The Role of Nurse Midwife Technicians in Task Shifting in Malawi

Abstract

<bold>Background</bold> The nursing role for all cadres of nurses in Malawi is shifting to add to their responsibilities. This shift is difficult for the nurse midwife technician cadre, due to the already unformed nature of their role. Current research on the nursing role tends to group all cadres of nurses together, which can lead to confounded results. This paper describes a secondary analysis of survey and focus group data focusing on the preparedness of nurse midwife technicians for task shifting of HIV-related tasks. The purpose of the primary analysis was to illuminate gaps in and to provide an evidence base for improving nurse midwife technician training. <bold>Methods</bold> Nurse midwife technicians were selected through weighted random sampling to participate in focus groups discussing preparation for nursing practice and their lived experience as nurses. They also participated in a quantitative survey of essential nursing tasks. Focus group data were analyzed using inductive and <italic>a priori</italic> coding, while survey data were analyzed through frequencies and unadjusted measures of association. <bold>Results</bold> Nurse midwife technicians expressed discomfort with some key tasks related to obstetrics, antiretroviral therapy, and non-communicable disease. Although trainings for many of these tasks are available, often nurses are unable to access them because of their status in the health care hierarchy, favoritism, and failure to pass on knowledge by those who are able to receive training. Additionally, nurse midwife technicians find themselves with insufficient supervision and an unclear idea of their scope of practice. <bold>Conclusions</bold> Like people working in similar nursing cadres in other countries, nurse midwife technicians find themselves in a position of ever increasing duties, a vague and malleable scope of practice, and a lack of support from supervisors. In order for the cadre to take on the increased responsibilities needed to meet the health needs of the Malawian population, the nurse midwife role needs to be clearly defined and properly supported.