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Internationally, nursing shortage has led to closer scrutiny of either preservation or recruitment of nurses both domestically and worldwide since a large portion of the nursing personnel in nearly all the industry in Saudi Arabia solely depends on the international expatriates. However, in the resent past, recruitment into nursing practices has favored Saudi women. The many implications that are associated with provision of local nursing services and nursing workforce in Saudi Arabia have greatly affected the history and growth of the economy of this nation. This paper therefore tries to follow that path.
The research has contributed to the provision of some insights into nursing pre and post the illumination that accompanied the influence of Prophet Mohammed. In this article we basically put much emphasis on the influence of women leaders who emerged in Mohammed's time and brought or led to a lasting capability to the development of nursing in Saudi Arabia. The paper also highlights on the cultural issues that have blinded women in this society are explicated and related to recruitment and retention issues in nursing. Education concerns, both past and present, are emphasizing the gains that nursing as a distinct occupation has realized. To end with, the paper bring to a close by looking at the contemporary achievements in Saudi Arabia moving nursing towards the much needed professional status and uniformity with other careers in health care practices.
Health care is one of the largest sectors in Saudi Arabia practice in order to assure Saudization. Just like in many parts in the world this industry is one of the biggest areas that require serious attention. The development of this industry, education and healthcare services quickly led to the improvement on the standard of other industrialized countries. Currently, the Kingdom of Saudi Arabia has developed and therefore many of the cultural practices and nursing practices. It is clear that according to history, the nursing profession in Saudi Arabia flourished during the reign of Prophet Mohammed (PBUH) under the guidance of Rufaida Al-Asalmiya.
Generally, it is important to note that (mention of the Prophet Mohammed is followed by acronym PBUH which is the shortened form of Peace Be Upon Him). This is used here to stress the writer’s acknowledgement of the values of Muslim faith. After the demise of the prophet, mention of Saudi nursing has been limited. According to tradition as well as cultural values Saudi women have been deterred from taking part in nursing or employment in general. This paper is likely to explore on the changes and requirements that need to be put in place in order to have the women seek employment (Al-Omar, 2003, p153). This is due to the fact that nursing profession in Saudi Arabia solely depends on the workforce of expatriates.
Therefore, the main rationale of this critique is to look at the historical, cultural, and contemporary influences on the status of women in nursing in the country of Saudi Arabia. The writers scrutinize the historical advancement of female nursing in Saudi Arabia and argue on cultural barriers, limitations, and public pressures that pervade Saudi community and deter women entering into nursing profession. Existing or contemporary practices in nursing education designed to increase the female Saudi nursing workforce are also discussed.
To begin with, the Monarchy of Saudi Arabia issued a royal decree for expatriates’ workforce including their increasing or rising salary (Aboul-Enein, 2002, p829). The decree therefore stated that the Saudi nationals be given the opportunity to acquire education in various areas in employment in order to replace the current employees. Most of non-Saudi men and women from the country have led to an increased concentration in the workforce. In the process of Saudization, healthcare is one of the largest sectors in Saudi Arabia that has showed up. The ministry of health in Saudi Arabia is currently targeting nursing which requires the largest number of employees for recruitment.
The society of Saudi is largely patriarchal, with the male population enforcing strict rules on the population of women. Women therefore have no option but adhere to these rules or codes which are implemented by the male counterparts but it unfortunate because women are reluctant to challenge the men. For the past so many years the role of women according to Saudi male was being mothers and wives. In the recent past, Saudi women have developed the interest of engaging in workplace in many occupations. Although men still dominate most industries, women are also being employed in work places.
Currently women are also coming slowly employed in various health industries as doctors, nurses, and allied health workers. However, many of the Saudi women who have chosen nursing as a profession are faced with various obstacles. These obstacles are primarily based on both social as well as social norms. Nursing as a profession in the health sector, suffers from a very poor image in Saudi community, as the job is considered as worth for maids and illiterate women. On the other hand, women also suffer criticism from family and friends. However, the plights of women taking nursing as a profession in Saudi Arabia are more problematic as compared to men and must be considered in the global nursing community.
Historical Aspect of Nursing in Saudi community
The history of the Saudi community is usually presented within the context of the life of the Prophet Mohammed (PBUH). The following excerpt explains the historical development of nursing in Saudi community beginning from the Islamic period to current times. As the history of nursing run deep to the times when Prophet Mohammed reigned, still the profession did not receive the required respect and also women were not considered in the recruitment processes.
The Islamic Period
Little information can be gathered in relation to nursing in the Pre-Islamic period before 570 AD. In the ancient period, medical systems consisted of doctors who did home-base care and also visited patients at their homes. And therefore, there no need to have nurses. Most of the jobs that were designated to nurses were done by women companions of Prophet Mohammed (PBUH).
Historical information pertaining to nursing profession in the period after the death of Prophet Mohammed during 632 AD is sparse. Some little information can be traced back to commentaries made by physicians. The physician named al-Razi was described as the teacher and a compassionate personality who provided nursing care (El-Sanabary, 2003, p62). Throughout this period, nursing were given the mandate of purely serving food to patients.
Late to Middle Age
During this period, Aabs did contribute by constructing hospitals and came up with new ways of treating sick people. They created a unique feature which spread out across the vast Islamic civilization that led to segregation of female from male. While there have been some kind or relaxation created through segregation in the contemporary times, ethics of some traditional Islamic people propose hospitals and their strategies to reflect these past isolation practices.
Cultural influences on Female Nurses
Contemporary Saudi Society and Women in Nursing
The practices that were brought about by Rufaida together with her female companions conducted within boundaries in the process of attending to sick people. Because of the contributions of Rufaida, exemplary behavior and nursing can turn to be a noble profession for women.
Limitation of women entering nursing profession
As mentioned earlier, nursing is not considered a respectable profession for women in Saudi society, despite long respected historical background of the famous Prophet Mohammed. Saudi Arabia is divided in its view concerning nursing profession and the reason being inadequate financial rewards as well as working hours. The nursing profession according to Saudi Arabia families is not an honorable profession.
Contemporary opportunities and influences for nursing education
According to (Jackson & Gary, 1991, p454), certification of the history of nursing education since the time of Rufaida up to the early 1960s is not dense. In Saudi Arabia, the earliest record of current female nursing education dates back to 1961 when the ministry of health in Saudi launched two women’s institute in cooperation with World Health organization. One was located in the Riyadh-m capital city of Saudi Arabia while the other one was located in Jeddah- the largest seaport and trading center.
The above two institutes whose major objective is educating women to become aides of the nurses, admitted students who had accomplished at least six years of primary school education mainly from non-governmental schools. Parents and students fraught these move with opposition due to the fact that it was going to equip female students to work for many hours far away from their home and incorporation with men. The nurse leaders were prompted by this opposition at the time to endorse interest in this course by bringing public sermons and writing editorials for the popular press. After the agreement that women would remain covered by not working in corporation with male physicians, providing care to female patients alone and not working in the afternoon or during night hours, the ministry of health agreed to support that program.
The education of nurses was expanded to three years and not unlimited to students who had accomplished nine years of school-based education as nursing education developed. A college nursing curriculum to upgrade nursing training and improved the image and status of nursing was invented in the mid-1970s and replaced the lower high school curriculum that originated in the 1960s (Jammal, 1986, p29). Development of nursing education across Saudi Arabia served as an indicator of the rising education and status of women through both its number and acceptance.
The Ministry of Health in Saudi Arabia planned and opened health institutes for both males and females so as to meet the increased country’s health needs. In Saudi Arabia, health institutes are not less than Further Education and Training colleges that provide Nursing Diploma that is not less than Australian Enrolled Nurse. In Saudi Arabia, Saudi health institutes are not similar to the universities due to the fact that they provide Diploma degrees alone. Twenty-seven health institutes were operational in 1975 and this number rose to thirty-two by 1980s.
Bachelor of Science in Nursing was established in 1976 by the college of nursing at King Saud University and introduced a master of science in nursing later in 1987. These curriculums are not unlimited to female students. Consequently, nursing education in Saudi Arabia was made up of two levels by the year 1980. The two levels included technical nurse- graduating from health institutes and the professional nurse- graduating from the university. The technical nurse attained a diploma in nursing after accomplishing three years of study. Licensed Practical Nurse in the United States and an enrolled nurse in Australia can be equated with the Saudi technical nurse. When comparing, the professional nurse accomplished a five year curriculum and warded with Bachelor of Science in Nursing (BSN) on completion.
According to (Aboul-Enein , 2002, p830) the current Saudi nursing workforce was permeated by the two levels- BSN and DN. Normally; graduates of BSN curriculum assume roles of leadership and management in Saudi Arabia immediately after graduation in accordance to the Saudization authorization. The diploma nurses are being phased out slowly in favor of the BSN so as to be in accordance with the global trends. In colleges, diploma degrees are being phased out slowly in favor of the BSN that are being provided by universities.
In addition, a preponderance of Saudi nurses who are holding diploma degrees is undertaking bridging curriculums so as to earn their BSN from numerous universities across the world including Canada, United States, Australia and Britain). Unluckily, there is no availability of modern prevalence statics of the two kinds of nurses.
Nursing today in Saudi Arabia
El-Sanabary (1993, p1342) asserts that in Saudi Arabia, the nursing workforce has been made up primarily of a widespread expatriate population that is both temporary and recurring and that it has been reducing recently. Saudi nurses were made up of nine percent of the total nurse workforce in the year 1996. By 1999, seventeen percent of the total nurse workforce constituted Saudi nationals. The percentage has been increased to eighteen percent by the increase in the Saudi graduates from home-based graduates in the year 2003.
Currently, Saudi nurse graduates have been encouraged to join in higher degree curriculum. Nurses who own higher degree qualifications are the future’s promise thus they will assume leadership position. This has led many Saudi nurses to travel abroad searching earn master’s and doctorial degrees so as to enhance their field of nursing. Some universities including Monash University located in Victoria, in conjunction with King Faisal Specialist Hospital and research center, provide in-country higher degree curriculums. Saudi nationals have been provided with easy and adequate chances by the curriculums to study, be with their relatives and work in their mother country. Some of the objectives that were attained by the Board by the year 2003 include: - Development of structure and organization of the Board - Development of licensure and registration principles - Standardization of technical nursing programs. - Establishment of authorization process Many other additional achievements had been achieved by the end of the year 2004. Many curriculums were established such as bridging curriculum like advanced diploma, and post-basic nursing occupation, pediatrics, critical care and diploma in midwifery (El-Sanabary, 2003, p66). Accreditation principles for nursing services for the function of training nurses were completed. There were accomplishing of development of post-basic specialization curriculum procedures. There was development of the entire nursing positions and updating of nursing examination banks. Currently, dispatch of Nursing Board is still in development process and it has been expected that it will enlarge its focus to comprise of disciplinary principles, practice guidelines, and specialist conduct. All nurses including Saudi or expatriate were to be registered with the Nursing Board by January 2005. There has been an obvious difference of numbers of Saudi nurses against Western nurses across different hospitals. It is envisaged that this disparity will learn favorably towards Saudi nurses being a majority in the future years other than minority in their mother country with the implementation of Saudization.
Some of the objectives that were attained by the Board by the year 2003 include:
- Development of structure and organization of the Board
- Development of licensure and registration principles
- Standardization of technical nursing programs.
- Establishment of authorization process
Many other additional achievements had been achieved by the end of the year 2004. Many curriculums were established such as bridging curriculum like advanced diploma, and post-basic nursing occupation, pediatrics, critical care and diploma in midwifery (El-Sanabary, 2003, p66). Accreditation principles for nursing services for the function of training nurses were completed. There were accomplishing of development of post-basic specialization curriculum procedures. There was development of the entire nursing positions and updating of nursing examination banks.
Currently, dispatch of Nursing Board is still in development process and it has been expected that it will enlarge its focus to comprise of disciplinary principles, practice guidelines, and specialist conduct. All nurses including Saudi or expatriate were to be registered with the Nursing Board by January 2005. There has been an obvious difference of numbers of Saudi nurses against Western nurses across different hospitals. It is envisaged that this disparity will learn favorably towards Saudi nurses being a majority in the future years other than minority in their mother country with the implementation of Saudization.
Professional development programs
The major teaching hospitals in Riyadh provided professional development curriculums candidates who possessed a DN; this was in response to the need for Saudi clinical nurses. A twelve month nurse development curriculum was developed with King Faisal Specialist Hospital with an objective of educating Middle Eastern nurses for a more international level of practice. Professional development program was operated from 1997 to 2001 by King Abdul-Aziz Medical City- Riyadh – initially referred to as the King Fahad National Guard Hospital. This curriculum was aimed at integrating practical and theoretical skills so as to increase the level of Saudi nurse of associate diploma to a level of nursing practice that is similar to other nations such as England, United States, Canada and Australia. These curriculums were transitory and led other developments in the field of nursing education. However, approximately forty-seven associate diplomats- both male and female- graduated and have been employed subsequently as registered nurses throughout Saudi Arabian hospitals. Other graduates of these professional development curriculums have sought to travel worldwide so as to study nursing at the baccalaureate level (Al-Omar, 2003, p155).
Nursing colleges and universities
In 2001, Allied Health sciences and the College of Nursing at the Kind Abdul-Aziz Medical City- Riyadh, commenced and provides Bachelor of Science in Nursing for females who desire to pursue a occupation in nursing referred to as Stream I. furthermore, the college provides BSN for the females who held a bachelor of science degree referred to as stream II, before. It is envisaged that the college will provide bridging curriculums in future for those who hold a diploma or associate degree in nursing and postgraduate training.
Currently, nursing education has remained the dispatch of the health’s industry and the ministry of education. While the ministry of health is accountable for the health institutes curriculums aimed at both men and women, the ministry of education supervises the university and college curriculums for women alone. Differential preparation carried out on gender has been viewed that they are hindering this technical graduate’ integration into multicultural hospital setting. Quite a number of institute gradates are demoted to functioning barely not below a nurse assistant. Therefore, there is disadvantaged and under utilized due to already inadequate Saudi nurses.
The decreasing opposition to women’s education in Saudi Arabia is diminishing. However, nursing is still experiencing challenges which hamper its development and lessen its appeal to young Saudi women. It is worth noting that there is an increase in number of women who are entering g the profession despite the continuing negativity. It is apparent that as these women acquire clinical skills and critical thinking their awareness of the barriers which obstruct the development of nursing also grows. A contrasting situation could be like in Rufaida where nurses don’t have the backing of the religious sector. In order to be accepted in the society they are supposed to really prove that they are able to work under the limitation of the traditional Islamic boundaries. In addition to that, they are expected to embrace family honor as they engage professionally with others. This group includes both men and women in the affected population.
Saudi Arabia became independent in September, an indicator that it is still a young country. The rapidly growing population results into demand for healthcare facilities and services thus the need for the professional nurses. Comparatively, the nursing profession in Saudi Arabia is at infancy stage thus the need for patient nurturing and acceptance. The degree of self confidence in the nurses has increased especially in their demands for equitable recognition in the health care system. This has been shown with the willingness to voice out their concerns. However, archaic and traditional nursing services still exist. Presently, Saudi nurses still strive for professional independence and in turn a growing influence in nursing. This therefore also affects the participation and presence in all the levels of decision making and health policy in general.
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