Choosing to become a nurse in Saudi Arabia and the lived experience of new graduates: a mixed methods study.

Abstract

Saudi Arabia has undergone rapid social and economic change in recent years. As one of the largest employers in the country, these changes have had a significant impact on the healthcare sector, in particular on the nursing workforce. In the past, Saudi Arabia relied almost exclusively upon expatriate nurses to meet the healthcare needs of its growing population. However, an increase in the Saudi population, high levels of Saudi unemployment, and a desire to redress the country’s reliance on an expatriate workforce, led the Saudi government to implement a Saudisation program, an initiative to recruit, train and employ Saudi nationals throughout the workforce. As a result, approximately 50% of nurses are now of Saudi nationality. This research is a mixed methods study. A quantitative study was undertaken to gain a description of the Saudi nursing workforce in Riyadh city; in particular their motivations, views of the profession and future plans. The initial aim of the quantitative study was to ascertain why high numbers of Saudi males were entering the nursing workforce in Saudi Arabia; however, female nurses were also surveyed in order to understand if there was a relationship between gender and motivations to undertake nursing, views of the profession and future plans. In this component of the study, a self-administered survey was distributed to all Saudi nurses working as registered nurses in Ministry of Health (MOH) hospitals in Riyadh. The results indicated that the Saudi Arabia nurses surveyed were young and inexperienced with a mean age of 27 years and with 80% having less than five years’ experience in the nursing field. Other important issues emerged in this study, such as the nurses’ desire for educational and professional development; poor working conditions in the sector; the low social status of the profession; difficulties associated with working in a mixed-gender environment; and cultural and communication problems. Significantly, just below half of all respondents intended leaving the profession. These results informed the second, qualitative component of this study which sought to explore in more depth, some of the findings which emerged from the initial component of the study. The second study aimed to explore the lived experience of newly gradated Saudi Nurses. Twelve newly graduate nurses who had been working in Ministry of Health Hospitals in Riyadh five years or less were interviewed. In-depth interviews in the Arabic language were performed with the nurses, who had been working in the profession for five years or less. Themes were identified from the data using van Manen’s hermeneutic phenomenological approach. Six major themes emerged from analysis of the data. Firstly, nurses felt unprepared for nursing. They felt they lacked the educational and training support they required, had little knowledge of the profession before joining, and had rarely chosen the profession themselves. Secondly, nurses in the study felt they were not readily included in nursing teams and were marginalised and discriminated against by management and expatriate nurses. In addition, Saudi nurses suffered from the poor social status associated with the profession and were subject to criticism and poor treatment by family, other health professionals and society at large. Despite this, nurses in general had a positive attitude to their profession. Saudi nurses indicated that they believed Saudi nurses were vital to the profession; both male and female nurses considered male nurses of central importance to the profession to ensure that the cultural and religious needs of Saudi patients were met. Finally, Saudi nurses showed an awareness of social changes occurring in nursing and in society in general and expressed a desire to be part of this change. This study offers important insights into a segment of the Saudi nursing workforce, which has not been the subject of intensive study. This new, emerging nursing workforce is making a mark on the Saudi healthcare sector. In order to prevent attrition in the nursing field, Saudi nurses need to be provided with appropriate education, training, respect and working conditions. This study offers important recommendations and insights for the future of Saudi nursing.