Assessment of the capacity of selected clinical placement sites in supporting the development of nursing students' clinical skills and competence in Bomet and Kericho Counties, Kenya

Abstract

This study used a mixed-methods design (QUAN + QUAL) to assess the capacity of clinical placement sites in Bomet and Kericho Counties to support nursing students' skills development. Clinical placements are crucial for translating theoretical knowledge into practical skills, but their quality can be affected by resource limitations. Data was collected from students, nurse educators, nurse managers, and principals of nurse training institutions using questionnaires, Key informant interviews, and Focused Group Discussions, which achieved a response rate of 89.5 per cent (N=213). Students reported high confidence in basic nursing procedures (M=4.03), indicating successful skill acquisition. However, the development of full competence was significantly hindered by overcrowding, resulting in high student-to-patient and student-to-instructor ratios. Qualitatively, Nurse Managers reported that hospital staff were overwhelmed, leading to inconsistent mentorship. A positive correlation (r=0.488, p<0.01) was found between clinical competency development and curriculum implementation, underscoring the necessity of effective capacity management. Stakeholders emphasised the need for increased investment in simulation-based learning to bridge the theory-practice gap. The study concludes that while the system successfully builds basic student confidence, the quality of competence development is severely compromised by resource limitations and pervasive clinical overcrowding. Urgent systemic reform is required. The study strongly recommends that clinical placement sites establish a formal capacity management system based on effective student-to-patient ratios, standardise and resource a protected clinical mentorship program, and strategically invest in modern simulation infrastructure to secure the competence of future nurses.