Saudi Arabia has achieved tremendous accomplishments as a nation. Despite many improvements, the country's health care system continues to experience a nursing shortage; the enrollment in baccalaureate nursing is minimal. Most of the nurses there are Americans, Phillipinos, and Egyptians.
A review of the literature reveals that nursing suffers from a poor image in many countries. In the United States, despite the increasing professionalization of nursing, nurses are still the most exploited characters in movies (Wheelock, 1976). Benton (1970) notes that many potential candidates do not select nursing as a career because of the profession's stereotyped image.
In Britain, although nursing enjoys a special position in the public's eyes, the image is not ideal. Data collected by Mori (cited in Rayner, 1984) indicate that the public does not endow the nurse with high social status. Hunt ( 1984) wrote that nursing is linked with domestic activities and with women and that it does not require high intellectual abilities.
In Canada, nursing has changed dramatically over the last 30 years. The profession, however, is still portrayed in the media as the "less objective and less skilled appendages of the medical profession" (Bampton et al., 1986).
In Egypt, nursing has long been devalued (News, 1986). Hassan (cited in Meleis, 1980) reported that it was only through the establishment of two baccalaureate nursing programs in 1955 and 1964 that the image of nursing improved.
In Kuwait, Meleis (1980) found that the majority of her subjects are reluctant to enroll in nursing because of the poor image, long working hours, and mixing with the opposite sex. No studies could be found that investigated this problem in Saudi Arabia. It is hoped that such a study would enhance enrollment in professional nursing. The study attempted to determine reasons for not selecting nursing as an area of study, to identify perceptions of nursing among university students and their parents, and to identify recommended strategies to increase enrollment in nursing.
The preliminary results pertained to 43 students from the colleges of medicine, dentistry, and pharmacy, and to 34 of their parents.
The questionnaire consisted of three sections. The first section included independent variables that may influence one's perception of nursing. The second section consisted of questions that elicited reasons for not selecting nursing, and a 3-point Likert scale of the subject's perception of nursing. The third section pertained to strategies for improving enrollment in nursing.
The face validity and the test-retest reliability were established. The "structured interview group" method and the take-home method were used to collect data from the students and the parents, respectively. Subjects were assured confidentiality and their consent was secured.
Data were analyzed manually using the chi-square to determine differences in perceptions between the students and their parents at the .05 a level of significance.
The majority of the subjects were Saudis (81.5% and 82.5% of students and parents, respectively). Fifty-nine percent of the parents had completed secondary or higher levels of education; 61.8% were professionals.
Eighty-eight percent of students and 94.2% of parents perceived nursing as a humanistic profession, that it requires licensure (81.4% of students and 76.5% of parents), and that it involves completing a secondary and or a university level of education (74.5% of students and 76% of parents).
Moreover, 83.8% of students and 88.2% of parents replied that there is a need for Saudi nurses. Reasons mentioned were: that it will be easier to communicate with patients (48.8% of students and 44.1% of parents), that Saudi nurses will be more loyal to Islamic principles (37.2% of students and 32.3% of parents), and that they will understand better the patients' culture and psychology (23.2% of students and 20.5% of parents). Chi-square value (?2 = . 199) indicates that the students' and parents' responses were not significantly different at the .05 u level.
Forty-four percent of students and 55.9% of parents did not approve of nursing for their son or daughter. The reasons given included: the social image of nursing (47.4% of students and 42.1% of parents), the working hours of nurses (36.8% of students and 26.3% of parents), and mixing with the opposite sex (26.3% of students and 31.6% of parents). There was no significant difference between the students' and parents' responses at .05 a level (?2 = 2.975).
Both students and parents had negative images of nursing. The majority either disagreed or were neutral in response to positive statements about nursing. All chisquare values indicated no difference in perceptions between students and parents. Results also showed that nurses, on a job-prestige scale, are perceived much lower than doctors and pharmacists; on the same rank or slightly higher than secretaries, laboratory technicians, and dietitians; and much higher than hospital cleaning personnel. None of the chi-square values were significant at .05 a level.
When subjects were asked to respond to nursing and nonnursing duties, a majority had inaccurate information about nurses' giving medications and caring for a patient's psychological problems. All chisquare values were insignificant. Moreover, the subjects were asked about the fields in which nurses can work. The majority did not know that nurses can work in administration, education, or research.
The results showed that a majority believed that nurses work harder than other health professionals (44.2% of students and 50% of parents), that nursing is an acceptable career for men (65.1% of students and 61.8% of parents), that nurses cannot make critical decisions (60.5% of students and 50% of parents), and that nursing is mainly carrying out doctors' orders (62.8% of students and 67.7% of parents).
When the students were asked about their reasons for not selecting nursing as an area of study, 86% indicated that they did not think of nursing as a career goal. The majority of subjects (60.5% of students and 76.5% of parents) indicated that the main source for their perceptions of nursing was "personal experience with nurses." In relation to the recommended strategies to improve enrollment in nursing, 51.2% of students and 47% of parents emphasized the need to follow Islamic principles (i.e., no mixing, proper uniform), and 41.9% of students and 35.3% of parents expressed the need for mass media education.
The results of the study can be divided into two groups. On the one hand, there are the positive results, namely that the majority of parents and students perceive a great need for Saudi nurses, that nursing is a humanistic profession, and that it is an acceptable career for men. On the other hand, there are the negative results, namely, the students' reluctance to enroll in nursing, and the incorrect knowledge and negative images of nursing. The overall findings indicate a strong need to develop strategies to remedy any deficits in the public's image of nursing, since there is potential for change.
The negative findings are consistent with earlier studies reported in the literature such as that reported by Meléis ( 1980) and Rayner (1984). Chaoman (1985) comments that idealistic young people do not select nursing as a career because they are confident in their worth, and choose to sell their labor to a more rewarding master. Bampton and colleagues (1986) conducted a study to determine the perceptions of nursing among the public. They found that many respondents were uncertain about whether nurses could be involved in activities such as administering blood transfusions (40%), updating patient's records (33%), or removing sutures (27%). Their respondents also were uncertain about the role of the nurse in patient education and research. Lee (1979) reported that two thirds of her respondents regarded nurses as doctors' assistants, regardless of professional status.
Mass media education is needed to correct the public's misconceptions about nursing. Orientation programs in schools might encourage potential candidates to enroll in nursing. Providing financial, social, and professional incentives can draw more men and women into nursing. The working conditions for nurses (long hours, shifts, mixing) need to be examined; they should be modified to suit the Saudi nurse. Policies need to be changed to allow men into professional nursing. When this happens, it will be possible to assign female nurses to work with female patients, and male nurses with male patients. Finally, expatriate nurses should be role models to influence young potential candidates to consider nursing as a career choice.
- Bampton, E., Cunningham Weir, C, & Kyle, J. (1986). What is a nurse? Canadian Nurse, 82(7), 33-37.
- Benton, D.W. (1970). You want to be a what? Nursing Outlook, 27, 388-393.
- Chaoman, E. (1985). Once upon a time. Nursing Mirror, 161, 7, 43.
- Hunt, J. (1984). Do we deserve our image? Nursing Times, 80(9), 53-55.
- Lee, A. (1979). How and where the handmaiden image is changing. AJV, 42, 36-39.
- Meleis, A.I. (1980). A model for establishment of educational programmes in developing countries: The nursing paradoxes in Kuwait. Journal of Advanced Nursing, 5, 285-300.
- News. (1986). Better education for Egypt's nurses. Middle East Health, 10(9), 4.
- Rayner, C. (1984). What do the public think of nursing? Nursing Times, 80(35), 28-31.
- Wheelock, A. ( 1976). The tarnished image. Nursing Outlook, 24, 509-510.