In resource-constrained Low Middle-Income Countries (LMICs) one nurse may be responsible for the care of 20 or more babies. The effect of such understaffing is poorly studied and there are no published studies that have investigated the effect of increasing staffing numbers on quality of patient care. This research examines nursing care provision in Kenyan newborn units with resource challenges and evaluates what effects a prospective intervention to increase the number of ward nurses has on the quality of newborn care provided in these units.