Nurses experiences with an intervention enhancing skill-mix in Kenyan neonatal units with severe workforce deficits: A qualitative study.

Background: Nurses remain critical in newborn care delivery in Kenya. However, persistent nurse shortages in newborn units limit their ability to provide optimal care. Staff shortages contribute to missed care and high workloads, negatively impacting the motivation and well-being of nurses. Evidence from Low and middle-income countries reveals strategies employed by nurses to manage high workloads. These include prioritisation of care and informal task shifting, where tasks are delegated to caregivers, student nurses, and support staff. While sharing and shifting non-technical tasks to less qualified personnel may be helpful, perceptions linked to the cadre of staff taking on extra roles and effects on the care performed and other critical relational aspects of care are often unclear or overlooked. To generate evidence on the impact of staffing interventions, we investigated the effects of workforce interventions on supporting neonatal care in hospitals in Kenya. In this paper, we report on the experiences of nurses with the intervention.

Methods: We adopted an ethnographic approach to explore nurses experiences with a staffing intervention in four Kenyan newborn units (neonatal units). Non-participant observations on neonatal units and in-depth interviews were conducted with healthcare providers. Data collection occurred in three phases: at baseline (Phase 1), after supplementing the units with additional nurses (Phase 2), and after supplementing the units with ward assistants (Phase 3). Over 1000 hours of observations and 112 in-depth interviews were conducted between January 2022 and July 2023. Drawing from the project's theory of change, we used a thematic approach in analysing and interpreting the data.

Results: Additional nurses and ward assistants were perceived as contributing to the overall motivation and well-being of existing nurses. Additional nurses meant that there were more hands per shift, which enhanced teamwork, task sharing, and task completion. The reported benefits of having more ward assistants included nurses being able to delegate non-technical tasks to ward assistants, which reduced nurses workload and freed up their time to concentrate on critical nursing tasks. This contributed to improved nurse motivation and well-being.

Conclusions: Adequate staffing is crucial for delivering optimal care quality and is central to nurses well-being. There is a need to increase nurse staffing in neonatal units. Further beneficial support for nurses may be gained by carefully designing and implementing non-technical task-sharing roles.