Abstract
BackgroundDefinitions of advanced nursing practice abound, yet little has been published concerning the context for advanced nursing in sub-Saharan Africa. This study set out to explore the existence of, and potential for, advanced nursing practice in Kenya.MethodsTen nurses were invited to participate in semi-structured qualitative interviews. Participants were purposively selected to provide insight into the practice of experienced nurses in urban, rural, community, hospital, public and private health care settings. Interview narratives were recorded, transcribed and subsequently analysed using a thematic approach.ResultsAll participants reported that they were engaged in the delivery of expert, evidence-based care. The majority also undertook administrative activities, teaching in the practice area and policy and practice advocacy. However, only the two private practice nurses interviewed during the study were working with the level of autonomy that might be expected of advanced nurse practitioners.ConclusionsWhile participants were undertaking many of the activities associated with advanced nursing roles, advanced nursing practice as widely understood in the (largely western derived) international literature was not identified. The nurses practicing with the greatest autonomy were generally those with the lowest educational qualifications rather than the highest. Highly qualified nurses and midwives tend to move into management and education, and see little opportunity for advancement while remaining in clinical practice. It is notable that, although a growing number of universities offer master’s level education, no African countries have yet regulated an advanced level of practice. The existence of the physician substitute ‘clinical officer’ cadre in Kenya, as in other Sub-Saharan African countries, suggests that the development of the advanced nurse practitioner role is unlikely at present. However, there is a pressing need for advanced nurses and midwives who can implement evidence-based practice and exercise clinical leadership in the drive to attain the Millennium Development Goals and their post-2015 successors.
Highlights
This paper presents the findings from a small-scale scoping project that aimed to explore the nature of, and potential for, advanced nursing practice in Kenya
According to the International Council of Nurses (ICN), an Advanced Practice Nurse (APN) is: A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for advanced practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed
While Private practice nurse (PPN) practice is closely regulated by the Ministry of Health, both PPNs interviewed for this study considered themselves unusually well qualified, with some other PPNs reportedly being of ‘very low level’ (Participant 9)
Summary
This paper presents the findings from a small-scale scoping project that aimed to explore the nature of, and potential for, advanced nursing practice in Kenya. The study reported here was conducted as a follow up to an INEPEA situation analysis survey that identified the need for more detailed examination of existing senior nursing roles in Kenya, with reference to internationally recognised frameworks for advanced practice. Contextual variation in APN roles is acknowledged, but a master’s degree is recommended for educational preparation. The key drivers for APN role development in many countries has been medical substitution alongside a strong professionalising impetus in which enhanced status, recognition and remuneration is accorded to nursing roles through a formalised process of regulation and educational preparation [4]. The substitution agenda is clear, but the nursing profession has had only mixed success in creating recognition for an enhanced nursing role through formalised regulation, education and the development of new career pathways [5]
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