FIN-CT11
lolo1339
2.Almadani.pdf
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Degree education as an entry requirement for qualified nurses in
Saudi Arabia:AnOverview
Noura A. AlMadani, RN, BSN,CI, MSN, PhD candidate at UoS
Abstract
AIM: This study aim is to provide an overview of the implications of Bachelor degree nurse
education in Saudi Arabia (SA).
BACHGROUND: Ministry of Health (MoH) and other health care sectors in Saudi Arabia
have stipulated the minimum requirement of a Bachelor’s degree for entry into nursing
practice in 2010, while the majority of nursing workforce was diploma holder. The
implications of this requirement have not yet been investigated; therefore it is important to
establish baseline information as a basis for future workforce planning and development.
METHODS: Data related to degree nursing education andthe nursing workforce in SA were
extract from the local and global published literature identified through search of arrange of
databases such as ProQuest, Medline, Science Direct, Wiley Inter Science, CINAHL via
EBSCO, Pub Med and Google Scholar. Obtained information was evaluated for influence
and order under thematic basis.
CONCLUSION:There are three major problems related to the nursing workforce in SA:
which can be ordered under the headings of educational, ognisational and social.Firstly,the
educational issues include many nursing personnel do not even have a degree of bachelors of
Science in Nursing. Hence, this lack of education in the nursing staff is a hindrance in
providing high quality of nursing care to the patients who need advanced level of nursing.
Secondly, the organisationalissues involve the policy and regulations related to nursing along
with the turnover and retention rate of nurses. Lastly, social issues include the working
environment involving the gender ratio, long working hours, job dissatisfaction and low
wages and these factors are a cause of the high turnover rate. Yet, all these issues need to be
addressed in workforce planning to improve the Saudi nursing sector.
KEYWORDS
Nursing education, nursing workforce, qualified nurse, Saudi Arabia
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Degree Education as an Entry Requirement for Qualified Nurses in
Saudi Arabia: An Overview
Noura A. AlMadani, RN, BSN,CI, MSN, andPhD Candidate at UoS
Introduction
A nursing career is a major need in all the countries but there is still a serious shortage of
professional nursing staff in many nations (Al-Ahmadi, 2014). Due to this shortage, some
nations are hiring unqualified nursing staff hence not giving patients the required level of
need and care from the nursing staff (Alyasin and Doughlas, 2014).This paper provides an
overview of the implications of Bachelor degree nurse education in Saudi Arabia (SA). It
first explores the policy perspective; the scenario of shortage in global and local nurses and
the high rates of turnover. It also examines current nursing education levels and entry
requirements. Focus has been put on integrating knowledge with practical training in order to
maximize the utility of the labour workforce.
An Overview of Policy Analysis
This policy summary illustrates the development of degree nurse education in the global
context. There has been consideration of education delivery and entry requirement by nursing
organisations globally, for example the International Council of Nurses (ICN) andSigma
Theta Tau International(STTI). As yet within policy analysis there has been little
consideration of workforce planning issues. Saudi Arabia has a wealth of information from
the global nursing field to use to develop its own healthcare system and manage its workforce
to make it fit for the 21 st century. It has the advantage of looking at countries that have
already implemented the policy making degree a minimum requirement for nursing and work
with the outcomes of these to shape its own policy. In neighbouring Jordan, the first nursing
baccalaureate was introduced in 1972 followed by a Masters’ degree in nursing in 1986 and
this has lead the way in nursing education in the Middle East. Jordan has 17 nursing schools
and also offers doctorate level nursing degrees (Nabolsi, et al, 2014) whilst Saudi Arabia only
recently made the degree in nursing mandatory. Jordan has long encouraged the professional
development of nurses in obtaining degrees by supporting students with scholarships to study
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abroad to developed nations (e.g. USA, Canada, and UK). Where it was not possible for
students to go abroad e.g. due to family commitments, Jordan responded with the
development of its own high quality nursing education programmes at home and leads the
way in the Middle East in the field of high quality nursing education (Shuriquie, et al, 2008) .
Jordan is not without its problems though; the adoption of international standards to meet
global requirements has meant there has been a gap in the delivery of services that are
culturally and economically sensitive and need addressing (Shuriquie, et al, 2008); something
for Saudi Arabia to consider when developing its nursing educational policies.
An increase in global ageing population is expected with better health care and
increase in longevity therefore, Saudi will need to consider whether the policies it develops
meets the need of this future population. Other aspects to cover includes covering training in
predicted disease areas as there will be shift in the type of ailments seen with shift in time as
seen historically. For example, according to WHO, there has been an increase in diseases
associated with life style in recent years in the Middle East; high on the list among these is
coronary heart disease and diabetes. Acute Coronary Disease is one of the biggest killers in
adult population in Saudi Arabia according to the WHO (2011) and coronary heart disease
accounted for 23% of total deaths in Saudi Arabia (WHO, 2011). Training and resources to
deal with such issues need to be addressed now to equip staff in readiness. Being prepared to
deal with such issues will reduce financial and staff burden. The cost to the MoH in treating
Saudi patients with heart condition is on average US$10,710 with average stay in hospital
ranging from almost 8 days if patients do not have co-morbidities to 11 days if patients have
co-morbidities (Alsultan, et al, 2011). The rising rate of obesity is likely to add to this
problem in the future. A degree level education which deals with health promotion would
cover these high need areas making policies and health care systems robust. Predicting and
preparing for such issues would allow the MoH to allocate resources appropriately and
manage the workforce to its full potential.
In contrast to Saudi Arabia, Kuwaiti Ministry of Health requires a nursing qualification
(not necessarily a bachelor’s degree) and one years’ experience, however like Jordan; Kuwait
does offer scholarships to encourage students to be educated at degree level in countries such
as USA, UK, Australia and Ireland. Globally, the requirement for level of nursing
qualifications varies. For example in India, there are many levels of nursing qualifications.
The vocational courses are: Multi-Purpose Health Worker Female training, Female Health
Supervisor training, General Nursing and Midwifery certifications. Degree level and above
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courses, in line with international standards, includes BSc in Nursing, MSc in nursing, MPhil
and PhD – all of which are taught at universities (Nursing Education, 2013). The purpose of a
policy offering such a wide range of courses in nursing is to meet the requirement of the
society at different levels, which is socially and culturally incredibly diverse like the Middle
East and has dealt with the issues overlooked in Jordan. India’s varied approach to nursing
education offers opportunities to all those who want to pursue a career in nursing at any level
depending on personal circumstances and resource availability.
The need to reform nursing education as the world entered the 21 st century drove the
global impetus to reassess old policies and standardise education fuelled by the diversity of
nursing roles and the global migration of nurses from one country to another. Furthermore,
other health related fields were already one step ahead in offering and making degrees
mandatory for practice e.g. physiotherapy, pharmacy and social care. The trend followed so
that as one country made it mandatory to make degree in nursing the minimum requirement,
soon after others followed, for example UK started the ‘Project 2000’ programme to move
nursing education into university and allow nurses to acquire degrees. The reason for this
shift includes many researchers demonstrating that education of nurses was directly linked to
quality of patient care and patient mortality (Aiken, et al, 2014). There is a great shortage of
nurses in the Middle East, majority of its nursing population are foreigners, therefore for the
Middle Eastern countries to participate in the global nursing arena, and seen to be providing
the same level of care, countries such as Saudi Arabia have also made it mandatory to make
degree the minimum requirement for nurses recently following trends in other countries.
The change in the US policy on nursing education has actually seen an increase in the
number of students taking up nursing (Aiken, 2002) despite the concerns from oppositions.
As predicted, one of the reasons maybe that the nurses are given more autonomy, respect, and
a wider range of transferable skills among others. The change in policy and the rise of uptake
of nursing as a career will help ease the shortage of nurses globally. The ICN is an
international body representing nurses from 130 countries aims to provide nursing guidelines
to standardise nursing globally and unite the nursing community as one. The ICN identified a
historical shortfall in the nursing profession i.e. nurses did not have a role in nursing policies,
the ICN endorsed the need for more autonomy to nurses and their involvement in policy
making on a global scale to help influence the profession as nurses are the individuals with
front line hands on experience of the system. As part this initiative, the ICN recommends the
improvement of education equivalent to degree level to help provide nursing services fit for
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the new millennium as degree education has been shown to enhance patient safety, quality,
competency and service delivery (ICN, 2009; Aiken, et al., 2014).
Saudi Arabia offers both degree level and associated degree (diploma) level education
in nursing. The Saudi Ministry of Higher Education (MoHE) has a policy to deliver high
quality education to international standards in all fields including nursing (Alamri, 2011). It
has taken steps towards achieving this in order to provide a nursing service equivalent to that
of other developed nations; e.g. Saudi Arabia has also made it a policy to make degree the
minimum requirement for nursing in the hope of addressing the previously poor nursing
standards (Al-Homayan et al, 2013). Saudi Arabia has significantly increased its funding of
student nurses, scholarships and encourages study-abroad programmes (Alamri, 2011). The
feeling of political and social pressure to conform to standards of other developed nations in
making degrees in nursing mandatory has driven the change in Saudi Arabia (Alamri, 2011).
Until recently, the nursing policy only affected females as they were target group, and males
were not offered nursing degrees. Males nurses are still not offered Masters’ degree in
nursing. The change in this has again been influenced by international standards and the need
to increase home-grown nurses and widen the talent pool, an amendment to the policy that
will have important positive impact on the workforce reaching out to another potential 50%
of the population. Policies need to be implemented with the use of media as aid to reach a
wide target audience. As previously mentioned, the change from diploma to degree level
entry, may see a change in shift due to the prestige and accolade that comes with a degree and
allow the profession to gain more respect and recognition in a country where nursing is seen
as a low status job. There is great scope for any policies that are developed to shape the future
of the country through changes in culture, education and social perception.
Although the Saudi government is trying to meet international standards when it comes
to nursing degrees, it still has a lot of issues that need addressing; for example, the MoHE
still does not have an established syllabus/learning outcomes and this is driven currently by
the faculties themselves so that the standard of nursing varies according to the education of
the head of the faculty (Alamri 2011). Furthermore, as the change in policy to degree level
education is recent, nurses with associated degrees do not have any way of converting their
associated degrees to a BSc equivalent and this is something that needs to be tackled in the
policy as it affects a large portion of the Saudi work force. As explained previously, there is a
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vast number of nurses within Saudi Arabia that are not currently employable due to the lack
of bridging degree on offer to convert their nursing diplomas into Bachelor’s degree. If Saudi
wants to be a global participant, it also needs to address within its policy, offering these
bridging degrees to foreign student to attract more staff and meet shortfalls in the current
workforce and also deal with future predicted shortfalls in staff. Given Jordan has lead the
way in nursing degrees in the Middle East, for Saudi Arabia to attract students away from
competition, its policies need to cover incentives and welfare of foreign students and staff
and not just the native population.
Associated degrees in nursing and funding for health care fall under the jurisdiction of the
MoH, in order the bridge the gap above, there needs to be better communication and links
between the two departments; or the policy needs to be transferred to one of the two
departments for coherence e.g. MoHE. In Switzerland, due to the two different linguistic
communities, the nursing education model has taken two separate pathways with high
variability and inconsistency between them (Spitzer &Perrenoud, 2007) defeating the goals of
organisations such as the WHO and the ICN in trying to standardise nursing education
globally. Saudi Arabia could learn from the Swiss example in bettering its own nursing
education system by merger or even the creation of a new department to help drive the
initiative.
Nursing Workforce Challenge
The largest groups of health care professionals in the country are nurses; they delivered the
high percentage of health care (Oulton, 2006). Despite the fact that being the largest group of
health providers, the nursing profession has experienced an acute shortage of qualified nurses
affecting the delivery of health care (Almalki et al, 2011; Chan &Marrison 2000; Fochsen et
al. 2006). Saudi Arabia is challenged with a chronic shortage of qualified Saudi nurses,
accompanied by high rates of turnover; in addition, the annual rate of Saudi graduate nurses
is insufficient to meet the increasing health care demands (Gazzaz, 2009). Within the large
numbers of Saudi students over the world, there is a low percentage of nursing students
locally and internationally (Alamri, 2011). Recently, the admission level of entry into the
nursing practice has been changed to baccalaureate degree (Alamri, 2011).
Today, according to Majeed (2014), above fifty percent of the workforce is comprised of
nurses and other health care staff. The focal point and centre of the health care system are the
nurses and the health care system without nurses will not be functional (Alyasin and
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Doughlas, 2014). In Saudi Arabia, the healthcare sector workforce mostly comprises of
emigrant nurses; only 34% of the nursing workforce is Saudi nurses as stated by AlYami,
(2014). A major portion of the emigrant nurses use the Saudi Arabian healthcare
opportunities temporarily in order to get practice and knowledge. After gaining the required
experience, they return to the healthcare sectors of the developed nations like USA, UK and
Australia (Majeed, 2014).
The high rate of turnover among professional nurses in Saudi Arabia is adding to the
worries such as management issues, organisational plan obstruction and bad service of
delivery thus affecting the workforce (Al-Ahmadi, 2014).The effectiveness of various
healthcare systems is greatly threatened by such problems; for example, there is a constant
need to replace and train staff. There are no reliable statistics related to this important
problem but for the managers of the health care facilities, this emigrant movement is a big
issue (AlYami, 2014). High turnover of nurses creates an unstable healthcare system where
the burden of workload falls on the remaining staff. This inevitably has the potential to
compromise the care given to patients, creates an environment of discontent and affects moral
and motivation of remaining staff (Lamadah, et al., 2014). Lower staff turnover rates, higher
staff retention and high level of nurse to patient ratio has been shown to be linked to higher
quality of care and reduce in-patient stay (Collier and Harrington, 2008). High turnover of
nursing staff also has a significant impact in the finances of a healthcare system.
A survey of Jordanian nurses showed job satisfaction was a significant factor in retaining
nursing staff (Alsaraireh,et al, 2014). Saudi nurses were happier when there was effective
leadership shown by management and happier to stay in their jobs suggesting further need to
address this at the policy level (AbuAlRub& Alghamdi,2012), therefore, Saudi MoH could
retain staff through providing a better work environment to its employees, better leadership,
and training programmes; these suggestions should be explored, for example offering
incentives, facilities and rights, working conditions, and/or shorter working hours.
Restructuring the education system to offer equal opportunities to men and women and offer
higher degrees across various universities is more likely to allow recruitment and retention of
nursing staff.
The total number of nurses in Saudi Arabia is 139,701; and the number of Saudi nurses is
50,554 (see table 3.1). The latest figures show that the number of Saudi nurses has increased
from 44.5% in 2008 to 55.3% in 2012 of the total nursing workforce which illustrated in table
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(1.1 ).Almalki et al (2011)argue that the total number of Saudi nurses is still smaller in the
private health sector where native nurses make up only 4.1% of the workforce (see Table 1).
The lack of local nurses is a big problem due to various social, educational, and individual
reasons.
Table (1.1): Nursing personal in the healthcare sectors in Saudi Arabia
Sector No. Saudis (%) Non-Saudis (%)
MoH 82,948 45,875 55.3 37,073 44.7
Other Govt. 28,380 3,820 13,5 24,560 86.5
Private Sector 28,373 859 3.0 27,514 97
Total 139,701 50,554 36.2 89,147 70.9
Source of the data: Annual Statistic book, Ministry of Health (2012).
However, despite increasing interest in enrolment in different nursing education programmes,
it has been estimated that 25 years will be needed to train enough Saudi nurses so that they
comprise of 30% of the Kingdom’s nursing workforce requirements (Abu-Zinadah 2006).
Educational challenges
In Saudi Arabia, many nursing personnel do not even have a degree of bachelors of
Science in Nursing (Al-Makhaita et al, 2014). Hence, this lack of education in the nursing
staff is a hindrance in providing high quality of nursing care to the patients who need
advanced level of nursing care (Al-Ahmadi, 2014). AlYami (2014) suggested that the
increasing requirements of the Saudi healthcare sector are not being met by the low yearly
induction of nursing graduates from Saudi Nursing schools. The effectiveness of various
healthcare systems is greatly threatened by such problems and the Saudi MoH needs to
address this to increase the uptake of nursing degrees by local people.
According to Jahan (2005), nurses with associate degrees have a lower status of
professionalism than Bachelors of Science in Nursing (BSN); nurses and the education
acquired by BSN nurses was linked with the social reciprocation on the funding in education.
Al-Ahmadi (2014) gave three factors as to why associate degree nursing is not regarded as a
professional and these are: nurses are not educated but trained; medics mainly control the
nurses and ultimately, nurses do not have to answer for their actions. Majeed (2014) stated
the training of people, forming their personality and preparing them for accountability is the
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responsibility of a university and this could be address with the introduction of the new
policy in nursing education. It is widely believed that a Diploma is technical and a low level
education (Aldossary et al, 2008); hence there is a need to eventually enhance the nursing
education level to at least BSN level.
Almalki et al, (2011) stated that, all Nursing Colleges and health institutes were transferred
from the MOH to the MoHE during 2008 as the first step to improve nursing education in the
kingdom of Saudi Arabia. In addition, a Bachelor of Science in Nursing (BSN) is awarded
following a five year curriculum at all the universities offering BSN programmes. The down
side with a five year degree programme is that the length of commitment required before
being able to practice and earn may hinder people from the profession, given nurses are
already complaining of resource and time issues. Nevertheless, the Ministry of Health has
been implementing the recommendation of the WHO that emphasis the bachelor degree as a
minimum requirement for entry into nursing practice in 2010 (Almalki et al, 2011).
In the States, a historical review of the role of nursing shows that more and more nurses
want to study for a degree in nursing as a way of increasing future career prospects, as a sign
of prestige and achievement, as part of professional development (D’Antonio, N.D.).
D’Antonio argues that the nurses should not be hindered socially or by policy and that this
social upward movement should be supported and encouraged at government and policy level
regardless ethnic background. Prior to the Civil Rights Movement in the 60’s and 70’s
majority of the degree educated nurses in the States were white females but post movement,
this has changed so that there are more African Americans nurses with degrees or equivalent
as well as other ethnic minorities. Saudi has policies that are favourable to Saudi nationals or
women only (e.g. Master’s degree in nursing), perhaps broader policies may help recruit and
retain staff.
A study on American nurses indicates that many nurses with diplomas or associated
degrees did not pursue a Bachelors’ degree because of lack of financial incentives and
because of their own financial situation; other barriers in taking up degree courses included
lack of flexibility in their current working situation, and family commitments (Romp et al.,
2014). These are important issues that are likely to affect the Saudi nursing population and
the results of Romp et al. (2014) study can be used to set up solutions before they cause a
major problem in Saudi. For example, Saudi MoHE can offer scholarships to those wishing to
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complete an accelerated degree programme, or bridging degree. The government can offer
paid study leave, distant learning opportunities and provide subsidised childcare facilities.
Organisational challenge
Al-Ahmadi (2014) examined anticipated turnover among nurses in the hospital of
Saudi Arabia. The study included 5459 nurses in 80 hospitals who were randomly selected
from the hospital database in The MOH. Al-Ahmadi observed in a survey that most of the
individuals (interns, staff nurses, and senior nurses) mentioned education while serving and
on-job training as reasons that affected their resolve to keep or quit the job at a specific
organization. The participants considered the chance for uninterrupted education and
advanced level training as key factors for their enthusiasm and contentment. For these
individuals, their professional knowledge and practice is strengthened by in-service education
and training. But on-the-job services differed significantly in various hospitals and fields. The
nurses doing their jobs at government hospitals seem more annoyed and dissatisfied than the
similar workers at other government sector jobs for getting fewer chances to be a part of such
services (Al- Ahmadi, 2014).
Due to less nursing staff in Saudi Arabia, the Saudi governmental and private sector
healthcare set ups are becoming more and more dependent on expatriate nurses serving to fill
the void. According to Al- Ahmadi (2014), a large percentage of the nursing system is based
on expatriate nursing. One of the implications of making a degree the minimum requirement
for nursing in Saudi Arabia, which depends so heavily on foreign nurses, is that it may reduce
its workforce considerably, if a country which supplies nurse to Saudi Arabia, does not offer
nursing degrees or does not make it mandatory, meaning Saudi Arabia will start reducing its
recruitment area from other countries.
The nursing care provided differs due to the diversity in educational and cultural
backgrounds. Therefore, Adossary et al (2008) gave the following suggestion for the Saudi
nursing department: "The main challenge for Saudi Arabia, presently, is to develop Saudi
national nursing staff in order to provide quality healthcare following the Saudi cultural and
linguistic aspects. In the absence of such measures, it will be increasingly difficult to provide
a high quality of healthcare to the Saudi nationals.”Aldossary (2008) predicted that the rising
requirement of health care services for the elderly was expected to be even more in the
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coming years and the problem needs to be addressed immediately by the Saudi government
and make necessary improvisations to the systems that facilitates and attracts more female
workers (Majeed, 2014). Currently, training the nurses in departments such as gerontology
needs to be practised at most to cater the growing percentage of the elderly people (Al-
Ahmadi, 2014). It was stipulated that the Saudi kingdom must increase the count of nurses in
the hospitals to meet the rising population percentage. This can only be achieved if the
authorities break the cultural barriers that restrict women to opt into nursing as their
profession (Aldossary, 2008).
Social challenge
Majeed (2014) asserted that Saudi Arabia needs to realise two things in their society. Firstly
the current role and status of nurses in health care units and how it has evolved. Secondly, the
realization of ways to improve the female nursing service for the public welfare and address
the rising challenges (Al-Makhaita et al, 2014).For individuals who have selected the nursing
profession, nursing education seeks to provide knowledge, skills and attitudes (Tumulty,
2001). Nursing programmes started to be improved in Saudi Arabia, with the development of
the curriculum, nursing education and practicing at graduate level programmes (Tumulty,
2001). Today, applications from female Saudi nationals with the right set of abilities, skills,
intelligence and motivation for the study of nursing science are encouraged at Saudi
universities (Almutair, et al, 2014). However, the universities considered in this study were
exclusively developed for female students and therefore all respondents are females. This
limitation of the study should be highlighted as previously mentioned.
The hospitals in Saudi Arabia are facing a new challenge owing to the rising rate of
attrition of the female nurses. The reason of this deficiency in hospitals is due to averting
attitude towards the profession (AlYami and Watson, 2014). The hospital management in
Saudi Arabia needs to systemize their records and maintain them periodically. In spite of this,
the hospitals in Saudi Arabia have not addressed this problem and increased their female
nursing staff compared with other countries across the globe. The most affected are the
elderly personnel in the country. The grave concern of the deficiency of competent nurses in
the Saudi hospitals requires a profound scrutiny on the current and future nursing system
which includes the training facilities (Almutair et al, 2014). This scrutiny should address the
problem with special focus on elderly people.
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Al-Ahmadi (2014) and Majeed (2014) asserted that with the policies attracting women
to opt into this profession, the shift is seen by the kingdom’s females. Although, this shift is
quite slow and the experts claim it to be fully achieved with time. The reason for the delay is
that women in Saudi culture face a lot of hindrances and the profession itself possesses an
uncouth image in the society (Al-Makhaita et al, 2014). The apropos system for recruiting
and training the nursing is inconsistent owing to the diversity of professionals working in
these hospitals (Majeed, 2014). Another factor that contributes to this problem is the lesser
percentage of female applicants when the recruitment programmes open (Al-Ahmadi, 2014).
The prime reason lies in the social image of the nursing profession. Most often, females
resort to take the administrative jobs owing to the high promotional chances (Almutairi, et al,
2014). Moreover, the female lots after acquiring the professional training are bound to
marriage which forces them to leave the profession as per the social norms (Al-Makhaita et
al, 2014). This creates a gap and affects the nursing education in the society.
All the issues above are related to female nursing; this is because whilst it is well
known that nursing is a female dominated profession globally, it is more so in Saudi Arabia.
Limited numbers of females want to go into the profession due to the social image and
pressures, but even fewer men want to go into the profession. There are calls to overhaul to
the policies affecting nursing in Saudi Arabia which are seen as inadequate with
recommendation to enhance the status of nursing in Saudi Arabia to make it a worthwhile
career, and this starts with dealing with some of the social stigma (Al-Omar, 2004; Al-Malki,
et al. 2011). The Saudi government needs to use media to help engage with people and
promote a positive image of the nursing profession to help with the shortfall in the local work
force (Al-Malki, et al. 2011). The policy should not start out aimed at females and then be
extended to men as it will enforce stereotypes and take longer to see changes. Instead,
policies should be aimed at both genders from the outset.
Interviews conducted by the Saudi Gazette (N.D.) with health care workers in Saudi
Arabia echoed some of the social stigma the health care workers have to face and overcome
on a daily basis. For example, men and women equally feel that public perception of nursing
is negative; opinions include a male should be in a role where his strength is required, for
example, in the emergency department and not nursing the sick and frail. Those who go into
nursing see it as a rewarding humanitarian job and have support from family meaning change
in an individual’s perception to get them into nursing may not be sufficient but the
family/community need to be targeted. Saudi men avoid marrying female nurses due to the
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long hours of shifts and night work requirements. Family and social concerns aside, the long
hours and night work also deters many from going into the profession. For those who are
married and with children, they encounter difficulties with getting childcare; something
resolvable through subsidised childcare.
Conclusion
The literature above indicates that the dire shortage of nursing staff in health care
sector is compromising the quality of health care in Saudi Arabia. This is not only a
phenomenon here but it is a global issue. Proper professional education and providing
adequate job facilities to nursing staff is required in order to bring improvements. The
universities need to improve their curriculums in order to cope with the changing and
evolving needs of the nursing profession. The nursing staff promotional hierarchy should be
revisited and improved as that is also a factor affecting the lack of professional nurses. The
major nursing strategists have put their focus into combining knowledge with training to
benefit the nursing profession and to improve its conditions. The issues of nursing staff, like
lack of promotion, need to be carefully considered and resolved. There should be provided on
job training and education in order to keep them up to date with the latest in the health
technology and develop their skills as part of continuing professional development. These
form the backbone of the healthcare sector, and their betterment is an imperative. Qualified
nurses will be able to provide the required level of health care and a level of professionalism
that is necessary with the job.
Acknowledgement
This paper is part of the authors’ doctoral research, supported by the Saudi Ministry of
Health, and University of Salford.
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