1. Introduction

There is a global nursing workforce shortage, and the demand for nurses continues to be an ongoing battle in healthcare systems; an estimated 13 million additional nurses are needed to fill the global nurse shortage gap (ICN-CGFNS 2022) [1]. The shortage crisis can only be addressed by increasing the number of nurse graduates to 8% per year on average to improve the capacity to employ and retain these graduates, according to the World Health Organization (WHO) [2]. There is a worldwide crisis concerning the nurse workforce shortage, identified as driven by mobility and migration [3]. Globally, despite the increasing demand for nurses, there is inadequate workforce planning in nursing which is crucial to reducing health inequalities while ensuring sustainable health systems [4]. In addition, the scholarly work of the authors in [5] states that nursing care faces a human resource crisis hence the researchers argue that there is no single global and local measure of nature, but rather the shortage of nurses is multifaceted. The researchers also highlighted that the shortage of nurses is at a critical point for healthcare services on both global and local levels.

The South African healthcare system is nurse-based, and the nursing workforce consists of four categories, namely, professional nurses, general nurses, enrolled nurses, and enrolled nurse assistants South African Nursing Council (SANC) [6]. Nurses play a huge role in the South African healthcare system by providing comprehensive patient care by administering treatments and emotional support, as well as working with interdisciplinary teams to ensure seamless coordination and holistic treatment regimens for patients under their care [7]. South Africa has approximately 280,000 nurses, or one nurse for every 213 people, according to the recent data from the SANC. Nearly half of the nurses who work in South Africa’s healthcare system are scheduled to retire in the next 15 years, making the current shortages simply the beginning of what is expected to become a bigger issue [8]. According to Bierman’s analysis, the nursing industry will face even greater challenges because of the Department of Public Service and Administration’s new policy surrounding early retirement [9]. As more students are receiving training to enter the field, there are currently more nursing staff members quitting their jobs or retiring. The number of nurses who qualify for early retirement will cripple the already struggling healthcare system.

In South Africa, providing high-quality healthcare is a constitutional requirement [10]. The possibility that intended health outcomes will occur because of individual and population health interventions is referred to as quality of care [11]. Therefore, over the years, the government has implemented several improvements and programs to enhance health care, efficiency, safety, and access for all users. The negative effects of human resource shortages include increased litigation, burnout, work overload, poor record keeping, delays in urgent procedures, and adverse occurrences [12]. As a result, there were significant health system difficulties including poor staff attitudes, lengthy waiting times, dirty facilities, lack of drugs, inadequate infection control, and compromised staff and patient safety and security [12].

The South African public health sector is subsidized by the government and serves 71% of the population [13]. The condition of the public health system, effectiveness, and capacity to deliver sustainable services are consequently causing growing concerns [14]. The public healthcare sector in South Africa dropped from second to fourth on the list of spending priorities between 1997 and 2010, despite growth in the use of public healthcare because of the high burden of disease and rising patient load [15]. Despite the government establishing several admirable targets for bettering the standard of healthcare service delivery, reports by the media and communities indicated that public health institutions’ services were still falling short of fundamental standards of care and patient expectations. Public confidence in the healthcare system has been damaged as a result [16].

Healthcare in South Africa is too expensive. In the long term, enhancing the standard of care in the public sector would offset people’s need for medical insurance which is expensive [17]. A quality improvement plan must be established in the context of limited resources due to the numerous difficulties these institutions must overcome [17]. To take the necessary steps needed to change the quality of care provided, the following are required, namely, critical self-evaluation, readiness to change as well as determined commitment, and contributions from client, staff, and management [14].

The lack of qualified personnel is a result of a few causes, including the increasing need to care for an aging population, an aging nurse workforce nearing retirement, a shortage of academics and educators with the necessary nursing expertise, and a high rate of turnover [18]. The main causes of turnover are unsatisfactory performance appraisal and grievance handling, unfavorable working circumstances, strained relationships between managers and the nursing staff, and inefficient management assistance for training [19]. Moreover, it is seen in the literature that numerous factors contribute to human resource shortage which affects the quality of care rendered to patients.

Hence, a qualitative approach was deemed suitable for addressing the study research question about human resource shortage “What is the impact of human resource shortage on quality patient care based on registered nurses accounts in the Ekurhuleni district in Gauteng province?”

2. Research Methods and Design

3. Results

4. Discussion

This study underscores the critical shortage of human and material resources in South African healthcare, severely impacting patient care quality. As highlighted by the authors in [24], the deficit in medical equipment and nursing staff in hospitals is alarming. The shortage of nursing staff at the selected hospital is a serious area of concern as participants revealed that they are short-staffed in the wards, and this shortage hinders them from providing quality patient care. The same finding was shared by the author in [25] that inadequate services are driving the South African healthcare system to deteriorate and erode public confidence.

Despite objectives set by the government for better service delivery in healthcare settings, media and community reports in 2009 revealed that public health institutions’ services were still falling short of fundamental standards of care and patient [12]. Health issues become worse due to the shortage of nursing staff within the public sector, as well as across the provinces, which results in physical and emotional tiredness as well as a worsening of medical illnesses [14]. The registered nurses reported an increased workload resulted in employee absenteeism, significant staff turnover, and burnout of staff [26].

This study revealed that meeting medical demands, rising life expectancy, constrained budgets, and physical shortages is almost impossible due to resource limits [27]. In addition, inadequate medication negatively impacts patient care, leading to increased hospital visits, financial stress, and a lack of trust in healthcare professionals. Lack of access to medications can result in patient suffering, treatment delays, and negative patient outcomes [28]. The shortage of nursing staff is a significant concern, as it hinders the provision of quality patient care.

This study mentioned that the shortfall leads to substandard care, eroding public confidence, and exacerbating health issues due to physical and emotional strain on staff; the same conclusion is that social determinants of health such as health inequalities are multiple and inter-related, leading to inadequate health services being highlighted by the work of the following scholars [24, 25].

The current study reported burnout syndrome as a growing management concern as it can have detrimental effects on nursing care rendered to patients. This finding indicates that burnout reduces job performance and is convergent to that of the authors in [29]. In addition, the findings of the authors in [30] reported that working in an environment of understaffing and attrition might lower job satisfaction, sharing the same finding with this study. Scholars [30] state that the inability to continue providing high-quality patient care can lead to employee attrition through a vicious circle of job unhappiness, stress, demotivation, and intentions to look for new employment. The study participants shared the same sentiments.

Furthermore, registered nurses stated that burnout is driven by understaffing and resulting in diminished job satisfaction and potential attrition, worsening the situation [29, 30]. In addition, high absenteeism and staff turnover further destabilize staffing, impacting patient care negatively [31, 32]. Financial challenges and poor work motivation contribute to this crisis, leading to prolonged hospital stays, treatment delays, and increased mortality rates [33, 34].

Participants stated the effects of human resource shortage on quality patient care as they expressed how different factors contribute to this issue. Prolonged hospital stays: The study reveals that prolonged hospital stays in developing countries, where nurse-to-patient ratios are high, cause unnecessary suffering for patients. This is particularly concerning for critical patients, who may not receive the necessary care. The work of the authors in [34] showed that patients suffer unnecessarily because of their prolonged stays, which could have been averted if the resources had been available.

The participants concluded that South Africa’s procurement process struggles with issues such as supplier nonpayment, subpar supplier performance, drawn-out buy-out procedures, and inaccurate electronic inventory management systems [33]. Lack of access to medications may result in patient suffering, treatment delays or cessation, the use of less effective alternative treatments, and negative patient outcomes [14]. In addition, the registered nurses concluded that the patients may not be getting the care they need, especially in so-called developing or third-world countries where the nurse-to-patient ratio is so high that the most needy and critical patients receive all the facility’s attention [12].

Moreover, the reported findings of the current study highlight the issues that hinder infection prevention and patient safety, escalating the risk of hospital-acquired infections and their associated burdens [35]. Furthermore, the study captured the acquired hospital infection from limited structural architecture, amenities, and human resources making it difficult to adopt infection prevention best practices in South African public healthcare facilities [35]. The study reported that lengthy hospital stays of patients are important for both the effectiveness and quality of the care provided, although extended lengthy hospital stays in acute care wards raise morbidity, mortality, readmissions, and medical costs [36].

The necessity for nurses to collaborate effectively with patients and caregivers is emphasized to mitigate these challenges [37]. The overall situation is aggravated by occupational fatigue among nurses, leading to a range of adverse outcomes [38]. In summary, South Africa’s healthcare system faces a severe crisis due to understaffing, resource shortages, and the resulting poor patient care, necessitating urgent attention and remedial actions.

5. Study Limitations

With the limitation that the study was conducted in one public hospital in Gauteng province, the study gave a deeper perspective and insight into healthcare services at public hospitals. If the study was conducted in a different situation, the responses of the registered nurses at the hospital under study might yield different results. The researchers cannot conclude that the study findings can be generalized to other public hospitals in the same Gauteng province area. However, the results may be transferable to other public hospitals. Furthermore, sustaining research integrity through ethical considerations and trustworthiness improves the study’s rigor.

6. Implications for Nursing Practice

The research highlights the urgent necessity for strategic workforce planning and investments in human resources to combat the persistent staffing shortage. Moreover, the deficiencies in staff and resources directly affect the quality of patient care. Nursing management should focus on empowering their staff, providing continuous professional development opportunities, and fostering supportive environments to mitigate burnout and ensure job stability and satisfaction.

7. Conclusion

The study concluded that due to a shortage of nursing staff and health resources, patients experience poor quality care. It was noted that nursing staff are often burned out, overworked, and lack motivation as they must work under poor circumstances with minimal resources, which affect the quality of care rendered to patients. Based on the conclusions that the study question and objectives were answered and achieved, respectively, the researchers noted that there is a need for the hospital and Department of Health to address the shortage of nursing staff and provide adequate resources such as machinery, funding, and medication to improve the quality of care rendered to patients.

Ethics Statement

The researchers obtained ethical clearance from the University of South Africa (17186447_CREC_CHS_2023) before data collection followed by permission from the Gauteng Department of Health and Hospital Management. The interview was voluntary, and informed consent was obtained before the commencement of data collection. By signing the consent, participants consented to being recorded and having their responses captured anonymously for the study.

Disclosure

This article’s opinions and views are solely those of the authors and do not necessarily reflect the official policies or positions of any affiliated agency or publisher.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

C.J.W. and N.L.N. are the sole authors of this research article.

Funding

The University of South Africa supported the study with financial means (University of South Africa). The research was not funded by any specific agency in the public, commercial, or not-for-profit sectors.