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Shortage of Nursing in Saudi Arabia

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Shortage of Nursing in Saudi Arabia

Nursing shortage is a critical problem affecting most countries, including Saudi Arabia.

This shortage has negatively impacted the healthcare system of Saudi Arabia for years. Some of

the reasons that can be associated with the increasing demand for nurses in Saudi Arabia include

increasing population, medical requirements, and services. However, the supply of nursing staff

has not been able to respond to this demand appropriately. This significantly overwhelms the

available personnel. However, cultural adjustment challenges and performance issues with

contract staff promote the reliance on expatriate staff. This aspect greatly impacts staffing

stability. However, the emerging nursing shortage remains a significant issue despite the fact that

Saudi Vision 2030 seeks to improve the community health status. This shortage does not only

reduce the quality of care but also increases pressures that lead to burnout, turnover, and shortage

cycles. Nursing shortage is a significant problem facing Saudi Arabia today.

Two Research Articles that Support the Topic

Alsadaan, N., Jones, L. K., Kimpton, A., & DaCosta, C. (2021). Challenges Facing the Nursing

Profession in Saudi Arabia: An Integrative Review. Nursing Reports, 11(2), 395–403.

https://doi.org/10.3390/nursrep11020038

The article “Challenges Facing the Nursing Profession in Saudi Arabia” by Alsadaan et

al. (2021) identifies the key factors that have led to the shortage of nurses in Saudi Arabia. Some

of these include hiring expatriate nurses, cultural and social considerations, and recruitment and

retention problems. The nursing workforce in Saudi Arabia depends on the foreign nurses, which

contribute to 60–70% of the total nurses. According to Alsadaan et al. (2021), dependency

occurs due to the scarcity of Saudi locals joining the nursing profession. Although expatriate

nurses help to fill an existing shortage of nurses, they encounter numerous problems, such as
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language and cultural barriers. These problems affect both employee engagement and quality

service delivery to patients. The authors point out that most of the expatriates, particularly those

from the Philippines, India, and Malaysia, suffer from cultural isolation and difficulty adapting to

Saudi social norms. This leads to high turnover rates. Furthermore, language differences existing

between expatriate nurses and Saudi patients, most of whom are illiterate in English and any

other language other than Arabic, make health care provision a challenge. These language

barriers mean that either Saudi nurses, or interpreters, have to translate, a situation that adds

workload pressure on the national staff.

The article further explains that culture and perception towards nursing in society are

some of the reasons that discourage Saudi nationals from taking nursing courses. Nursing is well

understood as a ‘woman-oriented’ occupation that rarely receives any type of appreciation in

comparison with other jobs. The stereotypical view that nursing is a female profession combined

with gender bias makes many Saudi Arabian men avoid this profession (Alsadaan et al., 2021).

Moreover, the nature of interaction with the opposite sex required for the job goes against the

highly conservative gender segregation in the Saudi Arabia. Thus, this results in social and

familial disapproval for many female Saudi nurses. This is particularly the case when the patient

is a male patient. In addition, most Saudi families discourage women from working at night or in

places where they can come across people of other genders (Alsadaan et al., 2021). Thus, most

Saudi nurses look for day shift or outpatient clinic shifts that give room for nurses to carry out

their familial duties. This leads to expatriate nurses working at night and during the weekends.

This day shift preference by Saudi nurses as well as the preference for the non-hospital sector

also puts a lot of pressure on the expatriate staff as they work extra hard and have less scheduling

flexibility.
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Alsadaan et al. (2021) highlight that the challenge in addressing the shortage of Saudi

nurses’ attributes is the negative perception of nursing education. The low enrolment in nursing

courses is a result of a poor perception of the nursing profession and inadequate support. Also,

there is a limited offering of financial incentives or scholarships for the nursing students

(Alsadaan et al., 2021). Although there are efforts such as Saudization, which is a government

policy to increase Saudi Arabia workforce in the countries workplaces, the authors point out that

these efforts have not helped in meeting the workforce demand. Saudization has not positively

impacted the retention of Saudi nurses to deliver patient care as bedside care personnel. This is

because many of them opt to go for further studies and managerial jobs rather than clinical

practice. Retention challenges also compound the scarcity (Alsadaan et al., 2021). Saudi nurses

often leave the clinical practice at an early stage in their nursing profession. They do this with a

view of getting higher education overseas so as to be appointed to managerial or education-

related jobs in the health sector. This preference leads to the shortage of skilled clinical nurses.

Most of the Saudi nurses take up the administrative positions after spending relatively little time

treating patients, which results in major shortages in the frontline workforce.

Albalawi, A. M., Pascua, G. P., Alsaleh, S. A., Walaa Sabry, Sitti Nursa Ahajan, Abdulla, J.,

Abdulalim, A., & Salih, S. S. (2024). Factors Influencing Nurses Turnover in Saudi Arabia: A

Systematic Review. Nursing Forum, 2024(1). https://doi.org/10.1155/2024/4987339

The article “Addressing the Nursing Workforce Shortage in Saudi Arabia” by Albalawi

(2024) reveals the magnitude of the nursing shortage in Saudi Arabia. The authors note that the

situation has strategic significance for the development of the country’s healthcare system. Over

the past few decades, there has been an increased need for health care services. This is mainly

prompted by increased life span and the emergence of chronic illnesses. Albalawi et al. (2024)
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highlight that the nursing shortage has been a chronic problem and, despite efforts made by

healthcare facilities and the government to attract and retain talented nurses, no long-term

solution has been found. The article also states that the solution to the problem is required to

ensure that there is provision of quality healthcare services. It is also relevant in fulfilling the

nation’s health care needs that are increasing with time. Albalawi et al. (2024) support the fact

that there are several reasons that lead to the shortage of nurses in Saudi Arabia. Among them is

the challenge of retention because the nurses in Saudi hospitals work long hours and have a high

workload with little chance for promotion. This leads to burnout and dissatisfaction. Therefore, it

results in a significant number of nurses leaving the profession. In addition, it leads to high

turnover rates, which in turn increase the shortage and put the remaining nurses under pressure to

fill the gaps resulting from the turnover. Also, Saudi Arabia has always depended much on the

hiring of foreign nurses to boost its personnel. However, this strategy poses challenges such as

cultural variations as well as language barriers that affect the delivery of efficient patient care.

Moreover, frequent turnover of international nurses has contributed to the instability of the

number of nurses in the workforce. Thus, this shows the necessity to develop more effective

long-term retention solutions.

Albalawi et al. (2024) propose the development of nursing education and training in

Saudi Arabia as one of the key strategies for mitigating the nursing shortage. The government

has already laid down massive investments in establishing more nursing schools and offering

scholarships to Saudi citizens interested in the field. However, this kind of approach has its

challenges. Such include inexperienced faculty and inadequate resources. Another significant

challenge is the limited availability of clinical placement opportunities for students. Such

restrictions have implications on the competency of student graduates, which translates to a

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limited number of nurses (Albalawi et al., 2024). The article also argues that improving

educational capital and offering sustainable staff development might lead to autonomous and

sustainable nursing staff. Over time, this will cut down on the number of foreign nurses being

employed in the country. Apart from education and training, the article recommends increasing

work conditions that may help to retain the existing nursing staff. Nurses suffer from job

satisfaction issues such as low wages, fewer promotions, and lack of proper support. Conquering

these challenges could significantly increase the retention rates (Albalawi et al., 2024). In

addition, the authors suggest ways to resolve the problem, including the improvement of salaries

and career advancement. These changes can bring more positive and satisfying conditions in the

workplace. They may help in the reduction of turnover and attract more professionals to the

field. The article also responds to the cultural and societal challenges affecting the nursing

profession in Saudi Arabia. Social beliefs and cultural norms that remain dominant in society

portray nursing as an inferior profession for Saudi nationals, particularly women. This perception

is further exacerbated by the absence of social support for women in the labor market, hence

depriving young Saudi individuals a chance to venture into nursing (Albalawi et al., 2024). In

addition, the article recommends creating awareness in order to change the perception of society.

Also, promoting cultural competence among healthcare workers would contribute to the

improvement of the organizational culture that integrates international nurses.

Benefits

The problem of nursing shortage is one of the significant issues in Saudi Arabia.

However, it does not remain devoid of opportunities that will pave the way to the enhanced

healthcare system and the overall workforce. One of the most important advantages is the

tendency towards the development of health care facilities and schools due to the need for
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professionals in the field of nursing. Health care expansion and achieving more healthcare

independence have also been acknowledged as key focus in Saudi Arabia’s Vision 2030

(Mohsen et al., 2020). Therefore, it has prompted the government and private sectors to invest

heavily in renovating hospitals, clinics, and training institutions. This focus not only works to

provide higher-value care to the patient, but it also helps to strengthen the capacity of the health

system to address increasing patient demand and increased medical needs. Development of

infrastructure means increased quantity and quality of hospitals, enhanced technical base, and

increased density of coverage of the population by medical facilities. Such investments serve the

purpose of addressing the current growing needs of patients and building the basis of a stronger

and better developed healthcare industry at the same time. They call for higher standards of care

and delivering benefits that could span generations.

The nursing shortage holds another advantage in that it creates numerous employment

chances for Saudis, which complements the country’s objective of boosting the domestic

healthcare workforce. Saudi Vision 2030 seeks to diversify employment and encourage Saudi

Arabian citizens to join sectors previously occupied by foreigners, such as nursing. This scarcity

has now become a challenge to educational facilities to set and develop nursing courses to serve

the Saudi students. It mostly happens through bonuses, grants, and collaborations with leaders in

international healthcare education (Al-Mahmoud, 2020). As more of the Saudi students turn to

nursing, the nation is slowly shifting towards the preferred model of health care system, whereby

local health care professionals can easily address the cultural and linguistic needs of the

population. This change may help to decrease the reliance on overseas employees and, over time,

create a stronger population of workers to support the nation's culture and economic objectives.

It will also help promote communication between the patients and the nurses since Saudi nurses
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are likely to be found in the health facilities across the country. This would create a friendly

atmosphere and trust from the patients.

The nursing shortage is the key to invention and career advancement. This is because

healthcare organizations are keen on maintaining their existing employees while providing

excellent service delivery to their patients (Udod, 2023). Due to the scarcity of nurses, training

institutions are being compelled by the healthcare institutions to put in place training programs

and to provide incentives that would enable them to retain professionals in the field. Such

activities include ongoing training, focused training on intensive care, promotion to higher ranks,

and sponsorships to further education. In order to manage workload and enhance effectiveness,

technological interventions like telemedicine, automatic systems, and electronic health records

are also under consideration by the healthcare centers (Haleem et al., 2021). Such developments

assist the nurses in the optimization of the time-consuming tasks in caring for the client while at

the same time reducing fatigue. Telemedicine, for instance, can help in reducing workload

through remote consultations done by the nurses, as it is favorable to patients from rural areas.

Other processes, such as patient records and medication, also help in decreasing the workload on

the nurses. This enables them to channel their skills towards performing basic care procedures.

These innovations contribute to a more streamlined, coordinated medical system. They have the

added advantage of developing a workforce that is well prepared to meet the challenges of

modern health care systems.

Challenges

The nursing shortage in Saudi Arabia is not only complex but also has a major effect on

the healthcare industry. It is one of the main issues associated with the additional pressure on the

current nurses. The World Health Organization recommends the nurse-to-patient staffing ratio
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that ensures optimal quality of the patient. Nevertheless, in many hospitals throughout Saudi

Arabia, this ratio is not achieved. Therefore, nurses are overloaded with many patients that they

cannot attend adequately to them, causing a lot of stress to the professionals. This increased level

of work pressure results in burnout for the nurses, leading to emotional exhaustion and reduced

personal accomplishment (The World Bank Group, 2022). The effects of burnout are significant.

It impacts the physical and psychological well-being of the nurses while at the same time

contributing to increased turnover, which in turn exacerbates the staffing shortage. When many

experienced nurses quit the job, it will mean the loss of important skills and knowledge that

cannot be quickly replaced. This is the case because new graduates do not possess the experience

required to offer the best care when under pressure. Therefore, it can create a vicious cycle in

terms of the quality of care delivered to the patients.

The shortage of nursing staff in Saudi Arabia results in a significantly low quality of

patient care. This means that due to a lack of adequate nurses, the patients will not receive the

attention they need or get the interventions on time. Besides, will not get appropriate dosages on

their medications and have other overall health issues. Nursing is a challenging career by nature,

as it entails a high obligation to detail and the patients. Therefore, if nurses are stressed high

workload, it translates to reduced quality of care and increased possibility of errors (Rana et al.,

2024). Research has demonstrated that lower staffing levels, particularly a high number of

patients per nurse, increase the risks of problems like medication mistakes, patients’ falls, and

infections. Furthermore, the emotional strain can diminish nurses' capacity for compassionate

care. This is because the workers give more priority to the number of tasks they have to

accomplish as opposed to the interactions they have with the patients. This decline in care quality

has implications not only on specific patient outcomes but with overall population health, as
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diseases worsen if left untreated or poorly managed. Thus, it will result in an increased burden on

the healthcare system.

The scarcity of nursing professionals is responsible for huge economic repercussions in

the healthcare sector in Saudi Arabia. In many instances, the demand for more qualified nursing

personnel results in increased salary expenses and utilization of contract staffing. This can be

financially draining for healthcare facilities. As a result of the staff shortage, most hospitals have

to employ expatriate nurses or hire the services of contract nursing agencies. Therefore, this can

further increase operational cost (Alanzi, 2021). In addition, other consequences arising from

understaffing, which include long waiting times by patients and reduced access to service, may

discourage patients from seeking care. This can potentially lead to more severe health

complications that may need extensive, costly treatments. The government has realized the need

to overcome these challenges. However, the effective strategies to recruit and retain nurses still

remain an important agenda. Measures aimed at minimization of working conditions, provisions

of fair wages, and improvement of development programs are required not only for recruitment

of more employees but also for maintaining the current nursing staff.

Conclusion

Saudi Arabia is experiencing a significant shortage of nurses. This significantly impacts

the ability of the country’s healthcare sector to deliver quality services to the patients. It also

impacts staff productivity and health care costs. Eliminating this scarcity is a complex process

that involves various measures. The strategies that can be put in place include increasing the

years of training for nurses, promoting the working environment for the nurses, and increasing

the community support for the profession. If Saudi Arabia increases its focus on recruitment and

retention and decreases dependence on such foreigners as expatriate nurses, the country will be
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able to proclaim a competent and efficient workforce. The necessary improvements for

managing this crisis need to be aligned with Saudi Vision 2030. Thus, this will guarantee

affordable and efficient medical service delivery for the continually rising population of the

country.
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References

Al-Mahmoud, S. (2020). The commitment of Saudi nursing students to nursing as a profession

and as a career. Life Science Journal, 10(2), 591–603.

https://www.researchgate.net/publication/289304926_

The_commitment_of_Saudi_nursing_students_to_nursing_as_a_profession_and_as_a_ca

reer

Alanzi, T. (2021). Prospects of Integrating Gig Economy in the Saudi Arabian Healthcare

System from the Perspectives of Healthcare Decision-Makers and Practitioners. Journal

of Healthcare Leadership, Volume 13, 255–265. https://doi.org/10.2147/jhl.s323729

Albalawi, A. M., Pascua, G. P., Alsaleh, S. A., Walaa Sabry, Sitti Nursa Ahajan, Abdulla, J.,

Abdulalim, A., & Salih, S. S. (2024). Factors Influencing Nurses Turnover in Saudi

Arabia: A Systematic Review. Nursing Forum, 2024(1).

https://doi.org/10.1155/2024/4987339

Alsadaan, N., Jones, L. K., Kimpton, A., & DaCosta, C. (2021). Challenges Facing the Nursing

Profession in Saudi Arabia: An Integrative Review. Nursing Reports, 11(2), 395–403.

https://doi.org/10.3390/nursrep11020038

Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare:

capabilities, features, barriers, and applications. Sensors International, 2(2), 100–117.

https://doi.org/10.1016/j.sintl.2021.100117

Mohsen Alsufyani, A., Alforihidi, M. A., Eidah Almalki, K., & Musaad Aljuaid, S. (2020).

Linking the Saudi Arabian 2030 Vision with Nursing Transformation in Saudi Arabia:

Roadmap for Nursing Policies and Strategies. International Journal of Africa Nursing

Sciences, 13(1), 100256. https://doi.org/10.1016/j.ijans.2020.100256

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Rana Ali Alameri, Almulla, H. A., Swyan, A., & Hammad, S. S. (2024). Sleep quality and

fatigue among nurses working in high-acuity clinical settings in Saudi Arabia: a cross-

sectional study. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-023-01693-z

The World Bank Group. (2022). The nursing workforce in Saudi Arabia.

https://shc.gov.sa/Arabic/Documents/KSA_Nursing_Challenges_and_Opportunties_pub_

6-22-20.pdf

Udod, S. (2023). A call for urgent action: Innovations for nurse retention in addressing the

nursing shortage. Nursing Reports, 13(1), 145–147.

https://doi.org/10.3390/nursrep13010015