The recent controversy over the budget for medical interns at the Ministry of Health of Kenya should not arise. In the journey to Universal Health Coverage, one of the solutions to the shortage of human resources for health and to healthcare financing is to stop internship for nurses and instead employ nurses direct from school. There is already enough work out there requiring nurses in both the public and private sector and nurses are already work-ready from training.
Medical learning requires acquiring academic knowledge on medicine and applying it in the medical environment it is required. From time immemorial the nursing profession has held together the medical field as the executors of medical instructions. As a result of this nurses serve as the quality control of the medical practice. Ask a nurse to tell you if the doctor knows what they are doing, and they will tell you. Why? Nurses see and observe the medics. They are also the ones caring for the patients. The nursing profession is also very hierarchical and they rarely do things out of their scope of practice in the circumstances they are in.
Medicine is a field that requires what in Kiswahili is called ‘harambee’ – collective effort. When one cog of the wheel does not work then the outcome is poor. In medicine a poor outcome can spell disaster.
Medical doctors on the other hand have always done medical internship. This is a one-year period after medical school where they work under the supervision and training of a more qualified doctor. The aim of medical internship is to ensure that what has been learnt in theory in medical school is applied in the real work situation, correctly and safely. There are guidelines that ensure that even during this training, the patients are safe. At the end of this period the supervising doctors sign off the medical intern doctor as being safe enough to work on their own. They can then be released to the public. That is the essence of medical internship.
Nursing training on the other hand, a little unlike the training of doctors produces work-ready personnel. From day one of nursing school, nursing students are exposed to patients under instructions of their superiors. By the time nursing students complete nursing school, in my view, they are ready to be deployed.
What do you think?
This will form part of the interesting conversations we will be having at the 52nd Kenya Medical Association Annual Scientific Conference, April 14 – 17TH 2025, at Kamel Park Hotel, Kisii County, whose theme is Healthcare Governance for UHC: Bridging the policy and practice gap.
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Am interesting read. To begin with, I am a nurse by profession who has undergone a mandatory one year internship.
According to the Nursing Council of Kenya, nurses conferred with a degree in Nursing are posted to various level 5 hospitals for the internship program. They are required to rotate in various hospital departments including specialized clinics such as ICU, Renal unit- both are allocated a week each.
Furthermore, they are posted to county level 4 hospitals and dispensaries for a cumulative period of 3 months.
The nurse internship are provided with a log book in which details of the practice is documented. The log book is signed by the nurse supervisor, facility charge nurse and county head of nursing services. After this the nurse intern is licensed to practice.
I beg to differ on your assertion that nurses are work ready personnel given the expectations in the clinical practice especially the degree nurses.
The statement generalizes the cadre of nurses we have.
In addition, the challenge of human resource in our country has never been lack of nurses to employ rather the refusal of counties to employ nurses.
You will agree with me that most level 5 hospitals in the county are run by medical officers and clinical officers interns in terms of clinical practice. Similarly, at the inpatient wards, nurse interns are always allocated duties just like qualified nurses and expected to practice like them.
The discussion we should be having is how the national government and county governments can come with policies which align to Abuja declaration.
Thank you
Excellent feedback Ezra.
I concede he he he.
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Good view,
My opinion is majority of nurses trained in Kenya are at Diploma level. This level is practice oriented.
Internship on the other hand is Theory oriented and that is why they must undergo internship.
Great opinion Warria.
This is an over- generalization of different nursing cadres. Only Diploma nurses in accredited medical institutions are ready for deployment upon completion of studies. This is because they begin their hospital rotations during the second semester of their study duration. BScN nurses however don’t have the same path as their diploma counterparts and as such the 1 year internship post-graduate is vital for their aptitude in the workplace.
Doc, while I acknowledge the struggles of Medical Interns, among other Health care professional interns, including Nurses, I think you cannot prescribe a solution to Doctors issues by altering Nurses training and practice. Those are 2 different professions that eventually have to work together after their respective trainings.
Solutions for doctors concerns should be sought around their training and practice in relation to the labour market.
This is noted.
My view though is that the training of Nurses allows them to be deployed to the workplace immediately after their training. Automatic employment of all nurses upon completion of school would really sort out a lot of the issues that we have in the health sector. Nevertheless I have seen comments by nursing personnel have said that internship is useful. I can only concede.
How a who kma decides to discuss nursing affairs in their all important conference or or forum or in whatever assembly surprises me,are you aware there are so many trained nurses who are jobless, and in your imagination the chronic nurses shortage is as a result of the training period and the solution is to shorten their training period.Nurses have for the longest suffered injustice in the administrative leadership of the medical fraternity and the least they can do is to keep off nursing affairs, stick to medical lane
I’m of the feeling that nurses should be automatically absorbed into the health sector immediately. In the ensuing discussion nursing internship has been cited as important. I conceded.