Saudi nurses' perceptions of nursing as an occupational choice: a qualitative interview study

Background: Saudi Arabia has always been dependent on non-Saudi nurses. However, the recruitment of these nurses has been challenged by the consequences of the first Gulf War of 1991 and the political unrest in the Middle East ever since. Moreover, the annual supply of Saudi nursing graduates has been insufficient in meeting the demands of the expanding healthcare services. Indeed, Saudi nurses make less than 30% of the total nursing workforce Kingdom wide. The Saudi literature links the shortage in Saudi nurses to socio-cultural factors found to influence the prevailing negative images and perceived low status of nursing. Hence, I have developed a personal interest to explore the impact of prevalent images and perceived status of nursing on the Saudi nurses’ perceptions of nursing as an occupational choice. The reviewed literature guided the development of a framework for my study using six concepts. Aim: To gain an understanding of the social, cultural, economic and political influences on Saudi nurses’ perceptions of nursing and their impact on recruitment of nursing students and retention of graduates. Method: Sixty eight semi-structured interviews were conducted in Jeddah, Saudi Arabia with a sample of student nurses (n = 38), staff nurses (n = 21) and senior nurses (n = 9) from government and private sectors. A purposive sampling approach increased the likelihood that the variability within nursing was represented in the data. A focus on the inclusion of Saudi male nurses is unusual; it allowed this study to explore gender issues in more depth. The interview guides covered selected concepts derived from the literature. These include: nursing images; status of nursing; perceptions of nursing as an occupational choice; nursing education; gendered-nature of nursing and nursing support systems. Interviews were conducted and transcribed in Arabic and participants were interviewed once. A socio-demographic checklist was filled at the end of each interview. Findings: Findings were presented using three explanatory themes. First, perceptions of nursing suggesting that, against a background of negative gender-related perceptions of nursing, there is an increasing recognition of nursing as a secure occupational choice in a shifting labour market. Second, challenges facing professionalism suggesting that participants acknowledged the importance of achieving a recognised professional status for nursing. Third, dealing with personal struggle suggesting that participants have been experiencing a personal struggle as they were learning to cope with the prevalent negative perceptions of nursing at social and professional levels. Conclusions: Findings from the study provide evidence of a personal struggle female and male participants have been experiencing in their attempts to transcend through shifting gender, social, cultural, economic and global boundaries. A struggle they had to deal with in order to achieve social and professional recognition. Overlooking causes of struggle might risk Saudi nurses’ recruitment into and retention within nursing. A new model for the Saudisation of nursing workforce has been proposed. Policy makers are requested to divert their strategies from focusing only on graduates from the nursing programmes to targeting Saudi school children. They are expected to design and implement Saudisation strategies that aim at changing the prevailing gender-related perceptions of nursing as an occupation among prospect candidates; and building on the nurses’ efforts to achieve professional recognition and integrate success in their career with their personal life