders (95% CI 0.51-3.01). This study found that there is a need to strengthen the dissemination of information about PrEP, and nurses in South Africa require training to improve their knowledge of and attitudes towards PrEP.Contribution: The findings of the study add to the current knowledge base regarding PrEP access in the public healthcare system and it highlights gaps in the training of healthcare providers.

Primary health care nurses' knowledge, self-efficacy and performance of diabetes self-management support.

Patients living with diabetes are primarily managed and supported by nurses in primary health care (PHC). Therefore, PHC nurses require knowledge of diabetes and confidence (self-efficacy) to perform diabetes self-management support (SMS). This study evaluated the diabetes knowledge, self-efficacy and performance of diabetes SMS by PHC nurses. Primary health care facilities in King Sabata Dalindyebo subdistrict, O.R. Tambo district, Eastern Cape. A quantitative cross-sectional and simple correlational design was used. Registered nurses (n = 100) completed a validated self-reporting questionnaire to measure diabetes knowledge, self-efficacy and performance of SMS. Participants' diabetes knowledge mean scores were high (mean of 11.9, standard deviation [s.d.] 1.8, out of 14). Self-efficacy scores (mean 18.91, s.d. 3.2 out of 24) were higher than performance of SMS scores (mean 17.81, s.d. 3.3 out of 24). Knowledge was not associated with self-efficacy or performance, but self-efficacy was positively correlated with performance of SMS (r = 0.78, p 0.01). Nurses with a postgraduate qualification in primary care nursing had significantly higher diabetes knowledge scores (mean = 92.9 vs. 83.8; p = 0.03), and years of experience as a nurse were positively correlated with the performance of SMS (r = 0.21, p = 0.05). Diabetes knowledge of PHC nurses in this study does not translate into self-efficacy and the performance of SMS in practice, indicating the need for specific SMS training, support by experienced mentors, appropriate guidelines and comprehensive integrated chronic care systems.Contribution: This is the first study to report on the SMS self-efficacy and performance of PHC nurses in South Africa.

Compulsory Community Service for New Nurse Graduates in South Africa: A Narrative Literature Review

<h3>Background</h3> In South Africa, nurses and midwives who have undergone a comprehensive 4-year diploma or degree in nursing (General, Psychiatric, Community, and Midwifery) from a public nursing college or university are expected to perform compulsory community service (CCS) at public health facilities. Compulsory community service is a requirement for nurses and midwives to be registered with the South African Nursing Council—the South African regulatory body—as professional nurses in terms of Section 40 (3) of the Nursing Act. <h3>Purpose</h3> This narrative review seeks to understand the effectiveness, strengths, and areas of improvement of the CCS regulation for nurses in South Africa. <h3>Methods</h3> A narrative review of the literature was conducted to consolidate reported experiences and perceptions regarding the formal South African CCS program for new graduate nurses. Using purposive sampling, three online databases—African Journals Online, Google Scholar, and Science Direct—were searched for relevant literature. The review search items included "community service for nurses," "compulsory community service," "community service nurses," "community service practitioners," and "newly qualified nurses." The review included theses, dissertations, and peer-reviewed publications written and published in English from 2008 to 2022. Included literature focused explicitly on the experiences of community service nurses (ie, nurses completing the CCS) or the perceptions of experienced nurses, including professional nurses and nurse mangers, with respect to CCS for nurses in South Africa. Media reports and reports from other databases were excluded. <h3>Results</h3> The findings identified from this review were categorized into three main themes: (1) positive and negative experiences of CCS, (2) perspectives regarding CCS, and (3) administrative and operational challenges encountered during CCS. <h3>Conclusion</h3> CCS enhanced the preparedness of new graduate nurses to practice, with several studies indicating a high level of confidence to practice among new graduates. However, the challenges encountered during the 12 months of the program—including issues with placement, remuneration versus the workload, and responsibilities, as well as the lack of scope of practice rules, clear policies, or standardized guidelines—cannot be ignored. There is an urgent need to address the administrative and operational challenges to achieve the objective goals of CCS for nurses in South Africa.

Preconception Care Recommendations, Training, and Competency of Primary Healthcare Nurses in South Africa: A Quantitative Descriptive Study.

There has been a growing interest in preconception care (PCC) as a primary means of tackling the high maternal and child mortality rates, as evidence has shown that the state of maternal health before conception can have a direct impact on the health of the mother and baby. Primary care nurses have been recognized as the highest providers of sexual and reproductive healthcare to the vulnerable population in resource-constrained settings. This study aimed to examine and describe the PCC recommendations, training, and competency of primary healthcare (PHC) nurses in South Africa. A cross-sectional descriptive study was conducted among 196 PHC nurses to examine the PCC recommendations, training, and competency. A self-administered survey tool was used for data collection. The self-reported PCC recommendations, training, and competency of PHC nurses were 63.3%, 88.3%, and 94.9%, respectively, in each aspect. The PCC training among the respondents was mainly in-service training. The only training that was indicated to have been done primarily at a pre-service level was training about reproductive life plan screening and brief counseling. Over 20% of the respondents indicated that they did not receive any training on how to provide alcohol, drug, or tobacco cessation services and how to conduct preconception risk assessments. Although PHC nurses reported a high level of recommendation, training, and competency, their level of reported PCC practice is not equivalent to their provision, as they rendered PCC services to fewer women, and they also reported fewer women seeking PCC. A future longitudinal study is required to examine the reason for low PCC-seeking habits among those at high risk of adverse pregnancy outcomes and contextual factors influencing the provision of PCC services among healthcare workers.

Factors influencing the information behaviour of doctors and nurses in South Africa’s Eastern Cape, Mpumalanga, Limpopo and Northern Cape provinces: a survey study protocol

IntroductionInformation is a prerequisite for quality healthcare service. Health professionals play a key role in the health system as they jointly have the responsibility of looking after patients everyday. Failure...

Anthropometric status of nurses working at a private hospital in Pietermaritzburg, KwaZulu-Natal.

The prevalence of overweight and obesity among nurses in South Africa (SA) is increasing. This is a concern as overweight and obesity increase the risk for non-communicable diseases (NCDs). This study aimed to determine the anthropometric status of nurses working at a private hospital and to identify the factors related to a high body mass index (BMI). This study was conducted at a private hospital in Pietermaritzburg (PMB), KwaZulu-Natal (KZN). Weight, height and waist circumference (WC) measurements were taken, using standardised procedures. A self-administered questionnaire was developed to collect data on factors associated with a high BMI. Most participants were overweight or obese (86.2%; n = 112). The mean BMI of females (33.55 kg/m2) was significantly higher than that of males (28.08 kg/m2) (p = 0.043). Nurses who did not smoke had a significantly higher BMI (33.84 kg/m2) than those who smoked (29.58 kg/m2) (p = 0.030). Nurses who skipped meals had a higher mean BMI (33.75 kg/m2) than those who did not skip meals (29.63 kg/m2) (p = 0.005). Most females had a WC above 88 cm (66.2%; n = 86), indicating a substantially increased risk for metabolic complications. There was a high prevalence of overweight and obesity among the nurses according to BMI. According to WC, most female nurses had an increased risk for metabolic complications. Being female, not smoking and skipping meals were associated with a higher BMI. This study highlights the increasing prevalence of overweight and obesity among nurses.

Community service nurses in primary healthcare clinics: Experiences of supervision and support from professional nurses.

Newly qualified nurses in South Africa are required to undertake a compulsory 1-year community service (CS) in a public healthcare facility. They are not yet competent to work alone and require supervision and support from senior professional nurses. This study aimed to explore and describe the experiences of community service nurses (CSNs) regarding supervision and support from professional nurses at primary healthcare clinics (PHC). The study was conducted with CSNs who were working in PHC clinics in Nelson Mandela Bay (NMB). A qualitative, explorative, descriptive and contextual study was conducted using semi-structured interviews with 10 CSNs. Purposive sampling was used. Data were analysed using Tesch's coding method of content analysis. Two themes and six sub-themes emerged, the key themes being participants' diverse needs related to CS placement at PHC clinics and participants' social interaction with the professional nurses during CS. Supervision and support for the CSNs during their CS rotation was inadequate at most clinics in this study. Recommendations, based on findings, were made for an improved CS experience and further research. The CSNs require supervision and support in the CS year, particularly in PHC clinics, clearly presented in this study. The findings of the study can be used to improve the experience of CS for CSNs in the PHC setting in NMB.

Development of a training programme for professional nurses in South Africa - An educational response to the COVID-19 pandemic.

AimThis paper describes the development of the training programme for South African professional nurses on how to manage critically ill COVID‐19 patients in intensive care units and repurposed general wards.Design and methodsThe Analysis, Design, Development, Implementation and Evaluation educational instructional design model guided the development of the training programme. A case‐based study approach and blended learning were used to deliver the six modules.ResultsThe training programme was developed, reviewed and validated by the coordinating team of facilitators involved in the initiative. Implementation of the training programme and the result thereof will not be discussed as part of this manuscript.ConclusionThe training programme aimed to enhance the knowledge of professional nurses in the management of critically ill patients with COVID‐19. As the pandemic evolves, a need for training and ongoing support was identified, which might address the need for surge capacity and hospital readiness planning.

Predicting behavioural intentions towards medication safety among student and new graduate nurses across four countries.

To identify final-year undergraduate students and new graduate nurses' behavioural intentions towards medication safety across four countries. Medication errors are a common and avoidable occurrence, being costly for not only patients but also for health systems and society. A multi-site cross-sectional study. A self-administered survey was distributed to students and new graduate nurses in South Africa, India, Turkey and Australia. Descriptive statistics were calculated for all survey items. Multiple linear regressions were performed to predict behavioural intentions using the three Theory of Planned Behaviour constructs: attitudes, behavioural control and subjective norms. This study adheres to the STROBE guidelines. Data were analysed for 432 students and 576 new graduate nurses. Across all countries, new graduate nurses reported significantly higher scores on all the TPB variables compared with student nurses. Attitudes towards medication management were found significantly and positively related to intention to practice safe medication management for both student and new graduate nurses. Total perceived behavioural control was significantly and negatively related to intention to practice safe medication management for students. Student and new graduate nurses showed favourable attitude, subjective norm, perceived behaviour control and intention in practising medication safety. However, differences in countries require further exploration on the factors influencing attitudes towards medication safety among student nurses and new nurse graduates. Understanding student and new graduate nurses' medication administration practices is important to inform strategies aimed at improving patient safety. The findings of this study highlight the need for an internationally coordinated approach to ensure safe medication administration by student and new graduate nurses.

Evaluating Knowledge, Practice, and Barriers to Informed Consent Among Professional and Staff Nurses in South Africa: An Empirical Study

Background: Informed consent (IC) is an ethical and legal obligation protected by constitutional rights to bodily integrity, well-being, and privacy in South Africa. The National Health Act 2003 codified IC regulations, requiring that all healthcare professionals inform patients about diagnosis, risks, benefits, options, and refusal rights while factoring in patients’ language and literacy levels. Objectives: This study’s primary aim was to determine the extent of South African professional/staff nurses’ compliance with current IC regulations and ascertain socio-cultural impediments impacting proper IC practice. Methods: A cross-sectional survey using semi-structured questionnaires was used to evaluate knowledge and practice of IC among nurses in KwaZulu-Natal province. Data were analyzed using SPSS, v.21. Descriptive statistics, chi-squared tests, and content analysis were used to compare nursing domains. Results: Three hundred fifty-five (355) nurses, 92% females, with 1 to 41 years of professional experience, completed this study. Information disclosed by nurses to patients included diagnosis (77%), treatment benefits (71%), risks (69%), recommendations (65%), risks of refusal (80%), and right of refusal (67%). Nurses (80%) felt information disclosure was adequate, while 85% reported that patients understood disclosed information. Conclusions: Nurses practicing in local public hospitals had moderate knowledge of IC regulations. Practical implementation appeared deficient. Barriers to IC included language, workload, time constraints, lack of interpreters, and skewed gender norms in the nursing profession. Nurses require continuing professional education in healthcare law and ethics, a “corps of trained interpreters”, and gender transformation in the nursing profession to improve IC practice and overall quality of healthcare service delivery in South Africa.

The knowledge, attitudes and practices of doctors, pharmacists and nurses on antimicrobials, antimicrobial resistance and antimicrobial stewardship in South Africa.

BackgroundSustained injudicious and indiscriminate use of antimicrobials has exerted selection pressure for developing antimicrobial resistance (AMR), requiring behaviour change from healthcare professionals (HCPs) based on their knowledge, attitudes and practices (KAP) on antimicrobials, AMR and antimicrobial stewardship (AMS).MethodsA cross-sectional online questionnaire-based survey was conducted nationally amongst doctors, pharmacists and nurses from November 2017 to January 2018. The questionnaire comprised demographic information and KAP questions.ResultsRespondents comprised of 1120 doctors, 744 pharmacists and 659 nurses. Antimicrobial resistance was considered a severe problem globally and nationally by majority of HCPs. Self-assessment of knowledge revealed gaps in understanding of antimicrobials, AMR and AMS. Confidence scores in prescribing by doctors, pharmacists and nurses were 57.82%, 32.88% and 45.28%, respectively. Doctors, 441 (45.2%) indicated no confidence in using combination therapy. Prescribing correctly showed a confidence level of 33.99% from 436 doctors, 41.88% from nine pharmacists and 35.23% from 107 nurses. Healthcare professionals (1600 [91.22%]) stated educational campaigns would combat AMR. Only 842 (40.13%) HCPs attended training on these topics and 1712 (81.60%) requesting more education and training.ConclusionThis is the first comparative survey on KAP of practising doctors, pharmacists and nurses in South Africa. Doctors had the highest knowledge score followed by nurses and pharmacists. Practice scores did not corroborate knowledge and the higher attitude scores. Gaps in KAP were evident. Healthcare professionals indicated the need for more education and training, thus requiring a review of pre-service and in-service education and training in addition to continued professional development programmes for practising HCPs.

Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa

BackgroundProviding viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme.MethodsWe undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed.ResultsAmongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were ‘good’ or ‘bad’ adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses.ConclusionsPOC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets.Trial registrationNCT03066128, registered 22/02/2017.

Competencies for structured professional development of neonatal nurses in South Africa

Background. The unpredictability of any illness at birth, and recovery from such an illness after birth, create challenges for nurses involved in neonatal care, and require competent nurses in the period following birth in both resource-limited and technologically advanced contexts. Neonatal nursing emerged worldwide as a nursing specialty over the last five decades to meet these challenges through in-depth knowledge of healthy, preterm and ill neonates. There is a high demand for neonatal nurses to lower neonatal mortality and morbidity, negative media exposure and litigation. Objectives. To reflect on a competency framework for nurses in neonatal practice to enhance professional development that is context specific. Methods. A competency framework for nurses involved in neonatal practice was developed and validated through nominal group techniques, literature control and Delphi techniques. Results. Although nurse training is done at tertiary education institutions, there is a gap in ensuring consistencies in clinical performance and professional development from novice to expert, especially in a field such as neonatal care. Professional development can enhance the standard of neonatal care, especially if linked to competencies that are specific to the neonatal context. Conclusion. A competency framework has an important role to play in equipping nurses in neonatal practice with the knowledge and skills required to reduce the persistent neonatal mortality and morbidity rates in South Africa.

Job satisfaction of nurses working in public hospitals: perceptions of nurse unit managers in South Africa.

Job satisfaction among nurses often determines whether they choose to remain in the profession or in the facility where they work. The study sought to explore and describe the job satisfaction of registered nurses in South Africa through the lens of their nurse unit managers. A qualitative, exploratory, descriptive design was undertaken. Fourteen unit managers were interviewed and Tesch's method of data analysis was used. Four themes emerged: 'staff shortages lead to nurses feeling overwhelmed and frustrated', 'nurses' work performance is undermined by limited resources and poor infrastructure', 'discontent among nurses with regard to poor top level and human resource management' and 'despite challenges, nurses experience rare moments of job satisfaction'. Unit managers need to find ways to enhance existing elements of job satisfaction by emphasising the nurse-patient relationship and teamwork among their staff in order to improve the overall job satisfaction of staff.