Quality improvement in healthcare has become a global imperative, with growing emphasis on integrating the perspectives of both patients and care providers in evaluating and delivering care (Ostern et al. 2021). Despite this global momentum, many low- and middle-income countries (LMICs), including Ghana, continue to face challenges in consistently delivering high-quality nursing care that meets patients’ expectations (Danso et al. 2024). Across settings, patients expect compassionate, competent and timely care from nurses – professionals who remain central to achieving positive health outcomes and patient satisfaction (Lee & Seo 2022).

The Institute of Medicine (IOM 2013) defines quality care as care that increases the likelihood of desired health outcomes and is consistent with current professional knowledge. This perspective aligns with the argument by Lachman, Batalden and Vanhaecht (2020) that quality must reflect the values and expectations of both patients and healthcare providers. Quality nursing care is therefore grounded in professional competence, ethical conduct, attentiveness and the ability to deliver care that is safe, timely, efficient, equitable and person-centred (Stavropoulou et al. 2022).

Nurses are foundational to healthcare systems, serving as frontline providers responsible for patient assessment, timely intervention, health education and emotional support. Their capacity to deliver safe and effective care is especially critical in resource-constrained settings. Studies indicate that nurses often employ adaptive strategies, such as teamwork and task prioritisation, to maintain care quality under pressure (Al-Akash et al. 2024). Nurse managers further strengthen these efforts by translating administrative policies into clinical practice, facilitating staff training and leading quality improvement initiatives (Agbanu 2023). Their leadership in areas such as resource allocation, performance management and staff support are essential for sustaining staff motivation and improving service delivery outcomes (Acheampong & Domfeh 2021).

In Ghana, public hospitals serve as the main access points for healthcare, providing services to most of the population through government subsidies and the National Health Insurance Scheme (Sarfo 2020). The Ghana Health Service’s Quality Assurance Programme exemplifies national efforts to improve care standards by involving both nurses and nurse managers in policy implementation and service evaluation (Kumah 2024). While nurses focus primarily on direct patient care – including treatment administration, patient monitoring, ethical practice and family education – nurse managers are responsible for supervision, resource allocation, staff development and ensuring compliance with clinical protocols.

Despite these initiatives, concerns about declining nursing care standards persist, particularly in the study setting.

Patients have reported feeling unsafe during hospitalisation, especially during weekends when staff shortages and lapses in care are more common (Konlan et al. 2020). Ongoing challenges such as neglect, medication errors, inadequate infection control and ineffective communication continue to undermine patient safety and public trust.

These systemic issues highlight the need for targeted, context-specific interventions to improve nursing care delivery.

Although patient perspectives on quality nursing care in LMICs are well documented (Afulani et al. 2023; Kassa et al. 2022; Makua, Mokoena & Mkhize 2024; Ojebode, Akin-Otiko & Sobo 2021), the voices of nurses and nurse managers – the primary providers of care – remain underrepresented in quality improvement discourse. Abugre and Bhengu (2024) report that nurse managers view patient-centred care as central to improving both care quality and nurse job satisfaction.

Conversely, Ansah Ofei and Paarima (2021) demonstrate how ineffective leadership practices negatively affect staff morale and performance, while Kumah (2024) highlights the influence of management approaches on nurse retention and professional commitment. These findings underscore the critical role of supportive leadership in shaping work environments and care outcomes.

Understanding the perspectives of nurses and nurse managers is therefore essential for identifying systemic barriers – such as resource limitations, communication gaps and inadequate supervision – that hinder effective care delivery. Insights from these groups can inform the development of contextually appropriate strategies to address such challenges, strengthen professional development and enhance healthcare system performance. This study explores how nurses and nurse managers perceive quality nursing care in public hospitals in Ghana’s Bono Region, with the aim of generating evidence-based recommendations to improve nursing practice and healthcare delivery in similar LMIC contexts.

This study explored the perceptions of nurses and nurse managers regarding quality nursing care in public hospitals in the Bono Region of Ghana. The findings indicate that quality nursing care is attributed to holistic and patient-centred care, underpinned by professionalism, clinical competence and ethical conduct. Consistent with previous studies (Fredericks & Naidoo 2023; Lateef & Mhlongo 2022), participants emphasised that quality nursing care involves the delivery of individualised, effective and efficient services that address patients’ physical, emotional and spiritual needs, while promoting patient participation and respect for patient rights. Participants further highlighted the need for adherence to professional codes, standards and ethical frameworks while performing core nursing practices. This supports the findings of Oldland et al. (2020), who reported that ethical compliance strengthens patient trust and enhances the safety and effectiveness of nursing care. In addition, participants highlighted continuous professional development as a key factor contributing to the quality of nursing care. This finding aligns with Shaw (2023), who argues that sound clinical decision-making and improved care outcomes are enhanced when nurses receive continuous training and professional updating. Participants also associated the delivery of quality nursing care with the availability and adequacy of material resources, observing that sufficient equipment enable timely, effective patient care. They further highlighted the importance of adequate monitoring and supervision, where structured oversight, feedback and performance monitoring help to ensure that care standards are upheld, support professional development and contribute to improved clinical outcomes. Research shows that adequate resources are key elements of a positive practice environment and are closely linked to perceptions of care quality, while effective supervision and delegation practices enhance teamwork, accountability and safe nursing care delivery (Rivaz et al. 2017).

Numerous barriers to quality nursing care were identified, particularly structural challenges. These included limited resources, including staff shortages, inadequate medical supplies and limited equipment. Similar challenges have been reported in other studies conducted in Ghana (Yakubu et al. 2022), which can reinforce increased workload, turnover and migration pressures, affecting their ability to provide optimal care. For example, literature on nurse emigration in Ghana indicates that it has led to higher nurse-to-patient ratios, intensifying workload pressures and contributing to emotional exhaustion, diminished morale and overall job dissatisfaction (Alhassan et al. 2025; Coudounaris, Akuffo & Nkulenu 2020). In addition, participants emphasised that inadequate supervision and language challenges affect the quality of nursing care. They advocated for regular in-service training, mentorship programmes and strengthened managerial oversight to enhance accountability and skill development. These findings are supported by Brás Baptista Sérgio, Rodrigues Faria de Carvalho and Correia Barroso Pinto (2023), who demonstrated that effective clinical supervision positively influences key quality indicators in nursing practice. Language barriers can significantly compromise the quality of nursing care by causing miscommunication, incomplete assessments and delays in treatment, ultimately affecting patient safety and satisfaction (Gerchow et al. 2021).

The study also revealed behavioural and cultural challenges within nursing teams as barriers towards quality nursing care. Participants reported negative staff attitudes, poor communication, a lack of professional commitment and identity, and professional jealousy such as interpersonal conflict as factors undermining the provision of quality nursing care. These issues contributed to workplace tension and negatively affected team cohesion and care delivery. This observation is consistent with Meneses-la-Riva et al. (2025), who emphasise the importance of nurse leadership in addressing relational barriers to foster collaborative and supportive practice environments.

Leadership and accountability gaps were identified as significant barriers to quality nursing care, with participants reporting that a lack of effective supervision and oversight undermined clinical performance, hindered professional support and negatively affected care standards. They also found that the absence of recognition and motivational strategies for nurses diminished morale and reduced accountability for high–quality practice, reflecting wider evidence that weak leadership and inadequate supervisory practices compromise staff engagement and the consistent delivery of safe, high–quality care (Alhassan et al. 2025).

The dual impact of quality nursing care on patient outcomes and well-being and satisfaction was clearly articulated. Poor-quality care resulted in adverse patient outcomes, including re-admissions, delays in care, worsened conditions and prolonged hospitalisation, resulting in additional strain on patients and the overall health systems. Conversely, high-quality nursing care was associated with enhanced patient recovery, satisfaction and overall well-being as well as improved health literacy, empowering patients. These findings are supported by Azevedo et al. (2020) and Enweronu-Laryea et al. (2018), who highlighted the direct relationship between nursing care quality and both individual- and system-level health outcomes.

There is a critical need to implement structured in-service training, mentorship programmes and continuing professional education to ensure nurses remain current with evolving evidence-based practices and standards of care. Hospital management, in collaboration with the Ministry of Health, should prioritise the consistent availability of essential medical supplies and functional equipment, which are fundamental to safe and effective care delivery. Strengthening supervisory systems and introducing performance monitoring mechanisms may further enhance accountability and clinical practice standards. In addition, recognising nurses’ contributions, providing opportunities for career advancement and offering psychosocial support are essential for improving morale, retention and workplace satisfaction.

At both practice and policy levels, stronger nursing support systems are required to sustain quality care. In practice, supportive supervision, continuous professional development and positive organisational cultures are vital. Nurse leaders should promote teamwork, uphold ethical standards and ensure adequate resource allocation. At the policy level, addressing staff shortages, workforce migration and infrastructure deficits requires coordinated national strategies. Priorities should include improving nurse-to-patient ratios, implementing retention incentives and investing in essential equipment and supplies. Integrating nurses’ perspectives into decision-making and institutionalising mentorship, supervision and professional development initiatives can strengthen accountability, patient safety and health system performance. In Ghana, such reforms are essential for advancing Sustainable Development Goal 3 on health and well-being.

This study offers valuable insights into how nurses and nurse managers in public hospitals in the Bono Region perceive and experience quality nursing care. Their accounts reveal that quality nursing care is a multifaceted concept encompassing not only clinical competence and ethical practice but also organisational support and effective teamwork. Participants further emphasised that quality nursing care depends on effective leadership, adequate resources and supportive supervision, which collectively enhance patient outcomes, satisfaction and well-being; conversely, deficiencies in these areas can compromise care quality and lead to poorer patient outcomes. The findings suggest that improving nursing care delivery in these settings will require more than individual effort – it demands systemic change. Targeted interventions such as enhanced supervision, regular training and improved interprofessional collaboration are essential. Moreover, overcoming structural and cultural barriers will require a coordinated response from hospital administrators, policymakers and frontline healthcare providers. By prioritising adequate resource provision, supportive work environments and continuous professional development, stakeholders can foster a culture of excellence in nursing care that benefits both patients and the health system as a whole.