HIV Task Shifting From Physicians to Nurses in Nigeria: Correlates of Self-Efficacy and Job Satisfaction

Purpose:

With 25% of the global disease burden and 3% of the world’s health workforce, the African region has the worst health worker shortage. According to the Joint United Nations Program on HIV & AIDS (UNAIDS), Sub-Sahara Africa accounted for 24.7 out of 35 Million people living with HIV globally and 70% of all new HIV infections in 2013. Task shifting (or sharing), a human resource strategy to maximize contributions of available health workers has improved access to HIV treatment in sub-Sahara Africa. However, it also led to nurses acquiring roles previously performed by physicians. The UNAIDS and World Health Organization (WHO) recommend institutionalizing task sharing to strengthen the health systems in order to achieve treatment goals in Africa by 2020. Although numerous patient outcome studies support task sharing between physician and nurses, there is limited research on nurse-related outcomes. This study examined the correlations among nurse demographic factors, setting characteristics, self-efficacy and job satisfaction among Nigerian nurses performing HIV task sharing roles. This study examined the correlations among nurse demographics, setting characteristics, self-efficacy and job satisfaction among Nigerian nurses in HIV task sharing roles.

Methods:

A pilot study using a focus group of ten expert nurses was first conducted to ascertain the content validity and contextual appropriateness of the study instruments in Nigeria. In the main study, 508 nurses performing HIV task sharing roles in 8 of 36 states in Nigeria were surveyed. A total of 399 (out of 454) returned surveys from tertiary (26%), secondary (46%) and primary (28%) health facilities met criteria for analyses.

Results:

 The mean age of participants and years in nursing practice were 42 (SD = 9.1) and 17 (SD = 9.2). About 86% worked in Government owned facilities, 76% were females; 70% were Registered Nurse/Midwives; and 82% had previous HIV nursing experience. Over 95% received training and mentoring for HIV task sharing. Self-Efficacy for task sharing had a statistically significant correlation with female gender but negatively correlated with years in nursing practice. Job Satisfaction had statistically significant correlations with years in nursing practice; dual licensure as Registered Nurse/Midwife; working in tertiary hospital; older age; male gender; duration of training and being mentored. However, longer HIV nursing experience and working in secondary and primary health centers were found to increase the likelihood for job dissatisfaction among nurses in task sharing roles.

Conclusion:

Implementing task sharing in spite of nursing shortage in Africa amplified stressful working conditions for nurses in these roles. Although over 95% of nurses in this study received the WHO recommended training and mentoring, they still faced systems related challenges which negatively affected their job satisfaction. Similar to other studies in the literature, these negative effects have critical implications for burnout, retention and quality service delivery. System Specific strategies are needed to support nurses in expanded roles such as ensuring complementary staffing mix; continuing education and skills update; certification; updated policies, guidelines, training for  nursing educators, curriculum and scope of practice which reflect current professional practice and patient care needs. Sustaining task sharing gains, also requires measures to ensure nurses and other health workers in expanded roles receive commensurate compensation.