Factors Influencing Nurses Intention to Work in the Oncology Specialty: A Mixed-Methods Study in Riyadh, Saudi Arabia

Abstract

Background: In Saudi Arabia, there is an identified problem with attracting and retaining oncology nurses. Specifically, there is a shortage of Saudi nationals in the specialty, negative attitudes toward caring for dying patients and a lack of palliative care knowledge amongst clinical staff. Development of the nursing workforce is a particular focus of the Saudi Arabian government, which is seeking to address the Saudi nursing shortage through the Saudisation policy and more recently through ‘Saudi Vision 2030’. These initiatives are designed to improve the number of Saudi national nurses in all areas of nursing and especially in specialty fields such as oncology and palliative care. Aim: The overall aim of this study was to explore the factors that influence nurses’ intentions to work in the oncology specialty in Saudi Arabia. Methods: The study used an explanatory, sequential mixed-methods design comprising surveys with three nursing groups: 178 undergraduate nursing students (UNSs), 263 oncology registered nurses (ORNs), and 33 postgraduate oncology nursing students (PONSs), and 19 semi-structured interviews with two groups of nurses, 10 ORNs and 9 registered nurses from other hospital departments. The survey included a range of previously validated instruments to assess palliative care knowledge, attitudes towards caring for dying patients, general selfefficacy, job satisfaction and intention to work in oncology. Data from the interviews were analysed using thematic analysis. The results from the quantitative and qualitative components were integrated using the ‘following the thread’ technique. Findings: The survey findings indicated that 28.6% (n = 51) of UNSs and 81% (n = 27) of PONSs surveyed reported an intention to work in oncology, and 49.4% (n = 130) of ORNs to stay in the oncology speciality. A nurse’s attitude was the only consistent and significant predictor of intention to work in oncology across all three groups. Higher levels of palliative care knowledge and self-efficacy were significantly associated with increased intention to work in oncology among PONSs, whereas general self-efficacy was a significant predictor among UNSs. The job satisfaction of ORNs was a significant predictor of their intent to stay in oncology. The qualitative study findings identified four major themes: advantages of working in oncology, psychological difficulties in oncology, structural barriers hindering oncology nursing, and workplace conditions reducing job satisfaction. Conclusions: The study identified the factors that influence nurses’ intention to work in the oncology speciality. It also highlighted the barriers and enablers of nurses working in the oncology speciality. This study offers important insights for policymakers and nursing leaders when planning to improve the oncology nursing speciality in Saudi Arabia. The thesis, the first of its kind undertaken in Saudi Arabia, has contributed to the body of knowledge about Saudi oncology nursing, and can serve as the basis for future recruitment and retention initiatives.