A good working environment is crucial for employee satisfaction and productivity. Patient care is directly related to the quality of work environment of nurses (Kramer and Schmalenberg, 2008:105). A negative environment causes employees to be unhappy with their jobs, and makes them less productive (Halfman, 2012:226). Florence Nightingale went further to state that a ‘healing’ environment ought to prevail for nurses who are responsible for patient upkeep and stressed that a healthy work environment should have the necessary infrastructure to create ‘healing spaces’ for all medical staff (Shirley, 2006:231).
Nursing is a profession that assumes responsibility for the continuous care of the sick, the injured, the disabled, and the dying. Nursing is responsible for uplifting the well-being of individuals, families, and societies in medical and public settings. Nurses can only render quality service if their work environment provides conditions that support them (Halfman, 2012:226). Further more effective healthcare services need individuals providing such services to be physically and mentally healthy (Parlar, 2008:56), which is only possible in a healthy and positive work environment.
A positive work environment is achieved through the creation of a work environment where policies, procedures and systems are designed for the employees to fulfil organisational goals and achieve personal satisfaction in the workplace” (Kramer and Schmalenberg, 2008:107). In other words, a healthy work environment involves practices carried out to increase the health and well-being of nurses, quality of patient care and social outcomes and institutional performance to the maximum level (Page, 2004:80). Although the origins of nursing predate the mid-19th century, the history of professional nursing traditionally begins with Florence Nightingale (Güven and Oktay, 2009:107).
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At the beginning of modern nursing history, Nightingale educated nurses to take on more complex nursing duties and responsibilities in the care of the sick (Güven and Oktay, 2009:111). While this training took place in hospitals, Nightingale prepared these early nurses for self-governing practice in the home. According to Güven and Oktay, (2009:112), until the 1920’s, nearly all hospital functions were carried out by unpaid student nurses under, the watchful eye of the nursing superintendent while graduate nurses provided care in the home.
The modern hospital was born soon after the First World War with the introduction of a myriad of new technologies, such as aseptic surgery, anaesthesia, modern pharmaceuticals, x-rays, and laboratories to measure biological functions. In a space of a decade, most serious patient care had moved from being home to the hospital. This saw the private duty nurses who had followed their patients into the hospital eventually being absorbed as employees of the hospital and lost their independence and entrepreneurial practice (Welton, 2007:98). The nurses lost their ability to set staffing standard and establish their salary, since they were no longer paid straight by the family or patients for their services.
Hospitals are complex and dynamic organisations that provide services 24 hours a day and seven days a week; they operate with an open system and matrix structure. Inpatient working conditions have deteriorated in most facilities worldwide because hospitals have not kept up with the rising demand for nurses (Welton, 2007:98). In low-income countries, nurses contend with an overwhelming disease burden and persistent health human resources crisis that manifests in deep personnel shortages, inappropriate skill mix and maldistribution of health workers (Crisp and Chen, 2014:169)
During the colonial era in the 1930s and 1940s the public health sector in Zimbabwe (Southern Rhodesia)was divided into first, mission hospitals, under the control of various denominations and based mainly in rural areas, provided medical services to Africans in the vicinity of the mission station; second, mining hospitals, again located in rural areas, provided medical care to mine workers; and third, government hospitals, the majority of which were located in urban areas (Masakure, 2015:4). White working women were the ones who toiled day and night to provide medical and nursing care to African and European patients: There were neither African nor Coloured qualified nurses in government hospitals or nursing schools.
During this same period, government hospitals existed in major towns such as Salisbury (now Harare), the capital, as well as Bulawayo, Umtali(Mutare), Gwelo (Gweru) and Fort Victoria (Masvingo). These hospitals employed the largest number of white nurses in Central Africa, on both a permanent and temporary basis. The colonial rule was based on segregated colonial governance, economic and social privileges for the white community.
According to the National Health Services Commission (1945) report the Southern Rhodesian Nursing Services experienced numerous challenges that had an adverse effect on the daily work of the nurses working in government hospitals. Records points to their frustrations with nurse shortages, increased workloads and low salaries. This is supported by Masakure (2015:116), who postulates that in colonial Zimbabwe, just as in neighbouring South Africa, nursing was construed as white women’s burden in support of the imperial project.
The colony relied on recruiting nurses from the United Kingdom or other parts of the British Empire and because of competition from other parts of the empire, the nurse were never enough. The shortage of nurses was also due to the Rhodesian Civil Service’s policy of restricting the permanent employment of married women. During the period between 1939 and 1945, it was reported that a single nurse had to attend an average of 20 patients per night.The frustration saw the birth of the training of non-white nurses in the 1958 (Masakure, 2015:125).
