Perspectives on barriers and facilitators influencing twinned nurse leader partnerships during implementation of the Rwanda human resources for health program.

BACKGROUND: The global nursing workforce shortage disproportionately affects low- and middle-income countries (LMICs), accounting for 89% of this deficit, with inadequately trained nurses due to limited resources. Addressing this shortage requires nurse leaders who are essential in education and training. One strategy to address this global health challenge is forming twining partnerships between high-income and LMIC institutions. The Rwanda Human Resources for Health (HRH) initiative (2012-2019) exemplified this partnership between Rwanda's Ministry of Health and U.S. academic institutions. However, little is known about the factors that affect the effectiveness of these global health nursing partnerships. METHOD: A qualitative descriptive approach was used to explore barriers and facilitators influencing twinned partnerships among global health nurse leaders in the HRH program. A purposeful sample of U.S. Faculty Nurse Leaders (USFNL) and Rwandan Nurse Leaders (RNL) who participated from 2013 to 2018 was recruited. The study was conducted at two teaching and referral hospitals and one University in Rwanda. Using Upvall and Leffers' revised conceptual model of partnership and sustainability in global health, data were collected through semi-structured interviews, document analysis, and observations. RESULTS: The sample comprised 10 USFNL and 10 RNL (10 dyads). Participants were aged 30-80 years, with Associate to PhD education levels. Language barriers, particularly in clinical settings, presented limitations in knowledge transfer. In contrast, role modeling by USFNL emerged as a consistent, valuable facilitator in empowering RNL toward sustainable skill development. A clear framework and guidelines were absent, resulting in inadequate monitoring and evaluation. USFNL and RNL notably initiated the first master's nursing program at the University of Rwanda. CONCLUSION: This qualitative exploration revealed that twinning partnerships led to collaborative nursing workforce development, challenged by language barriers. Future global health nurse leadership initiatives should emphasize the proper use of frameworks that support effective monitoring and evaluation and align with cultural and historical considerations.