Nurse and Patient Outcomes in Private and Public Hospitals in South Africa During the COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND

Nurse and patient outcomes in South Africa were poor before COVID-19 and are believed to have worsened during and after the pandemic. Limited evidence exists on modifiable organisational factors contributing to these outcomes hindering targeted interventions.

PURPOSE: This paper aims to develop a better understanding of potentially modifiable organisational factors of hospitals that, if addressed, would likely contribute to improving nurse wellbeing and retention, and quality and safety of patient care.

METHODS

Data were collected from 143 private and public hospitals (n = 4298 nurses) across South Africa using a cross-sectional survey. Independent variables included working time with COVID-19 patients, incidence of death and dying, resources, staffing, and the practice environment; dependent variables focused on nurse outcomes (job satisfaction, intent to leave, burnout, mental and physical health) and patient outcomes (quality of care and patient safety).

RESULTS

Nurse and patient outcomes were worse in public compared to private hospitals. Favourable practice environments had the strongest association with nurse and patient outcomes, followed by staffing and resources. Within the practice environment, nurse management, leadership and support of nurses showed the greatest association with job satisfaction (OR = 4.71∗∗; 95% CI = 3.97-5.58), lower intent to leave (OR = 2.81∗∗; 95% CI = 2.33-3.38) and more favourable mental health (OR = 2.58∗∗; 95% CI = 2.19-3.04). Greater nurse participation in hospital affairs was associated with more favourable nurse assessments of quality of care (OR = 3.74∗∗; 95% CI = 3.22-4.33 to OR = 6.51∗∗; 95% CI = 3.81-4.95) and patient safety (OR = 4.35∗∗; 95% CI = 3.81-4.95).

CONCLUSION

Interventions to improve nurse wellbeing and retention as well as quality and safety of care should focus on improving hospital practice environments, specifically nurse manager expertise, nurse leadership, nurse participation in hospital affairs, and adequate staffing and resources.