Abstract
BACKGROUND: The World Health Organization and the International Council of Nurses both support nurses' involvement in health policymaking, including readiness planning for public health emergencies. South Africa's frontline nurses often have limited involvement in healthcare policymaking, even though nurses comprise 56% of the country's total public healthcare workforce and 87% of its skilled health professionals. This has implications for the quality and safety of nursing care provided during past and anticipated future pandemic events. OBJECTIVE: This purpose of this study was to evaluate frontline healthcare professionals' perspectives on pandemic preparedness in South Africa to inform policy improvements. METHODS: Four focus groups with registered nurses (n = 11) and semi-structured interviews with disaster committee members (n = 4) were conducted. A review of existing disaster policies contextualized the findings, which were analyzed using qualitative content analysis guided by a health policy framework. RESULTS: Four key categories emerged that described barriers to working in a disaster context: working outside of role and scope, insufficient staffing, mental health impacts, and lack of training for disasters and pandemics, all of which contribute to challenges in pandemic preparedness. CONCLUSIONS: Despite being the majority of the health workforce, South African nurses often lack influence in disaster planning. This study highlights how systemic challenges in a resource-limited hospital setting-such as chronic staffing shortages, insufficient inclusion of nurses in disaster policy development, and lack of tailored mental health support-compromised pandemic preparedness. Interventions such as peer-led mental health support, bedside microteaching, and nurse-informed policies could strengthen future pandemic readiness. These findings offer practical, scalable solutions for similar low-resource settings and underscore the importance of involving frontline nurses in disaster policymaking.