Other Titles
Entry-to-Practice Requirements for Registered Nurses in The Kingdom of Eswatini: International Collaboration for Nursing Quality Care [Title Slide]
Abstract
The purpose of this study was to evaluate the entry-to-practice (ETP) licensure requirements for RNs in The Kingdom of Eswatini. Eswatini implemented RN licensing requirements in 2020. Previously, RNs were licensed by graduation from a nursing training institution. Now, nurses must also pass a written general nursing exam and submit a signed record book of clinical practice skills (SCCRB) (1). RNs who want to practice midwifery or mental health have additional requirements. In 2023, the Eswatini Nursing Council (ENC) collaborated with a midwestern U.S. nursing school to evaluate the ETP requirements. The Nursing Registrar of Eswatini and nursing faculty from the U.S. developed a mixed-method evaluation plan modeled on the CDC’s Framework for Program Evaluation (2): 1. The investigators met in Mbabane, Eswatini with 6 ETP Champions from nursing education to solicit input on the licensing requirements. They then interviewed 12 nursing administrators from major hospitals and clinics where students train. Analysis of the interviews indicated the themes: Clinical Practice & Education Quality, Preceptorship Challenges, Student Professionalism & Continuing Education, Student Preparedness & Skill Validation, Licensing & Examination Issues, Workforce & Job Market Challenges, Resource (Staffing) & Equipment Shortages, and Institutional/Regulatory Support; 2. Surveys were sent electronically to nurses and nursing leaders. 55% of survey respondents believe that the 2020 ETP requirements have a positive impact on the quality of care provided by nurses (mean 3.28); 84% of respondents believe that the SCCRB requirement has improved the quality of nursing care (mean 3.54); and 74% of respondents believed that having a written examination requirement has contributed to improvements in nursing knowledge (mean 3.13). 3. Written licensing examination scores across 7-domains of nursing were examined for 2020-2023. There are approximately 3,400 nurses licensed in Eswatini (3). Examination data indicates an average of 244 students take ETP nursing exams annually. Exam failure rates average 5.3% in 2020, 2021 & 2023 but only 2.2% in 2022. All domain scores dropped in 2021 and started to improve in 2022. Lowest domain scores are in quality of care, infection prevention, & leadership/management. Complicating factors to the study include the SARS-CoV-2 pandemic and a national hiring freeze resulting in unemployment rates in nursing between 16-18% (4).
Notes
References:
1. Msibi, G., Nkwanyana, N., & Kuebel, H. (2020). Eswatini nursing council regulatory reforms: Process towards entry to practice examination. Annals of global health, 86(1), 45. https://doi.org/10.5334/aogh.2800
2. Centers for Disease Control and Prevention. (2011). Developing an effective evaluation plan. National Center for Chronic Disease Prevention and Health Promotion: Office on Smoking and Health; Division of Nutrition, Physical Activity, and Obesity Atlanta: Georgia, USA
3. World Health Organization (WHO) (2023a). Data overview for The Kingdom of Eswatini: Health statistics, Eswatini: Density of Nurses. https://data.who.int/countries/748
4. World Health Organization (WHO). (2023b). Transforming the health workforce in The Kingdom of Eswatini: Policy brief on health labour market analysis. https://files.aho.afro.who.int/afahobckpcontainer/production/files/Final__Policy_Brief_on_Health_Workforce_in_Eswatini_.pdf
5. Ehlers, V. J. (2006). Challenges nurses face in coping with the HIV/AIDS pandemic in Africa. International Journal of Nursing Studies, 43, 657-662.
Klopper, H.C. & Uys., L.R. (2013). The State of Nursing and Nursing
Education in Africa: A country-by-country review. Chapter 19. Indianapolis, IN: Sigma Theta Tau International
6. Macintyre, K.C.E., Littrell, M., Hotchkiss, D.R., Mndzebele, S., Nkambule,R., Gumbi, S.,
Dhlamini, T., Brown, L. & Kemerer, V. (2011). Barriers to referral in Swaziland: Perceptions from providers and clients of a system under stress. World Medical & Health Policy, 3(4). 1-29
7. United Nations Program on HIV/AIDS (UNAIDS). (2022). Eswatini fact sheet.
https://www.unaids.org/en/regionscountries/countries/swaziland
Sigma Membership
Alpha
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Academic-clinical Partnership, Curriculum Development, Testing Strategies, Nursing Licensure Requirements for RNs, Registered Nurse License, Eswatini
Recommended Citation
Murray, Bethany A. and Nkwanyana, Nkosinathi Rejoice, "An Evaluation Study of Entry-To-Practice Competency Requirements for RNs in the Kingdom of Eswatini" (2025). International Nursing Research Congress (INRC). 156.
https://www.sigmarepository.org/inrc/2025/presentations_2025/156
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
An Evaluation Study of Entry-To-Practice Competency Requirements for RNs in the Kingdom of Eswatini
Seattle, Washington, USA
The purpose of this study was to evaluate the entry-to-practice (ETP) licensure requirements for RNs in The Kingdom of Eswatini. Eswatini implemented RN licensing requirements in 2020. Previously, RNs were licensed by graduation from a nursing training institution. Now, nurses must also pass a written general nursing exam and submit a signed record book of clinical practice skills (SCCRB) (1). RNs who want to practice midwifery or mental health have additional requirements. In 2023, the Eswatini Nursing Council (ENC) collaborated with a midwestern U.S. nursing school to evaluate the ETP requirements. The Nursing Registrar of Eswatini and nursing faculty from the U.S. developed a mixed-method evaluation plan modeled on the CDC’s Framework for Program Evaluation (2): 1. The investigators met in Mbabane, Eswatini with 6 ETP Champions from nursing education to solicit input on the licensing requirements. They then interviewed 12 nursing administrators from major hospitals and clinics where students train. Analysis of the interviews indicated the themes: Clinical Practice & Education Quality, Preceptorship Challenges, Student Professionalism & Continuing Education, Student Preparedness & Skill Validation, Licensing & Examination Issues, Workforce & Job Market Challenges, Resource (Staffing) & Equipment Shortages, and Institutional/Regulatory Support; 2. Surveys were sent electronically to nurses and nursing leaders. 55% of survey respondents believe that the 2020 ETP requirements have a positive impact on the quality of care provided by nurses (mean 3.28); 84% of respondents believe that the SCCRB requirement has improved the quality of nursing care (mean 3.54); and 74% of respondents believed that having a written examination requirement has contributed to improvements in nursing knowledge (mean 3.13). 3. Written licensing examination scores across 7-domains of nursing were examined for 2020-2023. There are approximately 3,400 nurses licensed in Eswatini (3). Examination data indicates an average of 244 students take ETP nursing exams annually. Exam failure rates average 5.3% in 2020, 2021 & 2023 but only 2.2% in 2022. All domain scores dropped in 2021 and started to improve in 2022. Lowest domain scores are in quality of care, infection prevention, & leadership/management. Complicating factors to the study include the SARS-CoV-2 pandemic and a national hiring freeze resulting in unemployment rates in nursing between 16-18% (4).
Description
The Kingdom of Eswatini implemented post-graduation RN licensing requirements in 2020. This project evaluated these requirements and the impact they have had on the quality of nursing care in Eswatini. Data were gathered in interviews with hospital administrators and educators, surveys with nurses, and by document review. Findings include positive benefits in nursing knowledge along with difficulties in clinical skills supervision due to a hospital nursing shortages and unclear preceptor roles.