|Year : 2022 | Volume
| Issue : 2 | Page : 190-192
My experience as a registered nurse in a middle Eastern Country
Lovely Simon1, Rajini Peter2
1 Clinical Specialist, King Faisal Specialist Hospital and Research Centre Riyadh, Riyadh, Saudi Arabia
2 Professor and Principal, College of Nursing, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
|Date of Submission||06-Jul-2022|
|Date of Decision||25-Jul-2022|
|Date of Acceptance||27-Jul-2022|
|Date of Web Publication||29-Aug-2022|
King Faisal Specialist Hospital and Research Centre Riyadh, Riyadh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Simon L, Peter R. My experience as a registered nurse in a middle Eastern Country. J Med Evid 2022;3:190-2
| Introduction|| |
In the Middle East, nurses from all over the world have always been welcomed, and Indian nurses have prospered from this for decades. For many years, it was a common practice among Indian nurses to get employed in the Gulf soon after their training. Plenty of Indian nurses worked in the Middle East, before migrating to a Western or European nation; and had a big impact on the economic progress of the Indian subcontinent by earning in their employer country(s) and providing for their homebound family (in terms of both gross domestic product growth and per capita income).
I hail from the Indian state of Kerala, and did my schooling and pre-degree in my hometown, before enrolling in Rajkumari Amrit Kaur College of Nursing in New Delhi for my BSc (Hons) Nursing (1989–1993). I relocated to Mumbai shortly after graduation and worked for about 2 and ½ years at Dr. Balabhai Nanavati Hospital. As my spouse was already employed in Saudi Arabia, I accepted a job offer to work as a staff nurse at a military hospital in Hafar al-Batin. To be honest, I had negligible knowledge about Arabian culture, language or nursing scope when I arrived in the country. I moved to Riyadh, Saudi Arabia's capital, after 4 years and started working as a staff nurse-1 in a medical ward at King Faisal Specialist Hospital and Research Centre (2001). I was promoted to the post of clinical instructor for the same unit in 2004, a position I held until 2020. I had the opportunity to supervise other medical and surgical units, participate in nursing student training at various levels and conduct orientation and competency testing of new staff nurses from around the world during this tenure. I enhanced the knowledge and skills while developing myself as a reliable and efficient resource for my units. In recognition of my work as a member of the Clinical Policies, Procedures and Forms Committee, I have been designated as the clinical specialist for nursing policies, procedures and forms as of 2020. During the course of my 26 years as a certified nurse in Saudi Arabia, I learned a lot and grew both personally and professionally. I have been living here for more than half my life and have never grown weary of it.
| Health-care Services in Saudi Arabia|| |
Saudi Arabia has a plethora of public and private hospitals and clinics. Public hospitals are primarily tasked with treating citizens and hospital employees for free. Contrary to this, individuals who have health insurance often rely on private hospitals for meeting their healthcare needs. Primary health care (PHC) centres are evenly distributed across the country and serve as a triage centre, as well as providing immunisation services. PHC centres conduct preliminary screenings, treat minor illness and transfer patients to local hospitals as needed. PHC nurses predominantly maintain a close contact with the individuals of their community and are empowered to make decisions within their scope of practice.
Hospitals both small and large with a range of bed capacities offer primary, intermediate and tertiary care. All hospitals are supervised and regulated by the Ministry of Health (MOH), which expects them to follow MOH laws and regulations at all levels of the organisation. Every hospital has its own set of policies and procedures. Hospitals assist one another by providing education and training based on their specialties, to create a network of health-care specialisations and integrate the functions of similar departments within this network. I work at King Faisal Specialist Hospital and Research Centre, one of the finest tertiary care hospitals in the Middle East. We have a variety of institution affiliations, as well as health outreach initiatives and telemedicine services. We train workers from other facilities, and medical and nursing students from various universities have their clinical rotations at this institution. Our health-care professionals also conduct educational sessions and workshops at various medical facilities. The facilities offered and professionals employed here makes King Faisal Specialist Hospital and Research Centre a world-renowned health-care institution and a well-established welfare organisation in the region.
| Nursing in Saudi Arabia|| |
In Saudi Arabia, nursing is relatively a new profession. Despite several changes over the years and the establishment of nursing programmes by various colleges and institutions, the country continues to provide excellent and extensive opportunities for international nurses within the institutional scalar chain. However, Nursing-Diploma holders are no longer employed by the government, although they get recruited by the private sector. Saudi nurses have begun to occupy leadership roles, thanks to the government's proactive interventions and strategical regulations – such as funding for higher education and professional development programmes.
According to a research published in 2020 titled 'Challenges and Policy Opportunities in Nursing in Saudi Arabia' the number of non-Saudi nurses employed in the country is larger than the number of Saudi nurses. Male nurses with foreign nationalities have comparatively less opportunities in the country, owing to the cultural norm that 'only' female nurses can care for patients of both genders; restricting the job role of male nurses into providing direct care solely for male patients, exceptions applicable only during critical situations. Despite this, Saudi men are not hesitant to pursue a career in nursing, resulting in a roughly equal proportion of male and female nurses [Figure 1].
|Figure 1: Number of nurses in the Kingdom of Saudi Arabia, by gender and nationality 2016–2018|
Click here to view
The Saudi Commission for Health Specialties (SCFHS) is the licencing body through which nurses obtain and maintain Saudi nursing registration. International nurses are mandated to verify their educational and experience certificates through DataFlow, and clear the Prometric exam. Prometric is a leading provider of technology-enabled testing to many of the world's most recognised licencing and certification organisations, academic institutions and government agencies. There are two types of licencing examinations for nurses in Saudi Arabia (specialist and technician). An employee must obtain the required number of continuing education points by attending educational programmes with continuing medical education (CME) points, certified by SCFHS, to renew their nursing licence. Compared to technicians, specialists need more CME points to renew their licence.
| Nursing Associations|| |
Nurses can join any nursing association from any country by fulfilling the requirements set forth by them (e.g., the American Association of Critical-Care Nurses, the Academy of Medical-Surgical Nurses and Oncology Nursing Society). The Saudi Nurses Association is restricted to residents of Saudi Arabia/Gulf countries. Many nurses are members of the United Nurses Association (UNA), India. There is an informal group called Riyadh Nurses Association. UNA and Riyadh Nurses Association were actively involved in arranging chartered flights during COVID restriction times.
| Culture and Language of Saudi Arabia|| |
The Kingdom of Saudi Arabia is an absolute monarchy ruled by Islamists, and it is a hereditary dictatorship. Women, irrespective of nationality or economic status, were obligated to wear an abaya (a black long dress with long sleeves that covers the entire body) and a headscarf or veil. Women were also obliged to cover their faces in several cities. In public, we were not permitted to associate with men other than one's father, husband, brother or son. During the Muslim prayer hours, shops had to close. Non-Muslims are still prohibited from visiting Mecca and Mediah's Mosques. Unmarried female nurses were only allowed to stay in the hospital accommodation and were driven around in hospital vehicles for shopping. Women were not permitted to drive.
A drastic departure from the above-mentioned scenarios has been witnessed over the years –attributed to a wave of opposing ideologies and the country's embrace of the globalisation trend. The transition has equipped its residents with an open-minded outlook. At present, if someone is dressed modestly, an abaya is no longer required. Some hospitals permit unmarried women to live outside the hospital residential area. Changes in regulations have allowed many retail centres to stay open during prayer hours. Even though some films have age limits, theatres have been opened to a larger audience. Females are allowed to drive and commute by public transport, even to distant cities. Indian nurses celebrate special occasions at organisational level. Nurses living with their families outside the hospital compound are part of different social groups and have more opportunities to take part in social gatherings.
Since most nationals' language proficiency is restricted to Arabic, it is necessary for a nurse to learn basic Arabic, especially medical phrases, as a means to understand the patients' problems and meet their primary needs. Nurses who do not speak Arabic tend to have a difficult time communicating with their patients and their families, which sometimes lead to difficulties in establishing the nurse–patient relationship. Saudi citizens, on the other hand, deserve praise for their patience and tolerance of the broken/mixed language of foreign nationals. They abstain from making fun of our mispronounced words and broken sentences, probably because they have got accustomed to it. They collaborate with international domestic workers, health-care providers and other experts and willingly corroborate their efforts. They employ both verbal and nonverbal communication techniques to help us understand their thoughts. They have come a long way and are ever ready to walk the extra mile to create an effective communication channel for all parties involved.
| Labour Laws|| |
Employers are expected to pay wages and benefits in accordance with the work contract and applicable labour laws. Expatriate personnel are hired on behalf of the employer, which could be a company or a sponsor. Foreign nationals are not allowed to work independently for anyone other than the designated sponsor. An employee is free to work for another company, only if the employer releases him or her from the contract. If the employer does not comply, the employee may file a labour court lawsuit. An employer can terminate an employee with a written notice. Employees can resign by giving notice to the employer, although fines may apply depending on the explicit contractual conditions and circumstances. Every time an individual leaves the nation, they will require an exit-re-entry visa or a one-way exit visa upon completion of contractual service in the nation. Employees are entitled to bring their close family members either on a permanent family visa or a visit visa. Tourist and business visas are also provided for people who meet the criteria. Foreign visitors are expected to leave the country before their visa expires.
| Challenges and Opportunities Being a Nurse in Saudi Arabia|| |
Saudi Arabia continues to hire international nurses, who benefit from higher salary, the opportunity to work with people from diverse cultures and attain first-hand expertise in innovative health technology. Professional and career development possibilities are aplenty in the nation. Employees of the hospital are entitled to free healthcare and medical benefits. They can scout for better job opportunities within the country and change jobs in accordance with the country's norms and regulations. Nurses who aspire to migrate to another country can complete the necessary prerequisites while working, which is a bane where experience is the deciding factor for opportunities abroad. Language tests (e.g. Occupational English Test [OET] and International English Language Testing System [IELTS]), certifications (e.g. Certified Medical Surgical Registered Nurse [CMSRN] and Oncology Certified Nurse [OCN]) and other computer-based tests are easily accessible in the country due to a well-established commuting system connecting health-care institutions and examination centres.
Nurses are encouraged to engage in research activities. They can either be primary researchers or can participate in researches conducted by other disciplines. King Faisal Specialist Hospital has a separate department for nursing research. Hospitals organise evidence-based workshops to teach nurses the basics of conducting a research and literature review. There is a digital health science library with e-books and journals. Research proposals need approval from the Research Advisory Council.
The country also serves as an important hub for international travel. People residing here with their families can provide education to their children through Indian schools or international schools. Indian schools follow the Indian syllabus which ensures smooth transition at any time if the students have to go back to India.
A major challenge nurses face currently is the threat to job security due to Saudisation. The availability of more nursing colleges and the changes in Saudi culture have resulted in an increase in the engagement of both male and female Saudi nurses. The government now prioritises the Saudi citizens for job opportunities, banking on the key operating procedures, credibility and knowledge garnered by foreign nationals over the years. The other challenge is the language barrier which limits our ability to communicate with patients. Effective communication is very important in nursing. Instances, where experienced senior nurses have struggled to provide proper instructions and guidelines to their patients, have undermined the valuable contributions of Indian nurses. Since immigration is not permitted and the nation does not provide citizenship, people must make plans for their lives after leaving their jobs in Saudi Arabia.
| Conclusion|| |
Many people believe that living in the Middle East for a longer period is arduous in nature. However, I have met quite a number of people who initially intended to stay in Saudi Arabia for a couple of years, but ended up staying for a much longer time. During my time here, I have come to believe that this chosen path has greatly enriched my growth at personal, professional and financial fronts. Three of my children were born and raised in Saudi Arabia, yet their opportunities outside the country were unaffected. Family-oriented people shall enjoy this place, as they will have ample time to spend with their loved ones. Individuals who aspire to relocate to other countries may discover that the Middle East is an excellent stepping stone for their dream career, as they get exposed to people from all over the world and have access to cutting-edge facilities and technology. I have seen nurses after working in the Middle East, transition well and thrive in other countries and they appreciate and cherish the experience they gained during their tenure in the Kingdom of Saudi Arabia. This place has always been a cradle for budding nursing professionals from all over the world, and still stands strong as an attractive and respectable destination for health-care professionals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Alluhidan M, Tashkandi N, Alblowi F, Omer T, Alghaith T, Alghodaier H, et al
. Challenges and policy opportunities in nursing in Saudi Arabia. Hum Resour Health 2020;18:98.