Informing the scale-up of Kenya’s nursing workforce: a mixed methods study of factors affecting pre-service training capacity and production

• Type of Material: Article
• Authors: Ashley A Appiagyei, Emory University Rwanda Zambia HIV Research Group; Rose N Kiriinya, Emory University Kenya Health Workforce Project; Jessica M Gross, Emory University Kenya Health Workforce Project; David N Wambua, Nursing Council of Kenya; Elizabeth O Oywer, Nursing Council of Kenya; Andrew K Kamenju, Emory University Kenya Health Workforce Project; Melinda K Higgins, Emory University; Patricia L. Riley, Centers for Disease Control and Prevention; Martha Rogers, Emory University
• Language: English
• Date: 2014
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Appiagyei et al.; licensee BioMed Central Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1186/1478-4491-12-47
• Title of Journal or Parent Work: Human Resources for Health
• ISSN: 1478-4491
• Volume: 12
• Issue: 1
• Start Page: 47
• End Page: 47
• Grant/Funding Information: This article was supported under a cooperative agreement from the Centers for Disease Control and Prevention (CDC) through the Association of Schools and Programs of Public Health (ASPPH) Grant Number 1U36OE000002. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC or ASPPH.
• Keywords: Scale-up; Kenya; Training; Nursing workforce
• Research Categories: Health Sciences, Nursing; Health Sciences, Education; Health Sciences, General

Abstract

Background Given the global nursing shortage and investments to scale-up the workforce, this study evaluated trends in annual student nurse enrolment, pre-service attrition between enrolment and registration, and factors that influence nurse production in Kenya. Methods This study used a mixed methods approach with data from the Regulatory Human Resources Information System (tracks initial student enrolment through registration) and the Kenya Health Workforce Information System (tracks deployment and demographic information on licensed nurses) for the quantitative analyses and qualitative data from key informant interviews with nurse training institution educators and/or administrators. Trends in annual student nurse enrolment from 1999 to 2010 were analyzed using regulatory and demographic data. To assess pre-service attrition between training enrolment and registration with the nursing council, data for a cohort that enrolled in training from 1999 to 2004 and completed training by 2010 was analyzed. Multivariate logistic regression was used to test for factors that significantly affected attrition. To assess the capacity of nurse training institutions for scale-up, qualitative data was obtained through key informant interviews. Results From 1999 to 2010, 23,350 students enrolled in nurse training in Kenya. While annual new student enrolment doubled between 1999 (1,493) and 2010 (3,030), training institutions reported challenges in their capacity to accommodate the increased numbers. Key factors identified by the nursing faculty included congestion at clinical placement sites, limited clinical mentorship by qualified nurses, challenges with faculty recruitment and retention, and inadequate student housing, transportation and classroom space. Pre-service attrition among the cohort that enrolled between 1999 and 2004 and completed training by 2010 was found to be low (6%). Conclusion To scale-up the nursing workforce in Kenya, concurrent investments in expanding the number of student nurse clinical placement sites, utilizing alternate forms of skills training, hiring more faculty and clinical instructors, and expanding the dormitory and classroom space to accommodate new students are needed to ensure that increases in student enrolment are not at the cost of quality nursing education. Student attrition does not appear to be a concern in Kenya compared to other African countries (10 to 40%).