The ‘Perfect’ Storm Facing Nursing in Kenya

The perfect storm of nursing could be variously described. There was a need for introspection and policies guided by stakeholders in nursing to look into the many storms facing nursing in  Kenya today.

I have decided to write on this topic after some people raised concern elsewhere about the Bachelor of Science Midwifery (BSM) program that was being considered by some universities in Kenya. Any program that gets started or is about to needs to answer to something in its uniqueness, it should in no way contribute to the storm that nursing is already in.

Nursing shortage creates demand for more nurses to be recruited; it also creates an environment that compromises on patient safety. The available nurses demand (might get) better terms and conditions of the working environment. It creates an urge for more people to want to join nursing. In Kenya, more nurses graduate than can be absorbed in spite of the nursing shortage even as more and more experienced nurses approach retirement age. It’s like a storm whichever way one looks at it. It seems to be the situation in most countries worldwide.

In 2007, A La´ Crosse, a health care administrator called it a “perfect storm” of a nursing shortage. It was also described by Talsma et al., in 2008. If the BSM answers to this then I think it’s not a bad idea. When BSN in Kenyatta University (KU) started it was called BSN with Public Health, it was to take 6 years. I do not know how long this program lasted. A good number of RN-BSN programs are actually winding up while other universities were considering tapering off. Not so much because there were no diploma RN nurses but something to do with reaching a saturation point, again contributing to the storm.

The utility value of Higher Diploma and Post Graduate Diploma is not in dispute but had continued to refer to as having got horizontal education. The nursing fraternity was caught flatfooted with less than the adequate number of specialized nurses in critical care and renal nursing when the government went for starting critical care units and dialysis centres in all the counties, it was all systems go. The employers had continued to got the most out of these specializations without commensurate emolument; many did not bother awarding an incremental credit in their pay. Interesting a good number after specialization (Higher Dip or MSN) got deployed elsewhere other than their area of specialization. This contributed to another storm.

There was this category of nurses who were ‘career students’ – lifelong learners, they had become too many nowadays, ‘everybody was in school somewhere doing the same or some other course’. Some of them possessed the higher diploma(s) before getting the BSN and apparently had plenty of knowledge. The generally overworked and not paid in commensurate. Then there was this lot the never finish or ‘graduated forever ago’.

‘Great universities worldwide are known for a reputable component of postgraduate (Masters, Doctorate, and Ph.D.) programs’. Prof. Jacob Kaimenyi (formerly Kenya’s Cabinet Secretary for Education). Many universities in the country lacked the nursing doctorate, Ph.D. faculty to teach and supervise the students. Some especially those that relied on external partners to run the MSN programs had stalled, restarted or perhaps received few interested students applicants, creating another storm. It also generally paid less to be in nursing education at least in Kenya. Few were able to start a stand-alone school of nursing and midwifery as required by Commission for University Education (CUE). For the few who try some had ended up with, some one or two- staffs run departments or one with several thematics merged. A good number of founding deans to many of these schools of nursing were not doctorate holders.

Every county wanted to start its MTC in an effort to tap on the free service the student nurses provided so that they did not have to employ more nurses. Certain (unnamed) county referral hospital, (not a very big one for that matter) had up to 3 universities and 2 MTCs clamouring to have it as their teaching hospital. They were all getting accredited. Officials from statutory bodies came to this same hospital despite having been there a month or so earlier and ‘inspected’ it all over again each time, but the difference was the same, one could easily read it all over their faces…

The Philippines, former Yugoslavia and of late Ethiopia train nurses for export, this author does not see why Kenya cannot realistically develop a similar policy and stand to benefit from exporting nurses and in return get diaspora remittances etc. Our graduates need to be those who demonstrate after completion of the required coursework eligibility to terminal program competencies. These included like being able to pass NCK licensing, Nursing Council of Kenya licensure examination as well others e.g. National Council Licensure Examination (NCLEX-RN) and Commission on Graduates of Foreign Nursing Schools CGFNS) among others.

To divert abit, in practice lay care providers (including relatives ‘caretakers’) whether they do assist with care or usurping, continued complementing or substituting nurses work in public hospitals. Sort of covering shortages; perhaps lowering the cost of providing services by shifting tasks from nurses to less specialized community members. Certainly also lowering the standards of care. Nursing professional bodies were against the training of aides. Of course, nurses may not take up (fully or otherwise) the roles that aides take in home care. That there is a demand for the aides was telling in and of itself, another storm.

Unique programs are good but must answer to something including sustainability. Bachelor of Science Midwifery (BSM) was being considered by Moi University Eldoret, Kenya and would begin soon. There was a need for introspection and policies guided by stakeholders in nursing to look into these storms in nursing. Please see turbulence elsewhere in this blog.

So much for that. What do the readers think? Use the comment, leave a reply below. Thank you.
Compleat Nurse

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