The gathered data for this study purposely targeted Nairobi County, Kenya. Figure 1 is the map for the study area. Nairobi County was the preferred area of study because of its high population, which infers the study area needs quality clinical and nursing services. Secondly, the study area is the capital city of Kenya, so there is a need to determine the effectiveness of clinical learning for nurses. In Nairobi County, there are twelve (12) clusters of middle-level nursing training institutions. These institutions are spread across the seventeen sub-counties of Nairobi. The study area categorized the twelve clusters of middle-level nursing training institutions into the following seven sub-counties: Starehe, Langata, Kamukunji, Westlands, Dagorett North, Kasarani, and Kibra. The twelve middle-level nursing training institutions considered in this study are Catherine McAuley Nursing School, Amref Nursing School, Armed Forces Nursing School, Pumwani School of Nursing and Midwifery, Cicely McDonell College of Health Sciences, Karen Medical Training College, Gertrude’s Children’s Hospital School of Nursing, Nairobi Women’s Hospital College, Mathare Mental and Teaching Nursing School, St. Francis Kasarani Nursing School, Kenya Medical Training College—Nairobi Campus, Kenyatta National Hospital Nursing School and Nairobi West College of Health Sciences. Table 1 highlights the distribution of the twelve middle-level nursing training institutions based on sub-counties in Nairobi County.

The study employed a descriptive survey and Focus Group Discussion to collect data from the participants. A sample size of 394 participants was selected using simple random and stratified sampling techniques. The sample size was drawn from the twelve middle-level nursing training institutions based on Probability Proportional to Size (PPS). The distribution of the sample size for the study is presented in Table 2 .

The sample size for this study was determined by [9] formula based on the target population size of 3368. Since the population size was known, the sample size was derived as follows:

$n=\frac{N}{1+N\left(e^2\right)}$

where: n was the sample size to be determined;

N is the population as given in the sample frame (3368);

e is the sampling error (0.05).

$\begin{array}{l}n=\frac{3368}{1+3368\left({0.05}^2\right)}\\ n=\frac{3368}{1+8.42}\\ n=357.54\end{array}$

The sample size based on the known population gave n = 357.54 participants. To cater for non-response, this sample size was adjusted by 10% non-response to a sample size of 357.54 × 1.1 = 393.3, which was rounded up to the nearest person n = 394.

The study established eleven Focus Groups Discussions, and the survey tool was administered in all institutions in which more than 10 students were sampled. FGDs are composed of 8 - 10 participants each except for where the total sample size in an institution was less than this number and where all students sampled were engaged. Table 3 shares the distribution of those FGDs among the targeted middle-level nursing training institutions.

The data gathered from the participants was cleaned and entered into Excel and SPSS software based on the responses of each respondent. Variables of data entered into the SPSS software are gender, marital status, age, level of study, religion, student decision to pursue nursing, skills lab simulations affect the quality of clinical support, assigned preceptors in the clinical area, students are allowed to make mistakes in the clinical area, students are always supposed to work under supervision, meeting of the training costs, family structure, motivation for a student to pursue a nursing career, and means of transport to the clinical area.

Data on student-related factors affecting effective clinical learner support were subjected to analysis using SPSS, data analysis software. Chi-square analysis was performed to determine the degree of several associations considered in this study at a significance level of p = 0.01.

The response rate for the study was 98%, with 380 respondents successfully participating out of the study sample size of 394. Table 4 and Figure 2 present the social-demographics of the participants in the study, and based on the analysis, the majority of the participants were female, Christian, 21 - 30 years old, second year of study, and had basic diplomas.

On cross-tabulation of demographic results with effective clinical learner support, it was found that the gender of the participant was significantly associated with effective support. The female gender was more likely to learn effectively than the male and other sexual groups. All the other variables were not significant, as indicated in Table 5 .

All the students reported that they had chosen nursing as their career of choice. None were reported to have been influenced by family, friends or parents. However, 19.2% (n = 73) had consulted their parents for them to make an informed decision, with 80.8% (n = 307) made a personal choice. The findings indicated that the majority of students’ (66.6%, n = 253) clinical learner support was affected by skills lab simulations, they did not perfect the skill before proceeding to the clinical area, therefore, felt incompetent to learn the skills on real patients. However, in the clinical area, 81.1% (n = 308) reported that they had been allocated clinical mentors. Despite the allocation of the clinical mentors, some students had never seen or met their clinical mentors.

Since the clinical area is a learning site, 76.1% (n = 289) of the students reported having made mistakes while handling the patients. It was reported that the majority (85.8%, n = 326) of the students were working under supervision from a qualified nurse. During the clinical placement, the clinical site fee was catered for by students. Relatively, some students paid for the clinical area on their own, some were paid for by their parents and others by their guardians at 33.4% (n = 127), 33.4% (n = 127) and 33.2% (n = 126), respectively. The study found that the majority of the students (85.8%, n = 326) came from monogamous families.

The students reported being motivated to pursue the nursing profession so that they could work abroad, while others were motivated by the fact that after training, they would get a ready job market for themselves. The findings presented in Table 6 indicated that the nursing career pays well and has an employment guarantee, as indicated by 33.2% (n = 126) and 33.4% (n = 127), respectively. On the means of transport to the clinical area, the majority of the students (57.1%, n = 217) reported being dropped at the clinical site by the college bus, while others were either using public means (23.9%, n = 91) and motorbikes (18.9%, n = 72), respectively.

On calculation of Chi-square test of independence, it was found that quality of skills lab simulations, students working under supervision, means of transport to clinical area site were significantly associated with effective clinical learner support at ꭓ² (1, N = 380) = 14.68, p < 0.001, ꭓ² (1, N = 380) = 22.07, p < 0.001, ꭓ² (2, N = 380) = 8.14, p = 0.017 respectively. The other factors were not statistically significant, as shown in Table 7 .

The significant factors: quality of skills lab simulations, students working under supervision, and means of transport to the clinical area after cross-tabulation were entered into a binary logistic regression, and the results are indicated in Table 8 .

From the above results, only the gender of the student, quality of skills lab simulation, and students always working under supervision were significant and were entered into multivariate logistic regression to adjust for confounding factors. After adjusting for confounding factors, only the gender of the student and the student always working under supervision were found to determine effective clinical learner support. The students who were supervised while practicing were 11.89 times more likely to learn effectively compared to those who were not supervised. The female gender was 5.89 times more likely to be supported in clinical areas than the male gender. During group discussion, a group member reported the following

“while working in the ward the patients are used to calling the nurse ladies ‘sister’ they fear calling the male nurse students, they only call them ‘daktari’ this mentality makes even the male nurses to feel like nursing is for ladies”.

(Participant 4, group 2)

This was supported by another participant in another group discussion who reported that

“…nursing is a ladies profession….according to the uniform nurses should be wearing nurse caps which cannot be worn by male nurses….”

(Participant 2, group 1)