Street-level bureaucracy and extreme work: understanding career shock perceptions among nurses in public hospitals

Purpose: The aim of this study is to explore how extreme work conditions influence nurses’ experiences of career shock in public hospitals. Design/methodology/approach: This study employed a phenomenon-based approach to gain a deeper and more nuanced understanding of real-world phenomena. Semi-structured interviews were conducted with 33 nurses working in public hospitals in Egypt. Thematic analysis was applied to analyze the interview data. Findings: The study identified three key factors contributing to nurses’ perceptions of career shock under extreme work conditions: (1) Refugee-related factors (e.g. differential treatment of refugees compared to nationals, refugees as opportunities to supplement income); (2) Contextual factors (e.g. increased courtesy from nationals, rising patient numbers and demands for wage increases) and (3) workplace factors (e.g. extended work hours, heavy job responsibilities and perceived treatment by managers). These factors were found to significantly influence nurses’ perceptions of positive or negative career shocks. Originality/value: This research fills a gap in the literature on human resources, public administration and healthcare by addressing the limited empirical studies on how extreme job duties shape street-level bureaucrats’ (nurses, in this case) perceptions of career shock, particularly in developing and non-Western contexts.