Causes of Health Professional Shortage in Saudi Arabia - Essay Example

? THE PROBLEM OF CURRENT SHORTAGE OF NURSES IN SAUDI ARABIA AND THE SOLUTIONS TO THIS PROBLEM By Abuthamer [Sur Presented to [Your Name] [Institution] [Date of Presentation] Acknowledgement: I would like to thank my Supervisor, Dr. X for all the assistance and support throughout the project. I thank her for her patience, extreme help, and for providing valuable tips. I also acknowledge her guidance in finding more sources related to my topic through her long experience. Table of Contents Contents Table of Contents 3 Contents 3 Abstract: 4 Chapter 1 5 Introduction: 5 Background Information: 8 Rationale: 9 Aims and Objectives: 10 Aims: 10 Objectives: 10 Chapter 2: 10 Methods: 10 Chapter 3: 11 Findings 11 Causes of Health Professional Shortage in Saudi Arabia 11 Possible Solutions to Reduce the Nursing Shortage in Future 14 Government’s Effort towards Decreasing the Shortage of Healthcare Professionals 16 The Impact of the Health Professional Shortage on Quality of Services with Saudi Healthcare System 17 Limitation of the study 18 Chapter 4 18 Discussion 18 Conclusion: 20 Reference 22 Abstract: The purpose of this project is to identify problems and solutions to the nursing shortage in Saudi Arabia. Moreover, the project investigates the effect of foreign workers in the country who work towards addressing this issue. Furthermore, the project investigates the plans that aim at increasing the number of Saudis to work in this profession. In addition, the project measures the impact of nursing shortages on the quality of health services. The key finding was that the country witnessed a high number of foreigners working as nurses. Among the issues contributing to this high number of foreigners are the lack of health colleges, lack of awareness among the community about the importance of nursing, and the weak role of the media in highlighting this issue. Additionally, many high school students do not show any interest in enrolling in the nursing profession in future. Moreover, the nursing workload and lack of flexibility in nursing work times promotes the low number of nurses. Amongst the proposed solutions, attracting more locals to the profession is fundamental. Other solutions include building more medical colleges and providing flexible work in nursing. In addition, the government should play a major role in solving the problem through training staff and giving them the opportunity to study abroad to obtain the scientific expertise and better work experience. The study found that the nursing shortage has a serious impact on the quality of health services. Hence, it contributed to patient dissatisfaction and deterioration of health services. Chapter 1 Introduction: All over the world, health care systems are in crisis (Paul, et al., 2006). Furthermore, many countries are seeking to develop the quality of health services and enable citizens to get easy access to quality services. In most developed countries, health care systems are struggling to provide the best possibilities so that they can meet the demands of the people. The most common challenge is the lack of healthcare professionals such as doctors and nurses (Paul, et al., 2006). Although some countries may be developed, they still suffer from a shortage of nurses. Walker (2010) called the problem of nursing shortage “a global shortage.” For decades, developing countries have suffered chronic deficits in health-care professionals with the reasons for these deficits lying in the lack of resources, which is in contrast with developed nations, such as the US,’ objective of reducing the recourses in healthcare (Porter and Kaplan, 2011). This results in the lack of training and adequate rehabilitation of sufficient numbers of nurses. In fact, the issue of the shortage of nurses became a global crisis in 2002 with world leaders realizing the need to address the issue (Oulton, 2006). Across Europe, reports indicate a shortage of nurses in almost every European nation (Gathercole, 2003). In the UK, The Times (2001) approximated the shortage to be fifty seven thousand (The Times, 2001). In Saudi Arabia, a 2004 report pointed the total number nurses as 54,000 with 53,000 being foreign nurses. According to some reports, the number of indigenous doctors in Saudi Arabia is much less than nurses (Pakkiasamy, 2004). Around the world, there is literature regarding the U.S. and Europe’s delivery of health services. Unfortunately, the literature on Saudi Arabia, specifically the reforms in the health system, the radical changes, and the health system challenges remain scarce. In the Kingdom of Saudi Arabia, health care services are provided through three official bodies. There are hospitals and health centres, which are under the Ministry of Health (MOH). The private health sector also provides these services. In addition, other governmental health intuitions provide health care services. MOH is the largest provider of health services in the Kingdom of Saudi Arabia as it covers most of the health services at a rate of 62%. Importantly, it offers comprehensive, services that are free to all citizens (MOH, 2005). A statistical report by the Central Department of Statistics and Information in Saudi Arabia (2010) showed that, Saudi Arabia's population was 27 million according to official census while the population was 22 million in 2004. From 2004 to 2010, the population growth rate was approximately 3% per year. The number of Saudi citizens was approximately 68% of the total population. Half of the people are males and the other half females. Sixty-six percent was less than 30 years in age while 37% was less than 15 years. Only 5% of the population was over 60 years. The high demand for quality healthcare and dissatisfaction about the quality of health services in the Kingdom has necessitated various studies by King Faisal Specialist Hospital and Research centre to access the quality of healthcare services (Walston, et al., 2008). The government allocates the hospital’s research centre an annual budget. The researchers focus on all health aspect including diseases, management, and education. However, the problem of staff shortages remains unaddressed. The lack of medical schools and the duration of training affect the shortage of nursed. In addition, the colleges of nursing lack faculty members, which contributes to a few graduates in nursing. In the last forty years, the education in infrastructure in Saudi Arabia has been insufficient, which explains insufficient nurses. Although education in Saudi Arabia is developing at a significantly high rate, it still has a large number of health care professionals who are non-Saudis (Al-Shahri, 2002; Almalki, 2011). According to (AL-Dossari, 2008) the situation is slowly improving in Saudi Arabia. In 2002-2003, a study on high school students showed that only a few wanted to enrol in nursing colleges, while on the other hand a lot of them wanted to enrol in computer science and teaching courses. Al-Omer, (2004) noted the association of the nursing profession with long working hours that make it unappealing. In addition, the contact of nurses with the opposite sex may create some concerns that nurses may lose the society’s respect due to the intimate nature of care on patients. In 2005, the total Number of Saudi physicians working in health sector was 3,451 that included 19% of the total Ministry of Health doctors. In contrast, only 5% tend to work in the private sector. Interestingly, Saudi doctors want to work for the Ministry of Health and other government hospitals more than working in private hospitals (Saudi Arabian Ministry of Health. 2005). This research will identify the challenge of health professional shortages that the healthcare system in Saudi Arabia faces. It will look at possible solutions that will help health decision makers in Saudi Arabia to avoid further shortages in future. The findings may be used to develop the Saudi health care system. Background Information: The Saudi government has placed health services on the top of its priority list. In the past few decades, health quality, and quantity have improved extensively (Almalki, 2012). In 2000, reports suggested that the health system in Saudi Arabia was ranked 26th among the 190-health systems in the world (WHO, 2000). No further updates regarding the ranking or position of Saudi Arabia in the tables of health systems is available. The health system leads some systems of developed nations such as Australia, Canada, and New Zealand. Importantly, the system is leads health systems in some countries in the Gulf region such as the United Arab Emirates, Kuwait, and Qatar. Nevertheless, the health system in Saudi Arabia faces challenges despite its good rank and in comparison to other health systems in developed countries. These challenges require urgent attention from the Ministry of Health through imposing new policies and strategies to the health system (Almalki, 2012). According to Abu Zunidah (2006), one of the biggest challenges faced by the health system in Saudi Arabia is the lack of indigenous professionals. Moreover, the majority of workers in the health sector in Saudi Arabia are non-Saudis with high turnover rate, which makes it unstable (WHO, 2002).    According to the Ministry of Health statistics of 2008, the total number of employees in the health sector was about two hundred thousand with more than half of those employees working in the Ministry of Health. Local professionals were about 50% of the total workforce, 19% of them doctors and 44% nurses. In every 10,000 citizens, there are only 22 nurses. Alamri, et al. (2006) and Alhusaini (2006) indicated the possibility of the reduction of this proportion due to the rising population and the establishment of health facilities throughout the kingdom. Rationale: Any country that wants to maintain and sustain a steady economic growth must ensure that its citizens remained healthy (Schultz and Strauss, 2008; Thomas, 2010). Importantly, a nation should ensure that it supported the delivery of quality care in its healthcare system by supporting the aspects that enable the quality service delivery. One such element regards nurses who play an essential role in delivery of healthcare services. However, Saudi Arabia experiences a shortage in nursing staff with foreign nurses playing the role of locals in the healthcare system (Almutari and McCarthy, 2012). In this regard, these expatriates use Saudi Arabia as the nation whereby they started their careers and gained the knowledge and experience to move to their countries for better wages. In effect, this left the country’s healthcare system affected by the leaving nurses since a majority of Saudis does not consider the nursing profession as an important profession. Conversely, the media does not play an effective role in highlighting this issue. In effect, this justifies the important role that this project will play in identifying the issue of shortage of nurses in the country while providing solutions to this challenge. Aims and Objectives: Aims: Review the issue of nursing shortage in Saudi Arabia and explain how it can be reduced successfully in the future. To carry out an investigation of the role-played by the government of Saudi Arabia in terms of improving the health care system. Objectives: Review of some relevant literature with a focus on the causes and solutions to nursing shortage, and the government's efforts in addressing this problem and its impact on the quality of health services. Propose recommendations regarding the future of nursing staff in Saudi Arabia. Chapter 2: Methods: In the process of identifying the topic, my supervisor was influential in the review of the literature by proposing the resources for the study. Among the sources used to find the relevant literature are PUBMED, Google Scholar and the e-library. Importantly, the internet contains a lot of information regarding any topic and it is essential to find the appropriate sources for a scholarly paper. Hence, keywords such as shortage-health-professional-Saudi Arabia, shortage-nurses-Saudi Arabia, and recruit-nurses-Saudi Arabia were essential in conducting research. Initially, about 30 studies were found although only a few were suitable, which led to the selection of the most relevant studies in the literature review. The inclusion and exclusion criteria were appropriate for including the most relevant studies. For the inclusion criteria, the studies focused on healthcare in Saudi Arabia, some elements of recruitment, articles need to be published within the last 5 years with a leeway of literature published within 10 years, and articles written in English. Although the research finding relied on most of the selected studies, some articles that were highly relevant, but were not research reports, were also included. Before writing up the study, only 11 articles were available with one being a substantial PHD study carried out in 2012. There was concern regarding the small number of studies that could be included in the literature review. However, through my supervisor’s input, we decided to continue and seek other studies from other countries that had some comparison to Saudi Arabia. Chapter 3: Findings Causes of Health Professional Shortage in Saudi Arabia There are various reasons that contribute to the health system’s professionals in the country. Importantly, these reasons range from the culture of the people in the country, and the education system of the nation. In effect, the country has relied on foreign nurses to provide healthcare to the citizens of Saudi Arabia. According to Ahmadi (2006), heavy reliance on foreign nurses is due to the overall nursing shortage in Saudi Arabia. Many expatriate nurses come to Saudi Arabia and start working in the health sector as temporary workers. In this case, they work as temporary workers in order for them to gain post-qualifying experience and training. Ahmadi (2006) also states that the expatriates learn these skills in nursing and gain the essential experience. Effectively, the skills and knowledge the nurses gained enabled them to work in developed countries such as Canada, Australia, America and the United Kingdom due to better working conditions that these countries provide their employees. Unfortunately, there is no official statistical publication to support this trend. However, Almalki (2011) further pointed out that a majority of managers in the healthcare sector are realising the importance of addressing the rapid turnover of foreign nurses. Abu Znadh (2004) found that there are other reasons directly related to the nursing shortage in Saudi Arabia. Among these issues, the lack of interest among the Saudis in the nursing profession remains the most fundamental reason behind the number of nurses in the country. In this case, it is evident that high school students identified nursing as the least choice of profession that they would likely join after high school. In addition, the nature of the nursing profession affects the life of the family and the personal life of an individual due to the high workload, night shifts and work during holidays, which are factors that make the nursing professional less appealing to most students. Abu Znadh (2004) supports this assertion by noting that the poor image of nurses is a common cause of the nursing shortage in Saudi Arabia. A survey conducted by Al-Omar (2004) to measure the image of the nursing profession focused on the aspects of attitude and the intention among high school students in the city of Riyadh towards the profession of nursing. Results indicated that only 5.2% students preferred working as nurses in future. In addition, the study identified the nursing workload, which was high in comparison to other professions, as having a significant negative effect on the student’s intention to engage in the nursing profession in the future. Among the recommendations, the research study identified the importance of decision makers in the country’s health system to carry out effective measures in changing this outlook. In this case, the study suggested that the decision makers in the health system could improve the attitude of high school students in taking up the nursing profession by improving the image of the profession through approaches that were effective. According to Paul, et al. (2006), the main cause for the nursing shortage in most countries is lack of resources. In fact, WHO (2010) supported this argument and noted that developed countries enticed nurses by high wages, which developing nations were unable to pay to their nurses. In effect, nations that offered better wages have witnessed an influx of nurses who look forward to earn these wages. Elmobasher (2007) reported the presence of several factors that cause shortage in nursing. First, the study identified the aging population as one of the fundamental reasons behind the shortage of nurses. Secondly, another reason contributing to the shortage of nurses includes the lack of job satisfaction. Furthermore, lack of health education about the role and importance of nursing contributed to the shortage of nurses in the country. Furthermore, Elmobasher (2007) stated, “The American Nurses Association (ANA) thinks that the main reason for the lack of nursing is inadequate work environment and that leads to job dissatisfaction among nurses”. In effect, the dissatisfaction among nurses regarding their roles and responsibilities requires physical and psychological treatment for the nurses in order for them to experience job satisfaction. Possible Solutions to Reduce the Nursing Shortage in Future According to Almalki (2012), long plans are required to reduce the nursing shortage. Among the issues that require immediate attention is the improvement of the image of nursing, which is the most fundamental reason. In addition, it is crucial to employ a large number of local nurses while looking for approaches to retain foreign nurses. In addition, it is essential to impose and devise strategies that the media will use in highlighting the importance of the nursing profession for the future of the country. In this case, the media should take a leading role in educating the country about the importance of developing a positive attitude towards the profession in order for more students to gain interest in the profession and embrace the profession. Importantly, local Saudi nurses are more qualified to work in the Saudi health system than their foreign counterparts were qualified since they know the language, customs and the culture of the nation (Abu-Zinadah, 2006; Alamri, et al., 2006). Vance (2011) noted the importance of implementing many strategies that addressed the shortage of nurses in the country. In this case, he proposed strategies that aimed at reducing the phenomenon of turnover, seeking to improve working conditions and the culture of nursing. In addition, the study highlighted the importance of designing nursing programs under the supervision of doctors and specializing in nursing in order to train a new generation of nurses. Nakata and Mizkaka (2011) conducted a study in Japan that identified the presence of three solutions whose implementation was influential in addressing the problem of the nursing shortage in Japan. The first solution sought to implement an employment program to recruit unemployed nurses. Secondly, another solution sought to introduce flexible workload and working hours for nurses that work in providing health care to member of families. In relation to the Japanese aging population, researchers believe that offering flexible work for nurses caring for the older can be one of the appropriate solutions to help nurses stay in their jobs and to reduce the rate of turnover. Thirdly, health authorities should raise the wages of nurses and this may be a challenge with current downturn situation of global economy. With the current economic recession, and especially in America, it might be a good solution and may make nurses stay longer due to her responsibility of household expenses since the husband might be retired or could not find work. Under these economic conditions, the nursing shortage can be improved, but on the other hand, it may become worse if the economic downturn may affect the global economy again. In a similar study by Maben, et al. (2010), Gulf States faced a problem with the shortage of nurses in the region and the study highlighted the importance of the states to take advantage of the resources in the region and particularly in Saudi Arabia. In this case, the reason for taking advantage of the resource available arises from the need to ensure that the state met the increased health needs while also increasing public health issues. Government’s Effort towards Decreasing the Shortage of Healthcare Professionals In Saudi Arabia, the government has engaged in a number of efforts to educate and train Saudis in the field of occupational health. Since 1958, many Nursing and Health schools have been opened in all parts of the country in order to achieve this goal (Aldossary, et al. 2008). According to the Ministry of Health (MOH, 2007) there are approximately 62 private college of Medicine and Nursing, as well as four health institutes by 2007. Moreover, Saudi Arabia has set up programs in these colleges, which aim at providing Saudis with labour instead of relying on foreigners in the health sector and in all sectors (WHO, 2006b; Tumulty, 2001). Since 2004, the University of Jazan, King Khalid University has established some departments to teach nursing. In addition, WHO (2006) identified the role of the Saudi government in preparing a huge budget for the scholarship and training programs in nursing. Thus, the government provided an opportunity to most of the staff in the Ministry of Health to continue their studies abroad. These efforts should develop skills in the Ministry of Health staff and improve the quality of health services. Moreover, this approach is crucial in reducing the rate of turnover among healthcare professionals (Rambur, Palumbo, McIntosh and Mongeon, 2003). There is a need to consider long-term strategies that enhances cooperation between the Ministry of Health and all other government agencies and the private sectors. For instance, King Abdullah international scholarship program, which the Ministry of Higher Education (MOHE) established, has devoted its fourth phase to Medical Specialties in nursing, pharmacy, health services management and other health disciplines (MOHE, 2008). According to Maben et al. (2009), there are many reasons behind the governments’ efforts in the Gulf towards reducing their dependence on expatriate workers. Some of these reasons include increasing the local nurses, which is crucial in strengthening health services in the region since it helps to increase the number of Arabic-speaking workers. Aldossary (2008) reported that only a small number of workers in the health sector spoke Arabic in 2008. In addition, Gulf governments are making efforts to decrease the revenue outflow outside, which foreigners send to their countries. Moreover, Pakkiasamy (2004) stated that foreigners sent about $60 billion annually out of the country with this figure being more than a fifth of the Saudi government’s annual budget. The Impact of the Health Professional Shortage on Quality of Services with Saudi Healthcare System Alamri, et al. (2006) identified the lack of experience in recently qualified nurses as a major cause of the deterioration of the nursing practice. In addition, this created extra work on experienced nurses since it becomes their responsibility to train and supervise new staff while also performing their core roles. In effect, this leads to an increase in errors within the healthcare system with these errors affecting the quality of services. Moreover, it affects patient satisfaction due to the quality of services provided. According to Aldossary (2008), Saudi Arabia is able to face these challenges and increase the number of Saudi nurses in the country to provide high quality of care and culturally appropriate services. In addition, nurses can talk to patients without any language barriers, which improve the quality of care. Without this, it is a challenge to provide effective health care. Buchan (2006) identified nursing shortage as a topic that was not befitting of economic analysis or the simple analysis of a problem within an organization. However, shortage in nursing has a direct negative influence on health care. In effect, the failure to reduce the nursing shortage at a national or global level will affect the quality of healthcare provided. Limitation of the study There are inadequate resources with only a few studies analysing issue of nurse shortage in Saudi Arabia. Furthermore, a majority of researchers use the same result and information to draw their findings, recommendations, and conclusions. In addition, there is a lack of updated studies and only few recent studies available. Chapter 4 Discussion Overall, the findings suggest different elements that caused the nursing shortage. However, most of them were unanimous that the nursing shortage problem is still existent in Saudi Arabia with the findings identifying the importance of addressing this problem. In addition, results demonstrate diverse solutions to the problem of nursing shortage although researchers suggest solutions regardless of the effectiveness of their research work. Consequently, some solutions created new challenges for themselves and the studies do not provide elaborate details or explain problems arising from applied or produced solutions. In other words, some solutions proposed by the researchers do not provide additional options in case the solutions gave negative effects on the health system in general and the nursing profession in particular. The most unexpected results regard the small percentage of students who prefer to work in the nursing profession. It appears that there is a direct correlation between the lack of preference for high school students to work as a nurse and the poor image of nursing. Results also suggest outstanding efforts from the Saudi government to curb the spread of the nursing shortage issue by supporting the nursing profession as a future career choice to most high school students. In effect, this helps to increase the quality of health services. However, government efforts may not be enough to solve the problem of shortages. Despite all these measures, it is important to establish more colleges and health programs all over the country. The government should take immediate and decisive decisions on health system in the Ministry of Health by imposing new systems and laws to develop the healthcare system by restructuring the system. Most researchers agreed that the nursing shortage could limit the development of health services. From the results, there are different factors that lead to the shortage of nurses with the proposed solutions insufficient in the elimination of the problem. Hence, this requires long-term plans in order to address the problem gradually. Future researchers should focus on investigating the main reasons that have real and tangible impacts, instead of secondary factors in order to reduce the factors that raise the problem and identify long-term solutions. Therefore, the decision-makers will have a more comprehensive overview on the main causes of the problem in order to avoid them and then identify the secondary causes to the problem. Conclusion: To summarize, nursing shortage is a global problem and some high rated health systems in developed countries experienced the problem of nursing shortage. The health system in Saudi Arabia has a shortage of nursing and most of the workers in the nursing profession are foreigners. Despite rapid population growth, there is a decline in the percentage of the local shortage of nurses. Multiple reasons behind the worsening nursing shortage problem include overreliance on foreign nurses. In this case, foreign nurses practice nursing in Saudi Arabia in order to gain experience, which enhances their chances of working in developed countries due to attractive wages and better working conditions. In addition, the inflexible nature of the work, which is in contrast to the nurses’ lifestyle in Saudi Arabia, contributes to this shortage. In addition, the common poor image of the nursing profession in the Saudi society and the weakness of the role of the media in educating the population about the nursing as an important health service play a critical role in the shortage and they require immediate action. Some solutions that will reduce the nursing shortage include the recruitment of locals as nurses, providing flexible requirements to support local to join healthcare colleges, train and develop current workers and designing work schedules that corresponded with each nurse’s schedule within an organization. Furthermore, increasing salaries to encourage existing workers will reduce the rate of turnover and attract new employees to work as nurses. The Saudi government has made great strides in solving the nursing shortage problem by establishing institutions and colleges of nursing around the country. In addition, the government allocates huge and separate budgets towards scholarship programs for the health ministry staff to study abroad and gain skills, knowledge and experience. Finally, it is evident that the nursing shortage has an impact on the quality of health services, which leads to dissatisfaction among patients. Decision and policy makers in the Ministry of Health should seek to provide high quality of services in order to enhance and build confidence and satisfaction among patients. In addition, they should address this issue in a manner that was fast, flexible and offered suitable solutions that were long-term and addressed the issue of nursing shortage. Reference Abu-Zinadah, S., 2004. The situation of Saudi nursing. Health Forum, 52, pp.42-43. Abu-Zinadah, S., 2006. Nursing situation in Saudi Arabia. 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