Implementation of a task-shifting and task sharing intervention: A case of ward assistants in Kenyan neonatal units

Nurses working in intermediate care neonatal units in Kenya often experience workload that is six times greater than global recommendations, and this presents quality and safety concerns. Fiscal constraints often limit nurse recruitment. Therefore, addressing workforce shortages to improve quality of care requires careful consideration of skill-mix. We evaluated the feasibility of a task-shifting and task sharing intervention that involved (re)distribution of non-clinical roles from nurses to ward (care) assistants in Kenyan neonatal units.

We conducted a mixed methods convergent study. We enhanced staffing by adding three trained ward assistants to each of four Kenyan neonatal units. Pre- and post-intervention data were collected on a cumulative set of 593 babies using a structured Nursing Care Index tool that involved over 6520 person-hours of direct observation and was complemented by 1340 h of non-participant ethnographic observation and 47 in-depth interviews of nurses and ward assistants. Integration occurred at the analysis, results synthesis, and interpretation stages.

After introducing ward assistants, the pattern of bedside care delivered remained largely unchanged; nurses continued to directly deliver an average of 32 % of the expected care bundle, ward assistants delivered only 1-2 % bedside care while about 19 % of overall expected care remained undone. Although they delivered little directly observed bedside care qualitative data confirmed that ward assistants took up 27 different tasks that we broadly categorized as routine newborn care, vital signs, catering, messenger, porter, customer care, cleaning and general housekeeping roles. Nurses and mothers appreciated ward assistants' work. While there was some element of extended roles, there was very minimal evidence of 'role creep'.

Ward assistants undertook non-clinical roles as envisioned, and nurses viewed them as valuable additions to the workforce. In a care setting with constrained nurse staffing, introducing ward assistants to undertake non-technical tasks present an opportunity to support nurses and improve some aspects of care quality.