Exploring professional nurses’ perceptions of structural, organizational, and workplace constraints affecting nursing assessment in a selected public hospital in South Africa: a qualitative study

Background: Efficient and effective nursing assessment is essential for developing comprehensive nursing care plans that support clinical decision-making and quality service delivery. However, nursing assessment is influenced by broader healthcare system conditions. Objective: This study aimed to explore nurses' perceptions of structural, organizational, and workplace constraints affecting nursing assessment and how these constraints influence the quality of care delivery in a selected public hospital in South Africa. Methods: A qualitative and exploratory descriptive design was used. Twenty professional nurses were selected through purposive sampling based on clinical experience and direct involvement in care delivery. Data were collected through semi-structured, in-depth interviews guided by an interview schedule. Interviews were audio-recorded and supplemented with field notes. Data were transcribed verbatim and analyzed using Tesch's open coding method to generate themes and sub-themes. Ethical principles were strictly adhered to throughout the study. Results: Two main themes and six subthemes emerged, highlighting significant structural and organizational constraints within the healthcare system. These included staff shortages, overcrowding, inadequate infrastructure, limited material resources, and inefficient resource allocation systems, all of which negatively influenced nursing assessment processes. Participants described how these systemic pressures resulted in workload escalation, fatigue, burnout, and reduced capacity for timely and comprehensive assessment. To cope, professional nurses reported relying on task prioritisation, workflow adjustments, and informal system adaptations within an overstretched service environment. Conclusion: Nursing assessment in the study setting is significantly shaped by structural and organizational constraints within the healthcare system. These systemic challenges negatively affect workforce well-being and the quality and timeliness of care processes. Strengthening healthcare staffing models, infrastructure capacity, and resource allocation systems is essential to improve nursing assessment and overall service delivery.