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Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 10-12

An overview of nursing in Saudi Arabia

1 General Directorate of Training and Scholarship, Ministry of Health, Riyadh, Saudi Arabia
2 School of Nursing, Faculty of Health and Social Care, University of Hull, United Kingdom

Date of Web Publication30-Jan-2014

Correspondence Address:
Mansour Saleh AlYami
General Directorate of Training and Scholarship, Ministry of Health, P. O. Box 36312, Riyadh - 11419
Saudi Arabia
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DOI: 10.4103/1658-600X.126058

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Achieving and maintaining a stable nursing workforce is an important issue for the well-being of the rapidly growing population of Saudi Arabia. However, high turnover of expatriate staff and low recruitment of Saudi nationals have led to a serious staff shortage in the professions, particularly of well-qualified and experienced nurses. Nursing leaders need to work to improve the image of nurses and facilitate the recruitment of women into the nursing profession. Reduced working hours and part-time contracts with increased salaries and benefits could attract more young women to the profession, as might the provision of facilities such as private transportation and on-site childcare. Furthermore, establishing a national association for nurses would advance the nursing profession and help to ensure that all nurses undertake fully comprehensive training before entering the workforce.

Keywords: Nursing, retention, recruitment, Saudi Arabia, shortage, workforce

How to cite this article:
AlYami MS, Watson R. An overview of nursing in Saudi Arabia. J Health Spec 2014;2:10-2

How to cite this URL:
AlYami MS, Watson R. An overview of nursing in Saudi Arabia. J Health Spec [serial online] 2014 [cited 2020 Aug 5];2:10-2. Available from: http://www.thejhs.org/text.asp?2014/2/1/10/126058

  Introduction Top

Achieving and maintaining a stable nursing workforce in Saudi Arabia (SA) is a prime concern of Saudi nursing leaders. [1],[2],[3] This paper presents an overview of the nursing workforce in SA, based on a review of relevant literature undertaken as part of a doctoral study, and offers suggestions as to how to address the main challenges facing it.

  The Healthcare System in SA Top

The rapid growth of the population of SA (annually about 3.2%) [4] exacerbates the demands that are placed on the Saudi healthcare system.

The Saudi Ministry of Health (MOH) provides approx-imately 60% of the health services through 244 hospitals (33,277 beds) and 2,037 primary health centres. [2] A health service council, led by the MOH, was established in 2002 to coordinate and integrate health policy among the various health service providers. [5]

  Ministry of Health Top

Residents of SA who work in the public sector are entitled to full access to all health services, while those who work in the private sector should receive health insurance from their employers. [3] Twenty Regional Health Affairs Directorates are responsible for the management of all MOH services, using central standardized guidance from the MOH.

The MOH provides primary, secondary and tertiary healthcare. The first level of care, available through the primary health centres, provides the initial point of contact between a patient and a public health provider. Patients who need additional care and further investigation can be transferred to the second level of healthcare (public hospital). More complex cases are transferred for third-level care to a central or specialised hospital. The MOH response to local demands for more beds and more specialised hospitals has been to establish medical cities-complexes on one campus providing mainly second and third level healthcare.

Medical cities need a different management approach so some public hospitals in various regions, including some medical cities, have been granted autonomy in the hope of increasing managerial and medical efficiency, administrative and financial flexibility and simplifying the contractual process with qualified health professionals.

  Nursing in SA Top

The nursing profession has traditionally had a good reputation in Islam; it was mentioned for the first time during the time of Prophet Muhammad (peace be upon him) when it served the Muslim armies during periods of war. [6] However, despite its long existence in the Saudi community and its respected history in Islam, nursing today is not viewed positively in Saudi culture.

The government's efforts to attract and retain more Saudis in the nursing profession encounter obstacles such as unappealing working conditions, limited options for balancing work and family responsibilities, and the perception of the role of nursing and the poor image attached to it.

The main reasons for not choosing nursing as a profession among Saudi women are to do with cultural values, family disagreement, gender desegregation, the low image of nursing and the night shift. [7] It is, thus, not generally viewed as a suitable profession for women.

  Nursing Education Top

Formal nursing training began in 1954 with a 1-year program. The first Bachelor of Science in Nursing (BSN) was established in 1976. Initially such courses were limited to women; it was only in 2004 that a BSN program for men was established. [8] More recently, new Saudi universities have offered male and female BSN courses. However, nursing courses in SA tend to have low levels of enrolment due to the poor image of nursing compared with other professions. [9]

While Masters' programmes in nursing are offered only to female students, international scholarships offered by governmental organizations enable Saudi nurse leaders and educators to study abroad at Bachelor, Master and PhD levels.

  Nursing Practice Top

Nursing has been represented at the MOH since 1987; however, it was only in 1994 that the MOH established the General Directorate of Nursing. This started to improve the quality of nursing by gathering data about the nursing situation, communicating with nurses in outlying areas, and empowering nursing staff by assigning nursing representation in all 20 health regions.

SA faces a shortage of nurses - the ratio of nurses to patients (36 nurses per 10,000 population) [1] compares unfavourably with, for example, Bahrain (58/10,000), Japan (95/10,000), Canada (100/10,000), and the UK (101/10,000). [10]

During the second Gulf War (1990) many expatriate nurses left the country without notice. This resulted in a staffing crisis that made the policy of "Saudization" a priority. However, Saudization of the profession will take a long time as currently Saudi nationals comprise just 34% of the nursing workforce.

The expansion in inaugurating new health establish-ments to increase health services has led to a dispro-portionate increase in the numbers of beds vis-à-vis the available workforce. The following issues related to staffing have been identified:

  1. The scarcity of qualified Saudi nurses and doctors in the workplace.
  2. The lack of expansion of health education facilities, especially in the field of female nursing, which would address the needs of the health services.
  3. Limited admission to the colleges and institutes of the medical sector, which has led to an insufficiency of output.
  4. Limited opportunities for training and scholarships in the MOH. [10]

  Professional Regulation Top

All nursing staff members have to be registered with the Saudi Commission for Health Specialties. However, the title 'nurse' includes graduates of health secondary institutes (the equivalent of secondary school), health institutes after secondary school, and Health Colleges, as well as graduates from universities (who constitute a small percentage of the Saudi nursing sector). There has been a dramatic rise during the last decade in enrolment into private nursing institutions and community colleges that have not received accreditation.

  Expatriate Nurses Top

The nursing system in SA relies a great deal on ex-patriate nurses, recruited from over 52 countries. Differences in religion, culture, social values and language can create barriers between expatriate nurses and local patients. [7] Expatriate nurses are typically women who come to Saudi for financial, professional or personal reasons (including Muslims hoping to perform the Haj). Typically offered a single contract, most of them are, thus, unaccompanied by partner or family. Contracts cannot exceed 1 year and there is no guarantee of renewal; furthermore, whenever a qualified Saudi nurse is available the contract can be ended without any compensation.

Nurses from western countries tend to be treated more favourably than nurses from elsewhere, in terms of payment and privileges, which causes some nurses to move to developed countries, such as the USA, Canada and the UK, to find a more congenial working environment. [2]

  Discussion Top

Nursing leaders need to work together to improve the image of nurses and facilitate the recruitment of women into the nursing profession. Reduced working hours and part-time contracts with increased salaries and benefits could attract more young women to the profession, as might the provision of facilities such as private transportation and on-site childcare. As the Saudi healthcare system is currently dependent on single, expatriate women, it would be prudent to ensure that their living accommodation and facilities for recreation are of a standard that will encourage them to stay.

The lack of accreditation for private institutions needs to be addressed; all nurses need to have undertaken comprehensive training before entering the workforce. Establishing a national association for nurses would advance the nursing profession.

Finally, nursing research in SA is needed in order to map the dramatic changes facing the health service and the profession, and to evaluate existing nursing practice and address the ambition among health decision makers to implement policies based on evidence-based studies.

  Conclusions Top

The nursing profession in SA is in need of urgent reform to ensure that there are adequate well-trained nurses to provide good quality health care to the Kingdom's growing population.

  References Top

1.Almalki M, FitzGerald G, Clark M. The nursing profession in Saudi Arabia: An overview. Int Nurs Rev 2011;58:304-11.  Back to cited text no. 1
2.Aldossary A, While A, Barriball L. Health care and nursing in Saudi Arabia. Int Nurs Rev 2008;55:125-8.  Back to cited text no. 2
3.Almalki M, Fitzgerald G, Clark M. Health care system in Saudi Arabia: An overview. East Mediterr Health J 2011;17:784-93.  Back to cited text no. 3
4.Central Department Of Statistics and Information. Saudi Arabia Population by Sex and Nationality (Saudi/Non Saudi) in the Kingdom. Riyadh: Saudi Central Department of Statistic and Information; 2012.  Back to cited text no. 4
5.Health Service Council. Health Service Council [Online]. Riyadh: The General Secretary of the Health Service Council; 2012. Available from: http://www.chs.gov.sa/Pages/default.aspx. [Last accessed on 2012 Oct 18].   Back to cited text no. 5
6.Almalki M. Quality of work life and turnover intention in primary healthcare organizations: A cross-sectional study of registered nurses in Saudi Arabia. PhD Dissertation, Queensland University of Technology; 2012.  Back to cited text no. 6
7.Al-Mahmoud S, Mullen P, Spurgeon P. Saudisation of the nursing workforce: Reality and myths about planning nurse training in Saudi Arabia. J Am Sci 2012;8:369-79.  Back to cited text no. 7
8.Omer TY. Leadership style of nurse managers at the Saudi National Guard Hospitals. Ph.D. Dissertation, George Mason University; 2005.  Back to cited text no. 8
9.Gazzaz L. Saudi nurses' perceptions of nursing as an occupational choice: A Qualitative interview study. PhD, the University of Nottingham; 2009.  Back to cited text no. 9
10.WHO. Global Health Observatory (GHO) [Online]. Geneva: World Health Organization 2010. Available from: http://www.who.int/gho/countries/en/. [Last accessed on 2012 Oct 22].  Back to cited text no. 10

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The Healthcare S...
Ministry of Health
Nursing in SA
Nursing Education
Nursing Practice
Professional Reg...
Expatriate Nurses

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