The Implication of Nursing Degree Education for Future Workforce Planning in Saudi Arabia : A Case Study

1. Dr. Noura AlMadani, RN, BSN,CI, MSN, PhD
2017
The Implicationof Nursing
DegreeEducationfor Future
WorkforcePlanningin Saudi
Arabia: ACaseStudy

2. TheContext forthe Study
Introduction
Problem statement.
Literature review
Theaim and objectives
Methodology
Outlines
Result &Recommendation
Conclusion

3. Introduction
• Thefastsocio-economictransitionperiodofSA.
• HCS as part of Vision2030, is undergoingmajor
transformationalreform aimedtodeliveringsignificant
improvementin healthcare,quality,efficiency,and
safety.
• Thecurrent health system hasshiftedcarefrom the
hospitalsettingas thecentralfocus of care, tomore
primary andpreventivecarethroughout thecommunity
(Albejaidi,2010).

4. Current Situation
• Nurses is the largest staffgroup in healthcare
system, with around 72,000 Saudi nurses,
representing 29.4% from 245,000 nurses working in
the kingdom of Saudi Arabia.
• The shortage of nurses is the majorissue , as it
greatly affect theefficiencyand productivity of
Saudi healthcare system (Alshmemri, 2014).

5. Current Situation
The rapid transitionand expansion of Saudi health
services with NTP & the current enrolmentstandards
for hospital accreditation will changethe increasing
demand for qualifiednurses

6. Problem Statement
There is a vast numberof Diploma nurses working
in thepublicsector face anuncertainfuture, in
terms of career progression and development, due
to the restricted requirement and limited seat for
bridging program to convert theirnursing diplomas
into Bachelor’s degree as there is no current policy
to address their situation.

7.  In order to bridge the gap, qualitativecase study
used to critically assess theimplications of Bachelor
degree nurse education,as a baseline from whichto
develop a nationalnursingstrategy for workforce
planning.
The Aim of the study

8. Global trends in Nursing Workforce
• Health sectors face a serious shortage of professional nursing staff
worldwide (Yun et al. 2010; Oulton 2006).
• The United States of America has the largest nursing workforce in
the world, about 3 million, but it failed to produce enough nurses to
meet the heath care and growing demand (Yun et al. 2010).
• Despite the acute shortage, potential student nurses are repeatedly
rejected, due to failing entry requirements or because of inadequate
resources and faculty (Juraschek et al. 2012).
Literature Review: 1st section :an overview

9. Local l trends in Nursing Workforce
There are three major problems related to the nursing workforce in
SA: these can be defined under educational, system and social
headings.
Educational issues include the fact that many nursing personnel do not hold a
Bachelor of Science Nursing degree and this lack of education for nursing staff is a
hindrance in providing high quality nursing care to the patients who need an
advanced level of nursing.
System issues involve reassessing policies and regulations related to nursing along
with the turnover and retention rate of nurses.
Social issues include the working environment involving the gender ratio, long
working hours, job dissatisfaction and low wages, as these factors are a cause of the
high turnover rate, as well as reinforcing the social image of nursing practice.
Literature Review1st section : an overview

10. Key Challenges
10
Education &
Training challenge
|: big gap between
theory and practice.
Different curriculum, long
study period, variation of
outcome between
governmental &private
college.
Lack of preceptorship
program.
Lack of awareness of
nursing role.
Negative impact of
media.
-Shortage of qualified nurses
lead to a steady increase in the
turnover rate a mong nurses.
-Increasing gap between
supply & demand
- Increase absenteeism
among Saudi nurses.
System Challenge|:
Absent a clinical pathway,
A lack of uniformity in job
title causes confusion in
terms of job description
Nursing Workforce
challenge|: workforce
mostly comprises of foreign
nurses; only 34% are Saudi
nurses
Social challenge |:
Nursing image , culture and
social influences.
Family pressure.
Gender segregation.
One performance appraisal
form is used for all and it is
not linked to the job
descriptions, Salaries are not
linked to levels of
performance. Work
environment.
Increase pressure on MOH for tangible improvements require major fundamental cultural shift, system development,
and nursing stakeholders engagement.

11. • The literature review involves a systematic review of
existing literature, exploring the effectual impact of
degree education entry upon care outcomes.
Literature Review:2nd section: systematic review

14. Key themes identified from the literature

15. Steps of case study method

16. Goffman’sFramework
‘Goffman (1974) frameis the way to explorewhat
happens and determinewhich is exceptionalin a given
case or experience.
According to Caldwell& Mays (2012), macro-meso-
micro framework analysis is a usefulway of exploring
thetransitionof a policy from highlevel of notionto
plans in action.

18. Data collection
• Documentary analysis used for reviewing the documents of
Ministry policies, advisory reports, and guidelines relating to
the decision to have degree entry, and process of
implementing degree entry- both printed and electronic
documents.
• Face-to-faceinterviewsused to collect in-depth information
from the first level of administration (Macro level).
• Focus groups conducted as groups for the two levels of
administration (Meso and Micro level).

19. The sampling strategy for each level

20. The confidentiality and anonymity of the participants are the main
ethical consideration during case study.
This study guided by
Code of professional conduct and ethics of
• Ministry of Health,
• Salford University,
• Royal College of Nursing Guidance for Nurses 2004 – university
of Salford. http://www.pg.salford.ac.uk/page/codes_of_ethics.
Ethical consideration

21. Trustworthiness of the Study

22. Qualitative Data Analysis

24.  The formal andinformaldocumentaryanalysis
indicated that there was a clearlackof
involvementfrom nurses in theconsultation
process prior to implementingthe degree
education policy.
Findings

25.  The interviewsconducted with nursingstaff (at
a macro,meso andmicrolevel) indicatedgeneral
agreement that a Bachelordegree in nursing
wouldfurther support the knowledgeand
communicationrequirements for improving the
qualityof nursing practice.
Findings

26.  Factors affecting degree attainmentincludeda
personal commitment/passionfor self-
improvement, private versus government
institutions,the quality of programmes of
education and financialissues.
Findings

27.  Data indicatedthe increasedknowledge base
gained through degree education,supported a
growth in confidence,decreased absenteeism,
enhancednursingskillsand responsibilities,and
gave opportunity for advancement. More
importantly,such benefits increasedthe quality
of nursing practice andpatient safety outcomes.
Findings

28.  Data indicatedthe need for differentiationof
distinctnursing job descriptions based on the
education levelattained and a focus on the
qualityof patient care through education,
validationand regulationof standardization for
the BSN, and adequate supervision
Findings

29. Onlytwo themeswere notdiscussedacrossall three
levels:
• Theimpactofsocial, culturaland familyinfluenceson
degreeattainment(nursing image),which was only
discussedatmicro level.
• Thebeliefthatdegreeeducatednurses aretooqualified
towork in PHCs and thatthisimpactsonpatientcare in
hospitals,which was only identifiedat themesolevel
Findings

30. Example of Meso findings using mind map

31. • Recommendationsbased on thefindingsofthis study,highlight
theimportanceofa process ofconsultationbetween
governmentalbodies andrelevant nursing staff,whoare
affectedby futurepolicy changes.
• The needfor a nationalcurriculum, and a differentiationof
nursing jobdescriptions,based on theeducationlevelattained,
togetherwith improvedclinical supervision for nurses in
practice.
Recommendation

32. Key message1
Thepolicy has been implementeddirectly ina top-downmanner,
withpeopleatthe mesoand microlevels notbeinginvolved. In
futurepolicy decisionsneedtotakeaccount of thisand
involvementfromthe bottomup shouldbestandard practice.
ThreeMajor Key Messages

33. Key message2
Diplomanurses and fundingforhealthcarefallunder the
authorityoftheMoH and nurse educationcomesunder the
MOHE. In order tobridgethegap, thereneeds tobebetter
communicationand linksbetweenthe twoorganisations(MoH
and theMoHE);or thepolicy needs tobetransferredtooneofthe
twofor coherence
ThreeMajor Key Messages

34. Key messages3
Professionaldevelopmentwithinnursing should bereinforcedby
evidence,within thecontextofa nationalnursing strategy. The
debateabout thecomparativevalue of generalistand specialist
nurses is a distractionfrom theneedtosupport Professional
Nursing Workforce andDevelopmentofCarrier LadderPlan &
Educationaland ClinicalPathway
ThreeMajor Key Messages

35. Conclusion
This needs to be taken seriously by the key government
bodies in the context of implementation for change and to
address the recommendation for future workforce
planning and development.
Nursesmust be positive and active in negotiating the
limitations of the health services they provide, recognising
the potential contribution of themselves and other
healthcare professionals.

36. Conclusion
The nursing workforcein SA needs strongstrategy and
national planning
“to ensurethe presenceof the right nurse with the right
qualification in the right role,at the right time, in the right
place with the properauthority and appropriate
recognition” (Affara & Styles, 1992:P .18).

37. Thank You
www.linkedin.com/in/noura-almadani2020
@noura_almadani

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