Sources of Waste in Nurses Working in the Clinic: A Qualitative Study

ABSTRACT

Aim

Waste is a very important issue in healthcare services. Waste can occur in many different areas and forms. Nurses constitute the largest workforce in health services. For this reason, nurses' perceptions and views regarding waste and their efforts to prevent waste are very significant. This study focused on how nurses perceive waste, how they define waste and what their recommendations are regarding waste.

Design

This study was conducted in a conventional content analysis design using qualitative research method. The study complied with the criteria for reporting qualitative research (COREQ) checklist.

Methods

Maximum diversity sampling, one of the purposeful sampling methods, was used to determine the study group. The research data were collected between 03.07.2023 and 28.08.2023. The study was carried out with the participation of 21 nurses. It was carried out with nurses working in six different hospitals in Türkiye. A semi‐structured interview form created by the researchers was used for data collection. A content analysis method was used to analyse the data, and the data collected with voice recordings and instant notes was transferred to text and transcribed; the transcript text consisted of 52 pages. The interviews lasted 20 min at the shortest and 40 min at the longest.

Results

It was determined that the age of the nurses participating in the study was between 28 and 48 years, the clinics where they worked were distributed as internal medicine, surgery, management, paediatrics, emergency service, intensive care, their weekly working hours were between 40 and 50 h, and the number of patients cared for daily varied between 2 and 25. In line with the data obtained from the participants, three themes were determined about the sources of waste: ‘Perception of the concept of waste’, ‘Nursing services and waste’ and ‘Iceberg’.

Conclusions

Participants drew attention to key issues such as the fact that nurses perceive waste as material and spiritual waste, that they think that nurses comprise the occupational group which causes the least waste in health services, and that training should be organized and procedures should be developed to reduce waste.

Patient or Public Contribution

This study provided new information about nurses' perceptions of waste. These results can create a framework for reducing waste resources and the experiences of nurses can be used as a guide. The study findings can be a valuable lead to managing and reducing waste in the clinics.

1. Background

The materials used in health service delivery are the basic resources that directly affect the quality of care provided. These materials cover 15%–25% of the financial resources spent while providing healthcare services and significantly consume financial resources (Sürme and Maraş 2022; Van Straten et al. 2021). The costs of these materials used in the health sector are increasing day by day, and the difficulties in procuring these materials cause healthcare organizations to experience difficulties in achieving their goals of providing quality service at an affordable cost (Çavmak 2020).

In its report on healthcare expenditures in the world, the World Health Organization (WHO) reports that these have reached 7.3 trillion dollars a year, which corresponds to 10% of the global gross domestic product. During the COVID‐19 pandemic, it was stated that there was a significant increase in healthcare expenditures and that there was a lot of waste related to care, which negatively affected both the environment and the economy (World Health Organization 2020). The United Nations, which has set sustainable development goals to achieve a better and more sustainable future by 2030, has reported that in the last two decades, the use of consumables in particular has increased more than ever before. Some of these medical consumables are reported to be masks and gloves, which have been used extensively during the course of the COVID‐19 pandemic (Nandy et al. 2022; Sürme and Maraş 2022).

Healthcare waste is no longer just an economic burden; it has become an ethical and significant issue that directly impacts patient safety, resource sustainability and the continuity of care (Erol 2022; Ferreira et al. 2024; Kenny and Priyadarshini 2021; Yeboah et al. 2024). Waste generated in hospital settings, in particular, contributes to increased treatment costs, shortages of critical medical supplies, delays in care services and environmental damage. As nurses are the healthcare professionals who interact most frequently with medical supplies and care processes, their approach and practices in this area play a decisive role in preventing these negative outcomes (Janik‐Karpinska et al. 2023; Kenny and Priyadarshini 2021).

One of the most critical issues in the provision of health services is that medical supplies used for care and treatment are now in the category of scarce resources. These should be purchased, distributed and used in a way that meets the needs of the entire population. Medical supplies should thus not be used in an unlimited and uncontrolled manner; and in this context, nurses have an important role to play in the identification, use, coordination and management of necessary medical supplies. Nurses working on the front lines are uniquely positioned to identify overuse, misuse, and inefficiencies in care processes. This makes nurses' role vital in minimizing both material and non‐material waste (Aljameeli et al. 2024; Schenk et al. 2023). In this way, nurses are directly involved in reducing the wastage of medical supplies and assessing needs, in order to provide quality care and ensure the safety of care (Chang and Thiel 2020). Shrank et al. (2019) estimated the total annual waste costs in the United States in their study and reported that billions of dollars were wasted due to failure in care delivery, failure in care coordination and excessive or low‐value care.

On the other hand, waste in health services is not only in medical supplies, equipment or devices. What is wasted in nursing may not be exclusively material. Although previous studies have primarily focused on material waste, resource consumption, environmental sustainability and operational inefficiencies in healthcare settings, limited attention has been given to how nurses conceptualize non‐material forms of waste encountered in everyday clinical practice. From a nursing perspective, waste extends beyond the misuse or overconsumption of physical resources and may encompass the loss of professional time, unnecessary workload, ineffective communication, underutilization of professional competencies, emotional exhaustion and missed opportunities for patient‐centred care. Such forms of waste may adversely affect the quality and continuity of nursing care while also contributing to decreased job satisfaction and reduced organizational efficiency.

For example, there is waste in labour, time, error, waiting, overproduction, overstock, unnecessary human displacement, waste of energy, overprocessing and underutilization of potential (Graban 2018). Recent studies have also emphasized that healthcare workers' attitudes and perceptions of waste significantly shape waste management outcomes and organizational efficiency (Ferreira et al. 2024; Udayanga et al. 2023). However, more robust empirical data—particularly studies quantifying waste reduction strategies or examining behavioural determinants among nurses—are limited, indicating the need for stronger and more context‐specific evidence (Şimşek and Özsoy 2021; Yeboah et al. 2024). It is reported that in order to manage healthcare waste in a country, attention should be paid to the negative perceptions of healthcare personnel (Bamakan et al. 2022; Mugabi et al. 2018).

As nurses constitute the largest workforce in health services, their perceptions and efforts regarding waste are very significant (Kleber and Cohen 2020). In addition, preventing waste in healthcare is an ethical responsibility (Erol 2022). The way to eliminate waste is possible by providing a human‐oriented and human‐respecting health service (Horlings 2015). Nursing care is based on human beings and nurses can contribute to a great extent to develop the awareness of conscientious responsibility to reduce waste, in order to ensure sustainable development and to guide the nurses of the future (Graban 2018; Minogue and Wells 2016).

Although international literature has addressed material waste, care inefficiencies and environmental sustainability, there remains a notable gap regarding how nurses conceptualize both material and non‐material forms of waste in their daily practice. Furthermore, few studies explore nurses' own solution‐oriented suggestions based on their frontline experiences. This study aims to address this gap by examining nurses' perceptions of waste holistically, covering economic, ethical, operational, and environmental dimensions and identifying their proposed strategies to reduce waste.

Making non‐material forms of waste visible is important not only for improving resource utilization but also for enhancing the quality of care, strengthening nurses' professional roles and improving patient outcomes. In particular, factors such as loss of time, unnecessary workload and the underutilization of professional potential may reduce the time nurses can devote to direct patient care, thereby negatively affecting the effectiveness and continuity of care. Indeed, nursing workload, time pressure, and inadequate resources have been reported to contribute to delays in care delivery and the omission of certain nursing care activities, which may subsequently have adverse effects on care quality, patient safety and nurse satisfaction (Ball et al. 2014; Bruyneel et al. 2021; Dall'Ora et al. 2020; Griffiths et al. 2018).

As nurses are directly involved in care delivery processes, understanding their perceptions of both material and non‐material forms of waste is essential for the development of sustainable healthcare systems. Exploring nurses' experiences may provide valuable evidence to inform waste reduction strategies, improve resource management practices, optimize nursing workforce utilization and support organizational sustainability initiatives. Furthermore, identifying nurses' solution‐oriented recommendations may contribute to nursing practice by promoting more efficient care processes, to nursing education by increasing awareness of waste and sustainability among future nurses, to nursing management by informing resource allocation and workforce planning, and to healthcare policy by guiding the development of institutional and national strategies aimed at reducing waste and improving the quality of care.

Consequently, the research issues that were examined in this study are as follows:

1. How do nurses perceive waste and how do they define the sources of waste?

2. What are nurses' suggestions for solutions to sources of waste?

2. Methods

2.1. Study Design

This study was conducted in a conventional content analysis design using a qualitative research method. In this investigation, we sought to reveal in‐depth information regarding the sources of waste in nursing services. The study complied with the criteria for reporting qualitative research (COREQ) checklist.

2.2. Research Participation

Maximum diversity sampling, one of the purposeful sampling methods, was used to determine the study group. The different opinions revealed through the diversity of the participants allow for a holistic understanding of the researched in depth (Richard et al. 2021). In this framework, the study was conducted with 21 nurses who agreed to participate and met the inclusion criteria. The research was conducted with nurses working in different six hospitals.

Nurses with at least 5 years of professional experience were included to ensure that participants had sufficient exposure to clinical workflows, resource utilization practices and organizational processes. This criterion was adopted to enable participants to provide comprehensive reflections on waste‐related issues based on prolonged clinical experience and observation across different situations and staff groups.

Inclusion criteria:

• –Being a registered nurse actively working in a hospital setting
• –Having at least 5 years of professional clinical experience
• –Being able to communicate effectively and be willing to participate

Exclusion criteria:

• –Having a communication barrier that could hinder participation in the interview process
• –Having less than 5 years of professional experience
• –Being on leave during the data collection period

2.3. Data Generation

A semi‐structured interview form created by the researchers was used for data collection. The semi‐structured interview form was finalized by taking the opinions of three different experts. The interview form included six questions about the sociodemographic information of the participants and 10 questions about waste. Examples of questions about waste were as follows: What does the word waste mean to you? Are there types of waste; if so, how would you classify them? How do you relate waste to your profession?

What are the situations that increase waste? Do you think waste can be prevented? Is there anything else you would like to say?

All interviews were conducted by the first researcher, who is a female academic holding a PhD in Nursing Fundamentals, currently working as a faculty member in the same field and experienced in qualitative research. The researcher had no prior direct relationship with the participants. Prior to the interviews, participants were informed about the researcher's academic role, the purpose of the study and the voluntary nature of participation. Participants were recruited using purposive sampling through head nurses. Nurses who met the inclusion criteria were identified with the assistance of head nurses and invited to participate on a voluntary basis.

With the participants' consent, all interviews were digitally recorded using an audio recording device. Prior to the interviews, written informed consent was obtained from each participant. In addition, once the audio recorder was activated, participants were asked to verbally reconfirm their consent to participate in the study to ensure that their approval was documented.

Data were collected face‐to‐face using a semi‐structured interview method. The interviews were conducted at times convenient for the participants, in the areas of their choice, and the interviews lasted an average of 30 min. During data collection, both instant notes were taken and voice recordings were made to prevent data loss. The research data were collected between 03.07.2023 and 28.08.2023.

2.4. Data Analysis

The data were analysed manually by two independent coders using a conventional content analysis approach as described by Hsieh and Shannon (2005). The analysis was conducted in a systematic and stepwise manner. First, audio recordings and field notes were transcribed verbatim into plain text, resulting in a total of 52 pages of transcripts. The transcripts were read several times to achieve a comprehensive understanding of the data.

Second, the data were examined line by line, and meaningful units related to the research phenomenon were identified. These meaning units were coded independently by two coders. Third, codes with similar content were grouped into categories, and relationships among categories were examined. Based on these relationships, higher level themes were developed to reflect the patterns emerging from the data. This inductive process ensured that categories and themes emerged directly from participants' narratives rather than being predetermined by the researchers. Coding discrepancies between the two coders were resolved through discussion until consensus was reached.

Data saturation was achieved after the 19th interview, when no new codes or meaning units emerged. Two additional interviews were conducted to confirm saturation, and no new concepts were identified. Therefore, the final sample of 21 participants was considered sufficient to represent the diversity of experiences within the study group. The sample included nurses with varying ages, years of clinical experience and clinical units, which enhanced the diversity and transferability of the study findings. The interviews lasted between 20 and 40 min.

The transcripts obtained from the interviews were returned to the participants, and necessary revisions were made based on their feedback. To enhance credibility, participant feedback obtained through transcript review was integrated into the analysis. When participants suggested clarifications or corrections, these were incorporated into the final transcripts. In cases where the feedback created ambiguity, the researchers reviewed the original audio recordings and reached consensus before finalizing the codes.

2.5. Validity and Reliability

Participant control (participant confirmation) method (Savin‐Baden and Major 2023) was used to increase the validity of the study. In order to ensure external validity, it was emphasized that the participants should be introduced in detail (Savin‐Baden and Major 2023), purposive sampling method should be used, and inclusion and exclusion criteria should be specified (Hennink and Kaiser 2022). In this framework, the purposive sampling method was used and the inclusion–exclusion criteria were included. The factor that increases reliability in qualitative research is to explain the research method in detail and to include the participant opinions in quotation marks (Anim‐Wright 2024). Reporting participant opinions in this way increases reliability.

The reliability of the study was calculated using the Miles and Huberman (1994) formula. This approach requires comparing the codes generated independently by two coders and identifying the number of agreements and disagreements for each code. In this method, inter‐coder reliability is computed using the formula:

Reliability = Agreement / (Agreement + Disagreement).

Accordingly, the coders' evaluations were examined, the frequencies of agreement and disagreement were determined, and reliability was calculated based on this ratio. In qualitative studies, a reliability level of 90% or above is considered acceptable. In the reliability assessment conducted for this study, an agreement level of 92% was achieved, indicating a high level of consistency between coders.

3. Results

It was determined that the age of the nurses participating in the study was between 28 and 48 years. The clinics where they worked were distributed as internal medicine, surgery, management, paediatrics, emergency service and intensive care; their weekly working hours were between 40 and 50 h, and the number of patients cared for daily varied between 2 and 25 (Table 1).

TABLE 1.

Distribution of sociodemographic characteristics of nurses.

Nickname	Age	Gender	Education degree	Nursing experience (year)	Working unit	Working hours per week	Number of patients cared for daily
N1	38	Female	Licence	25	Internal medicine	45	14
N2	37	Female	Licence	12	Internal medicine	45	12
N3	45	Female	Licence	19	Surgery	40	8
N4	35	Female	Licence	12	Internal medicine	45	12
N5	48	Female	Licence	13	Internal medicine	40	4
N6	33	Male	Postgraduate	11	Management	40	—
N7	31	Male	Postgraduate	9	Management	40	—
N8	32	Female	Postgraduate	10	Internal medicine	45	15
N9	28	Female	Licence	5	Paediatrics	40	10
N10	32	Male	Licence	8	Emergency service	45	25
N11	32	Male	Licence	9	Intensive care	50	2
N12	29	Female	Licence	7	Intensive care	50	3
N13	44	Female	Licence	11	Internal medicine	45	15
N14	32	Female	Licence	9	Internal medicine	45	10
N15	35	Female	Licence	10	Management	45	—
N16	28	Female	Licence	5	Management	45	—
N17	30	Female	Licence	7	Internal medicine	45	12
N18	33	Female	Postgraduate	8	Paediatrics	45	8
N19	45	Male	Postgraduate	7	Emergency service	45	22
N20	36	Male	Postgraduate	6	Intensive care	45	5
N21	35	Male	Licence	5	Intensive care	45	8

In line with the data obtained from the participants, three themes were determined regarding the sources of waste: ‘Perception of the concept of waste’, ‘Nursing services and waste’, ‘Iceberg’. The themes and categories are shown in Figure 1.

FIGURE 1.

Themes, categories and codes related to nurses' perceptions of waste identified through content analysis.

3.1. Theme 1. Perception of the Concept of Waste

In the interview with nurses, it was concluded that nurses perceive waste in different categories based on the answers obtained when nurses were asked how they perceive waste. In the interviews with nurses, some of the nurses defined waste in ‘material’ terms while others mentioned ‘spiritual’ waste and some mentioned both ‘material and spiritual’ waste.

Nurses stated that they first perceived items with material value in the concept of waste. Some examples of definitions made by nurses about ‘material waste’ are given below:

N1: The first thing that comes to my mind is water; we consume more than needed.

N10: Anything unnecessarily used, whether at home or in the hospital, is wasteful.

Some of the nurses mentioned the non‐material dimension of waste, some examples of the participants' statements about ‘spiritual waste’ are given below. The spiritual waste referred primarily to the depletion of emotional resources, although some participants also associated it with the inappropriate use or neglect of patient rights.

N7: Excessive emotional labor such as compassion or patience leads to emotional wear.

N9: Not using patient rights correctly is also a form of waste.

N20: For example, emotional waste comes to mind, if you give someone more value and labour than necessary, then you are wasting your emotions, in fact, when we think of waste, we first think of material things, but waste may not always be material.

N8: Failure to use the rights of the person who will receive and provide health care services in the right way is also wasteful.

Participants explained that these spiritual aspects of waste were not only emotional but also had practical implications, such as reduced motivation, slower decision‐making, and decreased attentiveness during daily tasks.

Several nurses noted that emotional depletion can diminish their responsiveness during critical clinical situations, demonstrating how spiritual waste affects the care process.

Among the nurses who participated in the research, there were some who stated that ‘waste has both material and spiritual’ dimensions. Sample participant statements are given below:

N3: Waste can range from unnecessary use of paper and water to spending extra effort on an unsolvable task.

N5: Waste varies from food to materials, labor, and paper.

N6: Unnecessary work we do during our work, wasting time, consuming more material than necessary is waste.

These combined perceptions showed that waste was seen as a multidimensional issue directly influencing both material resources and nurses' perceived emotional and cognitive workload.

3.2. Theme 2. Nursing Services and Waste

Waste in nursing services was defined by nurses in four categories: medical supplies, paper waste, moral waste and time waste.

Medical supplies wastage is defined as taking too much medication to the clinic and wasting medication, throwing away half doses of medication, opening more than one number of materials used in some nursing interventions, nurses making mistakes while using materials and equipment, reusing materials and equipment, waste due to technical malfunctions occurring in the clinic, and finally, having too many products in sterile packaged materials.

N1: Excess medication orders and unused half‐doses often lead to waste.

N8: Materials such as plasters or tourniquets are quickly discarded without considering reuse.

N21: Inexperienced nurses may open more materials than needed, causing avoidable waste.

N18: Especially since plasters and tourniquets are used a lot, they are always at hand. Employees immediately throw them away even if there is a slight contact. They do not think whether they can be cleaned or reused or whether they are really dirty.

Nurses emphasized that such material waste disrupts workflow efficiency, particularly when inexperienced staff open unnecessary materials, resulting in delayed task completion and increased workload.

Nurses stated that errors made during the filling of documents and the use of different documents for the same procedures, that is, waste of paper due to repetition of records, misuse of consumables in other jobs other than care and treatment in the clinic, routine procedures performed on patients without considering their needs, using too many documents during the admission of patients to the ward the most wasteful use of paper in health services was after medical supplies. Sample participant statements about ‘paper waste’ are given below:

N3: Paper is heavily wasted; even minor errors require rewriting whole documents.

N16: Mandatory forms used during hospitalization contribute significantly to paper waste.

N19: I believe paper is the most wasted resource in hospitals, especially in clinical units. We have to complete numerous forms and documents, which results in considerable paper waste.

Participants indicated that repeated documentation reduces the time that can be dedicated to individualized patient care, linking paper waste to both material and time loss in clinical routines.

The moral waste referred to the ineffective use of nurses' professional capacity, expertise, labour, and professional roles within healthcare organizations. On the other hand, they defined moral waste as the employment of a nurse in different clinics in nursing services without taking into account her/his area of expertise, wasting energy and eroding motivation due to frequent duty changes, nurses not being able to use their potential sufficiently, wasting nurses' emotions, and wasting nurses' labour due to unnecessary interventions and procedures. Some sample data obtained about moral waste are as follows:

N7: Nurses' emotional capacity is consumed, and they cannot react when necessary.

N11: Routine procedures performed without considering patient needs lead to wasted labor.

N20: Assigning nurses outside their specialty wastes both time and effort.

N2: When experienced nurses are frequently required to perform non‐professional tasks, their expertise remains underutilized. I consider this a form of waste because valuable nursing knowledge and skills are not used where they are most needed.

N5: Repeatedly carrying out unnecessary procedures that do not benefit patients can be discouraging. It creates a sense that nurses' efforts and professional contributions are being wasted.

Nurses stated that moral waste leads to frustration, a sense of inefficiency and diminished professional satisfaction. They explained that being assigned outside their expertise or performing unnecessary tasks reduces their ability to use their skills effectively and may indirectly impact care continuity and quality.

Nurses also mentioned the ‘waste of time’ in the field of nursing services. Sample participant statements on time waste are given below:

N12: The most wasted thing in nursing services is time; we cannot allocate sufficient time to patients.

N11: Heavy workload causes delays, and essential procedures may be postponed.

N16: Some colleagues complete a 15‐minute procedure in 45 minutes, limiting time for others.

N15: We spend a great deal of time searching for missing materials or resolving organizational problems. This reduces the time we can devote to patient care and creates delays in the workflow.

N17: When staffing levels are inadequate, nurses have to manage multiple responsibilities simultaneously. This often leads to inefficient use of time and delays in completing essential nursing interventions.

Nurses reported that emotional fatigue, high workload and inefficient task distribution extend the time required for routine procedures, contributing to reduced availability for patients' individualized needs.

3.3. Theme 3. Iceberg

Participants frequently described waste as the visible consequence of deeper organizational and individual factors. Therefore, this theme was conceptualized as an iceberg, where visible waste represented only the surface manifestation of underlying causes. In the interviews with nurses, two categories emerged about the situations that increase waste and reasons for waste, and they were grouped under the iceberg theme. Reasons for waste in nursing services include lack of awareness about waste, immaturity of ethical and moral values, not knowing the dimensions of waste, insufficient digitalization in nursing services, disposable consumables, over‐sensitive approaches due to the risk of developing nosocomial infections, nurses performing tasks outside their duties, authorities and responsibilities, inexperienced nurses, trainee nurses receiving training in the clinic for clinical practice and unnecessary application of routine procedures. Below are sample statements including the reasons for waste in nursing services.

N3: I think the reason for waste is not being conscious.

N6: Digitalization is insufficient in nursing services.

N17: Waste also occurs because some items cannot be reused due to infection risks.

N19: Some routine procedures are performed simply because they have always been done that way, even when they do not provide a clear benefit to the patient. This creates unnecessary use of time and resources.

N5: Many healthcare professionals are not fully aware of the different dimensions of waste. Without sufficient awareness, wasteful practices become part of everyday routines.

These explanations showed how cognitive and structural deficiencies translate into observable waste, such as unnecessary opening of sterile items, repeated documentation and increased consumption of consumables.

Nurses mentioned a large number of factors that increase waste in their work environment. The nurses stated the situations that increase waste in their work areas as the poor quality of materials and equipment, rushed and sloppy procedures, lack of awareness, excessive number of patients, inexperience, sudden staff changes in the service, management style of the hospital and insufficient number of nurses. Sample statements about situations that increase waste in nursing services are as follows:

N4: If poor‐quality materials are purchased, waste increases.

N8: The reasons for waste in nursing services are the high number of patients and low number of nurses.

N18: Lack of awareness and sudden staff changes also increase waste.

N13: When the number of nurses is insufficient, tasks accumulate and staff often rush to complete procedures. This increases the likelihood of mistakes and leads to unnecessary waste of materials and time.

N21: Frequent changes in personnel disrupt teamwork and communication. New staff may not be familiar with the routines of the unit, which can result in inefficient practices and increased waste.

Participants emphasized that these conditions contribute to both material waste and the depletion of non‐material resources such as motivation, emotional energy and time, creating a cumulative burden in the clinical environment.

The nurses participating in the study stated that in order to reduce waste in nursing services, training on waste should be provided, waste sources should be identified and integrated into the quality system, audits should be conducted on waste and some rules and procedures should be developed, an internal audit mechanism should be established where nurses can audit each other, and digitalization should be rendered widespread in nursing services. They suggested that the hospital management should take initiatives to increase the motivation of nurses and strengthen their sense of belonging to the institution where they work, raise awareness of other professional groups working in the hospital about waste, assign nurses to areas related to their areas of expertise, and review and reduce non‐essential routine procedures.

In addition, nurses used expressions that they think nurses cause less waste than other health team members when associating waste with nursing. In the interviews, nurses expressed that they are more sensitive to waste than other health personnel.

N2: Nurses are more sensitive to waste and try to return unused materials.

N4: Nurses use scarce resources carefully and often find creative alternatives when materials are unavailable.

Nurses' statements highlighted a professional awareness toward resource conservation, suggesting that their practices may mitigate certain forms of waste in the clinical setting.

4. Discussion

Nurses can help prevent and reduce waste in health systems by participating in various sustainability efforts, including educational initiatives, practice, policy changes and innovative research (Kleber and Cohen 2020; Mat and Baykal 2020; Öden 2021). There are many studies reporting that nurses have an important role in reducing waste (Sürme and Maraş 2022; RCN 2016; NHS [National Health Service] 2017). In this study, it was aimed to determine how nurses perceive waste, what the situations are that increase waste and the sources of waste.

Waste in healthcare services is associated with patient services and patient satisfaction, and anything that does not contribute to patient services and patient satisfaction is classified as waste (Graban 2018; Minogue and Wells 2016). Therefore, waste is not only related to products but also to care, clinical practice and service delivery (Çavmak 2020; Graban 2018; Minogue and Wells 2016). In our study, some of the nurses defined waste as material, while others mentioned the spiritual and material aspects of waste. In the literature, studies have been mainly conducted in relation to material waste (Kleber and Cohen 2020; Musa et al. 2020; Sürme and Maraş 2022). Thus, the identification of ‘spiritual waste’ in this study extends the existing literature by highlighting emotional and ethical dimensions that have rarely been examined. This theme emerged inductively through conventional content analysis, based on recurring patterns in participants' narratives reflecting emotional exhaustion, misallocation of professional effort, and loss of meaning in care practices. For instance, one participant stated, ‘Excessive emotional labour such as compassion or patience leads to emotional wear’ (N7), while another expressed that ‘Assigning nurses outside their specialty wastes both time and effort’ (N20). These findings demonstrate that emotional capacity and professional effort are perceived as valuable resources that may be depleted or wasted in clinical settings. This finding can be interpreted within the framework of Conservation of Resources Theory, which suggests that stress occurs when individuals experience actual or threatened loss of valued resources such as emotional energy and professional capacity (Wu et al. 2025).

The theoretical contribution of the concept of ‘spiritual waste’ lies in extending the understanding of waste beyond material resources to include the depletion of emotional and professional resources that are essential for nursing care. While healthcare waste has traditionally been conceptualized in terms of financial losses, material consumption and operational inefficiencies, the findings of this study suggest that emotional energy, compassion, patience and professional commitment may also be perceived as valuable resources that can be wasted. By introducing this perspective, the concept of spiritual waste broadens existing discussions of sustainability and resource management in healthcare and highlights the importance of preserving nurses' emotional and professional capacities as integral components of high‐quality and sustainable care.

In line with this framework, previous research shows that emotional labour and moral distress in nursing are associated with depletion of psychological resources, burnout and decreased quality of care (Chai et al. 2025; Iskender et al. 2023). Nurses frequently experience moral distress when they are unable to act according to their professional values or when resources are misused, which can negatively affect their well‐being and performance (Flaubert et al. 2021). From a practical perspective, these findings suggest that reducing excessive emotional workload, ensuring appropriate task allocation, and strengthening organizational and ethical support systems may help prevent ‘spiritual waste’, improve nurse well‐being, and enhance the quality of patient care.

From a nursing practice perspective, recognizing spiritual waste may help healthcare organizations identify hidden forms of resource loss that are not captured by traditional waste management systems. Interventions aimed at reducing excessive emotional labour, improving communication and minimizing non‐essential tasks may help preserve nurses' emotional resources and enhance care quality. In nursing management, ensuring appropriate task allocation, reducing unnecessary role ambiguity and providing organizational support may decrease emotional exhaustion and improve workforce sustainability. In nursing education, integrating concepts such as emotional resource management, sustainability, and waste awareness into undergraduate and continuing education programmes may strengthen nurses' ability to recognize and prevent both material and non‐material forms of waste. At the policy level, workforce planning strategies and institutional policies that support nurses' professional roles and well‐being may contribute to reducing spiritual waste while promoting sustainable and patient‐centred healthcare services.

It has been reported that the greatest wasted materials in healthcare services are medical materials and these are comprised of injectors, gloves, scalpels, plasters, blood tubes and expired medicines (Tushabe 2023; Tushar et al. 2023). In our study, nurses stated that medical supplies, disposable products in particular, are wasted the most in healthcare services. They included paper as an overly wasted product. More wastage of medical supplies may have resulted from the approach to prevent the development of infection. This finding parallels earlier studies indicating that strict infection‐prevention protocols may unintentionally increase single‐use material consumption, particularly through the widespread use of disposable personal protective equipment and single‐use medical supplies (Sherman et al. 2020; World Health Organization 2022; Chang and Thiel 2020; McGain and Naylor 2014).

With the largest workforce in health care, the nursing profession is well positioned to meet the challenges of reducing waste in hospital systems (Kalogirou et al. 2021). It is reported that nurses have the ability to lead the way for sustainable, healthy communities and environments with important roles, responsibilities and skills (Kleber 2018). By unifying and engaging staff through their positions, nurses can reduce overhead costs associated with waste and waste management and help maintain financial integrity. In such practices in healthcare organizations, it is seen that team leaders or the majority of the team consist of nurses (Cunningham et al. 2023; Deborah Sanford and Hannah Nadeau 2022). A nurse‐led waste prevention and waste reduction initiative in an intensive care unit was estimated to save the organization more than 72,000 USD per year. In this initiative, the team of nurses collected the cost of wasted materials and identified cost savings (Cockerham et al. 2016). Thus, they created important inputs on waste reduction and waste management of the organization. In our study, participants perceived nurses as being more sensitive to waste and resource conservation than other healthcare professionals.

This perception is consistent with previous studies suggesting that nurses often employ conservative resource‐use behaviours (Kalogirou et al. 2021; Kleber and Cohen 2020). This was also reflected in participants' statements indicating careful use of materials and awareness of unnecessary consumption in daily practice. Nurses' close proximity to care processes enables them to identify inefficiencies and intervene directly in resource use, positioning them as key agents in promoting sustainability within healthcare systems. From a systems perspective, nurses function not only as care providers but also as coordinators of resource utilization, influencing both clinical outcomes and organizational efficiency. This role is also emphasized in international reports, which highlight nurses as frontline contributors to sustainable healthcare practices and resource optimization (World Health Organization 2022). Therefore, their role in reducing waste extends beyond individual practice to institutional‐level impact, particularly in the implementation of sustainable healthcare strategies.

Although participants perceived nurses as relatively more sensitive to waste than other healthcare professionals, waste was still reported to occur within nursing services. In the literature, it is seen that medical materials are mostly wasted in nursing services (Fallahnezhad et al. 2023; Schenk et al. 2023; Sürme and Maraş 2022). In addition, it has been reported that wastage occurs in issues such as waste of time and inability to use the potential and unnecessary procedures (Çavmak 2020; Erol 2022). Similarly, in our study, it was determined that there was waste in terms of time, service and rights. These results indicate that inefficiencies in workforce allocation, organizational culture and management practices shape waste‐related outcomes, which is consistent with previous research on workflow disruptions and role misalignment. Moreover, by identifying emotional and moral components of waste such as wasted potential and emotional depletion, our study broadens the scope of existing research that has traditionally focused on material waste alone.

The causes of waste in nursing services and situations that increase waste have been reported as inadequate use of technology, lack of infrastructure, lack of education and insufficient awareness of waste (Janik‐Karpinska et al. 2023; Morrow 2021). In a study conducted with physicians and nurses on waste, the most commonly cited reasons for excessive waste were reported as the inability to reuse or reuse devices, consumables and pharmaceuticals more than once (Chang and Thiel 2020). On the other hand, it is reported that trainee nurses studying in the nursing department and coming to clinical practice, also cause an increase in waste (Pratap et al. 2021; Tiwari et al. 2021). Similarly, this study nurses pointed out that trainee nurses cause waste. By highlighting similar determinants, such as insufficient awareness and limited digitalization, our findings are consistent with global evidence and underline the structural nature of waste‐generating factors in healthcare settings.

Nurses pointed out that the low number of nurses, high number of patients, low quality of materials, unnecessary application of routine procedures and inexperienced nurses are among the reasons that increase waste. These factors mirror broader international concerns regarding staffing shortages, high patient loads and variability in material quality, all of which have been shown to increase clinical inefficiencies and resource consumption. Thus, our study confirms these established relationships while providing contextual insights specific to nursing practice.

It is seen that training programmes are organized, protocols are developed, new models are used, audits and sanctions are applied, and some strategies are used to reduce waste in healthcare and nursing services (Cunningham et al. 2023; Cockerham et al. 2016; Najmi et al. 2021). In our study, it was suggested that nurses should be provided with training on waste, that sources of waste should be identified and integrated into the quality system, audits related to waste should be carried out and some rules and procedures should be developed; digitalization should be made widespread in nursing services, nurses should be assigned to areas related to their areas of expertise, and non‐essential routine procedures should be reviewed and reduced. These recommendations are aligned with international best‐practice models and demonstrate that nurses' insights closely match global strategies for improving sustainability and resource management in healthcare. Overall, this study contributes to the literature by illustrating that nurses conceptualize waste in multidimensional ways: material, emotional, ethical and organizational—and by documenting both surface and underlying causes of waste, thereby expanding the existing knowledge base on waste in nursing services.

5. Limitations

This study focuses on revealing the perception of waste in nursing and determining the sources of waste, but the dimensions of waste are many and it is a complex intertwined concept. The sources of waste in healthcare have been evaluated only from the perspective of nurses. Comparisons can be made by including other healthcare team members in the study. More studies are needed to put into practice the suggestions offered by nurses to prevent waste, to evaluate the current situation and to reveal financial waste.

A further limitation of this study is that only nurses with at least 5 years of professional experience were included. Therefore, themes related to inexperienced or trainee nurses reflect the perceptions and observations of experienced nurses rather than the direct experiences of less experienced nurses themselves. Future studies including novice nurses and nursing students may provide a more comprehensive understanding of experience‐related sources of waste.

6. Conclusions

This study provided contemporary information about nurses' perceptions of waste. The results highlight important issues, such as the fact that nurses perceive waste as material and spiritual waste, that they believe nurses to be the occupational group which causes the least waste in health services, as well as the fact that training should be organized and procedures should be developed to reduce waste. In addition, since they defined the causes of waste and the situations that increase waste, these results can assist in the creation of a framework for reducing waste resources, where the experiences of nurses can be used for guidance. The study findings can be a valuable lead to managing and reducing waste in the clinics.

Author Contributions

Ayşegül Yildiz: conceptualization, data curation, formal analysis, writing – review and editing, methodology, project administration; Cevriye Özdemir: data curation, formal analysis, writing – review and editing, project administration.

Funding

The authors have nothing to report.

Disclosure

Statistical analysis: The authors have checked to make sure that our submission conforms as applicable to the Journal's statistical guidelines described here.

Ethics Statement

Prior to launching the study, ethics committee approval was obtained from Cappadocia University Non‐Interventional Research Ethics Committee  ethics committee (Date: 17.06.2023, Number: E‐64577500‐050.99‐44354), informed consent was obtained from all participants, information about the purpose and content of the study was provided, and anonymity of the participants was ensured. The research was conducted in accordance with the Declaration of Helsinki.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are not publicly available due to ethical and privacy considerations, as they contain information that could potentially identify the participants. De‐identified data may be made available from the corresponding author upon reasonable request.