According to the South African Nursing Council’s regulation R 2127, staff and auxiliary nurses must be supervised by professional nurses. This supervision is essential for quality care, leading to fewer patient complaints and higher satisfaction.
This study aimed to explore and describe the experiences of staff nurses and auxiliary nurses on the supervision of nursing care by professional nurses in Limpopo province.
The study was conducted in three selected regional hospitals located in different districts of Limpopo province: Vhembe, Mopane, and Waterberg.
A qualitative approach using exploratory, descriptive, and appreciative inquiry research designs was selected to gain insights into professional nurses’ supervision of nursing care. Non-probability purposive sampling was used to choose districts, hospitals, units, and participants. Data were collected through focus group interviews with participants from paediatric, maternity, and casualty units and analysed using Tesch’s eight steps of data analysis.
Four themes emerged: Staff shortages, educational and training challenges, attributes of a good supervisor, and the roles and responsibilities of supervisors.
To improve the quality of patient care outcomes and reduce patient complaints and lawsuits, professional nurses must supervise nursing care. However, the current difficulties jeopardise professional nurses’ ability to optimally supervise nursing care.
This study contributes to improving the quality of supervision of nursing care, which is aimed at achieving high patient satisfaction, reducing patient complaints and related medico-legal negligence cases. This study also demonstrates how effective supervision by registered professional nurses can enhance the knowledge and skills of both staff nurses and auxiliary nurses.
Nursing is the foundation of health care because admitted patients are cared for by nursing staff around the clock. To provide high-quality nursing care, professional nurses must continuously supervise staff nurses and auxiliary nurses. According to the South African Nursing Council’s (SANC) position statement (SANC
The Regulation for the Scope of Practice of Nurses and Midwives (R2127) further states that the staff nurses and auxiliary nurses must work under the supervision of the professional nurses (SANC
Supervision is an important strategy that complements the quality of nursing practice in implementing actions to improve patient satisfaction and ensure the quality of nursing care. Therefore, support and daily monitoring of patient care define the path for staff nurses and auxiliary nurses to gain knowledge and skills (Brás Baptista Sérgio, Rodrigues Faria de Carvalho & Correia Barroso Pinto
Supervision of nursing care is necessary to improve patient care, support professional development, and maintain ethical standards in the nursing profession. Nonetheless, it has been found that difficulties, including a heavy workload and a demanding workplace, make it difficult for professional nurses to supervise auxiliary nurses and staff nurses. Moreover, the lack of effective supervision of nursing care contributes to compromised patient safety and medico-legal negligence cases (Shongwe, Downing & Nene
The effective execution of supervision requires a conducive therapeutic environment between nursing staff and patients, despite the challenges that can arise, which can result in ineffective supervision of nursing care (Achempim-Ansong, Kwashie & Ofei
Supervision of nursing care has been implemented globally, locally, and in African countries for a long time; however, despite this, some challenges hinder its effective implementation. Globally, nursing care supervision is regarded as essential for enhancing nurses’ professional development and improving healthcare quality through guidance and mentorship. High-income countries, including the United Kingdom, Australia, and Canada, have implemented formal frameworks for professional development and supervision (Martina et al.
Effective supervision of nursing care in Africa faces challenges such as high patient-to-nurse ratios, staff shortages, inadequate supervisory skills, and task pressure (Alhassan et al.
In South Africa, nursing care monitoring aims to improve healthcare quality despite challenges like staffing shortages and financial constraints. Professional nurses play a vital role in overseeing care, ensuring compliance with standards, and enhancing patient safety (Shongwe et al.
The aim of this study was to explore and describe the experiences of staff nurses and auxiliary nurses regarding the supervision of nursing care by professional nurses in the selected regional hospitals of Limpopo province.
Proctor’s integrated supervisory model serves as the theoretical backdrop for the study, which aims to enhance outcomes for users and clinicians by supporting nursing supervision (Snowdon et al.
Normative supervision establishes ethical standards for supervisees, restorative supervision fosters their development, and formative supervision enhances their skills. Proctor’s model highlights the formative component, enabling nurses to improve their knowledge and practice, which positively influences nursing care supervision. Normative supervision enforces adherence to nursing standards among staff, thereby promoting quality and clinical audits (Litherland et al.
This study employed a qualitative approach using the exploratory, descriptive, and appreciative inquiry research design. This approach was used to explore and describe the experiences of staff nurses and auxiliary nurses regarding supervision of nursing care by professional nurses in the selected regional hospitals of Limpopo province (Polit & Beck
The study was conducted in Limpopo province, South Africa, which has a population of 6.5 million (Stats SA
A total of 37 nurses participated in the study, comprising 18 staff nurses and 19 auxiliary nurses. Six focus groups were conducted, each with six participants, except the last, which had seven. Participants were selected as they could provide detailed information about their experiences with the supervision of nursing care by professional nurses within the selected hospitals.
A non-probability purposive sampling method was used in this study, whereby participants were selected based on the researcher’s judgement and their in-depth knowledge of the supervision of nursing care by professional nurses (Brink & Van Rensburg
Since individuals are best understood in their living settings, data were collected in the Maternity unit, Paediatric ward, and Casualty department of the selected regional hospitals where the participants work.
To learn more about the experiences of staff nurses and auxiliary nurses regarding nursing care supervision by professional nurses, the researcher conducted focus group interviews using interview guides (Gray, Grove & Sutherland
The questions asked were: (1) What are your experiences regarding supervision of nursing care by professional nurses in your hospital? (2) What do you think needs to be improved when it comes to the supervision of nursing care by professional nurses in your hospital? (3) How best do you think professional nurses should supervise the nursing care in your ward and hospital? (4) In the coming years, what changes would you like to see introduced in your hospital to improve supervision of nursing care by professional nurses?
These questions were developed based on the four dimensions of Appreciative Inquiry: discovery, dream, design, and destiny. Participants were encouraged to openly discuss their experiences regarding the supervision of nursing care by professional nurses. A voice recorder was used with their permission; the researcher employed probing to ensure all topics were covered, and the researcher took notes during interviews to document their informal behaviour (Polit & Beck
The researcher used Tesch’s eight steps to analyse the data as mentioned in Creswell and Creswell (
The researcher compiled the themes and sub-themes into a summary. After sending the raw data to a skilled independent coder, a consensus was reached on the identified themes and sub-themes.
According to Polit and Beck (
Transferability was enhanced by purposive selection of districts, hospitals, units, and participants.
Additionally, the researcher thoroughly described the research setting, study participants, and research process (Grove & Gray
Ethical clearance to conduct this study was obtained from the University of Venda Higher Degree Ethics Committee under reference number FHS/23/PDC/01/1409 in September 2023. Approval was also sought from the Limpopo Department of Health Ethics Committee, as well as from the three district health offices and three selected regional hospitals in Limpopo province. The researcher ensured that ethical principles were upheld by protecting participants’ privacy and confidentiality throughout the study. Consent to participate was obtained from each participant voluntarily, without coercion, and they had the right to withdraw at any time without penalty. Participants’ identities were kept confidential, with no personal names or identifying information recorded. Instead, code names such as FG 1: M1 were used. All digital data was secured with passwords, while hard copies were stored in a locked cupboard.
Thirty-seven staff nurses and auxiliary nurses participated in the study; of these, 31 were female, and 6 were male. There were few males because nursing is a female-dominated profession. The participants from Maternity were 13, from Casualty units were 12, and from the Paediatric ward were 12. The interviewed participants’ ages ranged from 40 to 60 years, and their years of experience ranged from 10 to 40 years. Data was collected through six focus group interviews for both categories of nurses. Each focus group had 2 staff nurses and 2 registered auxiliary nurses, for a total of 18, from the three wards and/or units of three selected regional hospitals.
However, 1 regional hospital had 3 auxiliary nurses, bringing the total to 19.
After reading and re-reading the transcripts, the researchers extracted 4 themes and 10 sub-themes: Staff shortages, education and training challenges, and the supervisor’s roles and responsibilities. These findings were underpinned by Proctor’s supervision model and were based on the experiences of participants as outlined in their own voices. The findings were grouped into themes and subthemes as shown in
Summary of themes and sub-themes.
| Themes | Sub-themes |
|---|---|
| 1. Shortage of staff | 1.1. Increased workload |
| 2. Educational and training challenges | 2.1. Lack of staff training |
| 3. Suggested attributes of a good supervisor | 3.1. Approachable and avoid favouritism |
| 4. Supervisory role and responsibility of professional nurses | 4.1. Delegation of staff |
Data on the experience of being supervised by professional nurses was collected from staff nurses and auxiliary nurses. Subsequently, the participants informed the researcher about the difficulties they encountered when supervising nursing care, including staffing shortages, difficulties with education and training, features of effective supervisors, and the duties and responsibilities of supervisors.
Shortage of staff was cited by the majority of participants as a challenge in most hospitals and was due to unfilled posts after the exit of nurses, either due to death, retirement, or resignation from the management.
‘Supervision, to me, I can say it is difficult because of the shortage of staff, as one can find that there is only one auxiliary nurse and one registered enrolled nurse, together with one professional nurse who should attend to the whole ward routine. This makes it difficult for us to do all the tasks because there is an increased workload that makes us fatigued.’ (FG2, member 12, male participant)
‘It is evident to me that the other colleagues are correct when they say that supervision is challenging due to the busy wards, staffing shortage, and excessive workload for the few nurses who are on duty. The workload seems excessive to me; the department should definitely think about recruiting more employees, as this is having a detrimental effect on our lives.’ (FG 4, member 22, female participant)
‘The other challenge we are experiencing is the challenge of absenteeism, which results in a shortage of staff and affects the quality of care that can be rendered. The employer should try to address this challenge as it is negatively impacting nursing care.’ (FG5, member 30, female participant)
‘What I can say is that, the standard of supervision has gone down because, from the era that we are coming from, the issue of resources was allocated fairly within all wards, but now we are experiencing the challenges of a shortage of resources, which stems from the equipment, supplies, and medication. All these resources are very vital when it comes to managing patient care, but the unit is running without these vital resources.’ (FG6, member 37, male participant)
Absenteeism is a problem that many participants mentioned, and it affects nursing care supervision. According to several participants, the staff’s increased burden because of the personnel shortage also motivated them to miss work. The ongoing staffing deficit because of absenteeism, which is a problem for nursing care monitoring, has a detrimental effect on the quality of nursing care.
‘The nurses are fatigued by too much work they are faced with due to overworking, as the ward is full of patients, but very few staff. Eish, it is painful because we are always tired and there is no time to rest. We don’t have time for tea or lunch breaks.’ (FG2, member 12, female participant)
‘Eish, the other issue that is challenging is nurses’ fatigue and exhaustion; it is because of staff being overworked due to a shortage of staff, which makes them burn out. I strongly feel that it needs to be addressed to revive their morale.’ (FG3, member 18, female participant)
Another obstacle to efficient nursing care supervision, according to the participants, is a lack of education and training. Other participants indicated that the tactics required for staff development and capacity building are employee education and training, as their absence compromises nursing care supervision and work performance. Because the staff is underprepared, some participants stated that a lack of education and training is a contributing factor to poor work performance. The sub-themes that emerged were a lack of staff training and supervisor training.
‘Staff nurses and auxiliary nurses, we really want the training to come back so that we can be trained and progress from one level to the other. But because of a lack of training, we find ourselves being stagnant and also lacking knowledge of some of the procedures that are within our scope.’ (FG2, member 11, female participant)
‘All the hospitals here in our province have not conducted the formal training of nurses for too long, and this brings about so many challenges in our profession, leading to nurses not having the knowledge and skills for the work. This poses a challenge to patient care and supervision because some of us do not know what to do.’ (FG3, member 15, female participant)
‘The challenge that nursing faces is that there are some professional nurses who are lazy and do not know what to do when they are on duty, and they tend to harass other nurses and patients. It seems they are not sure of what to do when on duty and hide behind a negative attitude. Some of the professional nurses are not well trained, which is why they are unsure of what they are doing, as they lack the skills to supervise us.’ (FG2, member 08, female participant)
‘This profession is challenged by professional nurses who lack professionalism and competency in supervising nursing care, and they end up not supervising; this has led to challenges in the supervision.’ (FG5, member 23, male participant)
Some participants said that some of the supervisors lacked the necessary training, making them incompetent at supervising. The participants also mentioned that a large number of supervisors are not competent.
According to the participants, a supervisor must possess specific positive qualities that motivate employees to persevere through difficulties to supervise effectively. The qualities mentioned were crucial for nursing care supervision. The participants cited the following attributes of a good supervisor: approachability, avoidance of favouritism, and possessing strong communication skills.
‘The supervisors are our resource people in times of need, and they must have the positive qualities of being personable and courteous. Additionally, they must not exercise favouritism.’ (FG1, member 05, female participant)
‘I see that professional nurses should also treat us the same and not practice favouritism. By this, I see that their supervision of nursing care was best as the task allocation will be the same throughout the same categories of nurses. There will be no one who will not be given tasks that are not the same as others because we will be treated in the same way.’ (FG6, member 32, female participant)
According to the participants, a supervisor needs to be friendly to both staff and patients in order to properly oversee. According to some participants, managers should be approachable and kind to everyone so that employees feel comfortable and can concentrate on their work without any concerns.
Some of the participants indicated that the supervisors should treat them the same and avoid favouritism.
‘The supervisors [
‘The supervisor should also improve on the way they speak to us as junior nurses because you will find that the patient has requested a bedpan and the professional nurses respond by saying the once for the bedpan shall come and attend to you or telling the patients that they are assistants and not nurses.’ (FG6, member 35, female participant)
It is the supervisor’s responsibility to make sure that nursing tasks are completed on time and accurately. It is crucial for the supervisor to make sure that nursing care is being supervised. Supervisors are required to fulfil certain responsibilities while on duty to enhance employee performance and motivate employees to perform to the best of their abilities. Participants reported that some of the roles supervisors must perform include delegating to staff, providing direct supervision, and rewarding good performance.
‘What I see is that the supervision that goes well is when they have delegated us the responsibilities, because when you have been delegated, you know the tasks that you must do for the day, even if there are some tasks that can be added, you know your expectations for the day. Delegation also assists them because some of the important tasks cannot remain unattended.’ (FG3, member 13, female participant)
‘Professional nurses must always be present in the ward to check on the work of subordinates. This strategy addresses the challenge of supervision of nursing care. Professional nurses must practice direct supervision of nursing care; without direct supervision, staff members always end up not doing their responsibilities.’ (FG1, member 05, female participant)
‘The professional nurses are also responsible for direct supervision of patient care; therefore, the challenges of supervision will be solved. Direct supervision of nursing care improves staff performance, thus addressing the challenges of supervision of nursing care.’ (FG3, member 13, male participant)
‘The managers must really motivate us to do the work to the best of our ability so that there will be improved supervision of nursing care. The managers must also reward good performance to boost staff morale.’ (FG 1, member 04, female participant)
‘The manager must always take care of the workers so that they can render quality patient care. The manager can reward good performance. The staff will become effective, and supervision of nursing care shall improve.’ (FG3, member 15, female participant)
Proctor’s supervision model underpinned the discussion of the findings of this study, and the experiences of participants were discussed based on the model. The supervision of nursing care is adversely affected by increased workload, as inefficient work results when there is excessive labour and not enough hands, lowering the standard of nursing care. Proctor’s supervision model states that effective supervision leads to greater nurse efficiency; however, due to a lack of staff, increased workload may lead to greater job dissatisfaction. The quality of nursing care is compromised by increased workload, resulting in patients’ complaints, as participants occasionally attend to patients’ basic needs while neglecting other duties.
According to the findings of a study conducted in Manila, Philippines, by Bautista et al. (
Consequently, the international studies’ findings are also relevant in the South African supervision context, as supervision is severely affected by a shortage of staff and resources in some hospitals, even though in some hospitals, it is not like that, as there is a sufficient number of supervisors and equipment. In some areas, there is a maldistribution of these resources and personnel, which affects the nursing care and supervision.
Absenteeism, according to Khateeb (
Staffing shortages have made fatigue and burnout syndrome extremely prevalent among nurses. Studies conducted reported that absenteeism and staff shortages are the main causes of exhaustion and burnout syndrome in the nursing profession. According to a study conducted in London, United Kingdom, by Razai, Kooner and Majeed (
For an organisation to achieve a high productivity level, staff members must receive training, either formally or informally; likewise, it is necessary for hospitals to improve service delivery. Proctor’s restorative dimension of the supervision model supports professional and skills development among nursing staff, which can be enhanced through effective supervision. Proctors’ formative dimension of the supervision model further indicates that once staff members are trained, they become knowledgeable and competent and are able to adhere to nursing standards, thereby promoting quality and clinical audits; hence, the need for effective supervision (normative dimension). While management conducts training for personnel, the staff are responsible for attending training as scheduled. A few individuals mentioned the difficulty of not having enough training opportunities, which is causing them to stagnate rather than advance. Additionally, they stated that hospitals no longer offer in-service training, depriving them of the opportunity to receive the training. According to a study conducted in South Africa, in Limpopo, by Nyelisani, Makhado and Luhalima (
Lack of supervisory competence was identified in a number of studies as a barrier to effective supervision. Rothwell et al. (
Effective communication skills were reported in several studies as essential for supervisors to interact with staff members and enhance nursing care supervision. To improve nursing care supervision, some studies stated that supervisors should be proficient communicators who can interact with both staff and patients. The study conducted in Palestine by Sharkiya (
Proctors’ normative dimension of the supervision model highlights adherence to ethical standards, with delegation of staff and direct supervision as core practices that need to be followed to improve supervision. Several studies have reported that staff delegation is one of the practices that enhance employee performance, ensuring that everyone is focused on the work and every task is completed on time. According to Jooste (
Direct supervision, according to the SANC’s position statement (SANC
One of the things that drives employees to do well at work is rewarding them for their efforts.
Employees should be motivated to reach their full potential, so the manager needs to further inspire them to enhance their productivity. Supervisors are supposed to inspire employees to work diligently so as to improve patient outcomes. In the study conducted in the United States by Waltz et al. (
The findings of this study have revealed that staff nurses and auxiliary nurses should work under the supervision of registered professional nurses, and consequently, quality nursing care can be delivered. The limitation of the study was that it was conducted in three selected regional hospitals; therefore, the findings cannot be generalised to other hospitals and other provinces. Additionally, the study focused on one of South Africa’s nine provinces; its applicability to other provinces may be limited.
The researcher determined the experiences of staff nurses and auxiliary nurses regarding the supervision of nursing care by professional nurses in the selected regional hospitals of Limpopo province. The study recommends that the shortage of staff should be addressed in order to improve supervision by professional nurses. Furthermore, the management should strengthen the retention of existing nurses in order to retain the very few nurses that are available through the introduction of retention packages, such as rewarding good performance. Debriefing of staff is necessary and may improve job satisfaction and communication; therefore, nursing managers must engage the staff and refer them timeously to debriefing sessions. Mentoring and coaching should be part of the nursing profession in the pursuit of mature and well-developed nurses. The management should address the lack of training of staff through fostering life-long learning to avoid waiting for training by the institution. Nursing education should incorporate the introduction of a supervision module for staff nurses and auxiliary nurses to highlight their expectations during supervision by professional nurses. The study further recommends that there should be a policy for supervision by professional nurses. Future research should be conducted in other provinces and hospitals in order to generalise the findings.
The study aimed to explore the experiences of staff nurses and auxiliary nurses regarding the supervision of nursing care by professional nurses. The study findings highlighted the experiences of staff nurses and auxiliary nurses regarding the supervision of nursing care by professional nurses. These findings need to be addressed so that the supervision can be improved, which will result in a reduction of patients’ complaints and lawsuits.
The authors would like to thank all the lecturers who participated in the study.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Munyadziwa R. Raliphaswa: Conceptualisation, Data curation, Formal analysis, Investigation, Methodology, Resources, Visualisation, Writing – original draft. Takalani R. Luhalima: Conceptualisation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing. Julia L. Mafumo: Formal analysis, Resources, Writing – original draft. Vhonani O. Netshandama: Data curation, Writing – original draft. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication, and take responsibility for the integrity of its findings.
The data are not publicly available due to the university’s policy restrictions.
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or the publisher. The authors are responsible for the article’s results, findings, and content.