Factors Contributing to Attrition of Nurse Educators at a Gauteng Public Nursing Education Institution, South Africa

Abstract

Introduction

Addressing factors contributing to the attrition of nurse educators within the nursing education and training institutions is crucial because the problem affects the training of nurses globally. Public nursing education institutions in South Africa are missing nurse educators. That makes it difficult for the nation to improve healthcare outcomes. There are insufficient nurse educators at one nursing education institution because nurse educators quit within their first to fourth year of work.

Purpose

To explore factors contributing to the attrition of nurse educators in the Gauteng public nursing education institution.

Methods

A qualitative, exploratory, descriptive research design was employed to gather relevant information in support of the research objectives. Due to data saturation, an in-depth, unstructured one-on-one interview was conducted with fifteen out of twenty nurse educators. Participants were selected through a non-probability purposive sampling approach. The interviews were conducted in the participants’ work offices as per the participants’ agreement. Tesch's eight processes were used to analyse data. Ethical principles and trustworthiness were followed.

Results

Two themes were revealed: 1. Description of the contributory factors to attrition of nurse educators. Sub-themes: paradoxical experiences causing suffering, emotional suffering associated with support from management and colleagues, workload, and lack of recognition of nurse educators’ clinical experience and qualifications. 2. Description of on-the-job challenges by nurse educators. Sub-themes: poor interpersonal relationships, communication with other nurse educators, and shortage of human and material resources.

Conclusion

Based on the study findings, nurse educators’ attrition remains a global challenge. Factors contributing to the attrition of nurse educators relate to aspects that require policymakers at the national and institutional levels to revisit available structures that can help curb this problem and shape the future of nurse training.

Introduction

Nursing education is the basis of nurse training in all countries worldwide. The attrition of nurse educators observed worldwide harms the health system and training of new nursing students (Al-Suraihi et al., 2021). Bandeali and Maita (2023) indicate that the shortage of nurse educators is a growing problem in nursing programmes throughout the United States of America (USA) and is expected to worsen in the next few years. Nursing Education Institutions (NEIs) are challenged to maintain full employment in faculty positions due to resignations, transfers, retirements, and the death of nurse educators (He et al., 2018), as well as the growing student enrolment and poor wages (American Association of Colleges of Nursing (AACN), 2019). This is a cause for concern because as nurse educators leave the institution, it becomes challenging to replace them, leading to attrition.

The difficulty in maintaining qualified, experienced nursing educators in the USA due to increased retirement and academics leaving for higher-paying positions in the private sector (McFadden et al., 2021) results in attrition. The attrition of nurse educators affects the production of graduate nurses with the necessary skills. Rosseter (2018) and Jung et al. (2021) reported that over 64,000 and 75,000 qualified nursing applicants were denied admission to baccalaureate and graduate nursing programs between 2017 and 2021 due to insufficient human and material resources. Bizzarro (2023) noted that clinical nurses have limited skills and knowledge necessary to transfer nursing proficiencies to nursing students. Hence, there is a need to design and implement strategies that support new nurse educators, who are in short supply, as they enter the field, enabling them to remain in academia worldwide.

Countries such as Botswana, Lesotho, Swaziland, and South Africa are also experiencing high attrition rates of nurse educators (Bryant et al., 2022). Botswana's shortage of nurse educators prompted the government to recruit nurse educators from universities in other countries (Tshweneagae et al., 2020). As nurse educators leave one country for another, attrition increases in the country from which they departed. Therefore, there is a need for an equitable application of policies and strategies that attract, recruit, and retain nurse educators, as well as prevent attrition.

The South African Nursing Council (SANC), the regulatory body for nurse training and education, has 14947 registered nurse educators in South Africa (Sodidi & Jardien-Baboo, 2020). Still, not all nurses are practising as educators. According to (SANC), 16% of South African nurses are aged 60–65 years, and 3% are above 65 years, including nurse educators who are within nine years of retirement and will have to be replaced in the coming years (Du Plessis, 2019). This poses a threat that, as they retire, NEI will be left with inexperienced nurse educators (Brown, 2021; Masimula et al., 2021).

The National Health Insurance (NHI) project, to be implemented in South Africa, requires a sufficient number of health professionals, including nurses. This resulted in the South African National Department of Health increasing the number of students admitted to public nursing education institutions. This, in turn, increased the workload because there is an incompatibility between the number of nurse educators available to facilitate learning and the number of students to be trained.

There is a lack of research on the factors contributing to the attrition of nurse educators. This study aims to investigate the factors contributing to the attrition of nurse educators in the Gauteng public nursing education institutions and to provide recommendations to address this gap. The study's results may help the Gauteng Department of Health examine its policies and formulate strategies for recruiting, attracting, and retaining nurse educators.

Literature Review

A literature review was conducted to search for previous and current knowledge about the attrition of nurse educators. The literature review was done to understand, support, identify the gaps, and strengthen the recent study. Search conducted on Google Scholar online database focusing on keywords nurse educators’ attrition, attraction, retention, and public nursing education institutions using CINAHL, EBSCO HOST to search for electronic online peer-reviewed published articles from 2017 to 2023. Herzberg's motivation-hygiene theory (Herzberg, 2005) guided the search to determine the factors that motivate employees to remain within the institution and those that demotivate them to leave. Literature supports the need to reduce the attrition rate in every feasible way, including hiring and retaining sufficient certified nurse educators. NEIs should employ sufficient, skilled, knowledgeable nursing educators to train present and future nurses (Collard et al., 2020). Organisational structures and workgroups are disrupted by the difficulty of recruiting and retaining new nurse educators, which lowers productivity and increases workloads for the remaining staff (Collard et al., 2020). Forty-five currently published articles were obtained from the database. Little research has been conducted to explore and describe the factors contributing to the attrition of nurse educators.

Methodology

Design

The explorative, descriptive qualitative research design was used because little was known about the problem in the context of the PNEIs in South Africa. The researcher sought to gather comprehensive data and describe factors contributing to attrition among nurse educators in a specific PNEI.

Conceptual framework

Figure 1 presents Herzberg's two-factor theory as the motivation-hygiene theory that was used to explore factors contributing to the attrition of nurse educators (Herzberg, 2005). Herzberg's motivation-hygiene theory guided this qualitative exploratory research, which investigated factors contributing to the attrition of nurse educators at a PNEI in Gauteng province, due to a decline in the attraction of new nurse educators (Herzberg, 2005). Herzberg's two-factor theory posits that certain factors contribute to job satisfaction, while others contribute to job dissatisfaction in the workplace.

Figure 1.

Factors contributing to attrition of nurse educators at a gauteng public nursing education institution SON-24-0217.herzberg's two-factor theory (adapted from Herzberg, 2005). Note: the motivation-hygiene theory was used to explore factors contributing to the attrition of nurse educators. By Herzberg (2005). Motivation-hygiene theory. Organizational behavior one: Essential theories of motivation and leadership, eds JB Miner, ME Sharpe Inc, New York, 2(4), 61-74.

Motivation is defined by Saraswathi (2011) as the willingness of an individual to exert high levels of effort to achieve organizational goals and needs, which involves an intrinsic feeling. During interviews, participants answered the question “Share with me the factors that contribute to the attrition of nurse educators at PNEI”. Participants alluded that recognition of their level of education, achievement, professional development, and growth is lacking within the PNEI. These are motivational factors that bring satisfaction, making individuals want to continue working for the organisation. Unfulfillment of motivation factors demoralizes them and pushes them out of the institution to other health-related jobs. In this study, these factors were not recognized, which may have contributed to the high attrition rate of nurse educators.

According to Wrike Team (2024), hygiene factors are the elements of a job that satisfy basic human needs, such as security, salary, fairness, and working conditions, which the employer is obligated to provide for the employee. In this study, the nurse educators expressed that the PNEI offers non-competitive salaries compared to the demands of the work and their level of qualifications. A poor interpersonal relationship is evident in the inadequate communication among new nurse educators, experienced nurse educators, and managers. This increases the stress level of newly appointed nurse educators and compromises their health, causing them to leave the institution, resulting in attrition.

This theory is relevant to this study because it enables researchers to describe the factors contributing to the attrition of nurse educators, as expressed by the participants in relation to the research question. According to this theory, poor performance, lack of recognition, bad working environment, and lack of progress are all linked to job dissatisfaction, which makes nurse educators less likely to stay in the PNEI. According to Herzberg's theory, adequate hygiene factors are necessary to create a neutral working environment. This study revealed that the PNEI lacks the motivational and hygiene factors to enable nurse educators to remain within the PNEI, resulting in their resignation and attrition

Study Setting

The study was conducted at a selected PNEI in Gauteng province, South Africa, where one of the researchers is based, and attrition was observed among nurse educators. The province of Gauteng has four PNEIs. Compared to other PNEIs, the chosen PNEI has the most remarkable attrition rate. It is difficult for the chosen PNEI to replace nurse educators who quit their jobs.

Population

The researcher obtained a list of nurse educators from the Human Resources department after obtaining permission from the principal of the PNEI. The population of this study was the nurse educators who left the PNEI. The target population for this study consisted of all nurse educators employed within the selected PNEI between January 2014 and April 2019, who had in-depth knowledge regarding the study topic. The accessible population consisted of twenty individuals who agreed to participate, and none declined. However, only 15 were interviewed due to data saturation.

Sampling

The non-probability purposive sampling approach was employed to select participants who met the specified characteristics and represented the target population (Grove & Gray, 2022). An appointment was scheduled to meet with participants who were employed between January 2014 and April 2019 and subsequently left the institution. The first author made phone calls with each participant to make appointments to explain the purpose of the research.

Inclusion and Exclusion Criteria

Only nurse educators employed between January 2014 and April 2019 who left the public nursing education institution were selected as part of the sample. The sample included males and females of all races between the ages of 30 and 55. Nurse educators employed before 2014 were excluded from this study.

Data Collection Process

The researchers applied Herzberg's theory in data collection to gather information on both hygiene and motivator factors. The first author, a female nurse educator and master's student at the time of data collection, conducted a pre-test with one participant to answer the question, “Share with me the factors that contribute to the attrition of nurse educators,” at PNEI. This question served as the interview's starting point, and subsequent follow-up questions were based on the participant's responses. Before being used in the main study, the question was clarified, and the data from the pre-test were excluded from the data analysis. The first author explained the study's purpose, benefits, and objectives to the participants. Participation in the study was voluntary, and the participants signed an informed consent form.

The interviews were conducted over a two-month period, from August 1 to September 30, 2021, in the participants’ new work environment, in their offices, according to their preferences. The country was under a level 2 lockdown at the time. Infection control principles were adhered to prevent the spread of the coronavirus. Only 15 of the 20 participants invited were interviewed to answer the research question, as data saturation was reached. An in-depth one-on-one interview was conducted in English and lasted 45 to 60 min each.

A digital recorder was used to collect and store the data, with the participant's consent. The interviews were documented with field notes and encrypted with the researchers’ password for confidentiality and privacy. All data were transcribed and provided to the two female supervisors and independent coders. Member checking was conducted to establish the truth of the study's findings. Researchers had no relationship with the participants, and no repeat interviews were conducted.

Data Analysis

The digitally recorded interviews were transcribed before analysis. It was read aloud numerous times to help participants make sense of their experiences after the audio recordings were transcribed verbatim. The proofread transcripts were organized into categories. Using Tesch's eight processes for data analysis, the researchers examined the data (Creswell & Creswell, 2017).

Step 1 – Reading Through the Data

The researcher gained a comprehensive understanding by carefully reading all the verbatim transcripts. That provided insight into the data segments and what they look like/mean. The meanings that emerged during reading were written down, and all ideas as they came to mind. The researcher carefully and repeatedly read and understood the participants’ transcripts. An uninterrupted period was created to digest and think about the data. The researcher analyzed data and wrote notes and impressions as they came to mind.

Step 2 – Reduction of the Collected

The researcher scaled down the data collected to codes based on the existence or frequency of concepts used in the verbatim transcriptions. The researcher then listed all topics that emerged during the scaling down. The researcher grouped similar topics, and those that did not have an association were clustered separately. Notes were written on the margins, and the researcher started recording thoughts about the data in the margins of the paper where the verbatim transcripts appeared.

Step 3 – Asking Questions About the Meaning of the Collected Data

The researcher re-read the transcriptions and analyzed them. This time, the researcher asked herself questions about the interview transcriptions based on the codes (mental picture codes that emerged while reading through) derived from the frequency of the concepts. The questions were “Which words describe it?” “What is this about?” and “What is the underlying meaning?”

Step 4 – Abbreviation of Topics to Codes

The researcher started to abbreviate the topics that had emerged as codes. Differentiation of the codes was achieved by including all meaningful instances of a specific code's data. All these codes were written on the margins of the paper, corresponding to the data they represent, with a different pen colour than the one used in Step 3.

Step 5 – Development of Themes and Sub-Themes

The researcher developed themes and sub-themes from coded data and the associated texts, and reduced the total list by grouping topics that relate to one another to create meaning for the themes and sub-themes

Step 6 – Compare the Codes, Topics, and Themes for Duplication

In this step, the researcher reworks the work from the beginning to check for duplication and refine codes, topics, and themes as necessary. Using the list of all codes, she checked for duplication. The researcher grouped similar codes and recoded others as necessary to fit them into the description.

Step 7 – Initial Grouping of all Themes and Sub-Themes

The data belonging to each theme were assembled in one column, and a preliminary analysis was performed. This was followed by a meeting between the researcher and co-coder to reach a consensus on themes and sub-themes that each had independently identified.

Step 8 – Recording

The identified common themes and sub-themes, as agreed by the independent coder, were sent to the supervisor, who also made recommendations. As the themes and subthemes emerged, Hertzberg's two-factor theory was clearly represented. Participants alluded that recognition of their level of education, achievement, professional development, and growth is lacking within the PNEI. These are motivational factors that bring satisfaction, making individuals want to continue working for the organisation. The data interpretation strengthened the linkage between participants’ narratives and the theoretical foundation of this study.

Trustworthiness

Credibility, dependability, confirmability, and transferability—four concepts highlighted by Lincoln and Guba (1985) and further emphasized by Babbie (2020) and Creswell and Poth (2018)—were employed to ensure reliability throughout the investigation. To establish credibility, the researcher first developed a rapport of trust with the participants, allowing them to speak freely. Additionally, the researcher spent a significant amount of time engaging with the participants during the interview sessions. The selected participants accurately reflected the population and its characteristics, ensuring the transferability of the findings. During data collection, dependability was ensured by using a voice recorder and field notes to verify the accuracy of the data. In addition, physical copies of the transcripts and field notes were maintained to ensure an audit trail. Finally, confirmability was ensured by recording participants’ actual responses through triangulation, using both a voice recorder and field notes.

Ethical Consideration

The researchers considered the ethical principles involved in research, including respect for persons, beneficence, and justice (Grove et al., 2018). This study has five ethical principles: permission to conduct the study, anonymity, confidentiality, autonomy, and informed consent. Ethical clearance for this study was obtained from the Research and Ethics Higher Degree Committee of the University of Venda, Project No.: SHS/20/PDC/42/3009. The researcher presented the Ethical Clearance Certificate to the Principal of the selected PNEI, and permission was granted to conduct the study.

Results

Demographic Characteristics of Participants

Table 1 presents the demographic characteristics of participants. There were fourteen females and one male, with ages ranging from 30 to 59 years. See the table for more information.

Table 1.

Participants’ Demographic Characteristics.

Participant Number	Age	Gender	Race	Work Experience
1	59	Female	African	35 years
2	40	Female	African	16 years
3	42	Female	African	18 years
4	57	Female	African	33 years
5	46	Female	African	17 years
6	55	Female	African	31 years
7	31	Female	African	7 years
8	35	Male	African	11 years
9	43	Female	African	19 years
10	41	Female	African	17 years
11	45	Female	African	21 years
12	56	Female	African	32 years
13	33	Female	African	9 years
14	50	Female	African	26 years
15	48	Female	African	20 years

Presentation of the Findings

Two themes, with multiple levels, are identified as contributory factors to attrition among nurse educators: paradoxical experiences cause suffering at multiple levels, emotional suffering associated with support from management and colleagues, an unreasonable workload allocation, and a lack of recognition of nurse educators’ clinical experience and qualifications. The themes and sub-themes emanating from the study findings are presented in Table 2. Verbal quotations from the participants support the presentation of the sub-themes.

Table 2.

Themes and sub-Themes Reflect the Factors Contributing to the Attrition of Nurse Educators.

Themes	Sub-themes
1 Description of the contributory factors to attrition of nurse educators.	1.1 Paradoxical experiences cause suffering at multiple Levels. 1.2 Emotional suffering associated with support from management and colleagues. 1.3 Unreasonable allocated workload. 1.4 Lack of recognition of nurse educators’ clinical Experience and qualifications.
2 Description of on-the-job challenges experienced by nurse educators	2.1 Poor interpersonal relationships and communication With other nurse educators. 2.2 Shortage of human and material resources.

Sub-theme 1.1 Paradoxical experiences cause suffering at multiple levels

This study revealed that nurse educators work in a hostile environment lacking love, support, and compassion, which can lead to frustration throughout their employment in the NEIs. Three categories emerged.

Category 1. Less prepared educators

Participants experienced challenges when they were less prepared to encounter the students. This led to their frustrations and increased their stress.

“I had to present the content I did not understand in class, as I did not have enough time to prepare. Students would ask me questions to which I did not have an answer, and I would say, ‘Let me enquire, and I will come back to you.’ It was so frustrating (sobbing)” (P1).

The study examined how a lack of preparation may result from a lack of knowledge of the subject matter and pedagogical techniques, as well as low self-esteem, which impairs one's ability to respond appropriately to students’ questions.

Category 2. Lack of professional growth

Most participants stated that PNEIs do not offer career paths or opportunities for professional and academic growth. The PNEIs have only two development grades as a lecturer: Grade 1 and Grade 2. The following excerpts from the participants support this.

“Working in college is not attractive. The job is stagnant, with no growth and no promotion. It is such a monotonous job” (P3).

“People move from college to clinical areas where they are employed as managers, and there is the opportunity for growth and promotion” (P9).

“Advancement within the nursing college is very narrow as all the lecturers look forward to becoming the HOD at one point” (P14).

The findings suggest that it takes the lecturer 14 years to become a Head of Department (HOD), if, by chance, the nurse educator has that opportunity; otherwise, one remains a Lecturer Grade 2 for life.

Category 3. Cultural inertia

The participants stated that managers and experienced nurse educators do not accommodate new nurse educators who bring ideas to improve teaching strategies.

“There is a spirit of ownership in the management. The manager does not take anything from the lecturers. There is an autocratic leadership style in which the ‘ ‘manager's word is final and inputs from the lecturers are not taken” (P2).

“There is much resistance to change in management and amongst colleagues to such an extent that it is not considered when you try to bring new ideas as a new lecturer. Most lecturers were critical of my diverse teaching styles, particularly those that incorporated technology. They did not coach or guide me to say this was unacceptable, but complained about it behind my back” (P8).

This study reveals that when nurse educators and managers hold meetings and new nurse educators provide input, their input is often not taken into consideration. Managers always resist change.

Sub-theme 1.2: Emotional suffering associated with support from management and colleagues

The study could affirm that the participants received minimal or no support from experienced nurse educators and managers. The lack of support in the new work environment is a critical factor that needs to be addressed within PNEIs and in other settings of the healthcare system. The following statements support this.

“At this time, you need support and mentoring, but you are just thrown into the pit and swim by yourself (shaking her head). There is no one to voice out your problems. Instead, they expect you to know everything. I only encountered my HOD when she moderated my test paper. I was never shown how to set that paper” (P6).

“The HODs are not supportive; they do not care that they are losing people because of a lack of support and mentoring. They say if you want to go, go because others will come” (P12).

“My manager was busy with the curriculum and did not have time for me. I went to the HOD to report that I was not coping. She did not even listen to my frustrations; instead, she called me “uyi vila” (meaning you are a lazy person). It was like I did not want to work; she was taking me to her level of understanding (sobbing)” (P1).

New nurse educators need support through orientation and on-the-job mentoring to ensure they are effectively performing their roles. That means supporting an individual could bring hope that this can be done, and one can do it.

Sub-theme 1.3. Unreasonable workload allocation

Most participants mentioned that they find it challenging to accomplish the allocated work within the expected 8 h per day stipulated in the labour relation policy. The nurse educator has numerous responsibilities, including lesson preparation, teaching, and grading student assessments, such as tests and assignments. Two categories that emerged are presented below.

Category 1. Abnormal working hours

Working from home is considered a concern, as nurse educators could complete their work at home. As a nurse educator, one must often sacrifice time to meet the deadline of the expected activity.

“The preparation of lesson plans, teaching and marking of students’ assignments, and the test were too much to such an extent that I must take work home” (P5).

“The 8-h working period is not enough to prepare lessons, to set tests and assignments, and to mark—most of the work you do at home and even on weekends. In our department, we conduct both theory and clinical studies. That did not allow the lecturer enough time to prepare, so you must work from home to prepare for the class. This arrangement resulted in an increased workload for me. I also took the time to be with my family” (P7).

Most college coursework is completed at home when time should be spent with family. As a nurse educator, you may contribute more than just the benefit. This is regarded as an unfair labor practice since there is no payment for the extra time spent.

Category 2. Increased number of student intake

The fact that the PNEIs have many students makes it difficult for nurse educators to interact with students appropriately and reach them. The following statements from participants support the study findings.

“There are so many students in the college to teach; that was another challenge as a new lecturer. There are too many students at the college (she emphasized). This high number of students made it difficult for me to control them” (P5)

“Many students made it difficult to have close interaction with most of them, and it does not allow didactic influence as it also does not allow the use of different learning strategies except lecturing” (P13).

Most participants expressed concern about this large number of students as they struggled to reach out to them. The teaching strategy most suitable for large groups is the lecture method, which allows students to benefit from it.

Sub-theme 1.4: Lack of recognition of nurse educators’ clinical experience and qualifications

This study revealed unfair labour practices regarding salaries and concerns about the qualifications of nurse educators. Participants expressed that there is an unjust salary grading system in the PNEI, as entry-level nurse educators are paid the same salary level, regardless of their clinical experience and qualifications.

“When I joined the college, my salary dropped because I am a Grade 1 nurse educator. The college salary is not competitive with the salary of nurses in the clinical area. When I came to college, my salary was cut. When you enter college, they do not consider your years of experience in clinical nursing” (P6).

“The salary that I was earning was incompatible with the years of my clinical experience as a nurse. I started at the bottom of the scale as if I were a newly qualified nurse. I was given an entry-level salary because I do not have experience in nursing education” (P8).

“They do not consider your experience. You will earn the same amount of money a newly qualified nurse educator earns, which is a nuisance. I was being underpaid” (P13).

The lack of recognition of nurse educators’ qualifications also seems to be a significant factor contributing to the attrition of lecturers, leading them to return to clinical and other health facilities for better-paying jobs.

Theme 2: On-the-job challenges experienced by nurse educators

The participants explained the difficulties they experienced when performing their duties. The factors contributing to attrition that nurse educators experience while rendering their service include poor work conditions, interpersonal relationships, communication, and a shortage of resources.

Sub-theme 2.1. Poor interpersonal relationships and communication with other nurse educators

The lack of interpersonal relationships among nurse educators was raised. The hostile reception of the new nurse educators evidenced this. Experienced nurse educators often fail to show love or adequately welcome the new nurse educator.

“Oh my God, the relationship with staff in that college is toxic. You have poor communication skills, and there is an element of hate within you. When I arrived, I tried to introduce a secret pal, but some colleagues did not want to participate; I was shocked. You must learn to love and appreciate one another” (P3).

“There is also a lack of teamwork in the college. There is more than one college in the same college. I felt unwelcome and isolated as the lecturers continued working without noticing my presence. With my experience, I felt so unwanted in the college” (P7).

Due to this kind of reception, the new nurse educators felt isolated, unwelcome, and sometimes bullied by experienced nurse educators.

Sub-theme 2.2: Shortage of resources: human, material, and infrastructure

The participants stated that the PNEI lacks adequate human and material resources to support nurse educators in achieving the goal of teaching nursing students. The shortage of human resources is a primary cause of nurse educators leaving the institution, leading to attrition. There is no replacement for those nurse educators who leave as they go. Three categories emerged from the sub-theme.

Category 1. Lack of human resources

The study revealed a shortage of nurse educators in the PNEI. The work environment is attributed to the lack of nurse educators within the NEIs. Participants reported that as nurse educators are pushed back to clinical areas, the PNEIs experience the challenge of attrition, increasing the workload of the remaining nurse educators.

“Many students’ intakes should be reduced for proper learning and practice. They should look at the number of lecturers available to teach the students, not to bombard the lecturers with more students without adequate human resources” (P6).

“There is a lack of human and material resources; hence, the environment is not conducive to work because you find yourself doing the work of two or more people because of the shortage” (P7).

“To teach so many groups of students in large numbers was a problem; the lecturer should have had one group to teach and accompany. There was a shortage of lecturers, and I could not stay because I had four groups of students. It was like I worked for four people, but the salary was different” (P10).

The shortage of human resources is linked to the increased workload of the remaining nurse educators because it is difficult to replace them as they leave the institution. With its diverse disease profile, South African society must be nursed by well-groomed nurses moulded by adequate nurse educators. Because lecturers resign due to increased workload, those who leave the institution are not replaced, causing attrition.

Category 2. Lack of material resources

Regarding the shortage of material resources, this study's findings revealed a lack of classrooms, computers, offices, and Wi-Fi to support the Internet, which is essential for facilitating teaching through research and innovative education.

“I was technologically inclined in my teaching, but found the unavailability of the necessary equipment needed for that” (P8).

“At that college, there are not enough computers for the lecturers and no WI-FI for internet access. There is no database that will help nurse educators to advance themselves” (P12).

Some nurse educators reported that they are technologically inclined, so working at an institution that lacks adequate technological equipment put a strain on them; hence, they left the institution, contributing to attrition.

Category 3. Lack of infrastructure

The PNEIs have an increased number of ‘students’ intakes. The large number of students does not correlate with the infrastructure of the nursing college. The participants expressed concern that inadequate infrastructure increases workload, as students should be divided into groups to accommodate them in classes.

“The college's infrastructure is inadequate to accommodate students in one class. The only class with a bigger space is the auditorium. In the auditorium, it is challenging to monitor students’ activities as it does not allow free movement between the students” (P9).

“The students in the class were divided into three groups because there was no larger class to accommodate them. Some will be in the auditorium because it is the only space accommodating more students, but it is difficult to monitor their activities because there are many” (P11).

Due to the high number of students, the institution lacks classrooms that are compatible with the large numbers required for proper teaching. The inadequate proportion of infrastructure and classrooms to the number of students is one factor that increases the workload of nurse educators, which in turn increases their stress level, leading to resignation and attrition.

Discussion

The study explored and described paradoxical experiences, emotional suffering, unreasonable workload, and lack of recognition of nurse educators’ clinical experience and qualifications as factors contributing to the attrition of nurse educators at a Gauteng PNEI. Nurse educators often leave the PNEI due to insufficient support, including induction, orientation, and mentoring. The findings are discussed in relation to Herzberg's two-factor theory, which posits that motivation factors contribute to job satisfaction; therefore, nurse educators should be motivated to remain at PNEIs through on-the-job mentoring and professional development courses. Most participants stated that their orientation was ineffective or not done at all. There is a need for specific orientation on the exact work the lecturers would do. Orientation on clinical skills through videos would assist new nurse educators in remembering clinical procedures. PNEI should ensure a mutually beneficial long-term induction process tailored to the individual nurse educator (King et al., 2018; Pezzimenti et al., 2022).

Worthy et al. (2020) and Hallaran et al. (2023) noted that newly employed nurse educators often experience frustration when encountering students due to a lack of guidance at the beginning of their careers, as was the case in the current study. Therefore, a formalised, extensive orientation is required to accommodate the unique needs that arise within this profession as a nurse educator (Dale-Tam & Thompson, 2021). This could enhance job satisfaction, improve retention, and reduce the attrition rate in PNEIs. Bagley et al. (2018) support Hallaran et al. (2023), who suggest that when experienced nurses begin teaching in NEIs, they experience stress and apprehension, which results in new nurse educators’ inability to achieve a work-life balance (Crawford, 2021). Newly appointed nurse educators could become more competent and confident if they receive proper support through mentoring by experienced nurse educators and professional development opportunities, such as workshops, conferences, and seminars. A study conducted by Matahela (2021) in a nursing college in Johannesburg, South Africa, supports a study by Sekoe (2012), which shows that nurse educators require mentorship. Sekoe (2012) designed a model for mentoring nurse educators; however, it is not currently in practice, as nurse educators report that they still experience a lack of orientation and mentoring. Matahela recommended that a mentoring programme be designed for new nurse educators. During the course of this study, there was still no mentoring program in place, which led to the continuation of the problem in PNEI in Gauteng.

Poor salaries were identified as another factor contributing to attrition. PNEI struggles to attract and retain nurse educators due to more attractive opportunities outside the teaching environment. The salaries for managerial posts in clinical areas are higher at the entry level than those of nurse educators in PNEI. That could prevent the PNEI from retaining nurse educators, causing attrition. Poor salaries are a hygiene factor that should be addressed to ensure job satisfaction and retention. Therefore, salaries for nurse educators should be competitive. The issue of salaries is supported by Aragon et al. (2020) and Jarosinski et al. (2022), who demonstrated that happy employees may experience greater job satisfaction when their salary levels are accompanied by other benefits. Therefore, unhappy employees leave organisations with lower salaries and benefits, reverting to areas where they can receive better compensation, which prevents the PNEI from retaining nurse educators and causes attrition.

Research further indicates that education and salary are essential for recruiting and retaining most faculty members (Lassila, 2021; McQuilkin et al., 2020). Most participants expressed that the College of Nursing should consider clinical experience when grading the salaries of nurse educators. Christian (2021) states that nursing faculty struggle to meet high workload demands and experience a work-life imbalance, yet the same nurses receive lower salaries than those in similar positions in practice settings. Lack of equitable financial compensation between academic and practice positions significantly affects retention and recruitment.

Most participants said the PNEI does not offer a career path and professional and academic growth since they only have two grades of Development: Grades one and two. The narrow organogram caused some nurse educators to return to clinical practice, offering more opportunities for growth and Development. Moving to Grade 2 lecturing takes an individual between 8 and 10 years. It takes a lecturer approximately 14 years to become a Head of Department (HoD) if there is an opening; otherwise, one remains a Grade 2 lecturer for their entire career. Frisbee et al. (2019) and Hoffmann (2021) support this view that the inability to advance in one's career and inadequate support can lead to attrition of nurse educators. The findings of this study are consistent with those of Matahela (2021), who found that nurse educators leave academic institutions to pursue careers that offer advancement in skills and career development, rather than remaining at the PNEI in one position.

The study findings revealed that nurse educators struggle to teach both clinical and theoretical aspects in NEI, resulting in an increased workload for nurse educators (Younas et al., 2019). Dale-Tam and Thompson (2021) argue that new nurse educators have challenges in teaching content that does not relate to their previous clinical work. The increased workload of teaching clinical and theory disciplines could be the main factor contributing to attrition, as there were no replacements for nurse educators who left the NEI.

The study reveals a high intake of students within the PNEI, which does not match the number of available nurse educators to teach them. Nurse educators often find themselves heavily burdened with work, particularly due to the poor distribution of work concerning the appropriate student-to-nurse educator ratio, which creates an unfavourable work environment and increases the risk of burnout (Mthimunye & Daniels, 2019; Scheid, 2022).

The PNEI has inadequate infrastructure and human and material resources to improve working conditions. Hudgins et al. (2021) observe that the shortage of nurse educators increases attrition, which is caused by poor management style within the PNEI. The NEI does not have resources like offices for individual nurse educators, Wi-Fi, laptops, and printers. The sharing of offices reduces privacy and confidentiality when students consult with a specific lecturer. The availability of adequate computers would assist with research and lesson preparation. Green (2020) pointed out that resources are constrained in NEIs, mainly due to the lack of budgets for teaching equipment.

The hostile reception new educators get from experienced colleagues is one factor that leads to attrition. Therefore, PNEI must implement formal induction, orientation, and mentoring programmes for new nurse educators to prevent dissatisfaction as suggested by Hertzberg's theory. Globally, the challenges of NEIs remain the same. Hence, the problems need solutions.

Strengths and Limitations of the Study

Despite the small sample of nurse educators from selected PNEI who participated in the study, in-depth interviews allowed nurse educators to discuss factors contributing to the attrition of nurse educators in PNEI at Gauteng Province with minimal researcher interference. The researchers cannot generalise the findings as the study was contextualised within a selected PNEI. Therefore, the result cannot be transferred to another setting. Further research is needed to develop strategies, guidelines, and programs for attracting and retaining nurse educators.

Implications and Impact

The attrition of nurse educators in the selected PNEI is associated with retirement, transfers, and resignation of nurse educators due to various factors. This results in an increased workload for the remaining nurse educators. The lack of support, poor management style, uncompetitive salaries, increased workload, and lack of recognition of clinical experience and qualifications continue to erode nurse educators from the PNEI to other areas with better working conditions and remuneration. The study recommends that PNEI ensure supervisors support new nurse educators and offer competitive salaries to improve retention, thereby avoiding work overload. Further research should be conducted to determine if the attrition of nurse educators is experienced in other PNEIs in South Africa and to enable the government to review policies related to the attrition of nurse educators.

Conclusion

The study concludes by describing that nurse educators’ attrition remains a global challenge. Factors contributing to the attrition of nurse educators relate to aspects that require policymakers at the national and institutional levels to revisit available structures that can help curb this problem and shape the future of nurse training. Policy makers should provide a sustainable solution in NEIs by creating a work environment where nurse educators feel valued and motivated; taking into consideration the specialized work they do in nurse training. More research should be conducted on the attrition of nurse educators at both national and international levels.