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IntroductionBackground The Kingdom of Saudi Arabia has committed vast resources by allocating more than 13 percent of its annual budget in improving the Kingdom's medical care system, with the ultimate goal of providing free medical care for everyone. This commitment has been translated to more than 330 hospitals operated by the government and the private sector, with a capacity of more than 50,000 beds. Of these hospitals, 184 are run by the government, with more than 16 thousand doctors, 40 thousand nurses, and more than 25 thousand assistant nurses according to the Ministry of Health (2003). Based on these figures and the Saudi population of 20 million people, to satisfy and maintain the current health care standard, one out of every two hundred Saudi nationals and residents should work within the Saudi medical sector. This number would not include all other personnel working within the private medical sector or other personnel working behind the scenes; where all managerial and logistical decisions are being made. This task of maintaining the current standard is hard, especially at the nursing level.
With a country that has a young history, young education system, and young population with more than 50 percent of its citizens under the age of 18 years old. With these facts, having enough nurses seems to be an impossible task to be achieved. Other factors as long working hours and working night shifts in a country that is over protective of its wives and daughters are also factors that contribute to hardening the task. Due to these issues among others, Saudi Arabia has become one of the most nurse importing countries in the world, if not the most, with over 80 percent of its nurses are non-Saudi nationals. The Shortage:To understand the Saudi shortage in nurses, one has to understand the Saudi dependence on foreign nurses. In a country as young as Saudi Arabia; going from the tribal age to the informational age in less than 70 years was and still considered a dream come true for many people. With a low literacy rates, 15 percent for men and less than 2 percent for women in 1970, Saudi Arabia with its new untapped oil reserved was committed in producing and providing the best for its citizens; schools, hospitals, communities, industries, and jobs.
As result, Saudi Arabia has decided that it would import all means and personnel in need to produce a better society. For some time, importing everything was the only solution to the Saudi lack of all modern life necessities, but with the new education system, placed in the mid 60s, Saudi Arabia started collecting its harvest of educated citizens. Unfortunately, the Saudi education system has only focused on high paid, prosperous, and prestigious jobs like doctors, engineers, and lawyers and left basic yet complementary job as nursing way behind. This lack of attention to necessary and complementary jobs, has led the Saudi education system in creating less than 20 percent of the nursing staff working in Saudi today, which in return led into today's significant shortage in qualified and competent Saudi nurses and to high rate of imported nurses (Sadeeq, 2003). Even with a limited nursing teaching facilities, the Saudi social perception of nurses was a major factor in the nurse shortage in the country today. First, being low paying job, nursing is considered a middle to low class job, in contrast with it counterpart of being a physician.
Secondly, with long working hours and night shifts, Saudi female nurses have had hard time in practicing their jobs due to strict social traditions. Last but not the least, the people's perceptions of being the nurse of nothing more than a maid; who has to follow the physician's orders and the patient's needs, has ruined the nurse image completely. As hospitals across the country face a shortage in nurses, King Abdulaziz University Hospital (KAUH) as most other Saudi hospitals have chosen the path of importing professional labor to satisfy its needs of necessary nurses. Yet, with a nurses turnover of almost 30% a year, importing nurses has become a constant headache to hospital staff and management. Work overload due to nurse shortage, low salaries and additional factors as expected nurse conduct and behavior standards, in addition of competition with other recruitment countries have made recruitment and marinating the right nurse with the right qualification harder every year. Therefore, within this review we would examine causes that lead to this high turnover and try to provide effective solution for each cause. Variables of Concern:Through this review we will examine some of the variables that lead to the high rate of turnover in the King Abdulaziz University Hospital and how this number can be reduced significantly with few marginal adjustments to the recruiting policy:Behavior & Conduct Standers As most foreign nurses come to Saudi Arabia from countries like the Philippines and India, living the Saudi different culture and tradition becomes a daily ritual of these nurses' lives.
Due to its pride in the Arabic and Islamic heritage, the Saudi Arabian customs and traditions sometime impose stricter rules and specific behaviors other than nurses have been accustomed to. Due to these differences in customs, imported nurses have a hard time to adjusting with Islamic & Arabian customs and traditions. Life luxuries substance as alcohol, sexually suggestive magazines, and narcotics among other things including any and all additives are not available in Saudi. Plus, the separation in the Saudi life between single men and women has made the lives of some a little bit harder. According to Polt (2003) "All Saudi Arabian social life functions are separated into male and female. The position of women in Saudi Arabia is very different from that in Western countries.
In public, a Saudi woman is completely covered from head to toe. From an early age women live in extreme privacy, and are not normally seen by other men except for their husbands and close male relatives. Single Western males and females are not allowed to mix socially except in the presence of a married couple. Islam and deep-rooted traditions play an important role in Saudi Arabia". This way of expected social conducts has made it hard for foreign nurses to adjust to the Saudi Arabian living standard, especially as some foreign workers see working abroad is an opportunity to meet people and learn more about other cultures.Life Expectations & Recruiting Competition In addition to behavior and conduct standers which are expected from all foreign workers in Saudi Arabia, other Saudi residential rules and regulation have made living in Saudi harder for foreigners than one would expect. For a country that was built with the help of people who came from all around the world, the Saudi government have made sure that when this country is up and running, only a hand full of needed foreign nationals would be here to benefit from what they help achieving.
The government also made sure that Saudi citizens should be able to carry out the task when foreign workers are leave back home. Lack of granting foreigners a permanent residential status or the ability of purchasing a real estate has kept nurses from considering Saudi Arabia a home to them especially, for married foreigners with more than one source of income. These families would save as much money as they can to spend it back home. Yet, other countries as Britain, the United States, and Canada, which have aggressive recruiting programs, have provided another good alternative to Saudi Ara ....
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