Strategies to address the nursing shortage in Saudi Arabia

Clinical nurse managers' leadership styles and staff nurses' work engagement in Saudi Arabia: A cross-sectional study

BACKGROUND

Effective nurse leadership enhances nurse welfare, improves patient care, and increases organisational success. A lack of adequate, supportive leadership significantly contributes to many nurses leaving the profession. Nurse managers need to prioritise engagement and retention as significant focus areas to address the nursing shortage in Saudi Arabia and accomplish the national program's objectives.

AIM

To examine the correlation between the leadership styles of clinical nurse managers and staff engagement.

METHOD

This study used a descriptive, cross-sectional, correlational design. The leadership styles of clinical nurse managers were evaluated using the Multifactor Leadership Questionnaire (MLQ-5X). Work engagement was assessed using the Utrecht Work Engagement Scale (UWES). Questionnaires were distributed to 450 nurses in four public hospitals in western Saudi Arabia. Non-probability convenience sampling was used to collect the data.

RESULTS

A total of 278 nurses from a range of clinical areas participated in the survey, which revealed that the leadership styles of clinical nurse managers positively or negatively impact nurse work engagement. Most clinical nurse managers exhibit transformational leadership, followed by transactional, then passive-avoidant styles. Respondents displayed a high level of work engagement, emphasising the positive impact of transformational and transactional leadership on work engagement outcomes. The findings showed significant differences in leadership styles and work engagement levels between Saudi and non-Saudi nurses across various dimensions.

CONCLUSION

Understanding the effect of leadership styles employed by nurse managers on work engagement can positively impact staff retention rates and the quality of patient care. Nurse managers should participate in training programs to enhance their practical leadership skills to enhance the work engagement levels of nurses.

IMPLICATION

Nurse work engagement can be improved by establishing training programs that promote effective leadership and highlight the significance of various leadership styles and their subsequent impact on nurse work engagement. Nursing students should receive education on leadership styles. Nursing leaders should be given access to mentoring programs and opportunities for career advancement to support the introduction of effective leadership styles.

Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study

Background

The transition of nursing education from traditional methods to more advanced approaches is crucial for adequately preparing students to deliver competent care in tertiary care centers. Moreover, clinical faculty in nursing plays a key role in guiding nursing students through their clinical training in various healthcare settings.

Purpose

This study aims to describe the perceptions of undergraduate nursing students regarding the effectiveness of the learning environment and clinical teaching in clinical areas across various countries.

Methods

The study, conducted using a descriptive, cross-sectional research design, gathered data from 215 nursing students using the Clinical Learning Environment Inventory and Clinical Teaching Effectiveness Instrument. Data analysis included frequencies, percentages, mean, standard deviation, t-tests, analysis of variance, and correlation assessments to comprehend the impact of clinical teaching and learning environments.

Results

Nursing students' perceptions of the clinical learning environment produced mean scores between 2.03 and 3.38 on a scale from 1 to 4, resulting in an overall mean score of 2.72 across 42 items. This indicates a general satisfaction with their clinical learning experiences. Regarding effective clinical teaching, the mean student responses varied from 3.02 to 3.40 out of a possible 5 points, with a total mean of 3.22. The study revealed notable correlations in the context of effective clinical teaching, particularly with demographic variables and the clinical learning environment. Specifically, a significant correlation with age (r = .177, p = .009) and the clinical learning environment (r = .572, p < .001) was identified.

Conclusion

The study concludes that students expressed overall satisfaction with their clinical learning experiences. They recognized the importance of participating in clinical training, fulfilling clinical responsibilities for assigned patients, exerting extra effort for learning, receiving support from preceptors in clinical settings, and being attentive to communications from staff. The collaboration between clinical preceptors and academic nursing lecturers is crucial in providing a positive learning environment for students to complete clinical tasks effectively.

Do internship students do well in a clinical environment? A qualitative naturistic study

Background

The internship year marks the culmination of the nursing program across all Saudi universities, bridging theoretical learning and practical application. The significance of the internship year lies in the application of skills acquired during the preceding years of study. Understanding interns' experiences, identifying influences, and sharing their recommendations for best practices become crucial.

Objective

This study aimed to explore the experiences of internship students and address the challenges they encountered in a clinical environment.

Methods

A qualitative naturistic descriptive approach was employed, involving 20 purposively selected participants from internship students in two regions in Saudi Arabia. Data were collected in January 2023 through semi-structured interviews, focus group discussions, and observation. A conventional content analysis approach was used for data analysis.

Results

Four major themes were generated: 1) Transferring Shock, 2) Self-Learning, 3) Supportive Environments, and 4) Factors Facilitating Learning. Transferring Shock comprised two subthemes: feeling lost and feeling left out.

Conclusion

Internship students acknowledged the utility of orientation and mentorship programs in advancing the practical skills of new nurses and enhancing patient safety. The findings also indicated that those with prior preparation and robust communication skills reported a positive experience. Consequently, integrating communication courses into the nursing education curriculum could be beneficial. Establishing a supportive learning environment for nursing interns is imperative to address challenges and ensure the delivery of safe and effective patient care.

Estimating the number of required nurses in different types of hospitals: An application of the workload indicators of staffing needs (WISNS) method

BACKGROUND

Health system performance depends on the availability, accessibility, acceptability, and quality of health workforces. Policymakers seek whether the number of nurses is optimally matched based on patients' needs. This study aimed to assess the workforce stock, workload activities, activity standards, and workload pressure to determine the number of required nurses in different types of hospitals in Iran.

METHODS

This study applied the workload indicators of staffing needs (WISNs) method and was conducted in 22 surgical and internal medicine wards at five hospitals in the southwest of Iran during six months. A time-motion study, and several group discussions, interviews were used to extract the required data. Descriptive statistics were used for data analysis.

RESULTS

All selected hospitals faced nursing shortages. The highest shortage (-47) and workload pressure (WISN ratio 0.45) were observed in the general-educational hospitals. In the specialized hospitals, the workload pressure was high (WISN ratio 0.49). The lowest shortage belonged to the private hospital. Based on our assessment, in all of the hospitals, nurses typically worked overtime due to high workload. The studied hospitals covered an average of 25% of their shortage with nursing overtime working. We noted that nurses were predominantly occupied with health service and supportive activities (≈90% of their time).

CONCLUSIONS

Based on the WISN method, all of the hospitals faced nursing shortages from moderate to high. However, it would be essential to consider current labor market analysis based on accurate data to adopt appropriate policies in HRH planning.

Illness Anxiety Disorder and Distress among Female Medical and Nursing Students

Objective

This study aims to compare the prevalence of illness anxiety disorder (IAD) and distress between medical and nursing students and examine their associations with students' characteristics.

Methods

Cross-sectional data were collected using the Short Health Anxiety Inventory (SHAI, for measuring IAD) and the Medical Students' Disease (MSD) Perception and Distress Scales.

Results

Two hundred and sixteen Medical students and 250 Nursing students were recruited from a public female university in Saudi Arabia. Their mean age was 21.27 years. The findings showed that the overall prevalence of IAD (SHAI scores ≥18) among the total sample was 38.8%, with a significantly lower prevalence in medical students compared to the prevalence in nursing students (57.2% vs 17.6%, respectively, X2=45.26, p<.001). Nursing students had significantly higher SHAI scores and lower MSD Perception scores than medical college students, but there were no significant differences among them in the MSD Distress scale. Significant differences in the main study variables scores were reported among nursing students but not among medical students, with the fourth-year level nursing students having higher SHAI and lower MSD Perception and perception scores than other nursing students.

Conclusion

The highlights that medical and nursing students are susceptible to developing anxiety-related disorders and distress that may have negative impacts on their academic achievements and future careers. Both nursing and medical faculty should help in identifying strategies to support the students' mental health and well-being.

Barriers to conducting and publishing research among nursing faculty members at Shaqra University, Saudi Arabia: A qualitative study

AIM

To identify barriers to conducting and publishing research among nursing faculty members at Shaqra University, Saudi Arabia.

DESIGN

A qualitative descriptive design was used.

METHODS

This qualitative descriptive study was conducted on 12 nursing faculty members from two nursing colleges at Shaqra University, a public university located in Riyadh region, SA, under the supervision of the Ministry of Education. Data were collected between September and October 2021 using semi-structured interviews and analysed thematically using content analysis.

RESULTS

Three themes emerged in the study, namely (I) individual/personal barrier, (II) institutional barrier and (III) external factors. Barriers to conducting and publishing research included lack of time due to a high teaching load and lack of administrative and financial support. The present findings suggest that nursing faculty members in SA are facing many barriers hindering them from carrying out and publishing research activities. Such barriers need to be urgently addressed through different strategies, including allocating facilities and funds for research, motivating faculty members towards research, and ongoing education and training on research.

Levels and predictors of nurses' knowledge about diabetes care and management: disparity between perceived and actual knowledge

BACKGROUND

Nurses have a crucial role in managing, educating, and caring for diabetic patients. However, their knowledge should be regularly assessed to avoid preventable complications and reduce costs. Therefore, the present study assessed the perceived and actual knowledge about diabetes among nurses in Hail province of Saudi Arabia and investigated predictors of such knowledge.

METHODS

A cross-sectional study was conducted among 325 conveniently sampled nurses from all public hospitals and primary healthcare centres in Hail province from September to December 2022. A pre-designed questionnaire was used to collect demographic and practice-related characteristics of the nurses. In addition, data on nurses' perceived and actual knowledge about diabetes were collected using the Diabetes Self-Report Tool (DSRT) and Diabetes Basic Knowledge Tool (DBKT) self-report questionnaires, respectively. The mean knowledge scores for demographic and practice-related variables were compared using the independent-samples t-test and one-way analysis of variance. Multiple linear regression was used to identify significant predictors of perceived and actual knowledge. The correlation between perceived and actual knowledge was investigated using Pearson's correlation coefficient. A P-value ˂0.05 was considered statistically significant.

RESULTS

Based on a highest maximum score of 60 using the DSRT, the mean score of perceived knowledge was 38.4 ± 12.0, corresponding to a percentage mean score of 64%. On the other hand, based on a highest maximum score of 49 using the DBKT, the mean score of actual knowledge was 23.2 ± 9.6, corresponding to a percentage mean score of 47.3% of correct responses. Being Indian, having a diploma or a bachelor's degree, and having a poor or fair self-perception of competence in diabetes care were predictors of lower perceived knowledge scores, whereas having no access to diabetes guidelines was a predictor of higher scores. However, being non-Saudi and having experience of at least 16 years were predictors of higher actual knowledge scores. The correlation between actual and perceived knowledge about diabetes was negligible and statistically non-significant (r = 0.011, P = 0.055).

CONCLUSION

Nurses affiliated with public health facilities in Hail province lack adequate knowledge about diabetes, with no correlation between what is perceived to be known and what is actually known. Indian citizenship, having a diploma or bachelor's degree, not having access to diabetes guidelines, not attending courses/workshops, and having a poor or fair self-perception of competence in diabetes care can significantly predict nurses' perceived knowledge. However, being non-Saudi (Filipino or Indian) and having at least 16 years of experience can significantly predict their actual knowledge of diabetes.

Professional identity, job satisfaction, and intention to stay among clinical nurses during the prolonged COVID-19 pandemic: A mediation analysis

AIM

This study aims to examine the relationship between professional identity and job satisfaction and their impact on intention to stay among clinical nurses in China during the prolonged COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted from April 30 to May 25, 2021, in China. Data were collected using professional identity, job satisfaction, and intention to stay questionnaires from 1425 clinical nurses. A single mediation analysis was utilized to test the interrelationship among the variables, and the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist as a reporting guide.

RESULTS

Nurses indicated a medium level of professional identity, job satisfaction, and intention to stay, with mean scores of 3.85, 3.25, and 3.47, respectively. The professional identity displayed positive indirect effect on nurses' intention to stay through job satisfaction (indirect effect = 0.498, 95% CI [0.439, 0.558]).

CONCLUSION

Cultivating professional identity among nurses can increase their job satisfaction and ultimately enhance the intention to stay in the nursing profession. However, this study also suggests paying more attention to job satisfaction to keep nursing retention. These may be helpful to retain the nursing workforce.

The relationship between practice environment, job satisfaction and intention to leave in critical care nurses

BACKGROUND

Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID-19) travel restrictions have exacerbated this staffing issue.

AIMS

To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA.

DESIGN

Cross-sectional correlational (observational) design.

METHODS

Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted.

RESULTS

A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M = 2.89, SD = 0.44); however, nurse participation in hospital affairs (M = 2.83, SD = 0.47) and staffing and resource adequacy (M = 2.88, SD = 0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs = .287, P < .01). A significant negative relationship was found between NPE and ITL (rs = -0.277**, P < .01). However, job satisfaction was associated with ITL (rs = -.007, P = .930).

CONCLUSIONS

Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff.

RELEVANCE TO CLINICAL PRACTICE

Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay.

A systematic review study on the factors affecting shortage of nursing workforce in the hospitals

AIM

This study aimed to determine factors that influence the nursing workforce shortage and their impact on nurses.

DESIGN

This study applied a systematic review design.

METHODS

Using Cochrane library guidelines, five electronic databases were systematically searched (Research 4life-PubMed/Medline, Scopus, Embase, CINAHL) from 2010-2021. The remaining articles with pertinent information were presented in a data extraction sheet for further thematic analysis. A Reporting Items for Systematic Reviews and Meta-Analysis Flow Diagram was adopted and used. The studies published from 2010-2021 and in English language were examined and included in the systematic review.

RESULTS

Four themes were identified as factors influencing the nursing workforce shortage, including Policy and planning barriers, Barriers to training and enrolment, Factors causing nursing staff turnover and Nurses' stress and burnout. Nursing workforce shortage is a global challenge that roots in multiple causes such as individual, educational, organizational and managerial and policy-making factors.

Personal and Job-Related Factors Influencing the Work Engagement of Hospital Nurses: A Cross-Sectional Study from Saudi Arabia

This study explored the levels of work engagement and identified whether personal and job-related factors influenced the work engagement dimensions of vigor, dedication, and absorption of nurses working in a Saudi hospital. A descriptive, cross-sectional correlational survey of nurses in inpatient wards (general medical, surgical, and specialized wards) and critical care units in a tertiary hospital in Saudi Arabia, using The Utrecht Work Engagement Scale. Using a self-report questionnaire, 426 staff nurses and 34 first-line nurse managers were surveyed. Data collected consisted of selected personal and professional factors, including gender, age, education, current work setting, years of experience, nationality, and participation in committees, and/or work teams alongside the 17-item version of the UWES. The study participants showed high levels of work engagement. Age, years of experience, and participation in committees were significantly associated with work engagement. Nurses who were older, possessed more experience, and participated in committees showed higher levels of engagement. Healthcare organizations and their leaders, policymakers, and strategic planners should create a conducive work environment that supports the work engagement of nurses by considering the influencing antecedents. The nursing profession, patients' safety issues, and vital economic problems are the fundamental issues facilitated by the creation of practice environments that entirely engage nurses in their work.

Culture, religion, language and the assessment and management of children's pain by expatriate nurses in Saudi Arabia: A qualitative study

PURPOSE

Unrelieved pain among hospitalized children is a common problem that affects all aspects of children's health and their quality of life. Cultural and language differences between nurses and patients have been shown to impact the quality and safety of nursing care and management for children with pain. The aim of this study was to identify the cultural factors, barriers, and facilitators impacting the assessment and management of children's pain by expatriate nurses in Saudi Arabia.

DESIGN AND METHODS

A qualitative descriptive design was employed in this study. A sample of 16 nurses was conveniently recruited and interviewed through face-to-face semistructured interviews. Each interview lasted between 30 and 60 min and was audio-recorded. Content analysis was used to analyze the transcripts. Transcripts were carefully read, significant statements were highlighted, coded, categorized, and clustered thematically.

RESULTS

Three main themes were identified, namely, (I) low priority of children's pain, (II) culture and religious challenges, and (III) communication challenges.

PRACTICE IMPLICATIONS

Cultural and language differences described by expatriate nurses hindered their care of children with pain. A systematic education for expatriate nurses, children, and families is urgently needed to enhance inter/cross-cultural understandings and improve childcare in Saudi Arabia. This study identifies the unique challenges faced by expatriate nurses in Saudi Arabia. The findings reveal how a lack of knowledge about cultural values and beliefs can lead to misunderstandings and conflicts between nurses, children, and families and can have an impact on childcare and pain. It also highlights the need to improve pain management practices in multicultural healthcare settings, similar to those of Saudi Arabia and neighboring Arab nations, and across the globe.

Followership in nurses working in Saudi Arabian hospitals: A cross-sectional study

AIM

To explore the followership styles and their associations with nurses' sociodemographic profiles in Saudi Arabia.

BACKGROUND

In Saudi Arabia, nurses' role is seen as less important and passive. However, whether they were actually passive followers has not been examined. No previous research has examined nurses' followership styles in Saudi Arabia.

METHODS

This cross-sectional study used a convenience sample of nurses. The Kelley followership questionnaire-revised was used to determine the prevalence of the five followership styles. Participants' demographic characteristics, which included age, gender, nationality, education level, years of experience, and role, were collected to investigate their associations with followership styles. An online survey was designed and distributed using SurveyMonkey®. Data were analyzed with logistic regression and expressed as odds ratios.

RESULTS

This study included 355 nurses. Findings revealed that the predominant followership style was exemplary (74%), followed by the pragmatist (19%), conformist (4%), and passive styles (3%). Logistic regression analysis revealed that expatriates, higher education, and a leader role had an independent association with an exemplary followership style. Male gender was associated with a passive style. Younger age, male gender, Saudi Arabian nationality, undergraduate qualification, no previous leadership experience, a follower role, and fewer years of experience increased the odds of having a pragmatist style.

CONCLUSION AND IMPLICATIONS

Followership styles were influenced by sociodemographic and work-related factors. Young nurses with less experience tend to be pragmatist followers. Nursing managers should integrate followership styles when planning leadership and team development courses to ensure maximum team effectiveness as leadership and followership are interdependent.

The influence of authentic leadership on nurses' turnover intentions and satisfaction with quality of care in Saudi Arabia: A structural equation modelling study

AIM(S)

The study aimed to test a model that examined the relationships between authentic leadership, psychological safety, work engagement and team effectiveness and subsequent effects of team effectiveness on job turnover intentions and nurse satisfaction with quality of care.

BACKGROUND

Nurse leaders who exhibit authentic leadership have been shown to contribute to the development of healthy work environments. In workplaces with demonstrated authentic leadership, nurses are more engaged and have lower job turnover intentions.

METHOD(S)

A non-experimental, cross-sectional design was used to test the hypothesized model via structural equation modelling. A total of 456 nurses were included.

RESULTS

Structural equation modelling analysis indicated a good fit for the hypothesized model. Authentic leadership had a positive, significant and direct relationship with team effectiveness, nurses' work engagement and psychological safety. Team effectiveness was found to be negatively related to job turnover intentions but positively related to nurse satisfaction with quality of care.

CONCLUSION(S)

Results of this study may help nursing leaders have a better understanding of the essential role of leadership style in increasing healthy work environments.

IMPLICATIONS FOR NURSING MANAGEMENT

Applying authentic leadership style in nursing practice could help to reduce the shortage of nurses stemming from the high turnover intentions of nurses.

Organizational culture and readiness for evidence-based practice in the Kingdom of Saudi Arabia: A pre-experimental study

AIM

This study aims to establish postgraduate students' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces in the Kingdom of Saudi Arabia.

BACKGROUND

Nurse shortages and a reliance on a transient nurse workforce have long been a challenge in the Kingdom of Saudi Arabia. Developing a home-grown nurse workforce, a key objective of the Government of Saudi Arabia, can help to address this. Evidence-based practice offers a mechanism to address this. Evidence-based practice implementation is heavily reliant on the prevailing organizational culture. Establishing the organizational culture and readiness for evidence-based practice is crucial for sustainable evidence-based practice implementation.

METHODS

A pre-experimental pilot study collected data from the same participants at three different points. As part of this, a questionnaire measuring organizational culture and readiness for evidence-based practice was administered twice. Descriptive, inferential and correlational statistics were employed to analyse the data.

RESULTS

Results demonstrated improved participant perceptions of the organizational culture and readiness for evidence-based practice of their workplaces between the first (M = 76.58, SD = 19.2) and second (M = 92.10, SD = 23.68) data collection points, indicating moderate movement towards a culture of evidence-based practice. Strengths, challenges and opportunities for improvement were identified.

CONCLUSION

This study established participants' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces, affording insight into context-specific strategies to embed evidence-based practice in health care organizations.

IMPLICATIONS FOR NURSING MANAGEMENT

Assessing an organization's culture and readiness for evidence-based practice (EBP) can afford insight on the strengths, challenges and opportunities that exist to equip nurse managers to advance evidence-based practice at individual, professional and organizational levels. This study demonstrated the importance of promoting an environment conducive to EBP and putting in place the necessary resources to support evidence-based practice implementation. Nurse managers can play a central role in this.

Healthcare providers' attitudes, beliefs and barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in Saudi Arabia: a cross-sectional study

OBJECTIVES

To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral.

DESIGN

A cross-sectional online survey consisting of nine multiple-choice questions.

SETTINGS

Saudi Arabia.

PARTICIPANTS

980 HCPs including nurses, respiratory therapists (RT) and physiotherapists.

PRIMARY OUTCOME MEASURES

HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia.

RESULTS

Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was 'mobility affected by breathlessness' (64%), while the 'availability of PR centres' (61%), the 'lack of trained HCPs' (52%) and the 'lack of authority to refer patients' (44%) were the most common barriers to referral.

CONCLUSION

PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers.

Nurses' Perception of, and Barriers to, Delivering Cardiopulmonary Rehabilitation for Heart Failure Patients: A National Survey in Saudi Arabia

BACKGROUND

Heart failure (HF) patients require a holistic management approach to improve their clinical outcomes. Cardiopulmonary rehabilitation (CR) is a core component of HF patients' management and is supervised by a multidisciplinary team including nurses. Nursing attitudes regarding CR delivery for patients with HF and the possible barriers and factors that potentially affect referral have not been explored. Therefore, this study seeks to evaluate nurses' attitudes towards the delivery of CR programs and the possible barriers and factors that potentially influence the decision for a referral.

METHODS

An online survey with eight multiple-choice items was disseminated to all nurses between February and July 2022 in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables.

RESULTS

Overall, 1056 nurses completed the online survey, of which 395 (37.40%) were male. Out of 1056 nurses, 414 (39.20%) strongly agreed that CR would improve patients' physical fitness, and 392 (37.10%) strongly agreed that CR would reduce breathlessness in patients with HF. In total, 381 nurses strongly agreed (36.10%) that CR would improve HF patients' palpitation and fatigue. Out of 1056 nurses, 396 (37.50%) strongly agreed that CR would improve HF patients' ability to perform daily activities, and 326 (30.90%) strongly agreed that CPR would reduce the rate of hospital readmission. The at-home program was the preferred mode of delivering CR programs among 607 (57.50%) nurses. Apart from the exercise component, symptom management was perceived by 704 (66.70%) nurses as the fundamental component of CR programs. The most common patient-related factor that strongly affected the decisions regarding referral was "mobility affected by breathlessness" (57%). A lack of CR centers (46%) was the most common barrier.

CONCLUSION

Nurses perceived CR as an effective management strategy for HF patients. Although a home-based program, with symptom management being an essential component, in addition to the exercise component, was perceived as the preferred mode of delivery, CR centers are lacking, which represented a significant barrier to CR referral from the nurses' perspective.

An Overview of Missed Nursing Care and Its Predictors in Saudi Arabia: A Cross-Sectional Study

Background

Nursing care is holistic, and missing any aspect of care can be critical to patients' health. However, due to the complex and intense nature of the nursing practice, nurses have to unintentionally prioritize some activities, forcing them to omit some aspects of nursing care.

Aim

To explore the dimensions of missed nursing care and its predictors within the Saudi Arabian healthcare system.

Methods

Quantitative, cross-sectional study used the MISSCARE survey by utilizing nonprobability convenience sampling to collect the data of 604 staff nurses working in inpatient wards in Jazan, Saudi Arabia.

Results

The overall mean of missed nursing care is (m = 1.37, SD = 0.45). Missed nursing care activities were mostly failure to attend interdisciplinary care conferences (m = 1.66, SD = 0.96) and patient ambulation thrice a day (m = 1.63, SD = 0.97). Missed nursing care was mainly caused by human resource shortage (m = 3.53, SD = 0.88). Missed nursing care is predicted by the turnover intention (B = 2.380, t = 3.829, p < 001) and job satisfaction (B = −0.864, t = −4.788, p < 001).

Conclusion

Although missed nursing care is evident in Saudi Arabia, it is significantly lower than the international rates, and it is mainly caused by labor resource shortage which directly influences nurses' job satisfaction and intention to leave. Optimizing the recruitment process, resource allocation and effective nurses' retention programs are proposed solutions that may be beneficial to mitigate missed nursing care.

Perception towards nursing profession: A comparative study between Sudanese, Yemeni and Egyptian communities.. [DOI: 10.21203/rs.3.rs-2119216/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Communities’ perception is one of the most important factors in the development of the nursing profession. The purpose of this study is to identify the perception of Arabic communities (Sudan, Yemen, and Egypt) towards the nursing profession. Methods: A descriptive comparative study was used to identify the perception of Arabic communities (Sudan, Yemen, and Egypt) towards the nursing profession. The study was conducted in three Arabic countries (Sudan, Yemen, and Egypt) using an online approach by sending the link of questions to the targeted population using emails, WhatsApp, and social media. There were 529 participants from the three Arabic countries. Results: Almost 75.6% of the participants were less than 40 years, and most respondents (82.9%) were between 21 to 30 years old. There was a generally positive perception towards the nursing profession among these communities: 97.6% of Sudanese, 94.9% of Yemenis, and 96.1% Egyptian. There was a borderline statistical significance between the Sudanese and Egyptians' age and their perception toward their profession. Conclusions: Overall, the perception of Sudanese, Yemeni, and Egyptian communities towards the nursing profession is acceptable. The only influencing factor on the level of perception was Egyptian females who have high positive perception towards the nursing profession and Sudanese males who have high positive perception towards nursing profession We recommend further research to assess the perception towards nursing from different sociocultural backgrounds and on a larger sample size.

Turnover-attachment motive of Saudi Arabia nursing workforce: A Cross-Sectional study

AIM

This study aimed to explore the association of turnover-attachment motive with socio-demographic data among Saudi and foreign nurses in a hospital in the Eastern Province of Saudi Arabia.

METHODS

A cross-sectional correlation study was conducted among n = 180 registered Saudi and foreign nurses working at a private tertiary hospital in the Eastern Province, Saudi Arabia. The turnover-attachment motive survey was used to evaluate the eight motivational forces. Data were analysed using JASP version 16 statistical software and Orange 3 version 3.26.0. The data were subjected to correlation analysis and multiple linear regression.

RESULTS

Only 8% of participants were identified with a high intention to leave driven by alternative, behavioural, normative and constitutive forces. Younger healthcare workers tend to have higher intentions to quit the job; the 29-33 age group has a statistically significant negative effect, increasing intention to leave. It was found that those with 5-6 years of clinical experience at Dr. Sulaiman Al Habib Hospital, Al Khobar and no experience abroad had statistically significantly lower intention to leave.

CONCLUSION

This study presented the factors influencing nursing staff to stay or leave work in a hospital in the Eastern Province of Saudi Arabia that can be a basis for reviewing existing policies and procedures to improve nurses' working conditions.

A phenomenological exploration of nurse educators' roles in Saudi Arabia's Vision 2030

AIM

The purpose of this study is to examine the roles of nurse educators through the eyes of undergraduate and graduate students at selected Saudi Arabian universities in the context of Vision 2030, an initiative to transform the socio-economic reform plan that is opening Saudi Arabia worldwide based on the following three pillars: a vital society, a thriving economy and an ambitious nation.

BACKGROUND

Nursing education in Saudi Arabia has faced numerous obstacles due to cultural, educational, organizational and work-related factors, discouraging registered nurses and students enrolled in undergraduate and graduate programmes from pursuing career paths in nursing education.

METHODS

Descriptive phenomenology was used as the method. Twenty-two nursing students from selected government and private universities in Saudi Arabia's Eastern Region were recruited through purposive sampling and semi-structured in-depth interviews. The COREQ criteria list was adapted to report the study's findings.

RESULTS

Four themes emerged regarding how nursing students perceived nurse educators' roles, including philanthropists of learning, advocates for patient safety and quality service, proponents of individual transformation and beacons of hope for nursing's future.

CONCLUSION

Despite rapidly changing images, ideologies and perceptions of modernization and worldwide freedom of expression and speech, students continue to have positive perspectives on nurse educators' roles.

IMPLICATIONS FOR NURSING MANAGEMENT

The study's findings will provide an initiative for nurse managers and leaders to revisit the roles of nurse educators in moulding future generations of registered nurses and realign these roles towards the goals and objectives of Saudi Vision 2030.

Physicians' Attitudes, Beliefs and Barriers to a Pulmonary Rehabilitation for COPD Patients in Saudi Arabia: A Cross-Sectional Study

This study aimed to assess physicians’ attitudes toward delivering pulmonary rehabilitation (PR) to chronic obstructive pulmonary disease (COPD) patients and identify factors and barriers that might influence referral decisions. Between September 2021 and January 2022, a cross-sectional online survey was distributed to all physicians in Saudi Arabia. A total of 502 physicians completed the online survey, of which 62.0% (n = 312) were male. General physicians accounted for 51.2%, while internal-medicine specialists and pulmonologists accounted for 26.9% and 6.6%, respectively. Only 146 (29%) physicians had referred COPD patients to a PR program. The difference in referral rates between all specialties (p = 0.011) was statistically significant. Physicians with more years of experience were more likely to refer COPD patients to PR (p < 0.001). Moreover, a home-based PR program was preferred by 379 physicians (75.5%), and 448 (89.2%) perceived smoking cessation as an essential component of PR. Availability of PR centers (69%) was the most common barrier for not referring patients to PR. The overall referral rate was low among all physicians, owing to a lack of PR centers and trained staff. Home-based delivery was the preferred method of delivering PR, with smoking cessation as an essential component.

The experience of novice nurse faculty in Saudi Arabia

OBJECTIVES

To understand the experience of novice nurse faculty members in Saudi Arabia and the influences on novice nurse graduates in their academic role.

METHODS

A qualitative descriptive study grounded in naturalistic inquiry was used to better understand the experience of novice faculty in Saudi Arabia. Purposive sampling was used to recruit 10 novice nurse faculty from nursing schools in Saudi universities. Data were collected until saturation was achieved. The researcher interviewed participants using a video conferencing platform, and all interviews were digitally audio-recorded. Content and thematic analysis were used to analyze the data.

RESULTS

There were four major themes: teaching on a peninsula, navigating in the dark, grappling with the faculty role, and working hard to create hope for a better tomorrow.

CONCLUSIONS

The findings add to the literature regarding the novice faculty experience, self-confidence, and the strategies needed to enhance their teaching performance.

The Prevalence and The Relationship of Workplace Bullying and Nurses Turnover Intentions: A Cross Sectional Study

Introduction: Sustaining a healthy work environment is a major challenge for health care organizations worldwide. Nursing professionals are often exposed to workplace bullying, which imposes serious challenges to nursing retention. Objectives: To determine the prevalence of workplace bullying and turnover intention among nurses, and to investigate the relationship between workplace bullying and nurse turnover. Methods: A cross-sectional correlational design. Convenience sampling was applied, whereby 347 nurses working in a tertiary medical city in Riyadh, Saudi Arabia, were recruited. Data were collected using the Negative Acts Questionnaire and the Anticipated Turnover Scale. Results: The rate of workplace bullying was high, bullying occurred at a cumulative rate of 33.4% (n = 116). Work related bullying behaviors formed the most common bullying acts with (34.5%) followed by personal bullying with (31.1%) meanwhile physical intimidating accounted by (25.6%). Among the participants, 31.7% exhibited a high turnover intention. The demographic variable age was revealing an inverse correlation with workplace bullying. There was a positive significant correlation between workplace bullying and turnover intentions (r = .24, p < 0.01). Conclusion: The alarming prevalence of both bullying and turnover intention among participants confirms that when nurses are exposed to workplace bullying, they are more likely to demonstrate an increased intention for turnover. Managers are urged to use proper enforcement of anti-bullying policies along with education and training to create a healthy environment and mitigate workplace bullying.

An integrative review of nursing leadership in Saudi Arabia

Aims

The aims of this integrative review were to describe leadership styles from the nursing literature in Saudi Arabia and to identify the current state of evidence about relationships between leadership styles and nurse, patient and organization outcomes in Saudi Arabia.

Design

Integrative review was used as a design for this study.

Methods

The following search terms were used with databases: ‘Saudi Arabia’, ‘leadership theory*’, ‘leadership style*’, ‘leadership model*’, ‘management style’ and ‘nurse*’. Methodological quality was assessed using two different quality rating tools for quantitative and qualitative studies. Databases used for this review included Nursing & Allied Health Database, Cochrane Database of Systematic Reviews, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science and ProQuest Dissertations & Theses.

Results

Nine manuscripts representing eight studies were included in this review. The papers reviewed included quantitative (n = 6), qualitative (n = 2) and mixed methods studies (n = 1). Results were grouped into different themes, identified as nursing leadership styles in Saudi Arabia, leadership styles and nurses' outcomes, and demographics and leadership styles.

A pre-experimental pilot study exploring EBP Beliefs and EBP Implementation among post-graduate student nurses in Saudi Arabia

AIM

This study aimed to measure the impact of a dedicated EBP module on the knowledge, skills and capability for EBP of students undertaking the inaugural MSc in Nursing: Advanced Practice programme in the KSA.

BACKGROUND

Evidence-based practice (EBP) yields multiple benefits for all key stakeholders of healthcare. Key to this are healthcare professionals armed with necessary EBP knowledge and skills. Nurses, the largest professional group in healthcare, can be instrumental in effecting sustained EBP implementation. In the Kingdom of Saudi Arabia (KSA) achieving this is hindered by a chronic shortage of nurses and a heavy reliance on expatriate nurses who are often a transient workforce, resulting in a high turnover. The Government of Saudi Arabia 2030 Vision aspires to address the indigenous nurse shortage and the quality of healthcare. In 2017 the inaugural MSc in Nursing: Advanced Practice programme was established in the KSA to prepare Saudi nurses for emerging advanced practice roles. A dedicated EBP module was a core component of the programme.

METHODS

A pre-experimental pilot study conducted over 18-months collected data from the same participants at three different points. Two validated EBP questionnaires measuring EBP Beliefs and EBP Implementation were administered to post-graduate students undertaking the MSc in Nursing: Advanced Practice programme in one Higher Education Institution in the KSA. Descriptive, inferential and correlational statistics were employed to analyse the demographic data, group mean scores and distribution on the EBP scales, as well the correlation between EBP Beliefs and EBP Implementation.

FINDINGS

Findings demonstrated that the educational intervention did improve participants' EBP beliefs and implementation. Participants reported positive beliefs about EBP at all 3 data collection points (M = 57.4 SD = 7.0; M = 62.54 SD = 7.21; M = 55.31 SD = 15.81, respectively). EBP implementation was low prior to undertaking the module but improved thereafter as illustrated across the 3 data collection points (M = 15.14 SD = 11.9; M = 27.64 SD = 14.35; M = 25.9 SD = 20.43). On both measures, higher scores indicate higher EBP beliefs and implementation.

CONCLUSION

This study established the EBP Beliefs and EBP Implementation of a sample of postgraduate nursing students in the KSA. Findings revealed a substantial improvement in both EBP Beliefs and EBP Implementation following the EBP module. Findings support the use of a dedicated module to prepare nurses to use EBP and to practice at an advanced level while simultaneously preparing them for leadership roles in healthcare in KSA. In so doing, this will help to advance the healthcare goals of the KSA 2030 vision.

Nationalisation of Health Workforce in Saudi Arabia’s Public and Private Sectors: A Review of Issues and Challenges

Presently, Saudi Arabia depends largely on expatriate health workforce for delivery of health services. This article provides an overview of Saudization policy introduced by the Kingdom of Saudi Arabia and analyses its underlying impact on health workforce in public and private sectors. It also examines key strategic initiatives undertaken by the government for health workforce development and challenges of replacing expatriates in the country as envisaged in the Vision 2030. There are concerns about low participation of females in nursing, mainly due to a poor image attached to the profession, and further exacerbated by religious and cultural factors. There is a strong need to adopt a health workforce development policy that integrates local culture, values and social ties. Government needs to follow a multipronged approach to change the mindset of citizens to take up health care jobs, particularly nursing and pharmacist professions.

Working experiences of nurses during the novel coronavirus outbreak: A qualitative study explaining challenges of clinical nursing practice

Aim

To explore the clinical working experiences of Saudi nurses during the novel Coronavirus outbreak, identify the challenges and determine how these challenges affect their nursing practice.

Background

From the current experience of working during the novel Coronavirus outbreak, it is statistically significant to identify the challenges that nurses in Saudi Arabia face in their clinical practice and determine how these challenges affected their practice.

Designs

A qualitative descriptive study.

Methods

An in‐depth interview with eight Registered Nurses in Saudi Arabia who worked in areas where the novel Coronavirus patients are treated were conducted between 10 and 23 April.

Results

The following eight major themes were identified from this study: physical exhaustion, fear of infection, providing care with uncertainty, uncomfortable use of personal protective equipment, missed nursing care, prolonged procedures, lack of guidance during the outbreak and lack of managerial support.

Conclusion

The results suggest that nurses’ leaders should take active roles in empowering nursing staff. The absence of direct monitoring for nursing performance during their practice compromises patient safety and jeopardises the quality of care through missed nursing care. This study also revealed that nurses who worked during the outbreak need psychological support that can enhance their emotional resilience.

Work-Related Stress and Anxiety Among Frontline Nurses During the COVID-19 Pandemic: A Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic has strained the health system worldwide. Nurses caring for patients with COVID-19 reported experiencing significant work-related stress and anxiety. The current online descriptive cross-sectional correlational study aimed to investigate work-related stress and anxiety among nurses caring for patients with COVID-19. Data were collected from 240 nurses using the Stress Overload Scale and Self-Rated Anxiety Scale. Average stress and anxiety scores were 34.96 (SD = 5.85) and 52.8 (SD = 5.48), respectively. Statistically significant differences were found in mean stress overload and anxiety scores based on gender, professional title, average working hours per week, working area, and presence of fear of being infected with COVID-19. These findings suggest the need to promote well-being in nurses and assist nurses and other health care workers experiencing mental and psychological health problems in the context of the COVID-19 pandemic. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 31-42.].

Challenges Facing the Nursing Profession in Saudi Arabia: An Integrative Review

There is a paucity of recent literature identifying the issues facing the nursing profession in Saudi Arabia. The aim of this integrative review is to highlight the ongoing challenges facing the nursing profession in Saudi Arabia despite attempts to make a difference and suggests recommendations for the future. Literature published from 2000 to 2020, inclusive, relevant for nursing challenges in Saudi Arabia was accessed and reviewed from multiple sources. In Saudi Arabia, inadequate numbers of Saudi nurses have prompted an increase in recruitment of expatriate nurses. This has created its own issues including, retention, lack of competency in English and Arabic, as well as Arabic cultural aspects, insufficient experience, and a high workload. The result is job dissatisfaction and increased attrition as these nurses prefer to move to more developed countries. For national nurses, the issues are the need to recruit more and retain these nurses. There are a range of cultural factors that contribute to these issues with national nurses. There is a need to improve the image of nursing to recruit more Saudi nurses as well as addressing issues in education and work environment. For expatriate nurses there is a need for a better recruitment processes, a thorough program of education to improve knowledge and skills to equip them to work and stay in Saudi. There is also a need for organizational changes to be made to increase the job satisfaction and retention of nurses generally. Healthcare in Saudi Arabia also needs leaders to efficiently manage the various issues associated with the nursing workforce challenges.

Impact of work environment perceptions and communication satisfaction on the intention to quit: an empirical analysis of nurses in Saudi Arabia

OBJECTIVE

In consideration of the current nursing shortage in Saudi Arabia, we aimed to investigate the association among perceptions of work environment, communication satisfaction, and intentions to quit nursing profession among nurses. In addition, we aimed to investigate the mediating effect of communication satisfaction on the association between nurses' perception of work environment and their intentions to quit nursing profession.

METHODS

This predictive correlational study was conducted at one of the major hospitals in Saudi Arabia from January 2020 to March 2020. It included a convenience sample of 367 full-time registered nurses who completed three types of close-ended questionnaires. We used IBM SPSS version 24.0 to analyze the collected data. Regression analyses were used to test the study's hypotheses. All regression assumptions were assessed and confirmed. Significance for all tests was set at p ≤ .05.

RESULTS

The findings indicated an affirmative association between work environment perception and communication satisfaction (b = .764, p < .05) among nurses. In addition, findings showed that work environment perception (b = -.187, p < .05) and communication satisfaction (b = -.226, p < .05) have negative impacts on the nurses' intentions to quit; indicating that as work environment perception or communication satisfaction increases, the intention to quit decreases among nurses. Further, a mediation effect of communication satisfaction on the relationship between work environment perception and intention to quit was confirmed.

CONCLUSION

This study presents a novel conceptual framework developed based on the literature about the predisposing factors for nurses' intentions to quit nursing profession. Our results suggest that work environment perception and communication satisfaction among the most contributing factors for nurses resignation. Effective communication was established as a crucial factor for establishing attractive and healthy working environment. Nursing managers can benefit by applying these findings to develop appropriate strategies to inhibit the shortage of nurses in Saudi Arabia.

Clinical nurse managers' leadership practices in Saudi Arabian hospitals: A descriptive cross-sectional study

AIM

To understand the situational profiles of clinical nurse managers' transformational leadership practices in Saudi hospitals.

BACKGROUND

Clinical nurse managers' effective leadership may enable registered nurses to provide safe patient care.

METHODS

This included 29 clinical nurse managers and 318 registered nurses from three Saudi hospitals. Data were collected using the leadership practice inventory-self and the leadership practice inventory-observer.

RESULTS

A significant difference between self- and observer-assessed transformational leadership practices of clinical nurse managers was found. There was also a significant difference in transformational leadership practice between Saudi and non-Saudi clinical nurse managers. Ward experience of clinical nurse managers was statistically positively associated with higher ratings of "enabling others to act". Length of clinical nurse managers' experience was associated with "enabling others to act" and "encouraging the heart" practices.

CONCLUSION

Clinical nurse managers rated their transformational leadership performance higher than that reported by registered nurses. Further, non-Saudi clinical nurse managers working in Saudi hospitals overestimated the extent of their transformational leadership practices.

IMPLICATIONS FOR NURSING MANAGEMENT

Clinical nurse managers should gather feedback about their leadership performance regularly and implement required changes. Hospital administrations should provide additional support to clinical nurse managers through effective leadership programmes, enculturation and team-building strategies, to create a shared vision regarding the execution of optimal leadership.

'Senior Nursing Students and Interns' Concerns and Willingness to Treat Patients with COVID-19: A Strategy to Expand National Nursing Workforce during the COVID-19 Pandemic

Background

The coronavirus disease of 2019 (COVID-19) pandemic has challenged the existing healthcare delivery systems worldwide and overwhelmed the globally short healthcare workforce, particularly nurses. Nurses are recognized as front-line responders to the COVID-19 pandemic and are crucial healthcare members to win the fight against the evolving COVID-19. Considering the long-lasting shortage of national nurses, and turnover of the current nursing workforce, it is essential to consider unconventional strategies aiming at expanding the national nursing workforce in order to embrace the impact of COVID-19.

Objective

This study aimed to measure senior nursing students and intern's willingness to treat patients with COVID-19. Further, this study investigated their feelings, knowledge, and concerns regarding treating patients with COVID-19.

Methods

This quantitative, cross-sectional study utilized self-reported survey gathered from a convenience sample of 178 senior nursing students and interns. A 7-item scale was used to measure the participants' willingness to treat patients with COVID-19. The data were collected between March 2020 and April 2020.

Results

Out of 178 participants, 50.56% were at Level 8, 89.33% were single, and 53.37% had a very satisfactory grade point average. The highest proportion of the respondents (38.20%) felt neutral about treating patient with COVID-19, while 53.93% had good knowledge about COVID-19. The perceived willingness to treat of participants had an overall mean score of 20.19, which indicated neutral willingness to treat patients with COVID-19. Participants' feelings about treating patients with COVID-19 predicted their willingness to treat patients with COVID-19 (P<0.001).

Conclusion/Recommendation

There is a clear need for educational and training programs both in clinical practice and academia for the improvement among nursing students and interns who reported paucity of knowledge about COVID-19. Furthermore, hospital institutions should provide additional incentives or hazard protections to maintain and even increase the number of staff at the frontline who are willing to care for patients amid the deadly pandemic of COVID-19.

The visualization of stress in clinical training: A study of nursing students' perceptions

Aim

To determine the perceived level and types of stress experienced by nursing students during clinical training.

Design

A descriptive correlational cross-sectional design.

Methods

A convenience sample of 238 nursing students was recruited. Level and types of stress were measured by Perceived Stress Scale. The data were collected in February 2020.

Results

The mean score of perceived stress was 2.58 (SD 0.92). Different sources of stressors perceived by students were identified in current study. The highest type of stressors perceived by students was stress from taking care of patients (mean = 2.81, SD 1.13). In addition, junior students perceived higher level of stress than senior students and female students experienced a higher level of stress than male counterparts. Students who have been supervised by clinical instructors whom their "primary" language is English scored a higher level of stress.

Linking the Saudi Arabian 2030 vision with nursing transformation in Saudi Arabia: Roadmap for nursing policies and strategies

The Saudi government is currently facing multiple challenges in achieving “The Gold Standard” in nursing practice. This is not limited to educational challenges, staffing shortage, paucity of international and national benchmark evidence, absence of clear and defined scope of nursing practice, and lack of appropriate policies and regulations. This study presented a comprehensive plan for developing a policy based on current challenges, recognition of policy goals, assessment of potential options and alternatives, identification of stakeholders, proposition of recommended solutions, and implementation of the framework to transform nursing standards and link these changes with the Saudi Vision 2030. However, amendments are required in the present strategic plan for the better management of the nursing profession. It is doubtful that the current nursing profession status quo is capable of meeting the golden standards for health care. Thus, the transformation of the nursing profession in Saudi Arabia is necessary.

The relationships between nurses' work environments and emotional exhaustion, job satisfaction, and intent to leave among nurses in Saudi Arabia

AIMS

To examine relationships between components of nurses' work environments and emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia.

DESIGN

A descriptive correlational study with cross-sectional data.

METHODS

Data were collected in 2017 from 497 Registered Nurses working in a large tertiary hospital in Riyadh, Saudi Arabia. Participants completed an online survey like that used in RN4Cast studies to measure nurses' perceptions of their work environments and nurse outcomes. Hierarchical linear regression and logistic regression were conducted to examine the relationships between components of nurses' work environments and nurse outcomes after controlling for nurse and patient characteristics.

RESULTS

Nurse participation in hospital affairs was uniquely associated with all three nurse outcomes, whereas staffing and resource adequacy was associated with emotional exhaustion and job satisfaction, but not intent to leave. These two variables were also the components of the nursing practice environment that received the lowest ratings. Nurse manager ability, leadership and support of nurses, and nurse-physician relationships were associated with job satisfaction only. A nursing foundation for quality of care was not uniquely associated with any of the three outcomes. Finally, nurse emotional exhaustion and job satisfaction fully mediated the relationship between nurse participation in hospital affairs and intent to leave.

CONCLUSION

Magnet-like work environments in Saudi Arabia are critical to recruiting and retaining nurses in a country with critical nursing shortages.

IMPACT

This study addresses a gap in the literature regarding which components of the nurses' work environment are uniquely associated with emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. Study results will assist Saudi hospital administrators and nurse leaders to develop recruitment and retention strategies by focusing on those work environment components most associated with nurse outcomes: participation in hospital affairs and staffing and resource adequacy.

Assessment of Organizational Commitment Among Nurses in a Major Public Hospital in Saudi Arabia

Purpose

Nurses play a vital role in the provision of healthcare internationally. The level of organizational commitment of healthcare workers, including nurses, is closely connected to the productivity and quality of care provided by healthcare institutions. The aims of the present study were to explore nurses’ levels of organizational commitment and the impact of key sociodemographic variables on this issue.

Materials and Methods

A cross-sectional descriptive quantitative study was conducted at a major public hospital in Saudi Arabia during April and May 2019. A revised validated version of the three-component model (TCM) questionnaire was self-administered to a systematic random sample of 384 nurses. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 22. Mean scores were compared by independent variables using an independent sample t-test and analysis of variance (ANOVA). Multiple linear regression analysis was performed.

Results

Out of 384 participants, 337 responded, yielding a response rate of 88%. Overall, 47.88% of the nurses agreed with all items related to the organizational commitment scale, while only 22.3% disagreed. There was a significant difference in the levels of commitment among nurses in the various age groups (p = 0.024). The continuous commitment subscale received the largest number of positive responses.

Conclusion

Most nurses showed a moderate level of job commitment. Greater organizational commitment was positively related to sociodemographic variables, such as age and nationality, and the only positive predictor of overall organizational commitment was age. Nursing policy makers should enhance the organizational commitment of nurses by developing strategies to recruit, attract, and retain committed nurses.

A Shortage in the Number of Nurses-A Case Study from a Selected Region in the Czech Republic and International Context

A lack of nurses in the Czech Republic is an issue that has been under discussion for several years. The aim of this paper is to analyze the lack and need of general nurses and midwives in the Hradec Kralove region where the shortage is higher than the national average. The used methods are quantitative research and structured interviews, to determine the number of nurses in healthcare institutions. The study uses data obtained from publicly available sources, i.e., Czech Statistical Office (CSO) and the National Institute of Education (NIE). The shortage of nurses in the Hradec Kralove region can be expected by 2030 to be in the range between 647.6 and 667.1 nurses while maintaining the existing conditions, that is, five times more than at present. In addition to the commonly considered measures that appear in the country’s strategies—such as improving the quality of conditions during studies and during employment, specifying or adjusting the role and competency of nurses and midwives in the healthcare system, or unifying employment standards— a focus on promoting the nursing profession can be recommended. Schools and ministries should be encouraged to focus on and invest in the promotion of this profession, so as to play a key role in recruiting new students for the nursing field of study at a time when the nursing profession is perceived positively, as an embodiment of solidarity and selflessness.

Nursing shortage, a different challenge in Iran: A systematic review

Background: Nursing shortage is an important and multifaceted challenge in the health systems and has reached a warning threshold. The factors associated with nursing shortage vary from country to country. Therefore, this study compared the causes of nursing shortage and suggested strategies to help resolve this concern both in Iran and in the world.

Methods: To conduct this systematic review, search was done in English and Persian databases from 2000 to 2016. In the preliminary review, 537 articles were included in the study. After reviewing the titles, abstracts, objectives, and results of articles, 32 studies were finalized.

Results: The important causes of nursing shortage in the world included aging of the nursing workforce, inadequate admission and training of nurses, aging population, and job abandonment. However, the leading causes in Iran were unwillingness and lack of desire to enter and remain in the nursing field, job abandonment, inadequate salaries, low social status, and negative perception of nursing. Proposed strategies in the world are increasing the salaries, redesigning the work environment, improving the public’s perspective, retaining the existing nursing workforce, and flexible work schedules. In Iran, these strategies include increasing salaries and recruitment, enhancing the public’s perception of nursing, and supporting nursing organizations.

Conclusion: Nursing shortage is a multifaceted concept with varying magnitudes in different countries. Therefore, the strategies to resolve nursing shortage should be based on the unique conditions of each country. The most important strategies to overcome nursing shortage in Iran are focused on the improving the retention of existing nursing workforce.

Building the health workforce: Saudi Arabia's challenges in achieving Vision 2030

BACKGROUND

Saudi Arabia's Vision 2030 represents a major structural shift in all economic sectors. Health care is one of the largest sectors significantly contributing to achievement of the vision OBJECTIVES: To provide an overview of health workforce in Saudi Arabia and identify various critical issues and challenges that need to be addressed in achieving health system goals envisaged in the Vision.

METHODS

This paper is based on extensive review of literature conducted to stimulate pertinent descriptive information on health workforce in Saudi Arabia.

FINDINGS

Saudi nationals constitute 44% of all health workforce and 29.5% of all physicians employed by the health system. Among Saudi nationals, there is a significant underrepresentation of females except in the nursing profession. The health workforce is beleaguered with numerical inadequacy, skill imbalance, gender disparity, and access issues.

CONCLUSION

Health system needs to adopt a rigorous approach by investing heavily on medical, nursing, and other specialized fields of education. Planning for the health workforce needs to adopt appropriate strategies that reflect all aspects including the number, skills, and gender distribution for meeting the future health needs of population to facilitate achievement of Vision.

Nursing Education Challenges from Saudi Nurse Educators' and Leaders' Perspectives: A Qualitative Descriptive Study

Aim To explore the challenges in nursing education in Saudi Arabia from nurse educators' and leaders' perspectives. Background Saudi Arabia considerably lacks Saudi nurses and most nurses in Saudi healthcare facilities are expatriates with diverse academic, cultural, and linguistic backgrounds. The perception regarding nurses' profession and their low status in Saudi Arabia affect the nursing profession negatively, leading to staff insufficiency. Understanding the difficulties of the nursing profession could help intervene accordingly, in encouraging students to pursue a career in nursing. Methods An exploratory qualitative method was used. Three Saudi nursing educators and four leaders were interviewed. They were recruited through purposive sampling. The interviews were transcribed verbatim and data were analyzed using thematic analysis. Findings Participants indicated that nursing education in Saudi Arabia is facing multiple challenges requiring serious attention from Saudi leaders. The challenges were divided to four themes and different categories; cultural challenges, educational challenges, organizational challenges (weak nursing authority, lack of acknowledgement for Saudi nurses), and work challenges (poor working environment, language barrier). Discussion The challenges that face nursing education in Saudi Arabia were mainly at three levels: management, system, and social. These challenges were the reasons for Saudi nurses to leave the profession. Conclusion This study revealed some of the challenges facing nursing education in Saudi Arabia. These challenges are not unique to Saudi Arabia but knowing about these challenges will help nurse educators and leaders to improve nursing programs, enhance students' clinical experiences, and promote nursing profession in Saudi Arabia.

Spirituality and Spiritual Care Competence among Expatriate Nurses Working in Saudi Arabia

Background: In Saudi Arabia, where the majority of the nursing workforce are foreigners, little is known about perceptions of spirituality and spiritual caregiving among foreign nurses who provide nursing care to patients with varied spiritual and religious beliefs. Therefore, this study was conducted to investigate the spirituality and spiritual care competence and its predictors among expatriate Christian nurses in Saudi Arabia, who provide care for Muslim patients. Methods: A convenience sample of 302 nurses was surveyed in this descriptive cross-sectional study using the Spirituality and Spiritual Care Rating Scale and the Spiritual Care Competence Scale. Results: Results revealed high values on three domains, namely, spiritual care, personal care, and existential spirituality. The majority of the respondents reported competence in all six subscales of spiritual care. The participants’ age, educational level, perception of existential spirituality, and personal care were found to be relevant predictors of their spiritual care competence. Conclusions: The findings suggest that existential spirituality and personal care dimensions of Christian nurses’ spirituality and spiritual care perceptions play critical roles in the provision of competent spiritual care to Muslim patients.