Health System Barriers to Intravenous Fluid Administration among Nurses in a County Referral Hospital in Kenya: A Cross-Sectional Study

Background: Intravenous (IV) fluid administration is a high-risk nursing process. Health system barriers, particularly nurse staffing shortages, constrain safe infusion therapy and patient safety in resource-constrained LMIC settings and contribute to missed nursing care. This study examined health-system factors associated with IV fluid administration and monitoring practices by nurses in a county referral hospital in Kenya. Methods: A descriptive cross-sectional study was conducted among 52 registered and enrolled nurses in adult medical and surgical wards selected by proportionate simple random sampling. Data were collected using a validated self-administered semi-structured questionnaire. Quantitative data were analyzed with descriptive statistics and Pearson chi-square tests (SPSS v22). Open-ended responses underwent thematic analysis (NVivo). Results: Nursing staffing shortage was the predominant reported barrier (96.2 %; χ²=44.31, p<0.001). Shortage of intravenous fluids, cannulas, and infusion sets (32.7 %) and insufficient time for fluid-balance monitoring and documentation (25.0 %) were also significant (all p<0.05). Wards relied on gravity infusion sets and lacked infusion pumps or flow regulators. The reported challenges were significantly associated with IV fluid administration and fluid-balance documentation practices (χ²=23.512, p<0.001). Only 19.2% of participants had received additional IV fluid therapy training. Nurses recommended increased staffing, improved availability of supplies, infusion-control devices, and additional training. Conclusion: Nurse staffing shortages, absent infusion-control technology, and limited in-service training constitute interrelated health-system barriers to safe intravenous fluid therapy. Addressing staffing, supplies, equipment, and continuing professional development is essential to strengthen infusion therapy and safeguard patient safety in comparable resource-constrained settings.