The presentation of the results of this study is according to the demographic information of the study participants, as well as the themes and sub-themes that emerged from the data analysis.
4.1 Demographic information of the study participants
Twelve midwives participated in this study, and all participants were females. The age of the participants ranged from 25 years to 45 years. The participants' working experience ranged from two years to eight years as midwives and midwife specialists. The highest qualification of the participants was a Post-basic Diploma in Advanced Midwifery and Neonatal Nursing Science.
4.2 Themes and sub-themes
The study yielded four main themes: (1) challenges related to lack of resources,(2) emotional distress, (3) lack of support as well as (4) recommended measures for support. These central themes, together with sub-themes, are discussed below:
(Table 1 of Themes and Sub themes to be placed here)
Table 1
Themes | Sub-themes |
---|
1. Challenges related to lack of resources | 1.1 Shortage of staff and increased workload. 1.2 Training and orientating the novice midwives 1.3 Lack of appreciation. |
2. Emotional distress | 2.1 Grief over neonatal deaths. 2.2 Compassion fatigue. 2.3 Quite quitting |
3. Lack of support | 3.1 Management visibility and support when handling Patient Safety Incidents. 3.2 Neglected (not listened to). 3.3. Lack of psychological support. |
4. Recommended measures for support | 4.1 Effective communication and collaborative management. 4.2 Need for debriefing and referral to mental health care professionals. 4.3 Provision of Continuing Professional Development. 4.4 Recruitment of more staff. |
4.2.1 Theme 1: Challenges related to lack of resources
Midwives shared their experiences regarding the challenges related to lack of resources. Three sub-themes emerged: a staff shortage and increased workload, training and orientating the novice midwives, and lack of appreciation by nursing managers.
4.2.1.1 Sub-theme 1.1: Shortage of staff and increased workload
The midwives working in the maternity units where the study was conducted reported that they experienced challenges relating to a shortage of staff and increased workload. The quotation from the transcribed interview confirms this result:
“I feel like sometimes we don’t get enough support. Sometimes us, as midwives, due to shortage, influx of patients...But then when there’s a problem, immediately they’ll be here, but then they will be forgetting that the previous night we reported that there was a shortage and ward was full and this and this but you’ll see no-one coming and…just to ask, ‘guys’…or if they can find us someone to come and assist. So, yes, I feel like even that. ’Cause imagine if it’s three nurses and we have the full ward, obviously some patients are going to suffer because care it’s not enough…” P08
“I don’t know which excuse to give so you don’t come to work because here I am overworked, and then I am being given the duty that I don’t feel they are mine, patient care is neglected, we are short-staffed and everything” P01
“… But people like…almost three or four people leave every year, and then they never replace them. So, we have a shortage of staff and that one is a big problem. So, it’s just for booking. And if people are exhausted, no one is gonna come to work” P 05.
“… especially when we tell them that we are short-staffed, that we are only four midwives with twenty or fifty patients” P03.
In this study, the midwives revealed that most of the time, the maternity units are busy and they work short-staffed and that during those periods, management does not come to check on them. This results in midwives compromising the quality of care provided to the patients. Staff shortage has existed for many decades and harms the quality of care. Miseda et al. (29) concur with the study's findings and indicate that the shortage of healthcare workers has significantly restrained the realisation of health-associated Millennium Development Goals (MDG). A shortage of midwives is a severe obstacle to providing quality maternal and child health services (30). When the staff is not enough, the workload increases, resulting in staff transferring responsibilities to lower or other categories, opening a gap for the occurrence of negligence or poor quality maternal care (31).
4.2.1.2 Sub-theme 1.2: Training and orientating the novice midwife
The participants experienced challenges regarding the training and orientation of the novice midwives, and the participants had this to say:
“And then the replacement of staff, you find that they always, when experienced midwives resign, they bring these midwives that you have to train again, and then I feel like it takes as much as that is how everybody learns, but I feel it take away the time you should be giving to the patients, I don’t know if it makes sense, because for instance if you are supposed to be six midwives on duty, there is this person it’s her first day, for the next three months you have to hold this person by hand and show them the ropes, I feel like patient care will suffer because instead of bringing people who are experienced in labour ward, they always bring these new people for you to orientate and train of which yes it a good thing but not in the Tshwane labour ward because it’s always busy, there are always emergencies, you are always short staffed” P01.
“Staffing us more, we need more midwives. We need more midwives. Even if it’s comm-serve, we can train them. We can supervise them like we were supervised when we started.” P04.
“… you’ll find the experienced midwife who can work independently, unsupervised, or the advanced midwife is resigning in the hospital, and it’s difficult to replace that experienced midwife. They’re being replaced by the comm-serve where, in the shortage of staff, the comm-serve will also need supervision.” P10.
In this study, it was discovered that the training and orientation of novice midwives made it difficult to provide comprehensive support to the novice midwife. In addition, the time spent supporting the novice midwives hindered the provision of quality care.
Another study reported that the time experienced midwives took to orientate the new midwife increased workload, and patient care was also neglected (32). Furthermore, the orientation of the novice midwife directly affected the novice midwife as they felt unsupported, and this affected their confidence level in taking care of pregnant and labouring women (32). These findings are supported by Simane-Netshisaulu (33), who added that due to increased workload, midwives developed tension and a negative attitude towards the novice midwives, contributing to the unhealthy work environment. Thus, this animosity amongst the novice and senior midwives creates a hostile psychological environment for the team and the patients in maternal care units.
4.2.1.3 Sub-theme 1.3: Lack of appreciation
During the interviews, a lack of appreciation emerged from the data, and the participants had this to say: “… but I feel like, at this point, I am more scared of management than the actual public suing me for anything else. So, it’s just one of those things. I feel like now the public actually appreciates my efforts more than management” P11.
“...and then also, they were coming and checking up on us. I know we are not babies; we are here to work, but that appreciation means a lot to us. Then they mustn’t come here only if there is an incident or something. Just to say ‘hi, how are things happening? Any suggestions?’”. P09.
“I think it’s all that, and then maybe if they also support us to say, ‘we are there for you’, just to say in the morning, ‘guys, I see you are working very hard’. Those words, it’s only those words that are needed, but then nothing is like that… And then also even the…our nursing manager, our clinical, I feel like maybe they should also be more involved with us nurses on the floor, just to come and check on us, just to come and talk to us to say, ‘what are you guys working with? What can we provide? What are the experiences?’ especially in cases where you’d find maybe there’s three midwives on the floor, then you write the report, but then you will never see people coming or anything like that. But then when there’s a problem, immediately they’ll be here…” P08.
The current study participants indicated that lack of appreciation from nursing managers was of concern; this made them feel demotivated, and their contribution to maternity care was not valuable. According to Matlala and Lumadi (34), managers do not appreciate the midwives' challenges in maternity units. Thapa et al. (35) added to these findings and found that midwives shared they yearn for their managers to display interest in their work, provide their opinions and be more appreciative.
4.2.2 Theme 2: Emotional distress
Most of the participants experienced emotional distress while providing maternity care. Three sub-themes emerged: grief over neonatal deaths, compassion fatigue, and quiet quitting. Below is the detailed information on each sub-theme that emerged.
4.2.2.1 Subtheme 2.1: Grief over neonatal deaths.
The participants of this study exposed an experience of grief over neonatal deaths. The following quotations support this:
“… but then also, in a case where there’s an FSB {Fresh Still Born}, we also get affected; it affects us as well. For that whole month, you get affected” P08.
“The baby…it was foetal distress, and the baby didn’t make it. It was a fresh stillborn. But fortunately…I can say fortunately as such because it’s not fortunate for the mother, but for me, because she said… that’s what the manager said. ‘You are lucky because you managed to transfer the baby to {other hospital} on time, so it’s not your PSI’, and, yes, I might be off the hook, but I had an emotional attachment to the patient and the outcome, and it hurt me to say that ‘you are lucky that’” P12.
“...or maybe a mother who came with…what can I say? IUD. We cry deeply with the mothers, but as our profession, we are supposed to be empathetic instead of sympathetic, but we are human beings… we’ve never seen a psychologist. I think it’s for personal things for patients, but then do they bring them to us? No”. P02.
It is discovered in this study that midwives experienced grief over neonatal deaths. The midwives in this study mentioned that this experience affected them emotionally since they developed a bond while they monitored the pregnant woman’s labour progress. When the woman loses her baby, they grieve with the woman. During this period, they are not emotionally supported by managers. A study conducted by Barnes et al. (36) revealed that when a baby dies in the unit, midwives experience grief as much as the family does. This is because midwives form a bond with the patient; they can relate to the pain the parents feel.
4.2.2.2 Sub-theme 2.2: Compassion fatigue
The data showed that the participants experienced compassion fatigue, and two participants had this to say:
“I am not coping. I’m not coping psychologically. Forever tired. And again, it comes back to the point of passion and dedication. Just because I am passionate, I love my patients, so even if I’m not feeling well, I just say, let me push one more day up until it's the weekend, then I can rest those two days. It’s not easy, not at all, because when you get home after work, there is nothing that you can focus on; all you want is sleep. You don’t even have time for your own family” P04
“I feel so bad because I can see that most of the midwives that are leaving, one of the complaints is that we don’t get their support. So, I feel very bad. Sometimes, as I said before, I feel like not coming to work, but I’m not like that. I come to work because, thinking of my team… thinking of how much I love being a midwife, that’s when I come, but it makes me feel bad”. P03
It is found in this study that midwives experienced exhaustion; they only continued to provide maternity service because they cared for their patients and felt the need to support fellow midwives. One of the studies revealed that midwives highly identify and empathise with labouring women after a painful delivery, and this may lead to midwives shifting focus and occupying wrong roles, such as motherly figures to the patients (38). A study conducted by Turan (39) found that exhaustion encountered by midwives due to the work environment, such as stressful births, long working hours, burnout, and poor management, can produce anxiety and negatively impact the quality of the midwives’ lives. Furthermore, this author revealed that an empathetic response to prolonged exposure to traumatic situations contributes to compassion fatigue.
4.2.2.3 Subtheme 2.3: Quiet quitting
The current study discovered quiet quitting at work as four participants had this to say:
“Cause nowadays, you just come to work, it’s like you just work. You don’t have that thing that we used to have before. You just come to work, and you just do your things, you just go… there’s not that motivation to say, ‘I’m missing work. I can’t wait to go to work. It’s no longer like that” P08
“They are trying to push pressure on us. But I feel like it’s just being overdone to a point that it puts a strain on me. And me coming to labour ward now is just me coming to do the work and just go home” P11
“...you also feel like not coming to work... and most of the time you are exhausted... and it’s also changing the attitude towards you with your work… you feel like you even hate what you like. And you can’t even motivate some other people at work because, even yourself, you are not motivated. At the end, when you come, you just come, you feel like everything you are doing, you are forcing yourself because the environment is not good for you” P10
“I’m coming to work just for the sake of coming... But I’m exhausted, and I’m putting the patient’s life at risk ’cause I might miss some of the things, and sometimes your colleagues get angry ’cause now you are always tired. I’m just here because I have to come to work… I’m tired, but when I’m here, I’m like, where is seven o’clock so that I can go home and rest? I’m tired. It’s exhausting” P06
Quiet quitting is when workers decide only to do what they are hired to do and not put in extra effort. Furthermore, factors influencing quiet quitting are workers' job satisfaction, encouragement, support and collaboration (40). The current study participants indicated they no longer feel motivated to work. They only go to work to do what they are supposed to and cannot wait to knock off and go home. Quiet quitting constitutes a risk even without resignation (41). Boy and Sürmeli (42) concurred with these findings and mentioned that quiet quitting has a negative effect on the quality of work rendered and patient satisfaction, as it leaves the employer with minimal time to find substitute midwives who can provide quality care.
4.2.3 Theme 3: Lack of support
The third theme that emerged was the lack of support. Three sub-themes emerged and they included management visibility and support during Patient Safety Incidents (PSI), neglected (not listened to), and lack of psychological support. Below is the detailed information on each sub-theme that emerged.
4.2.3.1 Sub-theme 3.1: Management visibility and support during Patient Safety Incident
More than four participants indicated that when there is an incident in the maternity units, such as a neonatal or maternal death, they do not feel supported by their nursing managers; instead, they are blamed for the incident. The following direct quotation from the interview confirms this finding:
“So, I feel also the matrons, even if just…on a day just to come and check on us instead of coming to complain about certain things. You do get that support, but then also, in a case where there’s an FSB {Fresh Stillborn}, we also get affected; it affects us as well. For that whole month, you get affected. So, I also think maybe they will come and check on us instead of maybe pinpointing to say, ‘it’s your fault’. “and everything without doing a thorough investigation to say, ‘what happened?’ Because sometimes, when you pinpoint someone, and you blame that it’s us, whereas…yes, we know in cases always…patients are always right, but in some cases, you also need to look both sides instead of saying it’s the sisters who did this. So, rather, they must investigate first before they come to that point” P08
“I’m not being worried about…because I know I did my best, I know I did the best the way I know how to, but my worry is: will management see it as if it was the best? I feel like they are always looking for ‘What did you miss? What didn’t you do?’ They’re looking at what you did at that time with what you had. So, I always know they’re going to ask me, ‘ukuthi (that) why was this not done? Why was this not done?’ and I’m going to tell them this is why maybe this was not done, or something like this. So, I feel like, at this point, with my management, we are not getting support, but we always have to be defending ourselves. I find myself in a… let’s say maybe a Patient Safety Incident…they don’t get involved. A manager will tell you, no, I don’t know what happened; the midwife must know” P11
“So, now, my concern was when they…the management was supposed to call that shift, ask, ‘what happened? Do you know this patient? What happened?’ and then take it from there. Instead, they just came and then… Yoh, it was so terrible. They didn’t want to hear our side of the story. We know that it’s always patient first, but now, before you make a decision, it’s very important to take both sides of the story. ‘What is the patient or the family saying, complaining with?’ and then you go to your staff, ‘What happened?’ and then you compile a report.” P07
“And then I can say that some managers were very supportive when coming to work and making sure they have our back in terms of when there is a Patient Safety Incident report or something, they will come and support you emotionally and everything to make sure you are that you are well. But then you will find you sometimes get a manager that is not supportive, for lack of a better word. She will just throw you in the deep side”. P12
“Remember, when there’s neonatal death, there’s PPIP that is being filled, the patient comes to the lower level. Before they point fingers…” P03
Kang et al. (43) revealed similar findings and found that in most cases, after a traumatic or adverse event, midwives encounter a lack of support from their managers. Lack of support of midwives after an adverse event by managers has a negative psychological impact on the midwives, contributing to the lack of desire to return to work (44). The above findings were supported by Christoffersen et al. (45), who found that midwives experience a lack of support from their supervisors during adverse events, influencing the desire to leave employment without the nurse manager’s awareness.
4.2.3.2 Sub-theme 3.2: Neglected (not listened to)
The participants expressed that they are not listened to when they raise concerns as they provide care. The participants had this to say:
“… just to come and say…just to hear our regards ’cause we always have a lot to complain about but then no-one ever listens sometimes… And then, again, I feel… it’s only that. I feel like we are not listened to …ha ba re utlwelle (they don’t listen to us) that much. So, I think maybe if they listened to our opinion, complaints, because we always have something to complain about, we always have something. I feel like even during decision making; somehow we are sidelined” P08
“I feel like maybe if the management can try to have maybe some sessions with the staff where we just talk about these things, it will be better, or maybe somebody who can just listen. But there is no one to listen to you.” P10
“They don’t support us in a way that we…I will say happy because, in most cases, you’ll find a patient complaining or a family member complaining; they will take their side. They won’t come to us and ask us what happened? What is the problem? At the end of the day, when they find the true story, they don’t even come to us and apologise and give us support.” P03
The concept of nursing neglect started many years ago. Nursing was considered laid-back; nurses are not recognised in healthcare settings despite their massive involvement in patient care (47). The findings resonate with another study that found midwives mainly associated job satisfaction with autonomy and supervisor support. Similar findings were reported by Skinner, Madison, Humphries (2012). Midwives participating in their study were highly satisfied with their jobs, indicating that they were suited to their work, enjoyed the type of work, and did not want to leave their professional discipline. They even became accustomed to stress and considered it a part of their profession because they felt seen and heard by the relevant managers (48).
4.2.3.3 Subtheme 3.3: Lack of psychological support
Most participants indicated that when there was an incident, they felt unsupported by managers. They are left alone, and managers blame them for the incident.
“So, I think we need their support, emotionally. Maybe if they can bring us a psychologist to come and talk to us, I think maybe we can heal from whatever is happening.” P03
“So with regard to psychological support, I feel like our managers are not doing their utmost best because they are focusing on the patient, which is right”. P02
“I am not coping psychologically. Forever tired” P04
“I know, if something happens, you need to write it at that moment while you still remember everything, how it happened, but sometimes the pressure that they put on us…if now you are tired, the unit was busy, and something happened, in the morning, they will be like, ‘Before you go home, you must make sure you write this’ and your mind is just overwhelmed. You can’t think straight. If you ask, ‘Can I at least write this tonight when I come back? I will still remember, but now I am…’. They are just forcing us to say ‘no according to what-what you have to write about now’. Obviously, it is the right thing to do, but now I can’t think straight. It overwhelmed me, I’m emotional…but ja”. P07
“But I think I’m crying because we don’t have time to talk about it. So you feel like this is the time of expressing and some of the things happened in the past. It will happen today, it will pass, tomorrow, you have to look for the positive thing. But when you talk about it, that’s when you will see how deep it is”. P10
“It makes me feel like management just wants to get this job done. My mental well-being and how I’m coping at work really doesn’t matter”. P05
The psychological health status of nurses is easily negatively affected. Naturally, nurses immerse themselves fully while providing nursing care, neglecting their psychological well-being (49). Organisational support is closely related to psychological support (50). This author further found that positive perceptions of the work environment and organisational support are linked to nurses’ higher quality of care and job satisfaction. A study conducted by Jena et al. (51) concurred with these findings and revealed that mentally stimulating employees will assist the organisation in persevering and succeeding during work uncertainties.
4.2.4 Theme 4: Recommended measures for support
Recommended measures for support were the fourth theme that emerged from the findings of this study. Sub-themes for recommended measures include effective communication and collaborative management, the need for debriefing and referral to mental health care professionals, the provision of continuing professional development, and the recruitment of more staff. The sub themes for recommended measures for support are discussed below:
4.2.4.1 Sub-theme 4.1: Effective communication and collaborative management
Effective communication emerged as the participants said:
“Somehow, you get demoralised along the way, demotivated, and then we’ll need someone to come and say, ‘no, guys, keep up the work’, just those words only just to support us, especially those nurses on the floor… But then…., if we can get that support from the managers. So, I also feel even the matrons, even if just to…on a day just to come and check on us… And then, again…I think it’s all that and then maybe if they also support us to say, ‘we are there for you’, just to say in the morning, ‘guys, I see you are working very hard’. Those words, it’s only those words that are needed, but then nothing is like that. And then also even the…our nursing manager, our clinical, I feel like maybe they should also be more involved with us nurses on the floor, just to come and check on us, just to come and talk to us to say, ‘what are you guys working with? What can we provide? What are the experiences?’ And also, the OMs, they should not just be a manager, but they should also be a mother. Because if you can see our unit, there’s more young midwives. So, also, the mode of approach, when you approach someone, to say…when you try to go and talk to someone, just maybe that approach, it means a lot. Cause if you become defensive and then you want me to explain why I’ve been behaving like this, you won’t get anything, but then, if you have a good approach, then you can get that” P08
“Just to say, ‘thank you, guys, you are working hard, but we are working on getting more staff’, things like that, just to say ‘we are recognising your hard work, guys. We see what you’re going through, and we see how hard you are working, and there’s no complications in the ward; we are grateful for that, but we are working to get you new staff; it will be better” P05
“But if they can, just consider us a little bit. Sometimes, surprise management call day-staff and night-staff to say we are here; we just want to listen to you. How are you coping? How are you doing? Civil conversation and then management, how can we come through? How can we help you in a situation like this? So, that one, we really appreciate it. We’ll know they’re actually caring for us, and we know maybe they are kind of busy. But kaiwanenyana nje (just once)…how are we doing? That one can mean a lot” P07
“So, I feel like, if maybe they want to decide on something, rather include the midwives because it’s us who are going to suffer due to their decision-making because it’s us who are on the floor and then also implementing whatever they have decided on. So, I think it will be better if they involve us and ask us, ‘How can we do this?’ ’cause it’s us with the experience. We see those patients every day and all that. So, I think maybe we need that.” P08
“Now, honestly, the only time I…like I say, my immediate manager, she’s giving support, she’s fine. We give each other ideas and everything. She listens to us” P09
Communication is a critical competency required for nurse managers; it is through clear and direct communication that information is shared effectively (52). This author further found that a manager with exceptional communication capabilities can retain staff.
4.2.4.2 Sub-theme 4.2: Need for debriefing and referral to mental health care professionals.
During the interviews, the participants expressed a need for debriefing and referral as follows:
“I’ve experienced a lot of things. Sometimes, the patient abuses you, you have a difficult delivery, neonatal death, it was very straining and stressing for us. So, sometimes you just need someone just for a bit of debriefing to offload” P05
“And also, I feel like maybe if they can also have debriefing sessions for us midwives, maybe to see a psychologist or make someone to talk to after that case. It’s really important to us, so I think it can do maybe…it can also add maybe a support system as well” P08
“The only part that I see it’s lacking in here it’s debriefing part” P03
When involved in adverse events, midwives expressed the feeling of failure. They indicated that they feel like they have let the patient down, impacting how they view themselves as health professionals. They doubt their skills and knowledge, negatively affecting their mental well-being (45). A study conducted by Kinman et al. (53) concurred with the findings of the previous author and added that poor mental health of staff has a detrimental effect on the quality of care.
4.2.4.3 Sub-theme 4.3: Provision of Continuing Professional Development
To confirm these findings regarding the provision of continuing professional development, three participants said:
“And clinical wise, with the support and also maybe with… ’cause with midwife, there’s always…information is always changing. Recently, soon, there’s gonna be a new maternity guideline. So, I think with the skills development, if they can look at that, especially the senior midwives if maybe they can maybe also take them to…or maybe do in-service training or take them to workshops and all that so they can make sure…so we can be able to provide that quality care to the patient” P08
“Again, see what is happening, if they can…the shortage, if they can staff us more so that, whenever they say there’s in-service training, one is able to attend. And remember, when one attends, at least she comes with feedback and then empowers more midwives so, that way, it would be better.” P04
“’Cause, as midwives, I believe that we need to move with the times. We need to move with the new evidence, research-based guidelines, and principles. Like now, we have a new partogram. The people from the district came, and then they trained us so that when I go and nurse a patient, I know what I’m doing. At the end of the day, I’m delivering quality care to that patient. And, so, there’s in-service training, there’s people from the district, and, for being sent for workshops, ja, we do get sent to different workshops for Helping Babies Breathe, ESMOE, and so on, but I feel that it’s not enough ’cause, since I’ve been in labour ward, I’ve only went on one workshop, which was ESMOE, for the whole seven years and feel like ukuthi (to say) it’s not enough” P06
Participants in this study indicated that they must attend more workshops, seminars and symposiums to keep them updated with the latest guidelines and policies to provide relevant patient care. Similar findings were reported by Nyiringango et al. (54) indicating that nurses and midwives highly regard the significance of continuing professional development (CPD) because CPD contributes to improved quality of health care. In addition, midwives view CPD as essential for improving skills and understanding, especially because nursing is becoming more supported by scientific research. Continuing professional development benefits nurses and midwives. Still, a study also conducted by Ikemoto et al. (55) found that CPD plays a significant role in ensuring safe midwifery practices that benefit women and society.
4.2.4.4 Sub-theme 4.4: Recruitment of more staff
The participants suggested that more midwives should be employed in the maternity units. They believe adequate staff will improve the quality of care and reduce litigation. This experience is confirmed by five of the nurses in direct quotation from the following scripts:
“… but if there is more hands, then it means at least you don’t neglect other patients because you are delivering that patient, you don’t miss a patients review because there is a patient delivering, you don’t miss a patient review because you are loading a pre-eclamptic patient or there is a postpartum haemorrhage patient, the more hands the more the workforce is better delivered, the more we can deliver better service to our patients, and the more we can have less litigations probable litigations” P01
“The workload is too much. Tshwane has many patients, and we are short-staffed. In most cases, you find that we have eight deliveries a day, and we are only four or five on duty. So it’s tiring. We need more staff”. P03
“If they can staff us more so that whenever they say there’s an in-service training, one is able to attend. And remember, when one attends, at least she comes back with feedback and then empowered more midwives, so that way it would be better”. P04
“And then with the staff issue as well, if they can get us enough staff. Because the labour ward is unpredictable, we can’t say no, you have enough, you have four patients, and then you guys, you are five, you are enough. Anything can happen along the way. Pregnant women can get here; even two can make the ward go upside down if they have complications”. P05
“I think there should be feedback, if there is shortage of staff, just give us feedback that we are aware that there’s shortage of staff but, according to government, the posts are frozen or whatever” P02
The challenge of a nurse shortage has existed for many years. This observation is supported by Maresova et al. (56), who revealed that the shortage of nurses is not a new phenomenon in the nursing service; it is a worldwide concern that is predicted to be in place for the next coming years. Hastings-Tolsma et al. (57) found that shortage midwives result in an increasing number of litigations, increased workload, and patient neglect, and substandard care.