Basic nursing training and leadership preparedness of nurse managers in South Rift and South Nyanza, Kenya

Abstract

Background: Effective leadership and management are vital for strengthening global health systems, yet they remain under-prioritized in low- and middle-income countries (LMICs). Despite the essential role of nurse leaders in maintaining service delivery amid evolving epidemiological demands, training deficiencies often leave them feeling underprepared for managerial responsibilities. In Kenya, Mid-Level Nurse Managers (MLNMs) are central to hospital unit operations; however, significant knowledge gaps exist regarding whether basic nursing training sufficiently prepares them for these leadership roles. Objectives: The objectives were to assess nurse managers' level of preparedness for MLNMs’ leadership role, determine the level at which basic nursing training prepares nurses for MLNMs’ leadership roles, assess the contribution of role-induction programs to MLNMs’ leadership role preparedness, and determine MLNMs’ training needs for leadership role preparation. Methods: The study was grounded on Henri Fayol’s management theory and Frederick Taylor’s principles of scientific management. A mixed-methods study design employing a descriptive, cross-sectional approach was conducted in 9 hospitals and 4 Diploma nursing training institutions selected in South Rift and Nyanza, using a multi-level sampling process. The study population involved 68 purposively selected MLNMs and 7 Nursing Directors (NDs). Data was collected using pretested instruments adapted from validated tools, including self-administered questionnaires, Focus Group Discussions (FGDs), Key Informant Interviews (KII), and a document review checklist. Quantitative data was analyzed using frequency tables, percentages, mean, and mode, while Qualitative data was analyzed thematically. Results: More than half (56.9%) of the MLNMs perceived their level of preparedness for leadership roles as above average, 24.6% excellent, 15.4% average, and 3.1% below average. About 57%, 41%, and 2% of respondents rated their satisfaction with nursing training for leadership roles as satisfied, somewhat satisfied, and dissatisfied, respectively. This is largely due to a focus on theory (65%) through lectures, a change in assessment focus, and a one-month clinical rotation in leadership. Role induction programs contributed to leadership role preparation as follows: formal leadership training (M=4.84, SD = .412, Skw -2.502), Mentorship (M=4.69, SD = .499, Skw -1.196), Supportive supervision (M=4.66, SD = .565, Skw -1.430), ‘On-the-job (M=4.60, SD = .552, Skw -.955), and Preceptorship (M=4.35, SD = .734, Skw -.899). Nurse managers stated that formal leadership training, on-the-job training, mentorship, and supportive supervision significantly contribute to preparedness for the leadership role. They noted being appointed to leadership directly or through progressive promotion without structured leadership role preparation. Managers felt least prepared for budgeting and expressed a need for formal training in resource management. Conclusion: Majority of the respondents rated their leadership preparedness as suboptimal. Basic nursing training was inadequate due to overemphasis on theory, a shift in assessment focus, and limited clinical experience. Formal leadership training, on-the-job training, mentorship, preceptorship, and supportive supervision play a significant role in improving leadership readiness. To effectively fulfill their leadership roles, MLNMs require formal leadership training, resource management training, particularly in budgeting, and training in emotional intelligence. Recommendation: Hospital management teams (HMTs) should develop strategies to enhance the leadership preparedness of MLNMs. Nursing training institutions should reassess the leadership and management aspects of basic nursing programs, focusing on budgeting content and the length of clinical rotations for leadership training. Moreover, HMTs should introduce formal leadership training, structured role-induction programs, and training in emotional intelligence to build the capacity of their MLNMs.