Transition for Nurse Graduates in Saudi Arabia

Transition is the inevitable process of passing from one stage to another, where, the second stage is superior to the initial stage. Once nursing students have graduated from their studies, they have to undergo a transition from being nursing students to being professional medical practitioners, who can handle patients independently (Dyess, 2009). The transitional stage is very crucial as it enhances the growth and development of the nurses (Benner, 2004). Most nurses are likely to make use of the skills gained at this stage in their entire nursing role. The main aim of Saudi Arabias Ministry of Health (MOH) is to develop a health system with competent health care professionals, who can address the needs of the patients efficiently. Therefore, the ministry is employing all efforts to ensure that it recruits as many Saudis as possible into the medical field. Nurse transitional programs are playing a great role in ensuring that inexperienced nurses obtain the necessary exposure to their field of study. Indeed, the program ought to have the best practices that will enable the inexperienced nurses to fit into the nursing workforce (Garbett & McCormack, 2004). This research aims at finding out the implications of nurse transition in Saudi Arabia for the nurses, and the health care system.

Introduction to the study
The ministry of health established the nurse transition program with an intention of developing competent nurses into the healthcare systems. There is a probability that health care systems are experiencing the positive impacts of the nurse transition program. However, the transition program could be overwhelming to the nursing students. The students could be experiencing stresses due to workplace incivility and marginalization (Casey, Fink, Krugman, & Propst, 2004). There is a possibility that the students obtain inconsistent support from the co-workers and the hospital management team (Hillman & Foster, 2011). The entire study will seek answers to the following research question.

What is meaning of nurse transition in Saudi Arabia, and what are the implications for the nurse and the health system?

Background
The kingdom of Saudi Arabia (KSA)
The Kingdom of Saudi Arabia is the largest Arab state that hosts about 27 million people. Abdulaziz Al Saud was the core founder of the Arab state, which is approximately 2.24 million square kilometres. The kingdom has a large oil and gas reserves that generate massive incomes to the government. There are no political parties or national elections in Saudi Arabia, as politics occurs between royal families. The Islamic traditions require healthcare providers to embrace peace, justice, equality, and respect to all people (Gresham & Walsh, 2010).

Overview
The Kingdom of Saudi Arabia has experienced high population growth rates over the past few years. This has triggered the government to think of offering quality healthcare services to its people (Tumulty, 2006). Since the demand for healthcare services is on the rise, most regional governments have obligated citizens to have health insurance covers. The government spends about 3.8% of its GDP on preventive, curative and rehabilitative healthcare services. According to analysts, this is a poor government provision in terms of volume and quality towards the highly significant healthcare sector (Lee, 2004). In fact, Saudi Arabias expenditure on health is half of the amount of money that United States invests in health care programs.

Health care service
In the recent years, Saudi Arabia government has prioritized the development of heath care services, and it has obligated the Ministry of Health (MOH) to manage the healthcare sector (Ministry of Health, 2014). The government relies on imported medicine, imported medical equipment, and expatriates medical practitioners. Since the government is having trouble in managing the healthcare needs of the burgeoning population, it to invest in healthcare facilities (Fielden, 2012). Essentially, operators of private healthcare organisations play a great role in the provision of healthcare services, and indeed, they are finding the sector to be very lucrative. After the introduction of compulsory insurance covers, private hospitals doubled their revenues by imposing exaggerated medical statements to the insurance providers.

Health organisation structures
The ministry of health is the central head of the entire healthcare system in Saudi Arabia. The MOH has appointed various regional directors of health affairs, who monitor the healthcare facilities. Primary healthcare supervisors work together with the regional directors to ensure that healthcare facilities carry on their activities as expected (Ministry of Health, 2014). The hospital managers report to the primary healthcare supervisors, who address all arising issues to the regional healthcare directors. Essentially, the MOH is able to supervise the healthcare facilities through a team of healthcare managers.

Nursing in Saudi Arabia
History
The history of nursing in Saudi Arabia dates back in the times of Prophet Mohammed when the holy wars were common. Muslim women took the obligation of providing first aid to the wounded armies; they provided them with food, water, and protection. Since the womens nursing role was quite helpful, Prophet Mohammed ordered people to build a tent in a mosque, where the women could continue offering the essential nursing care. Rudaifa Al-Asalmiya had learnt some nursing skills from her father, and she displayed her expertise while handling patients. She is recognised as the founder of nursing amongst the Islam, and women continued offering nursing services after her death (Kelly & Courts, 2006). Nowadays, nurses are highly recognized in the medical field for their imperative nursing role. Various learning institutions train nurses, and before they qualify to become practitioners, they have to go through the nurse transition program.

Nursing education
The first health institute program was opened in 1958 in Riyadh following the tireless efforts of the World Health Organisation (WHO) and the MOH. The institute enrolled both male and female students, and after their graduation, they became nurses aides. The MOH opened more institutes, and in 1976, the Ministry of Education launched the Bachelor of Nursing Program. Currently, there are many , diplomas, degrees, masters, and PhD programs in nursing. The government is collaborating with the national universities to initiate programs that prepare high school students to pursue nursing.

Nursing workforce
It is noteworthy that most healthcare providers speak in English, yet the native nurses do not speak English (Newton & McKenna, 2007). Therefore, the nursing workforce relies on Indian, North American, South African, Australian, and Filipino expatriates. The number or Saudi nurses are slowly increasing; in 1996, 9% of the workforce comprised of Saudis, and the number increased to 22% in 2008. At that rate, the KSA would attain its dream of having about 30% of the nursing workforce comprising of Saudis within 10 years. However, the burgeoning population increases the demand for expatriate nurses, and it may take 25 years for the KSA to have 30% of its nursing workforce comprising of native Saudis.

Statement of the research problem
The nurse transition program is very important in any healthcare setting as it enables New Graduate Nurses (NGNs) to have a professional experience of the nursing role. The transition period should allow the new graduate nurses to work freely with experienced professionals. However, the exact opposite is happening in the healthcare facilities. The NGNs are marginalized in the workplace, and they experience many stresses during the entire period. The transitional program turns out to be uncomfortable and stressful. Only a few NGNs have reported to have pleasant experiences during their transitional programs. In many cases, the student turnover rates increase significantly in the second year of their transitional programs. Indeed, the nurse transition program ought to have great benefits to all the stakeholders involved; however, the entire program achieves negligible outcomes (Scott, Engelke, & Swanson, 2008). The submissive new graduate nurses are able to put up with the stresses, but most of them quit the program in the second year. The healthcare facility suffers greatly by loosing potential staff because of the transition programs, and it could be one of the reasons as to why the local healthcare system has a shortage of local health nurses. Indeed, nurse transition programs have failed in their aim of recruiting and retaining the nurse graduates.