South Africa has implemented several health improvements to strengthen primary health care (PHC). Despite that, there is an increasing number of patient complaints that may affect job satisfaction among healthcare providers, especially nurses.
This study explored how patient complaints can impact job satisfaction of nurses in the PHC clinics, Ehlanzeni District, Mpumalanga, South Africa.
Professional nurses from three PHC clinics in Ehlanzeni District, Mpumalanga, South Africa, were recruited.
A qualitative, exploratory and descriptive design was utilised. Eleven professional nurses were recruited purposively at the three selected PHC clinics until saturation was reached. Semi-structured, individual interviews were conducted, transcribed verbatim and analysed thematically using Saldana’s coding methods.
Five major themes and sub-themes emerged: perceived staff attitudes and patient complaints, work environment stressors, emotional impact on nurses, communication challenges and recommended strategies for improvement. Primary health care nurses reported that patients’ complaints often stemmed from long waiting, insufficient staff and a lack of communication; however, these were reflected as staff failures, leading to reduced morale and confidence.
Most reported patient complaints relate to negative staff attitudes, often compounded by systemic issues such as staff shortages, inadequate material resources and long waiting times. This study brings to the fore that patient complaints should be understood within the broader systemic context, as they can significantly influence nurses’ job satisfaction.
This study contributes empirical evidence to the under-researched area of the impact of patient complaints on nurses’ morale in the South African context.
Primary health care (PHC) serves as the first point of contact between patients and the healthcare system, focusing on basic treatment, preventive care, health promotion and the management of chronic diseases.
The South African National Patients’ Rights Charter was implemented in 2008 by the Department of Health (DoH) under section 27(1)(a) of the Constitution to guarantee patients’ rights to quality healthcare, including the right to complain about dissatisfaction with care provided.
These challenges are predominantly experienced in public PHC clinics, where nurses experience contextual difficulties such as insufficient staffing, high patient care demand and inadequate infrastructure and essential resources.
Long queues, system failures and weak referral systems further contribute to patient dissatisfaction, which frequently translates as complaints about negative staff attitudes.
Considering South Africa’s ongoing efforts to implement National Health Insurance (NHI) and achieve Universal Health Coverage (UHC), it is critical to understand how patient complaints affect nurses’ well-being. While there are numerous studies on factors influencing patients’ complaints,
The study is underpinned by the Job Demands-Resources (JD-R) model, which is a prominent occupational stress and well-being framework that distinguishes between job demands and job resources.
One of the key benefits of this framework is its ability to identify not only the direct relationship between the core constructs but also the underlying mechanisms (mediators) and influencing factors (moderators) that shape this relationship. By incorporating variables such as perceived stress and sense of professionalism, the framework captures the psychosocial processes through which complaints impact nurses’ mediating morale. Moreover, the inclusion of moderating variables like organisational support and work–life balance allows for a nuanced understanding of contextual and protective factors that may either buffer or intensify the effects of patient complaints.
This study used a qualitative, exploratory and descriptive design to understand how patient complaints affect nurse job satisfaction.
The study was conducted in three selected PHC clinics located within the City of Mbombela, a sub-district of the Ehlanzeni District in Mpumalanga province, South Africa. Ehlanzeni is the most populous district in the province with approximately 2.27 million residents (44% of the provincial population) and serves as the province’s economic hub. The district has 142 healthcare institutions, including 110 PHC clinics, 16 community health centres and 19 hospitals of various levels, with the City of Mbombela hosting the highest concentration of facilities (30 fixed facilities).
The target population (
Purposive sampling was employed to select participants who met specific inclusion criteria, including being registered with the South African Nursing Council (SANC) as professional nurses or nurse practitioners, being permanently employed, having at least 5 years of experience working in a PHC setting within the district and having been directly exposed to patient complaints concerning staff attitudes. Data saturation was reached by the 10th interview, with the final interview confirming that no new information or insights were produced (
This qualitative study utilised a descriptive phenomenological approach to exploring the lived experiences of nurses. A semi-structured interview guide was specifically developed by the researcher to capture these experiences. The guide was informed by the study’s objectives, a thorough literature review and the conceptual framework. It was designed to be open-ended, allowing for in-depth exploration, and included probes focusing on key areas:
Nurses’ perceptions of patient complaints regarding negative staff attitudes.
The impact of these complaints on nurses’ job satisfaction and professional confidence.
Coping mechanisms and support systems used by nurses.
Recommendations for improving nurse well-being and patient–provider relationships.
The interviews started with an open question, ‘Please describe the procedure for patients to lodge complaints. To whom are complaints made directed?’ Followed by other questions:
Can you describe an experience where you encountered a patient complaint regarding negative attitudes against professional nurses?
How did this complaint affect you emotionally?
Did this experience impact your professional confidence or sense of job satisfaction?
How did you handle the situation emotionally?
In your opinion, what factors in your work environment contribute to patient complaints about staff attitude?
Can you elaborate on specific examples of how these factors might lead to such complaints?
Can you suggest any interventions or changes that could improve the staff attitude of nurses and patients?
What kind of support do you think nurses need to manage patient concerns about attitude effectively?
Are there any specific communication strategies you think would help address these complaints?
Is there anything else you would like to share about your experiences with patient complaints regarding staff attitude?
A pilot study was conducted with three nurses (who were not included in the final analysis) to test the interview guide. This pilot revealed the need to rephrase two questions for greater clarity and served to test the quality of the audio recording equipment and time management. The guide was refined based on these findings before the main study commenced.
Following institutional permission, professional nurses were purposively recruited from three PHC facilities in the Ehlanzeni district. Potential participants were approached in person and provided with a study information sheet. They were given at least 48 h to consider their participation. Written informed consent was obtained from all participants prior to their involvement in the study. All participants were informed of their right to withdraw at any time without penalty.
The data were collected from February 2025 to April 2025 through face-to-face interviews. All interviews were audio-recorded with a digital voice recorder after obtaining permission from the participants to ensure accurate data capture. Interviews were conducted in private consultation rooms within the premises of the clinics to ensure confidentiality and comfort. Interviews lasted for approximately 20 min – 40 min. Additionally, field notes were taken to document non-verbal cues and contextual details. Probing was used to elicit deeper insights.
To facilitate richer and more authentic responses, participants were given the option to be interviewed in their preferred language, including SiSwati, a language widely spoken by professional nurses in the district. All interviews conducted in SiSwati were later translated into English, with the accuracy of the translations verified. A total of 11 participants were interviewed. Data saturation was reached by the 10th interview, with the final interview confirming that no new information was emerging.
Thematic analysis was employed using Saldaña’s coding techniques,
The trustworthiness of the study was ensured through several strategies aligned with the criteria proposed by Lincoln and Guba.
The ethical clearance was obtained from the University of Johannesburg’s Research Ethics Committee (REC) (REC-3157-2024). Permission was sought from the Mpumalanga Provincial Health Department REC and granted (MP_202410_011). Participation was voluntary, and nurses could withdraw at any stage without penalty. The study aimed to contribute positively to nursing well-being by giving participants a platform to share their experiences. Each participant was assigned a number for anonymity. Participants were monitored for distress during interviews, with referral pathways to counselling services available if needed. All eligible professional nurses meeting the inclusion criteria were invited fairly, ensuring equitable selection.
Eleven individuals participated in this study. Females made up 9 (81.8%) of the participants, and males accounted for 2 (18.2%). Participants’ ages ranged from 29 years to 55 years, with a median age of 42. Most respondents, 7 (63.6%), spoke SiSwati, while 4 (36.4%) primarily spoke English during the interviews (
Demographic data of respondents.
| Variables | Frequency | % |
|---|---|---|
| 20–30 | 1 | 9.1 |
| 31–40 | 3 | 27.3 |
| 41–50 | 5 | 45.5 |
| 51–60 | 2 | 18.2 |
| Male | 2 | 18.2 |
| Female | 9 | 81.8 |
| 5–15 | 6 | 54.5 |
| 16–25 | 5 | 45.5 |
| English | 4 | 36.4 |
| Siswati | 7 | 63.6 |
Thematic analysis yielded five overarching themes and several sub-themes (
Themes and sub-themes.
| Themes | Sub-themes |
|---|---|
| 1. Patient complaints and perceptions of staff attitude | - |
| 2. Workplace challenges and systemic barriers | High patient-to-nurse ratio Long waiting times because of understaffing Lack of basic resources External interference |
| 3. Emotional and professional impact on nurses | Feelings of frustration, helplessness and burnout Loss of professional confidence Emotional toll from systemic failures |
| 4. Communication and nurse–patient relationships | Lack of explanations De-escalation through empathy |
| 5. Strategies for improvement and support interventions | Increasing staffing Training on communication and conflict resolution Management support and community engagement Structured complaint resolution mechanisms |
This theme captured how nurses experienced patient complaints linked to their behaviour and communication. Patient complaints were frequently directed at perceived rudeness and dismissiveness, inadequate explanations and long waiting times, which nurses felt were often misinterpreted:
‘A patient accused a colleague of being dismissive … felt the nurse wasn’t taking their pain seriously, which led to a heated exchange.’ (Respondent 2, female, 38 years old, 12 years PHC experience)
‘Just last month, a patient complained because they had to wait for two hours to get a wound dressing.’ (Respondent 7, male, 44 years old, 14 years PHC experience)
‘Patients waiting for hours sometimes feel neglected, even though we’re doing our best.’ (Respondent 1, female, 45 years old, 18 years PHC experience)
Nurses attributed many complaints to systemic resource constraints rather than personal failure.
Nurses described how the high patient load prevented them from giving each patient sufficient attention, which patients sometimes misinterpreted as uncaring behaviour:
‘On a typical day, each nurse sees over 30 patients, which doesn’t allow us to spend enough time with each one.’ (Respondent 7, male, 44 years old, 14 years PHC experience)
Understaffing was highlighted as a major contributor to extended waiting times. Nurses reported that patients often grew frustrated during these delays, which escalated into complaints about staff attitude:
‘Waiting times at the clinic are three hours, and when patients don’t understand this, they get angry.’ (Respondent 10, female, 35 years old, 10 years PHC experience)
Resource shortages, such as a lack of medication, space or equipment, limited service delivery. Nurses expressed frustration that patients perceived them as negligent when systemic supply issues were beyond their control:
‘There are times when we run out of chronic medication, and patients think we are negligent when it’s a supply issue.’ (Respondent 3, male, 47 years old, 20 years PHC experience)
Community leaders and management sometimes intervened in patient complaints in ways that undermined clinical authority, adding to stress and negatively affecting staff–patient relationships:
‘A local councillor and his members stormed the clinic, demanding explanations about patient complaints.’ (Respondent 9, female, 42 years old, 19 years PHC experience)
Repeated complaints led to emotional exhaustion, self-doubt and reduced job satisfaction.
Complaints, especially repeated ones, left nurses feeling unappreciated and emotionally drained. This fostered burnout and decreased morale across the team:
‘When a complaint arises, it feels like all the hard work you put in goes unnoticed.’ (Respondent 3, male, 47 years old, 20 years PHC experience)
‘I was frustrated because I knew I was doing my best under difficult circumstances.’ (Respondent 6, female, 36 years old, 11 years PHC experience)
Nurses reported that frequent patient complaints led them to second-guess their clinical decisions, reducing confidence in their professional roles:
‘Such incidents make you second-guess your approach to patient care, even if you’re not directly involved.’ (Respondent 5, female, 41 years old, 13 years PHC experience)
Nurses often internalised complaints as personal criticism, even when systemic issues (such as shortages or waiting times) were the root cause. This emotional burden contributed to stress and reduced job satisfaction:
‘When patients complain, it feels like a personal attack, even when they’re just frustrated with the system.’ (Respondent 7, male, 44 years old, 14 years PHC experience)
Poor communication was a key factor behind misunderstandings that led to complaints.
Misunderstandings often occurred when patients were not adequately informed about systems such as booking or queue arrangements. These misunderstandings were frequently interpreted as unfair treatment:
‘If a patient does not understand the booking system, they feel discriminated against and assume we have favourites.’ (Respondent 8, female, 29 years old, 7 years PHC experience)
Nurses noted that clear, empathetic communication and honesty about delays or challenges helped reduce complaints and rebuild patient trust:
‘Acknowledging a patient’s feelings upfront can de-escalate tension.’ (Respondent 6, female, 36 years old, 11 years PHC experience)
Participants recommended key interventions to improve staff morale and patient satisfaction. These included increasing staff numbers, providing regular training in communication and stress management, enhancing management support with routine debriefing and community engagement and establishing clear complaint resolution mechanisms. Together, these strategies aim to address systemic challenges and foster a more supportive work environment.
Nurses consistently emphasised the need for more staff to reduce waiting times and workload, thereby improving both patient satisfaction and job satisfaction:
‘We need more staff to reduce the workload and waiting times.’ (Respondent 2, female, 38 years old, 12 years PHC experience)
Ongoing professional development in communication, conflict resolution and stress management was viewed as essential for handling patient dissatisfaction more effectively:
‘Periodic workshops on communication skills and managing patient expectations would help.’ (Respondent 2, female, 38 years old, 12 years PHC experience)
Nurses recommended greater managerial involvement, regular debriefing sessions and community meetings to foster shared understanding of clinic challenges:
‘Community meetings should include nurses explaining clinic processes to reduce misunderstandings.’ (Respondent 11, female, 55 years old, 22 years PHC experience)
Nurses expressed the need for a formal, transparent complaint-handling system that would protect staff from unfair blame while ensuring patients’ voices were heard:
‘There should be an efficient complaints-handling system that ensures both staff and patients feel heard.’ (Respondent 6, female, 36 years old, 11 years PHC experience)
This study explored how patient complaints about negative staff attitudes impact the job satisfaction of professional nurses in PHC clinics in the Ehlanzeni District, Mpumalanga. The findings reveal a deeply intertwined relationship between patient dissatisfaction, systemic healthcare challenges and nurses’ emotional well-being. These findings align with global
A central theme in this study is the misattribution of systemic healthcare challenges to individual nurses. While patients often perceive nurses to be rude or inattentive, nurses reported that these behaviours are often the result of overwhelming workloads, limited consultation time and high patient-to-nurse ratios. These findings are consistent with prior research by Van Der Heijden and colleagues
Respondents in this study did not dispute the occurrence of negative patient experiences but emphasised that their actions are frequently constrained by systemic barriers. This supports a study by Halcomb and colleagues,
Nurses reported internalising patient complaints, often viewing them as a personal attack rather than systemic indicators. This emotional burden resulted in feelings of helplessness, demoralisation and a gradual decline in job satisfaction. Studies by Kwame
The emotional toll is particularly acute in PHC contexts where nurses are often the sole health providers patients interact with. These findings resonate with the work of Gillespie and Reader,
Despite broader system challenges, respondents identified communication breakdowns as a common contributor to patient complaints. Misunderstandings were frequently rooted in a lack of clarity, rushed interactions or the inability to provide adequate patient education because of time constraints. This aligns with Karaferis and colleagues,
Importantly, this presents a modifiable area for intervention. Respondents suggested that regular training in conflict resolution, active listening and cultural sensitivity could mitigate patient dissatisfaction and improve interpersonal dynamics in PHC. The findings argue for investing in communication skills workshops and structured patient centredness. Enhancing communication can improve patient trust, reduce emotional strain on nurses and elevate the perceived quality of care.
The final theme captured practical interventions suggested by participants to address both systemic shortcomings and interpersonal tensions. Nurses overwhelmingly supported hiring additional staff to manage patient volumes and reduce burnout. This would allow for more patient-centred care and improved morale. Participants recommended structured training programmes to help manage patient expectations and de-escalate tense encounters. Suggestions included regular debriefing sessions, transparent leadership and public education campaigns to improve community understanding of clinic operations.
The findings underscore the importance of shifting from a blame-based complaint culture to one of system learning and psychological safety. Nurses advocated for structured complaint-handling systems that distinguish between legitimate misconduct and expressions of patient frustration stemming from systemic issues. These recommendations echo the conclusions of Novaes Neto and colleagues,
This study carries important implications for South Africa’s NHI ambitions. For the NHI to succeed, it must rest on the foundation of resilient, satisfied healthcare workers. Addressing nurse burnout, improving workplace conditions and reframing complaints as opportunities for systemic improvement are essential steps towards strengthening the PHC platform and achieving UHC.
The findings of this study demonstrate a strong conceptual alignment with the JD-R model. The model posits that high job demands, exemplified in this study by heavy workloads, repeated patient complaints and systemic shortages, can detrimentally affect employee well-being and job satisfaction, particularly when job resources are inadequate. Conversely, the model proposes that the provision of sufficient resources can mitigate the negative impact of such demands.
This study confirms the relevance of the JD-R model in the context of PHC settings in South Africa. Specifically, it highlights that patient complaints function as a significant job demand, which, when coupled with resource deficiencies and systemic inefficiencies, erodes nurse job satisfaction. The analysis further suggests that strengthening job resources, such as providing managerial and peer support, implementing targeted communication training and establishing structured complaints mechanisms, can act as a buffer against these demands. Consequently, the JD-R model offers a robust theoretical framework for the development of targeted interventions aimed at enhancing both nurse well-being and the quality of patient experiences within PHC facilities.
Conducted in the Ehlanzeni District, a region that typifies rural PHC challenges in South Africa, the study provides contextually relevant insights. Data saturation was reached by the 10th interview, with the final interview confirming that no new information or insights were produced, lending credibility to the thematic findings. Importantly, the study’s conclusions contribute to the broader discourse on health system strengthening under the
The research was confined to three clinics within a single sub-district, which may limit the generalisability of the findings to other settings. The study also captured only the perspectives of nurses; incorporating views from patients and other healthcare workers might have yielded more comprehensive insights. As the data relied on self-reported experiences, there is potential for response bias. Additionally, the study reflects a cross-sectional snapshot in time and does not assess the long-term impact of patient complaints on job satisfaction.
To improve nurse job satisfaction and patient care in PHC settings, several strategic interventions are recommended. Firstly, there is a critical need to invest in PHC nurse staffing to alleviate excessive patient loads and reduce burnout. Secondly, implementing regular training on communication and conflict resolution will equip nurses with the skills to manage difficult interactions, reduce incidences of perceived rudeness and foster a more empathetic approach to patient care. Such training prevents misunderstandings and enhances mutual respect, thereby improving patient satisfaction and strengthening nurse–patient relationships.
Most reported patient grievances emanate from nurses’ misconduct as compared to multiple systemic factors such as insufficient staffing, long waiting periods and inadequate essential resources. This study showed that nurses’ misconduct reflects systemic challenges. Moreover, nurses internalise the complaints, leading to self-doubt and reduced job satisfaction. Addressing these challenges is crucial in protecting the well-being of nurses and improving the quality of healthcare services.
The author thanks all registered nurses who participated in the study. This article is partially based on the author, P.N.D.’s, thesis entitled ‘How Patient Complaints About Negative Staff Attitude Impact Nurse Job Satisfaction in Ehlanzeni District, Mpumalanga’ towards the degree of Master of Public Health in the Department of Environmental Health, Johannesburg University, South Africa, with supervisor Dr Tebogo Tsele-Tebakang.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
P.N.D. is the author and was responsible for the conceptualisation, data collection, analysis, writing and finalisation of this manuscript. T.T.-T. was a supervisor and edited the final draft. All authors contributed to the article, discussed the results and approved the final version for submission and publication.
Data supporting the findings are available from the corresponding author, T.T.-T., upon reasonable request.
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.