4.5. Support Structure Available in the Hospital
Due to the nature of work that nurses provide to the patients, it is important that they receive special support from their management and colleagues in order for them to offer quality service. The following sub-themes will be discussed under support system available in the hospital; support from the managers, support from the psychologist and appreciation of staff.

4.5.1. Support from the Managers
Nursing managers are widely accepted as the most influential force in staff satisfaction and retention because of their role in work environments. Hospital management protects and provides staff with the resources to do their job. Within the clinical settings, managers are consistent in their presence; uniquely positioned with a front-row view of the intricacies of nurse-patient, nurse-physician, and nurse-interdisciplinary team dynamics. Hospitals, together with nursing managers, are expected to oversee the daily demands of unit operations while developing an environment that fosters nursing excellence and promotes an engaged nursing staff. On the other hand, nursing managers are the vital link between hospital senior executives and direct care nurses. Good management makes a hospital meet its complex target. Below are the comments made by the participants:
Nurse (N5) commented positively saying that: “we do receive full support that we need in the wards from the managers. But we are happy of the fact that the hospital CEO does support us, and the nursing service manager gives us support.”
Nurse (N6) also commented that: “Hmmm we believe that for now we just need a special support from the management and all TB programme leaders, to give us more knowledge and skills on TB.”
Nurse (N3) indicated that: “I believe that as a nurse it is more crucial that we have meetings with the doctors and other management staff.”
According to the findings of the present study even though the support structure from the management is available, there is a need for special support for TB patients. Lack of support from the management confuses the nursing staff and causes staff to lose interest in their job. The findings of this study concur with those of the study by Manyisa and van Aswegen [28], which revealed that South African hospitals’ working environments lack resources and managerial support.

4.5.2. Support from Psychologists
Nursing has long been considered as one of the most stressful professions. Stress in nursing is attributed largely to the physical labor, suffering, and emotional demands of patients and families; long working hours, shift work, and interpersonal relationships. Sophisticated healthcare technologies, budget cuts, increasing workload, and constant organizational changes in some healthcare environments appear to be the factors that have increased stress among nurses. Nurses seem to be overexposed to a range of psychosocial stressors. As a result, it is important that they receive psychological support regularly in order for them to cope in their working environment and remain productive. Below are the comments made by the participants:
Nurse (N2) indicated that: “The most painful and traumatizing thing in the TB wards is that patients die in large numbers and it is so stressing to see people dying just before you every day. We really need clinical psychologists to come and render counselling, but all they do is to schedule an appointment with us and never come to talk to us. We do not get even debriefing sessions. As a result, we feel that we are losing it, at times we just can’t cope.”
The findings of this study revealed that nurses do not receive personal psychological support. Even though the support structure is there in the hospital, their needs are not considered and attended to. A study by Mametja [16] reported concerns that were raised by nurses, that they needed counselling, not only when they have contracted the disease, but for them to cope with the demands of the high number of patients who no longer recover from the illness, but die as the result of HIV/AIDS. The findings of the present study agree with those of the study by Arjun [25], which concluded that nurses caring for MDR-TB patients did not receive psychological support from the clinical psychologists when they need it; neither was there a functional employee assistance programme available at the institution.

4.5.3. Appreciation of Staff
Hospitalized patients require more than a dozen daily medications that are administered at various hours and in multiple ways. Although physicians have the responsibilities to diagnose infections and prescribe medications for patients, nurses are responsible for actively caring, feeding, bathing, and dispensing medication for hospitalized patients throughout the day. Nurses are on the front line of fighting all kinds of diseases in the world, and they risk their lives to provide quality healthcare services in the hospital.
Nurse (N2) showed concern and said: “the hospital doesn’t even appreciate us for the good work that we are doing by risking our lives daily. We do not even get a danger allowance in case we contract infection in the wards. Instead we are being told that if we are found with TB we would be moved to another ward which is not a TB ward.”
Nurse (N1) further indicated that: “we do not have TB awareness campaign, even just for a day, where the management just appreciates us for the great work that we are doing. At times I even consider other opportunities. Even the families of patients blame us for everything that goes wrong with the patients they do not appreciate the effort we put to care for the patients.” 
According to the findings of the present study TB nurses feel unappreciated for what they are doing. TB nurses are on the frontline of the fight against the highly infectious diseases that affect many people. In spite of this, they do not receive a danger allowance and the hospital does not celebrate TB day as a way of appreciating TB nurses as pioneers in the hospitals who risk their lives in order to fight TB disease. In support of these findings, Loghmani et al. [29] reported that the participants’ experiences were that the families believed that nurses did not do their best for the patients and that they abused the patients. The findings of this study concur with those of the study by Sodeify et al. [30], which concluded that South African nurses were not well supported, appreciated, recognized, and well-rewarded; unlike in other countries since they provide quality service to patients under very difficult circumstances with limited resources. This is why they leave South Africa to work in other countries.