LEADERSHIP DEVELOPMENT OF NURSE MANAGERS IN A SAUDI HOSPITAL: A FOCUSED ETHNOGRAPHIC STUDY
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Saudi Digital Library
Abstract
Background: The Saudi Vision 2030 sets out the ambition of high-quality healthcare for all its citizens and residents. It requires nursing to be transformed to improve uptake, retention, and involvement of the workforce. Furthermore, all nurses should have a satisfying and rewarding professional career and develop their leadership roles. However, at present how nurse managers acquire and practise their leadership skills in the Ministry of Health hospitals in Saudi Arabia is unclear.
Aim: To explore the perceptions and experiences of nurse managers regarding leadership development in a Saudi hospital affiliated with the Ministry of Health.
Design and Methods: A focused ethnographic study was undertaken with multiple field visits (a total of eight months and seven days). Qualitative data collection involved observations of the workplace and Continuous Medical Education lectures, examination of relevant documents, informal interviews and discussions with five participants, and semi-structured interviews with 21 nurse managers. Framework analysis was used to identify common themes to provide a structured summary of the data.
Findings: Four main themes were identified. Firstly, imbalanced power dynamics were evident in the culturally pervasive and normalised capricious leadership approach. Workforce decisions were based on power in the absence of a clear hospital strategic vision and transparent human resource management processes, whereby decisions favoured some with financial rewards, favourable work assignments, meritless promotions, and arbitrary staffing allocations. Additionally, there was no shared vision shown by ineffective communication and a lack of job clarity. Workplace rituals and behaviours revealed a climate of bullying and punctuality issues. Gender segregation allowed female nurse managers to resist senior male managers and express their independent freedom of action. Finally, a need for learning was evident but was not clearly directed, with didactically delivered lectures providing a cost-effective way for the workforce to accumulate CME accreditation maintain their registration.
Conclusion: Whilst hierarchical and transactional management structures and processes were found in line with Arabic culture, they did not explain the managers' leadership experiences framed by wasta, a form of cultural nepotism normal to Saudi business practice but which is now officially recognised and condemned as corrupt by state legislators. The climate of fear and intimidation created by managers induced compliance, conformity and adaption within
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directorate practices. Furthermore, gender separation allowed female staff to avoid male directorate authority.
Keywords: Leadership development, nursing, nurse managers, CPD, CME, barriers, facilitators, organisational culture, focused ethnography.