POL-CT 11

IOSR Journal of Nursing and Health Science (IOSR-JNHS)

e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 5, Issue 2 Ver. I (Mar. - Apr. 2016), PP 95-99

www.iosrjournals.org

DOI: 10.9790/1959-05219599 www.iosrjournals.org 95 | Page

Saudi Community Perception of Nursing as a Profession

Dr. Hala Saied 1,

Haya Al Beshi 2 , Jawaher Al Nafaie

3 , Elham Al Anazi

4

1. Assistant Professor, College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

2. 2,3,4. Intern students, College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Abstract: Nurses are the largest group of healthcare providers, and the nursing shortage is a global concern. Due to this shortage, Saudi Arabia depends heavily on expatriate nurses from different countries. How the

Saudi community perceives nursing as a profession will affect the nursing recruitment and retention. The aim of

this study was to explore the Saudi community perception regarding nursing.A descriptive cross-sectional

design was used to collect data from a convenience sample of 500 male and female Saudi participants. Two

tools were developed by the investigator to collect the data: Demographic characteristics questionnaire and the

perception toward nursing questionnaire. The questionnaires were carefully constructed and piloted with 20

participants Non-parametric test has been used to analyze the 29 item Likert scale that measure the strength of

the participants agreement was used with one is strongly disagree and 5 for strongly agree.Most of the

participants (58%) were 20 to 40 years old. Slightly more than half of them (50.2%) had a bachelor degree and

60.4% had a family member or a friend work as a nurse. Overall there was a positive perception about nursing

among the majority of the participants.They perceive nursing as a human, respected profession but it is not

appreciated by the society. More than half of the participants believe that Saudi nurses are better than foreign

nurses and only 24% of the respondents think that nursing conflict with the customs and traditions of the Saudi

society. However this positive perception of the participants was not transmitted into a desire to join nursing.

Improving nursing professions social position, prestige, working condition and salaries might encourage more

applicants and young generations to enter the nursing profession.

I. Introduction Nurses are the largest group of healthcare providers and nursing shortage leads to serious effects in

terms of adverse impacts on the health and well-being of populations (WHO, 2013: ICN, 2013). Nursing

shortage poses extraordinary challenges for policy makers in high and low income countries (WHO, 2013).This

shortage is worldwide. Already, USA, Canada, Australia, Western Europe, South America Caribbean and Latin

America and Africa are reporting significant nursing shortages (Sigma Theta Tau International, 2001; WHO,

2010; Peterson , 2014; U.S. Department of Health and Human Services, 2014).

In Saudi Arabia, there is a huge shortage of nurses (MOH, 2013). The World Health Organization

(2011) reported that there are only21 nurses for every 10,000 of the Saudi Arabia population and the Saudi

Ministry of Health implied that shortage of nurses in KSA is increasing and is expected to reach ~48K nurses by

2020 (MOH statistic, 2013). Due to this shortage, Saudi Arabiadepends on expatriate nurses from over 52

different countries such as Philippimes, India, Australia, Malaysia, South Africa, Egypt, Jordan and United

Kingdome (Aboul-Enein, 2002; Al-Omar, 2003, Almutairi, 2015). Expatriate nurses represent66% of the total

nursing workforce in Saudi Arabia (MOH statistic, 2013).Cultural difference, lack of knowledge about Muslim

practices, culture shock, language barriers and high turnover rate that reaches almost 30% a year are some of the

challenges that results due to expatriation of foreign nurses (Sidumo, etal 2010; Al Mutari, 2015;Albougami,

2015)

Nursing education in Saudi Arabia is run by the Ministry of Education (MOE), Ministry of Health

(MOH), Military and private sectors. To get over the nursing shortage, the Saudi Ministry of Education (MOE)

established several nursing colleges that provide Bachelor of Science in nursing. The first public college was

established in Riyadh, the capital of Saudi Arabia in 1976 and now there are about 17 public nursing colleges

around the Kingdom(MOE, 2015; Tumulty, 2001). Master degree in nursing was established in 1987 and PhD

was initiated in 1994 by King Abdulaziz University (Almalki, FitzGerald, Clark, 2011). Nursing programs used

to admit females only until 2004, when some universities started to have programs for males’applicants

(Alhusaini,2006). Also, several scholarships were provided to the Saudi nursing students, leaders and educators

to attain their master and PhD from different countries outside the kingdom (AlYami& Watson, 2014).

Regardlessof the governmentefforts to attract Saudi nursing applicants, the number of people who would like to

enter the profession is very small. There might be several reasons behind that. One of these reasons is the

community perception of the role of nursing and the poor image attached to it (AlYami& Watson, 2014).

According to Price, et al., (2013) the community perception of nursing as a profession can affect the recruitment

Saudi Community Perception Of Nursing As A Profession

DOI: 10.9790/1959-05219599 www.iosrjournals.org 96 | Page

and the retention of nurses. The community positive perception of nursing attract more people, while a poor

community perception and negative nursing image leads to insufficient numbers of people entering the nursing

profession (Price, et al., 2013: Beck, 2000; Seago et al., 2006)

Abundant studies have been conducted globally on the western communities’ perception of nursing.

These studies show that most of the communities still perceive nursing as a feminine and caring job (Hemsley-

Brown and Foskett, 1999; Evans, 2004; Keogh and O’Lynn, 2006; Kemmer& Silva, 2007). Other studies

indicated that nurses competences, knowledge, skills, critical thinking and education are not recognized and

valued by the majority of publics (Kemmer& Silva, 2007; Hoeve, etal., 2013 ; Price &McGillis; 2013). Ben

Natan and Becker (2010) found that career in nursing is perceived as a career in a profession that lacks

challenges, responsibility, status, comfortable working conditions, career opportunities and high wages. With

regard to prestige and occupational status nursing continues to fall significantly behind medicine and

physiotherapy(Johnson& Bowman, 1997; Seago et al., 2006; Turner & Whitfield, 2007).

In Saudi Arabia,Al-Sad (2007) mentioned that Saudi society looks at nurses with doubt and contempt.

El-Sanabary (1993) examined the progress and problems encountered in recruiting Saudi women for nursing

education and reported that many families consider nursing as an inappropriate profession for women and a

carrier in nursing can affect the honor and the repetition of women.Moreover, some researchers investigated

high school Saudi student’s intention to peruse a carrier in nursing. Al-Johari (2001) mentioned that some Saudi

high school female students had interest in nursing; however, for work-related reasons such as night shift this

interest was opposed by their families. Similarly, Al-Omar (2003) conducted a study on high school students’

perception of nursing as a job. He reported that public image or social perception, family disagreement, cultural

values, long working hours, mingling with men, and the dilemma/fear/worry of not getting married were the

main factors why Saudi female did not choose nursing as a career. Al Fozan (2013) reported a positive finding.

The researcher conducted a study on patients and family caregivers’ satisfaction with care delivered by Saudi

nurses. Finding of this study reveled that the majority of the patients and care givers were satisfied with the care

provided by the Saudi nurses in areas related to respecting culture and religion, maintaining privacy and

confidentiality, communication and professionalism.

There are different factors behind this negative public opinion. Potential factor is the picture of nursing

in the media. Dahlborg-Lyckhage, et al.,( 2009) mentioned that the media play a major role in shaping the

community understanding of nursing and nurses . In the media nurses are viewed as a doctor handmaiden,

angels of mercy, sexy, feminine and caring not as autonomous healthcare providers who have critical thinking,

knowledge and skills (Gordon & Nelson, 2005; Bridges, 1990, Hallam, 1998, Takase et al. 2006, Price

&McGillis, 2013; Kemmer& Silva, 2007).

After the advancement of nursing education, the call for “Saudization” and the lack of current studies

that assess the Saudi perception, there is a need to explore the Saudi community perception of nursing as a

profession.

II. Methodology Research design: A descriptive cross-sectional design

Sample: A convenience sample of 500 Saudi Citizens female andmalesresident in the city of Riyadh, Saudi

Arabia.

Data Collection tools:

Two tools were developed by the investigator to collect the data: Demographic characteristics

questionnaire and the perception toward nursing questionnaire. The questionnaires were carefully constructed

and piloted with 20 participants. The questionnaire consisted of 29 items. Five-point Likert scale that measure

the strength of the participants agreement was used with one is strongly disagree and 5 for strongly agree. The

questionnaire was reviewed item-byitem by a panel of experts to establish face validity content validity was

substantiated by a group of 3researchers with experience in tool development and knowledge of research on the

community perception and image of nursing. All of these researchers rated each item for relevance and

clarity.Ideas for wording some of the questions was adopted from some studies such as (Al Jarrah, 2013).

Data collection procedure:

Data were collected from Riyadh malls and other public places. The researchers explained the study

purposes and eligible subject were asked to participate in the study.Eligibility for the study guaranteed based on:

being a Saudi citizen male or female adult and agree to participate in the study.

Saudi Community Perception Of Nursing As A Profession

DOI: 10.9790/1959-05219599 www.iosrjournals.org 97 | Page

Data Analysis:Data was coded for entry and analysis using SPSS statistical software package version 21.

Descriptive statistics were used to summarize the characteristics of the participants. The reliability of the

questionnaire was assessed by using Cronbach’s α coefficient which was (.87).

III. Results: Socio-Demographic Results

Table 1 shows the sociodemographic properties of the study population.

The study sample consisted of 500 participants, the participant’s age ranged from 18 to 70; 58.4% of the

participants were in the age group 20-40 .Eighty-one (81.4%) were females and 50.2% had bachelor degree.

Majority were single (62.8), and 60.4% of the subjects had a family member or a friend in nursing profession.

Table 1 General Characteristics of the Sample Item Characteristics N (%)

Gender Females Males

407(81.4) 93(18.6)

Age Younger than 20

20-40

41-60 ≥60

188 (37.6%)

292 (58.4%)

16 (3.2%) 4 (.8%)

Marital status Married

Single Widowed

Divorced

167 (33.4%)

314 (62.8%) 6 (1.2%)

13(2.6%)

Education Post graduate degree University graduates

High school

Middle School Elementary School

6(1.2) 251(50.2)

203(40.6)

27(5.4) 13(2.6)

Any of your relative a nurse Yes No

302 (60.4%) 198 (39.6%)

Perception about the nature of the nursing profession

Table 2 indicates that in general, most of the participants had a positive perception regarding nursing.

Nursing was perceived as a human profession that is important to any society (94.2%; 90.6%) respectively.

Most respondents think that nursing improves nurse personality, an important to patient’ recovery, improves

health, prevent disease, and provides self actualization (86.6; 87.2; 78.4%; 75.6%) respectively. Half of the

participants(50.6%) think that nursing is an occupation and not a profession. The majority of the participants

(65.6%) indicated that they don’t know if nurses are able to take their own decision and 41.8% think that nurses

obey doctors’orders without questioning them.

Table 2Percentage of responses related to the perception about the nature of the nursing profession

Statement Agree or strongly

agreeN(%)

Don’t know

N(%)

Disagree and strongly disagreed

N(%)

Nursing is an occupation not a profession 154(30.8) 93(18.6) 253(50.6)

Nursing is a human profession 471(94.2) 15(3.0) 14(2.8)

Nurses respects work ethics 293(58.6) 173(34.6) 34(6.8)

Nursing profession is important to any society 453(90.6) 31(6.2) 16(3.2)

Nursing is a dangerous profession 42(8.4) 83(16.6) 375(75.0)

Nursing profession provides self –realization 378 (75.6) 96 (19.2) 26 (5.2)

Nursing profession improves nurse’s personality 433 (86.6) 43(8.6) 24(4.8)

Nurse is able to take a decision by his/her own ----------- 328 (65.6) 172 (34.4)

Nurses obey doctors orders without questioning them 209(41.8) 174(34.8) 117(23.4)

Nursing profession is important in patient’s recovery 436 (87.2) 33 (6.6) 31 (6.2)

Nursing profession promotes health and prevents disease 392(78.4) 72(14.4) 36(7.2)

Certain education and legal license is required to practice as a nurse 352(70) 38(7.6) 110(22)

Perception about the Social Value and the Role Characteristics of Nursing Profession

As shown in table 3 below, while 87.8% of Saudi indicated that nursing is a respected profession in the

Saudi community only 37.0% thinks it is appreciated by the society. Nursing is seen as a female profession only

by 21.4% of the participants and 58 % think that Saudi nurses are better than foreign. Only 24% of the

Saudi Community Perception Of Nursing As A Profession

DOI: 10.9790/1959-05219599 www.iosrjournals.org 98 | Page

respondents think that nursing conflict with the customs and traditions of the Saudi society. Less than half of the

participants (49.2 %) feel that Saudi nurse can get marry.

Table 3Perception about the Social Value and the Role Characteristics of Nursing Profession

Statement

Agree or strongly

agree N (%)

Don’t know

N (%)

Disagree and strongly

disagreed N (%)

Nursing is a respected profession in Saudi community 439(87.8) 42(8.4) 19(3.8)

Saudi society appreciates nurses work 185(37.0) 157(31.4) 158(31.6)

Nursing profession is seen by the Saudi public as servant’s job 118(23.6) 88(17.6) 294(58.8)

Nursing profession conflict with the customs and traditions of Saudi society

24(4.8) 43(8.6) 433 (86.6)

I support evening shifts for female nurses 246(49.2) 117(23.4) 137(27.4)

Nursing is a female profession only 107(21.4) 78(15.6) 315(63.0)

Male nurse is better than female nurse 154 (30.8) 179(35.8) 167(33.4)

Foreign nurse is better than Saudi nurse 167(33.4) 123(24.6) 210(42.0)

I think Saudi female nurse can get marry 378(75.6) 84(16.8) 37(7.4)

Participant’s Perception about Choosing Nursing as Carrier

While 85.0% of responding participantsrecommended a carrier in nursing for a Saudi female 77.2%

recommended it for Saudi males. Only 13% agree or strongly agree that they will allow their daughter, sister or

any of their relatives to be a nurse. 18.6% female and 15% of the male participants said that they would like to

peruse a career in nursing.

Table 4: Participant’s Perception about Choosing Nursing as Profession

Statement

Agree or strongly agree

N (%)

Don’t know

N (%)

Disagree and strongly disagreed

N (%)

Recommend a carrier in nursing for Saudi female 425(85.0) 41(8.2) 34(6.8)

Recommend a carrier in nursing for Saudi male 386(77.2) 58(11.6) 56(11.2)

I will allow my daughter, sister or any of my relative to be a nurse 65(13.0) 177(35.4) 258(51.6)

As female, I would choose nursing as profession 93(18.6) 131(26.2) 276(55.2)

As a male, I would choose nursing as profession 78(15.0) 215(43) 207 (41.4)

IV. Discussion The purpose of the current study was to explore the Saudi community perception of nursing as a

profession. Overall there was a positive perceptionabout nursing among the majority of the participants. This

finding is inconsistent with the previous studies which indicated nursing is not considered a respectable

profession for women in Saudi Arabia and Saudi society perceived nurses as being uneducated, manual laborers

who do the “dirty work” (Alawi &Mujahid, 1982; Mansour, 1994)

Most of the previous studies refer to some culture and religious issue that make nursing unattractive job

for Saudi community such as mixing of sexes in the workplace, night shifts and female caring for male patients

(Hamadi and AlHaidar, 1996). In this study, 86.6% of the participants think that nursing profession doesn’t

conflict with the customs and traditions of Saudi society and they agree with the idea of night shift which in

contrast with the previous studies.

The change of the community perception that is found in this study may be due to several factors. One

of the factors is the change in the nursing education in Saudi Arabia over the years. The nursing education in

Saudi Arabia has undergone tremendous development over the last years of the 20 th

century and in the first

decade of the 21 st century. This is clear in the vast increase (from 100 in 1967 to nearly 6000 by 2005) of the

estimated number of places available to first year students in nursing the institutions, the number of the

applicants that exceedthe number of places for all types of nursing institutions and also the number of Saudi

nurses who are working (Al-Mahmoud, et al., 2012) . The number of Saudi nurses was around and now 33% of

the nurses working in ministry of health are Saudi.

In this study, almost 61% of the participants have a family or a friend work as a nurse. This is also

might be another factor that explains this positive perception of the participants in this study. A number of

studies found that having family members as nurses were important motives for positive attitude toward nursing

(Beck ,2012;Tayebi, et al., 2013).

However this positive perceptionof the participants was not transmitted into a desire to join nursing.

The majority of the male and female participants indicated that they will not choose nursing as a future

carrier.This result is consistent with several studies done in the western countries and reported that the high

public’s esteem for nursing as trusted and highly respected profession has not translated into an adequate supply

of individuals who are willing to join the nursing profession (Donelan et al., 2008; Gallup Organization, 2007)

Saudi Community Perception Of Nursing As A Profession

DOI: 10.9790/1959-05219599 www.iosrjournals.org 99 | Page

V. ConclusionAnd Recommendations The overall perception of nursing profession among the Saudi community is changing toward positive

in most of the areas related to the nature of the nursing, the social value and the role characteristics of the

nursingprofession. This community positive attitude should be invested to recruit more applicants. Anextended

and constant effort is needed to educate the community about nursing careers, give more benefits such as

increase the salary, reduce working hours; provision of on-site child care, more training, scholarship and

upgrading opportunities may attract more applicants.

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