Although nursing in the Kingdom of Saudi Arabia (KSA) has witnessed outstanding advancements in the core areas of education, workforce development, and practice, the kingdom continues to experience an acute shortage of local nurses, accompanied by low rates of retention (Almalki, FitzGerald, & Clark, 2011).
As acknowledged by these authors, foreign nursing professionals form a huge percentage of the nursing workforce in the Kingdom’s healthcare institutions, with local Saudis comprising below 30 percent of the total nursing workforce. In recent years, the Ministry of Health in the KSA has adopted a national policy to reduce the proportion of foreign staff working in the kingdom, with the view to increasing the number of Saudi new graduate nurses (NGNs) or novice nurses being absorbed into active employment in both public and private sectors (Fielden, 2012).
However, as acknowledged by Fielden (2012) and Growchow (2008), most of the young professionals do not remain in Saudi’s health care system for a period longer than the first year of practice, in large part due to transition-related challenges and subsequent turnover.
Available nursing scholarship demonstrates that the process of transitioning from being a novice nurse to becoming a professional practitioner is often complex and stressful (Growchow, 2008; Newton & McKenna, 2009), with several researchers concluding that the adverse experiences associated with this process have played a critical role in entrenching the problem of chronic nurse shortage in many countries across the world (Ferguson & Day, 2007; French 2011; Morrow, 2009).
Although new graduate nurses eagerly anticipate their first positions in the “real world”, they nevertheless experience challenges that make it increasingly difficult for them to adapt, fit in, integrate theory with practice, and develop clinical competence (Fielden, 20121; Morrow, 2009).
The experiences of novice nurses in transitioning to clinical settings within the first two years upon employment can be summarised in terms of role stress and role ambiguity, interactions with colleagues, and real or perceived sense of feeling unprepared for their roles as new nurses.
Role stress and role ambiguity, according to the available nursing scholarship, is triggered by new responsibilities for the novice nurses, constant testing of competence in an ever-shifting technological environment, need to adapt to a new culture, lack of confidence, high expectations of the self, unrealistic expectations by clinical staff, lack of support, values conflict, tensions within the social climate of the workplace, blocked learning opportunities, lack of experience, lack of organizational skills, as well as ineffective interactions with members of the interdisciplinary team (Levett-Jones & FitzGerald, 2005; Morrow, 2009; Saintsing, Gibson, & Pennington, 2011).
Adverse transition experiences arising from interactions with colleagues include horizontal violence experienced by novice nurses in their first year of practice, feelings of inadequacy when engaged in the interdisciplinary team, feelings of disorientation for “not knowing”, feelings of being neglected by other nursing professionals, unjust criticism, rude and humiliating verbal exchanges, exclusion, denial of access to available opportunities, as well as withholding of essential information (Morrow, 2009).
These experiences, according to Newton & McKenna (2009), are stressful in that they demonstrate the novice nurses as being ill-prepared for their new roles in practice settings. Stress and anxiety within this group of the nursing workforce are also compounded by lack of consistent support in the clinical environment, coupled with heightened socialization expectations of being a professional registered nurse and the attendant failure to deliver in line with the expectations outlined by other members in the workforce (Ferguson & Day, 2007; French, 2011; Growchow, 2008).
The relationship between these experiences and job retention and satisfaction has been well documented in the western-oriented literature. For example, Morrow (2009) acknowledges that the cumulative impact of the mentioned transition experiences “leads to high absenteeism, unreported incidences, consideration of leaving the nursing profession and then doing so” (p. 280).
Most of the available literature on job satisfaction and retention reports that the continued marginalization of novice nurses as they transition to become professional practitioners provides the framework for persistent inertia which impacts negatively on the recruitment, job satisfaction levels, and retention of graduate nurses, leading to acute shortages of nursing personnel and poor patient outcomes (Abualrub & Alghamdi, 2012; Morrow, 2009).
Inadequate nursing support systems and other holistic interventions geared toward ensuring an uneventful transition of novice nurses to registered nurses have been positively associated with reduced levels of job satisfaction and retention (Fielden, 2012), with other scholars suggesting that job satisfaction and nurse retention may also wane as novice nurses complete orientation and begin independent practice, only to experience a sustained conflict with ideals and values as they attempt to transition to professional practitioners (Ernst, Messmer, Franco, & Gonzalez, 2004; Morrow, 2009).
Drawing from this exploration, it is clear that the transition of novice nurses to registered nurses in the KSA presents unique challenges that need to be addressed by nurse managers and other relevant parties if job satisfaction and subsequent retention of nurses are to be achieved. The transition experiences have been cited as possible sources of feelings of fragmentation and frustration among novice nurses, hence the need to provide viable solutions with the view to ensuring that nurses become more satisfied in practice settings.
References
Abualrub, R.F., & Alghamdi, M.G. (2012). The impact of leadership styles on nurses’ satisfaction and intention to stay among Saudi nurses. Journal of Nursing Management, 20(5), 688-678.
Almalki, M., FitzGerald, G., & Clark, M. (2011). The nursing profession in Saudi Arabia: An overview. International Nursing Review, 58(3), 304-311.
Ernst, M.E., Messmer, P.R., Franco, M., & Gonzalez, J.L. (2004). Nurses’ job satisfaction, stress and recognition. Paediatric Nursing, 30(3), 219-227.
Ferguson, L.M., & Day, R.A. (2007). Challenges for new nurses in evidence-based practice. Journal of Nursing Management, 15(1), 107-113.
Fielden, J.M. (2012). Managing the transition of Saudi new graduate nurses into clinical practice in the Kingdom of Saudi Arabia. Journal of Nursing Management, 20(1), 28-37.
French, L. (2011). Student voices. The Unspoken: The stresses of a novice nurse. Nursing, 41(12), 16-17.
Grochow, D. (2008). From novice to expert: Transitioning graduate nurses. Nursing Management, 39(3), 10-12.
Levett-Jones, T., & FitzGerald, M. (2005). A review of graduate nurse transition programs in Australia. Australian Journal of Advanced Nursing, 23(2), 40-45.
Morrow, S. (2009). New graduate transitions: Leaving the nest, joining the flight. Journal of Nursing Management, 17(3), 278-287.
Newton, J.M., & McKenna, L. (2009). Uncovering knowing in practice during the graduate year: An exploratory study. Contemporary Nurse: A Journal for the Australian Nursing Profession, 31(2), 153-162.
Saintsing, D., Gibson, L.M., & Pennington, A.W. (2011). The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management, 19(2), 354-359.