Socioeconomic Determinants and Governance Effects on Nurses in India

Abstract

The sustainability of healthcare systems in India is closely linked to the well-being and performance of the nursing workforce. However, nurses continue to face a range of socioeconomic and institutional challenges that affect their work and overall quality of life. This study examines how socioeconomic conditions influence nurses’ quality of life (QoL), quality of work life (QWL), and quality of work (QoW), while also considering the role of institutional governance in shaping these relationships. Drawing on the Job Demands–Resources (JD-R) framework, the study adopts a qualitative approach using in-depth interviews and non-participant observations with nursing professionals across tertiary healthcare institutions in India. The data were analysed using Braun and Clarke’s reflexive thematic analysis.
The findings show that issues such as job insecurity, low and unequal pay, and limited access to social protection—especially in contractual roles and private hospitals—have a direct impact on nurses’ well-being and work experiences. Governance plays an important role in shaping these conditions. Participants highlighted gaps in leadership, weak implementation of policies, and uneven resource distribution, which often make workplace challenges more difficult. At the same time, supportive practices such as clear communication, fair management, and responsive leadership help improve work environments and reduce stress. The study also shows that QoL, QWL, and QoW are closely connected, with poor well-being affecting the quality of patient care.
This study provides a context-specific understanding of how structural conditions and organizational practices interact within the Indian healthcare system. It also extends the JD-R framework by showing how governance influences the availability of resources and the experience of job demands. The findings point to the need for better labour protections, improved governance, and stronger investment in the nursing workforce to support both employee well-being and the quality of healthcare delivery.