Reconfiguring retention: a qualitative exploration of the lived experiences of female nurses in an arid rural setting in Turkana County, Kenya

Abstract

Background: Retention is especially critical in rural and underserved areas of East Africa, such as Turkana County in Kenya, where resource limitations, harsh conditions, and a lack of professional development opportunities deter nurses from staying. In addition, female nurses face unique challenges shaped by systemic inequities and gendered expectations, influencing their retention.

Objective: The aim of this study was to explore factors influencing retention of female nurses in Turkana and to offer new perspectives on the concept of retention from underserved regions in East Africa. Methods: This quasi-ethnographic study was conducted in an arid rural setting in Turkana, in 2024. Data were collected through semi-structured interviews with 21 female nurses and 8 local health administrators and through participant observations at 4 health facilities. We used thematic network analysis guided by an abductive approach. Results: Female nurses in Turkana navigate a paradox of staff shortages alongside high unemployment, leaving many feeling stuck in occupational limbo or permanent liminality, hoping, and working toward better opportunities for themselves and their families. Although the motivation to work as nurses persists, challenging working conditions lead many to aspire to migrate abroad.

Conclusion: This study demonstrates the complex interplay of local and global dynamics driving retention of female nurses in Turkana. Perceived workforce stability is largely due to immobility caused by limited alternatives and systemic constraints. This immobility masks dissatisfaction, making the healthcare system in Turkana vulnerable to outmigration. Findings highlight the need for holistic, gender-sensitive policies that enhance rural career pathways for female nurses.