Barriers and Facilitators to the Recruitment of Student Nurses in Saudi Arabia: A Case Study

Abstract

Introduction: The universal nursing shortage is a ubiquitous threat to healthcare systems and national populations worldwide, due to the rising number of patients with comorbidities and increased mortality. Saudi Arabia also faces a severe nursing shortage, which is worsened by a heavy reliance on expatriate nurses, and Saudi Arabian students preferring not to pursue the nursing profession. Added to this are several cultural and familial issues surrounding the nursing profession in the country, such as negative societal perceptions of nursing, reduced marital prospects for female nurses, hesitance of female nurses to work in mixed-gender environments, and the inability of women to work at night and on weekends, all of which affect students’ decisions to choose the nursing profession. Reliance on expatriate nurses is an expensive and sustainable solution for the long-term, which undermines the nursing workforce’s ability to provide culturally appropriate and person-centred services to Saudi patients. Therefore, it is important to increase the population of home-grown nurses in the country by acting at the grass-roots level (i.e. by increasing the recruitment of Saudi students in university nursing education programmes). Aim: Despite efforts to increase recruitment of students in nursing education programmes, the number of recruits entering these programmes is not very high. Therefore, this study sought to explore the current recruitment strategies to attract more students into the nursing programme in a Saudi public university, and explore the barriers and facilitators associated with the current practice of recruitment. Methodology: A qualitative case study approach was adopted in this study built on the pragmatism framework. Four focus group discussions were held with 17 students in their second- and third-year nursing programmes, and four in-depth, face-to-face individual interviews were held with key administrative members for data collection; following this, thematic data analysis was undertaken. Results: Five themes were identified in the data: cultural and familial barriers’ influences; recruitment and admission policies; managerial challenges; perceptions of nursing; and students’ experiences with recruitment. Cultural influences related to both family members and society instrumentally preventing students from wanting to pursue the nursing education programme, which were considered the main barrier to students’ recruitment in this university. There is no focus on marketing the nursing programme in the university and its admission process of the programme was designed to assess only the academic proficiency of the students, regardless of other factors, such as compatible personality traits, aptitude, and even desire to study nursing. The central management of the university as a public institution, which made it difficult to implement any improving strategy or process solely for the nursing education programme. The perception of nursing among students and their families has been influencing the admission and retention rates in nursing programmes, which is variable among study participants. Some of them still maintain the old negative view of nursing, while other, who have family members working in healthcare, hold a more positive perception of nursing. It is clear, however that the vast majority of students had not come across any recruitment campaigns, and they had a very upsetting initial experience in their first days in the nursing programme, due to their lack of awareness and knowledge regarding the profession. Conclusion: This study identifies several factors that are heavily influential on the recruitment strategies of students into nursing programmes in Saudi Arabia. Some of these influence students’ decisions to choose nursing, particularly the influences of their parents and general societal attitudes related to perceptions of nursing, especially for women, who face barriers concerning the professional requirements of working in mixed-gender environments, night shifts, and weekends. The admissions process within universities only considers the academic proficiency of students, without taking into account students’ interests and extracurricular activities. Furthermore, nursing departments lack a coherent process to design specific recruitment strategies for the nursing programme, and space constraints prevent male students from being recruited to the nursing programme altogether, which is a massive structural barrier to the development of modern nursing in the country. All these factors were found to reduce the recruitment of students in the nursing education programme in the analysed university. The extent to which the findings of this study can be extrapolated to other universities in Saudi Arabia cannot be precisely gauged, although similar factors are faced in nursing programmes across the country due to similar policies being dictated by centralised decision-making at the health and education ministerial levels, and ubiquitous cultural and administrative features among public and private universities in the country. Consequently, the barriers to effective nursing recruitment identified in this study should be appropriately addressed at the national and institutional policy and administrative levels in order to increase nursing student recruitment in the country.