Nurses’ preparedness to practice in emergency departments in the kingdom of Saudi Arabia

In the Kingdom of Saudi Arabia (KSA) 68.2% of the nursing workforce personnel are expatriates. In an era when the Saudi government has adopted a policy of recruiting Saudi nationals to all workplaces, hospitals are challenged to ensure that staff (both Saudi and non-Saudi) are prepared for practice. The study seeks to understand the preparedness and support provided for nurses in Emergency Departments (EDs) in three KSA hospitals. The research question – “How are nurses prepared and supported for practice in the ED in KSA?” – was addressed using a focused critical ethnographic approach to enable in-depth description and exploration. The study was conducted in three Ministry of Health (MOH) EDs in the Al-Qassim region. Selected through purposive sampling, the 28 participants comprising eight nationalities worked in three MOH hospitals. The participants ages ranged from 22 to 68 years. Data collection included many hours of observation, interviews with the 28 participants, field notation and document reviews. All interviews were transcribed verbatim. Interviews in Arabic were then translated. Thematic analysis involved data reduction, coding and recoding. Microsoft Word and QRS NVivo 8 software packages were used for data management and analysis. The analysis then followed a process of seven key stages and these were: organizing the data; immersion in the data; coding the data; generating categories and themes; offering interpretations through analytic memos; searching for alternative understandings; and writing the report (Marshall & Rossman, 2006, 2011). Categorizing and grouping the NVivo coded words (nodes) led to the emergence of sub themes and three major themes: Current Level of Practice, Barriers and Enablers to Preparation, and Ensuring Practice Improvement. The analysis of the data revealed many barriers and some enablers to preparedness. Results suggest that the preparation of nurses prior to their appointment to EDs is variable with some nurses having ED qualifications and past work experience, and others with no relevant qualifications and/or experience. Availability and access to professional development training was found to be limited and ad hoc. Many nurses sought assistance from peers and other professionals such as medical doctors, in the absence of structured programs. How useful this process is in ensuring nurses’ preparedness for practice is dependent on the knowledge and skills of the identified professional involved. The project generated insights and implications into how to increase nurses' preparedness to work in EDs in the health care system of KSA. Key recommendations include the introduction of structured recruitment processes, and for hospitals to have more power in recruitment, for a standardised national system of regulation of nurses’ training; for nurses to collaboratively engage with management to enhance decision-making and enhance professional standing; and for additional qualified educators in KSA hospitals.