Linking Licensure Examinations to Nursing Practice through Task Analysis: A Case for Botswana

Poster Presentation By Phelelo Marole and Leah Hart ICN Conference May 2013

Facts about Botswana

Population: 2,038,228 ( 2011) Maternal mortality ratio: 193/100,000 Infant mortality rate: 54/1,000 National HIV prevalence rate: 17.6% (BAIS 111 2008) Health facilities Health posts: Clinics: Primary hospitals: District hospitals: Referral hospitals:

340 272 17 14 3

Health staff numbers and staff/populations Cadre Number #per 10,000 population Doctors 715 4 Nurses 4,753 26 Pharm 333 2

Introduction
The Nurses & Midwifery Council of Botswana utilizes academic certificates and transcripts to register nurses to practice and has not developed a reliable mechanism of ensuring competency of nurses who register with N&MCB, therefore compromising quality of nursing service. In the last three years, the N&MCB recorded 28 cases of professional misconduct. This fact demonstrates that the current method used for licensing nurses to practice in Botswana does not ensure they have competencies needed to perform safely and effectively. One strategic objective of the N&MCB is to develop and implement competency-based examination measures for all new registrants (N&MCB 2007).

Therefore, there is an urgent need for the N&MCB to reintroduce the licensure examinations as a method that will measure the competencies needed for safe and effective performance of newly licensed, entry-level registered nurses. The N&MCB used task analysis as a mechanism for developing an examination that is logically linked to the Essential Health Service Package for Botswana (EHSP). The EHSP is a document developed and vetted by the Government of Botswana Ministry of Health and it articulates key services that must be available within the health care system. Methodology A descriptive study was used. The survey tool was based on the Essential Health Services Package of Botswana. The task list was reviewed and approved by a panel of experts and the members of the N&MCB. The resulting tool contained 89 nursing tasks. Participants of the survey were registered nurses who were recent graduates or foreign nurses registered with N&MCB for the first time within the last 6 months to 4 years and currently working in Botswana. Data were collected through a facility-level, 1-day workshop. Participants provided three sets of data: 1) demographic data to be provided by all participants individually; 2) tasks 144 to be addressed by half of the participants; and 3) tasks 4589 to be addressed by the other half of the participants.

Findings
A total of 223 nurses from 39 health facilities representing 9 districts were recruited to participate in the study. All of the participants came from the eastern region of Botswana, where much of the population is concentrated.

Table 1:Demographic Characteristics of Participants

Variables Gender Male Female Facility Level Health post Clinic District hospital 7 26 42 4 27 10 43 26 11 (4.9%) 53 (23.8%) 22 (9.9%) 85 (38.1%) 52 (23.3%) 44 69 34 76 78 (35%) 145 Group 1 Tasks 144 Group 2 Tasks 4589 Total (%)

Primary hospital 12 Referral hospital 26

Table 2: Year First Registered with Nursing & Midwifery Council of Botswana
Year Group 21 Tasks 144 13 32 32 19 3 Group 2 Tasks 4589 18 19 28 20 10 Total (%)

2008 2009 2010 2011 2012

31 (16%) 51 (26.3%) 60 (30.9%) 39 (20.1%) 13 (6.7%)

Summary of the Number of Tasks per Frequency/Importance

The majority of respondents ranked 34 tasks low frequency and high importance. Only two tasks were ranked moderate frequency and high importance. Forty-five tasks were ranked high importance and high frequency by the majority of the respondents.

Findings (cont.)
More than 20% of the respondents ranked 15 tasks high importance but were unable to perform them. The table below shows the importance, frequency and lack of capability to perform the tasks. 70.4% of the respondents ranked Task 68 low frequency and high importance, and 54.2% of the respondents were unable to perform the task.

Table 3: List of Tasks in Order of Frequency: Importance Ranking and Proportion of Nurses Unable to Perform the Task
Task Number % High Importance/ Low Frequency % High Importance/ % Not Capable Not Capable

43 50 59 62 66 68 83

55.5 54.6 81.7 70.6 55.2 70.4 64.2

15.5 11.9 14.7 13.8 14.8 40.2 16

16.4 14.7 16.5 16.5 16.7 54.6 17.8

Graphical Presentation of Key Variables of Nursing Tasks Performance in Botswana

Figure 1 depicts the proportion of nurse respondents who consider the specified nursing task to be of high importance, the proportion who do the task with low frequency, and the proportion who reported being unable to perform the task. Figure 2 shows the importance of the tasks by frequency and capability. [Dana added red sentence; authors need to approve/change.] NB: Low frequency is defined as rarely or never. (Moderate frequency = monthly; high frequency = weekly or daily)

daily)

Figure 1: Importance, frequency, and lack of capability to perform specified nursing tasks in Botswana
120 100 80 % Respondents 60 40 20 0 43 50 59 62 Task number 66 68 83 %high importance % low frequency % not capable

Figure 2: Importance of task performance by frequency and lack of capability to perform specified nursing tasks in Botswana
90 80 70 60 50 % Respondents 40 30 20 10 0 43 50 59 62 Task number 66 68 83 %high importance/low frequency %high importance/ not capable % not capable

Table 4: Nursing Task Descriptions

Task Number Task Description 43 Provides effective postabortion care 50 Provides care and treatment of children with HIV/AIDS 59 Recognizes and refers patients with MDR TB 62 Provides care and treatment to clients infected with malaria 66 Provides care and treatment to clients with meningitis 68 Provides care and treatment to clients with leprosy 83 Provides care and treatment to patients with cancer

Conclusion
The respondents ranked 34 tasks as being performed with low frequency but of high importance. Forty percent of respondents are unable to perform a task Provides care and treatment to clients with leprosy but had ranked it of high importance. Twenty percent of respondents were unable to perform 15 tasks.

References
http//www.cso.gov.bw. 2011. Population and Housing Census Preliminary Results Brief. Ministry of Health. 2010. Essential Health Services Package. Botswana. Government Printers.