ArticleHuman resources for health2019
Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals.
Article in Human resources for health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 2 of them syntheses that pooled it.
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Who cites it
41 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Strategies employed by developed countries to facilitate the transition of internationally qualified nurses specialty skills into clinical practice: An integrative review.Nursing open · 2023Pooled it
- Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review.Human resources for health · 2023Pooled it
- Pathways of emergency care for severely ill children in Nigerian and Ugandan hospitals: A process mapping study.PLoS medicine · 2026Article
- Time for change in implementation research and practice.BMC medicine · 2026Article
- Quality Improvement Initiatives in Pediatric Emergency Care in Low-Resource Settings: Addressing Patient Safety and Outcomes.International journal of pediatrics · 2026Review
- Implementation fidelity of Ethiopia's Malaria test-and-treat guideline amid a resurgence in Amhara Region: A mixed-methods study.PloS one · 2026Article
- Understanding the initiation, formation, functioning, and performing of networks to change practices - Realist evaluation of a programme to improve newborn care in Kenya.SSM - health systems · 2025Article
- Experiences of mothers in the context of a staffing intervention in select newborn units in Kenyan public hospitals.International journal of nursing studies · 2025Article
- Neonatal unit human resources: coverage for six cadres and trends for staff-to-baby ratios in 65 neonatal units implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania.Human resources for health · 2025Article
- Nurses experiences with an intervention enhancing skill-mix in Kenyan neonatal units with severe workforce deficits: A qualitative study.International journal of nursing studies · 2025Article
- Implementation of a task-shifting and task sharing intervention: A case of ward assistants in Kenyan neonatal units.International journal of nursing studies · 2025Article
- Emotional dimensions of nurses' daily work in newborn units in Kenya: a qualitative study.BMC public health · 2025Article
- Co-design and implementation of nursing handover improvement tool in Kenyan newborn units: a pilot study.BMC nursing · 2025Article
- "Though there are some challenges, we try our best to follow the guidelines": a qualitative study exploring determinants of providing guideline-adherent care to hospitalized children in Kenya.Implementation science communications · 2025Article
- Delivery of care in high mortality hospital settings: a direct observational study examining 1848 h of neonatal nursing in Kenya.EClinicalMedicine · 2025Article
- After neonatal care, what next? A qualitative study of mothers' post-discharge experiences after premature birth in Kenya.International journal for equity in health · 2025Article
- Article
- Sustainability of an evidence-based intervention supporting transition to independent care for youth living with HIV in Kenya.PLOS global public health · 2025Article
- Beyond survival: The impact of birth complications on postpartum wellbeing for mothers, babies, and households in Kenya.PLOS global public health · 2025Article
- Health services under pressure: a scoping review and development of a taxonomy of adaptive strategies.BMJ quality & safety · 2024Article
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Authors and funding
4 authors.
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Abstract
backgroundNursing practice is a key driver of quality care and can influence newborn health outcomes where nurses are the primary care givers to this highly dependent group. However, in sub-Saharan Africa, nursing work environments are characterized by heavy workloads, insufficient staffing and regular medical emergencies, which compromise the ability of nurses to provide quality care. Task shifting has been promoted as one strategy for making efficient use of human resources and addressing these issues. AIMS AND
objectivesWe aimed to understand the nature and practice of neonatal nursing in public hospitals in Nairobi so as to determine what prospect there might be for relieving pressure by shifting nurses' work to others.
methodsThis paper is based on an 18-month qualitative study of three newborn units of three public hospitals-all located in Nairobi county-using an ethnographic approach. We draw upon a mix of 32 interviews, over 250 h' observations, field notes and informal conversations. Data were collected from senior nursing experts in newborn nursing, neonatal nurse in-charges, neonatal nurses, nursing students and support staff.
resultsTo cope with difficult work conditions characterized by resource challenges and competing priorities, nurses have developed a ritualized schedule and a form of 'subconscious triage'. Informal, organic task shifting was already taking place whereby particular nursing tasks were delegated to students, mothers and support staff, often without any structured supervision. Despite this practice, nurses were agnostic about formal institutionalization of task shifting due to concerns around professional boundaries and the practicality of integrating a new cadre into an already stressed health system.
conclusionOur findings revealed a routine template of neonatal nursing work which nurses used to control unpredictability. We found that this model of nursing encouraged delegation of less technical tasks to subordinates, parents and other staff through the process of 'subconscious triage'. The rich insights we gained from this organic form of task shifting can inform more formal task-shifting projects as they seek to identify tasks most easily delegated, and how best to support and work with busy nurses.
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