Health care is one of the largest sectors within Saudi Arabia engaged in the process of Saudization.

Saudi Arabia, like many areas of the world, is challenged by a nursing shortage. However, the shortage of Saudi nurses is related to the country’s unique history and context. Historically, the nursing profession in Saudi Arabia flourished in the time of Prophet Mohammed (PBUH), under the guidance of Rufaida Al-Asalmiya. (Note: Mention of the Prophet Mohamed is followed by the acronym PBUH. PBUH is the shortened version of Peace Be Upon Him – comment made after mention of the Prophet Mohammed’s name and a sign of respect in the Muslim religion. It is used here to signify the writers’ acknowledgement of the values of the Muslim faith). After the demise of the prophet until the late 1950s mention of the Saudi nursing profession has been limited. Traditionally and largely because of cultural values, Saudi women have not undertaken employment. It is only recently and with limited relaxation of cultural beliefs that Saudi women have actively sought employment. Prior to this change the nursing profession in Saudi Arabia depended largely on an expatriate workforce.

...Saudi women have become increasingly engaged in the workplace in many occupations and professional groups.

In previous years, Saudi Arabia attracted many foreigners to the country with incentives of sand, sun, tax free salaries, and travel. However, with heightened terrorist activity, uncertainty throughout Middle Eastern countries together with a global nursing shortage nursing recruitment to Saudi Arabia has dwindled making it necessary, with some urgency, to recruit Saudi women to establish and sustain a national nursing workforce.

The monarchy of Saudi Arabia issued a royal decree for the Saudization of the nursing workforce to replace the largely expatriate workforce and their escalating salaries (Tumulty, 2001). The decree demanded that Saudi nationals be educated or trained in all areas of employment to replace current expatriate workers. The departure of non-Saudi men and women from the country has led to increased participation of Saudi women in the workforce (Littlewood & Yousuf, 2000). Health care is one of the largest sectors within Saudi Arabia engaged in the process of Saudization. The Saudi Ministry of Health is targeting nursing, the largest group of workers, for recruitment efforts (Aboul-Enein, 2002).

Saudi society is largely patriarchal, with the male population in Saudi Arabia exerting strict codes of conduct on Saudi females. Women are bound to these codes, which are predominantly enforced by a male relative, and are reluctant to challenge them. Saudi males, on the other hand, have minimal constraints imposed on how they should behave within society. For many years, the principal roles of Saudi females have been wife and mother. Saudi Arabia had no public schools for girls before 1960, and no women were employed outside the home (El-Sanabary, 1993, p. 1332). In modern times however, Saudi women have become increasingly engaged in the workplace in many occupations and professional groups. While men still dominate the retail sector, women commonly are employed as shop assistants, albeit working in shops designated as "women only."

...Saudi females who chose nursing as a career face many obstacles, primarily based on religious and social norms.

Saudi women are also slowly becoming employed as doctors, nurses and allied health workers. Nevertheless, Saudi females who choose nursing as a career face many obstacles, primarily based on religious and social norms. Nursing suffers from a poor image in Saudi society, which considers it a job for "maids" or uneducated women. Saudi men who choose nursing also face criticism from family and friends. One Saudi male nurse known to the authors related, "My mother refused to tell her friends I am a nurse. If they see me in the hospital, she tells them I am a doctor, as doctors are better than nurses." (personal communication, M.A., November 12, 2005). Nevertheless, the plight of women in nursing in Saudi Arabia is more problematic than men and needs to be recorded and shared with the global nursing community. Thus, the purpose of this article is to discuss historical, cultural, and contemporary influences on the status of women in nursing in the country of Saudi Arabia. The authors examine the historical development of female nursing in Saudi Arabia and discuss cultural barriers, limitations, and public pressures that pervade Saudi society and militate against women wishing to enter the nursing profession. Contemporary practices in nursing education designed to increase the female Saudi nursing workforce are presented.

Historical Aspects of Nursing in Saudi Arabia

The history of Saudi Arabia is often presented within the context of the life of the Prophet Mohammed (PBUH). The following discussion traces the historical development of nursing in Saudi Arabia from the Islamic Period to modern times.

570 – 632 AD: The Islamic Period

Little is known or has been documented about nursing in the Pre-Islamic period (before 570 AD) (Tumulty, 2001). Documents from the Islamic period, which was steeped in holy wars, reveal few references to nursing. Ancient medical systems consisted of treatment solely by doctors, who would visit the patient at home, prescribe medicines and expect the relatives to provide ongoing care. Thus, there was little need for nurses. Activities now identified as the remit of nurses, such as providing physical comfort and emotional support, were undertaken by women companions of the Prophet Mohammed (PBUH) (Al-Osimy, 2004). One woman from that period who has been identified as practicing nursing long before Florence Nightingale was Rufaida Al-Asalmiya (Tumulty, 2001; Al-Osimy, 1994).

632 – 1000 AD: Post-Prophetic Era

Historical records of nursing or the nursing profession in the era following the death of the Prophet Mohammed (PBUH) in 632 AD are sparse (Al-Osimy, 1994). The limited documentation that does exist consists primarily of commentary by physicians of that period. The physician al-Razi was described as a teacher and a compassionate person who also provided nursing care (Anon, 2005). He wrote two works, "The Reason Why Some Persons and the Common People Leave a Physician Even if He Is Clever" and "A Clever Physician Does Not Have the Power to Heal All Diseases, for That is Not Within the Realm of Possibility." These writings suggest that care delivered by physicians may have been more nursing oriented and that doctors themselves were more practical than theoretical in their application to health care.

Through this period, nurses were relegated to merely serving food to patients and administering prescribed medicine and healing liquids (Al-Osimy, 1994). The female nurse was referred to as "AlAsiyah" from the verb, aasa, meaning curing the wounds.

1000-1500 AD: Late to Middle Ages

While there has been some relaxation of [segregation] in contemporary times, the values of many traditional Islamic people are for hospitals and their policies to reflect these past segregation practices.

During the late middle ages, Arabs built well-constructed hospitals and introduced new methods of caring for the sick. A unique feature of these hospitals, which spread out across the vast Islamic civilizations, included segregated male and female wards, with male and female nurses caring for patients of their own gender (Donahue,1985; Al-Osimy, 2004). While there has been some relaxation of this practice in contemporary times, the values of many traditional Islamic people are for hospitals and their policies to reflect these past segregation practices. El-Bar, a staunch opponent of women working outside of the house, suggested in 1987 that unavoidable moral corruption resulted when genders were intermingled (cited in El-Sanabary, 2003). Jammal voiced similar sentiments, suggesting that women be able to work as long as there were no intermingling of the genders (1986, cited in El-Sanabary, 2003).

Early Leaders in Nursing’s Development

Accounts of nurses and nursing in the years between the death of the Prophet Mohammed (PBUH) and the 1950s are sparse. According to one American missionary, doctors and nurses from Bahrain were invited to travel to Riyadh to care for King Saud and his immediate family in the late 1890s (Armerding, 2003). These health professionals marked the beginning of an expatriate health care labour force that remains dominant in Saudi Arabian health care today.

While Rufaida Al-Asalmiya, mentioned in the discussion of the Islamic Period (570-632 AD), has been acknowledged as the first Muslim nurse, the greatest contribution to nursing in the Middle East has been credited to Lutfiyyah Al-Khateeb, the first Saudi nurse-midwife (El-Sanabary, 2003). This section will discuss each of these early Saudi nursing leaders.

While nursing historians in Europe and America identify Florence Nightingale as the founder of modern nursing, Middle Eastern countries attribute this status to Rufaida, a Muslim nurse.

Rufaida Al-Asalmiya. Published records testify that Rufaida Al-Asalmiya, who practiced at the time of the Prophet Mohammed (PBUH), was the first Muslim nurse (Kasule, 2003; Mansour & Fikry, 1987). While nursing historians in Europe and America identify Florence Nightingale as the founder of modern nursing, Middle Eastern countries attribute this status to Rufaida, a Muslim nurse (Jan, 1996). Tales of Rufaida’s heroic deeds have been handed down verbally from generation to generation of Saudi nurses and continue to be savoured by many modern Saudi nurses.

Kasule (2003) has purported that Rufaida learnt her nursing skills from her father, who was a renowned healer in the time of the Prophet. Hussain (1981) attributed Rufaida with providing care to injured soldiers during the jihad (holy wars), as well as providing shelter from the wind and heat of the harsh desert for the dying.

Rufaida's practice with her female "companions," conducted within Islamic boundaries while tending the sick, serves as the model for Saudi females in nursing today.

Hussain (1981) claimed Rufaida devoted her life to developing and improving nursing. In addition to providing nursing care, Rufaida also allegedly was the leader and founder of the first School of Nursing in the Islamic world, although its location has not been reported (Jan, 1996). Rufaida advocated for preventative care and recognized the importance of health education. Kasule (2003) believed that Rufaida not only trained a group of women as nurses (known as woman companions), she also became involved in social work within the community. The Prophet Mohammed (PBUH) gave permission for her to erect a tent within a mosque and deliver health-related teachings to the community (Al-Osimy, 1994). By modern standards, this achievement is outstanding, as women are not encouraged to hold public meetings in a mosque.

Lutfiyyah al-Khateeb. Lutfiyyah al-Khateeb received her nursing diploma in Cairo, Egypt in 1941 and returned to Saudi where she dedicated her life to the improvement of education for women and the acceptability of nursing as a suitable profession for Saudi women. Al-Khateeb lobbied throughout the 1960s for the establishment of the health institutes and has been acknowledged by local Saudi leaders and has won the support of many (El-Sanabary, 1993).

After Al-Khateeb, Samira Islam, a pharmacology professor, was an advocate of nursing and the nursing profession in Saudi Arabia for many years (El-Sanabary, 2003). Like their predecessor Rufaida, Al-Khateeb’s and Islam’s success was attributed to working within the framework of the prevailing traditional culture and religious values of Islam (El-Sanabary, 2003). Interestingly, the accomplishments of these two latter pioneers are not presented in the literature in great depth.

Cultural Influences on Female Saudi Nurses

Modern Saudi Society and Women in Nursing

Rufaida’s practice with her female "companions," conducted within Islamic boundaries while tending the sick, serves as the model for Saudi females in nursing today (Al-Osimy, 1994). These boundaries include segregation of genders, modest dress for women (veiled) and subordination in both public and private life. Because of Rufaida’s exemplary behaviour, nursing can be a noble career for Muslim women (Jan, 1996).

Limitations for Women Entering the Nursing Profession

Nursing is not considered a respectable profession for women in Saudi Arabia, despite its long, respected history during the period of the Prophet Mohammed (PBUH).

Saudi Arabian society is divided in its view of the nursing profession. Nursing is not considered a respectable profession for women in Saudi Arabia, despite its long, respected history during the period of Prophet Mohammed (PBUH) (Mansour, 1994). In 1991, nursing was ranked last in the list of appropriate occupations for women (Jackson and Gary, 1991). Reasons for this low ranking included the type of work, inadequate financial rewards and working hours. Working hours are prohibitive for some women as they must fulfill obligations of the wife and mother role (Tumulty, 2001).

Modern conservative Muslim writers have produced extensive publications extolling the virtues of women who choose to remain at home, e.g., "Remain in Your Place and Be Grateful" (El-Sanabary, 2003). They argue that the breakdown of Saudi family values is directly related to women’s employment outside the home (El-Sanabary, 2003). On the other hand, they do endorse nursing, alongside teaching, medicine and social work, as religiously and culturally appropriate occupations for females, thus creating conflict in their message. One of these writers, Mohammed Jammal (1986), commented that Saudi women should work only with people of the same gender and suggested that they inspire other women in conforming to Saudi moral values. Jammal argued that "Saudi women, by virtue of their Arab Islamic society do not need to compete with men for jobs except those that are fit for them such as needlework, sewing and teaching girls"(cited in El-Sanabary 1993, p. 1336).

...community image, family disagreement, cultural and communal values, long working hours, mixing with members of the opposite gender, and the worry of not being a "marriageable" prospect were the main reasons why Saudi females did not choose nursing as a career.

Al-Omar (2003) conducted a study in Saudi Arabia about high school students’ perceptions of nursing as a possible career. He concluded that community image, family disagreement, cultural and communal values, long working hours, mixing with members of the opposite gender, and the worry of not being a "marriageable" prospect were the main reasons why Saudi females did not choose nursing as a career. Additionally, both historically and currently, nurses have been viewed as an extension of the physician (Jackson and Gary 1991; El-Sanabary, 2003) a stereotype of nursing that occurs in other cultures (e.g., Australia [Darbyshire 2000]). Indeed, El-Sanabary (1993, 2003) suggested that stereotyping of the nurse as an uneducated subservient female hospital worker discourages many Arab women from entering the nursing profession.

Saudi society places utmost value in the woman’s reputation and subsequently her family honour (El-Sanabary, 1993). Alawri and Ghazi (1982 cited in El-Sanabary, 1993) considering the issue of segregation, proffered that nursing is not viewed as an honourable profession by many Saudi families. They contended that "nursing forces a girl to mix with men, to stay long hours away from home and to work night shifts: a job condition that is socially unacceptable and runs contrary to deep rooted beliefs of what is permissible for a girl to do …" (p. 1337).

Marriage is a high priority for the Saudi population and any issue that interferes with marriage is taken very seriously (Batarfi, 1997). The perceived negative image of nursing remains steadfast in the minds of many Saudi parents. Thus, many families in Saudi Arabia do not see nursing as an appropriate area of study for women (Phillips, 1989). Mothers are reluctant to consider a nurse as an acceptable wife for their sons. This sentiment is also entrenched in the minds of the younger Saudi population. Jackson and Gary conducted a survey in 1991 of secondary and university students to ascertain perceptions of nursing as a potential career for Saudi females. Sixty-four percent of the respondents claimed they would not marry a nurse, citing "social" reasons as the main determinant.

Similarly, in a 2001 study, 69% of male secondary school respondents indicated that they would not marry a nurse (El-Gilany & Al-Wehady, 2001). These results may explain the high percentage of single female nurse (37.8%) in the study, since Saudi women traditionally marry at a young age. The study authors observed that young Saudis, both male and female, choose careers that offered higher prestige and financial remuneration than nursing. These two research studies demonstrate that the societal perception of female nurses is that of unsuitable marriage partners.

While correcting erroneous societal perceptions is the responsibility of all nurses, in Saudi Arabia, questioning the foundational aspects of society is not easily accepted.

Members of the medical profession also hold negative views of the nursing profession. Samira Islam, a former dean of the colleges of medicine and medical sciences at King Abdulaziz University, cited evidence from her professional experiences of nonacceptance of nurses by medical staff. She stated that women physicians, although spending their first academic years in the same classes alongside female nursing students, consider them to be inferior, less intelligent and less capable (El-Sanabary, 2003). Islam further stated that the medical staff like the idea of power and prestige associated with the medical profession and that they viewed the nurses as servants.

These negative images and stereotypes of nurses in Saudi Arabia reflect similar images previously held in Australian, European, and American society (Darbyshire, 2000). Although these images still pervade some segments of Australian, European, and American society, many have been overturned by educating the public about what constitutes women’s, and especially nurses’, work. While correcting erroneous societal perceptions is the responsibility of all nurses, in Saudi Arabia, questioning the foundational aspects of society is not easily accepted.

Education of Saudi Females

Saudi Arabia has significantly increased oil production in the 20th and 21st centuries. The resulting financial benefits of this increase have provided opportunities to develop Saudi social institutions, including health and education. However, the country’s traditional cultural and religious attitudes, as well as educational and employment policies, have remained a constraining factor (El-Sanabary, 2003). Until the mid 1960s, education for women was viewed as non-essential by various components of Saudi society.

The first formal school for girls opened in 1960. The opening was met with strong opposition from Islam Imans (religious leaders) as nonreligious education was viewed as useless and dangerous for girls (El-Sanabary, 2003). A great achievement has been the increase in the literacy rate, which may be attributed to increasing education and schools for girls and women. In the 1970s the literacy rate for females was around 2%; this rate had risen to 48% by the 1990s (Saudi Arabian Information Resource, 2003) and to 78% in 2005 (Bureau of Near Eastern Affairs, 2005). However, lack of foresight and planning in the education sector has left the country unprepared for increasing numbers of educated women. As a consequence, fewer resources have been allocated to higher education for women, as it was perceived that men were more likely to engage in higher education (The Saudi Arabian Information Resource, 2003). Funding for programs for educating women has been confined to those that prepare for occupations deemed culturally and religiously appropriate, such as teachers and school administrators. Nursing has not been as strongly funded, and it is only of late that nursing education has received financial backing from the government. The next section discusses contemporary influences on nurses and nursing education.

Contemporary Influences and Opportunities for Nursing Education

Recent History of Nursing Education and The Health Institutes

Documentation of the history of nursing education from the time of Rufaida until the early 1960s is sparse. The earliest record of modern female nursing education in Saudi Arabia dates back to 1961 (El-Sanabary, 1993) when the Saudi Ministry of Health, in cooperation with the World Health Organization, opened two health institutes for women; one in Riyadh, the capitol, and the other in Jeddah, the largest seaport and commercial center. These institutes, educating women to become nurses’ aides, admitted students mainly from private schools who had completed at least six years of primary school education. This move was fraught with opposition from parents and students, because it prepared female students to work with men and work long hours away from home. This opposition prompted the nurse leaders at the time to promote interest in this course by delivering public lectures and writing articles for the popular press (El-Sanabary, 1993). The Ministry of Health agreed to promote the program only after it was agreed that the women would remain covered, not work with male physicians, provide care for female patients only, and not work afternoon or night shifts (El-Sanabary, 2003).

The growth of nursing throughout Saudi Arabia, both in numbers and acceptance, was an indicator of the increasing status and education of women.

As nursing education developed, the education of nurses was extended to three years and limited to students who had completed nine years of school-based education. In the mid-1970s, a college level nursing program to upgrade the training of nurses and to improve the status and image of nursing was introduced, replacing the lower high school program that had begun in the 1960s (El-Sanabary, 2003). The growth of nursing throughout Saudi Arabia, both in numbers and acceptance, was an indicator of the increasing status and education of women.

To meet the health needs of the country, the Ministry of Health (MOH) planned and opened Health Institutes for males and females. Health Institutes in Saudi Arabia are equivalent to Training and Further Education (TAFE) colleges, offering a Diploma of Nursing which is the equivalent to the Australian Enrolled Nurse. Saudi Health Institutes differ from the universities in Saudi Arabia as they only offer Diploma degrees. In 1975, 27 Health Institutes were operational; in 1980 this number had increased to 32.

The College of Nursing at King Saud University established a Bachelor of Science in Nursing (BSN) in 1976 and introduced a Master of Science in Nursing in 1987 (Tumulty, 2001). These programs are limited to female students. Thus, by 1980 nurse education in Saudi Arabia encompassed two levels; the technical nurse (from the Health Institutes) and the professional nurse (from the University). The technical nurse completed three years of study and attained a Diploma in Nursing (DN). The Saudi technical nurse can be equated with a Licensed Practical Nurse (LPN) in the United States and an enrolled nurse in Australia (Phillips, 1988). In comparison, the professional nurse completed a five-year program and on completion was awarded a BSN.

...a majority of Saudi nurses who hold a Diploma degree are undertaking bridging courses to earn their BSN...

These two levels, DN and BSN, pervade the Saudi nursing workforce today. Graduates of the BSN program often assume leadership and management roles in Saudi Arabia immediately following graduation in response to the Saudization mandate. In keeping with global trends, the Diploma nurses are slowly being phased out in favour of the BSN. Diploma degrees are slowly being phased out in colleges, in favour of the BSN being offered by universities. Additionally, a majority of Saudi nurses who hold a Diploma degree are undertaking bridging courses to earn their BSN from various universities world wide, (e.g., Britain, the United States, Canada and Australia). Unfortunately, current prevalence statistics of the two types of nurses are unavailable.

Professional Development Programs

In response to the need for Saudi clinical nurses, the major teaching hospitals in Riyadh offered professional development programs for candidates who possessed a DN. King Faisal Specialist Hospital developed a 12-month Nurse Development Program to educate Middle Eastern nurses for a more world wide level of practice (Gary, 1992). King Abdulaziz Medical City – Riyadh (formerly known as King Fahad National Guard Hospital) operated the Professional Development Program from 1997 to 2001. The program was designed to integrate theoretical and practical knowledge to raise the Saudi nurse of associate diploma level to a level of nursing practice equivalent to other countries, e.g., the United States, Canada, Australia, or England. These programs were short-lived and preceded other developments in nurse education. Nevertheless, they graduated approximately 47 Associate Diplomates, both female and male, who subsequently have been employed as registered nurses throughout hospitals in Saudi Arabia. Some graduates of these professional development programs have sought to travel overseas in order to study nursing at the baccalaureate level.

Nursing Colleges and Universities

The College of Nursing and Allied Health Sciences, at King Abdulaziz Medical City - Riyadh, commenced in 2001 and offers a Bachelor of Science in Nursing (BSN) for females who wish to pursue a career in nursing (known as Stream I). The College further offers the BSN for those females who previously held a Bachelor of Science Degree (known as Stream II). In the future it is envisaged that the college will offer bridging courses for those nurses who hold a Diploma or Associate Degree in Nursing and postgraduate training (Strategic Planning Document, 2003).

The College of Nursing and Allied Health Sciences graduated its first class of 12 BSN-prepared nurses in 2004. Graduates are employed in various positions at King Abdulaziz Medical Cities in Riyadh, Jeddah and the Eastern Province. Other Ministry of Health hospitals throughout the Kingdom of Saudi Arabia employ a percentage of these graduates.

Nursing education today remains the remit of the Ministry of Education and the Ministry of Health. The Ministry of Education oversees the university and college programs for women only, whereas the Ministry of Health is responsible for the health institute programs, targeted for both men and women (Tumulty, 2001). Tumulty views this differential preparation by gender hampering "integration of the technical graduates into a multicultural hospital setting. Many institute graduates are relegated to functioning at a level barely above a nurse aide. Thus, the already scarce Saudi nurses are disadvantaged and under ultilised" (2001, p. 287).

Nursing Today in Saudi Arabia

...Saudi nurse graduates are encouraged to enroll in higher degree programs.

The nursing workforce in Saudi Arabia has consisted primarily of an extensive expatriate population, which is both cyclic and transient, and of late is reducing in numbers. In 1996 Saudi nurses comprised 9% of the total nursing workforce (Gary, 1992). By 1999, 17% of the total nurse workforce was Saudi nationals (Marrone, 1999). The increase in Saudi graduates from home-grown programs has increased the percentage to 18% in 2003 (Central Department of Statistics, 2004).

Saudi nurse graduates are encouraged to enroll in higher degree programs. Tumulty (2001) argued that nurses with higher degree qualifications are the promise for the future and they will assume positions of leadership. Many Saudi nurses choose to travel overseas to earn master’s and doctoral degrees. Some universities, such as Monash University in Victoria, Australia, in collaboration with King Faisal Specialist Hospital and Research Center, offer in-country higher-degree programs. These programs afford Saudi nationals the opportunity to remain at home to study, work, and be with their families.

Full membership in the ICN is an important step toward the professional-isation of nursing in Saudi Arabia.

Nurse leaders in Saudi Arabia have been attempting to establish a professional board to meet the requirements of membership of the International Council of Nurses (ICN). Full membership in the ICN is an important step toward the professionalisation of nursing in Saudi Arabia (Tumulty, 2001). The Nursing Board, was established as a professional regulatory board in 2002, under the direction of the Saudi Council of Health Specialties. The goals set by the Nursing Board included: definition of the profession and its members; determination of scope of practice; development of educational, ethical, and practice competency standards; and the establishment of accountability systems and credentialing processes (AbuZinadah, 2005).

By 2003, the Board had achieved a number of set goals, as follows:

• Establishment of the Board's organization and structure
• Establishment of registration and licensure standards
• Development of continuing education criteria
• Standardisation of technical nursing curricula
• Development of accreditation procedures

By the end of 2004, other achievements had been accomplished. Several programs were developed: Advanced Diploma (Bridging Program); and post-basic nursing specialization Diplomas in Midwifery, Pediatrics and Critical Care. Accreditation standards for nursing services for the purpose of nursing training were finalized. Development of post-basic specialization program protocols was established. Standardized job descriptions for all nursing positions were developed and nursing examination banks updated (AbuZinadah, 2005).

The remit of the Nursing Board is still developing and it is anticipated that it will widen its focus to include practice guidelines, disciplinary measures and professional conduct. By January 2005 all nurses, Saudi or expatriate were to be registered with the Nursing Board.

The disparity of numbers of Saudi nurses versus Western nurses throughout the various hospitals remains obvious. With the implementation of Saudization, it is envisaged that this disparity will, in future years, lean more favorably towards Saudi Nurses being a majority instead of a minority in their own country.

Conclusion

...today's nurses...are expected to prove they can work within traditional Islamic boundaries...

Opposition to women’s education in Saudi Arabia is lessening. Nursing however, is still experiencing mixed reactions that truncate its development and diminish its appeal to young Saudi women. Nevertheless, in spite of continuing negativism, the number of Saudi women entering the profession is increasing. As these women become proficient in clinical skills and critical thinking, their awareness of the barriers that impede the development of their chosen profession is increased. In contrast to Rufaida, today’s nurses do not readily have the blessing of the religious sector. Rather, in order to be accepted by all facets of society, they are expected to prove they can work within traditional Islamic boundaries, and uphold family honour while professionally engaging with others, both men and women, in the care of the population.

Saudi nurses are becoming more self-confident in their demands for equitable recognition within the health care system and are more willing to speak out against apparent disparities.

Saudi Arabia is still a young country, having come into its own since its unification in September 1932. The population is rapidly growing and so is the demand for health care to be delivered by educated nursing professionals. The nursing profession in Saudi Arabia is in its infancy and requires substantial nurturing and acceptance for it to grow. Saudi nurses are becoming more self-confident in their demands for equitable recognition within the health care system and are more willing to speak out against apparent disparities. Yet full recognition as professionals continues to be an aspiration for a majority of Saudi Nurses, as traditional and sometimes archaic nursing services continue to exist. In today’s society, Saudi nurses continue to strive for professional autonomy and an increase in nursing influence, presence and participation in all levels of health policy and decision making.

Author note:
The primary and second authors have worked and lived in Saudi Arabia for 8 and 2 years respectively. Both authors have firsthand experience with the paucity of a Saudi Nursing workforce and educating Saudi females in nursing. The lack of "local" staff means that Saudi Arabia has relied on expatriates to staff their many hospitals and health care systems. The first author arrived in Saudi Arabia as a staff nurse in 1996. Today she remains as an Education Coordinator and has had extensive first hand knowledge of Saudi nurses and their struggles for acceptance as professionals both globally and locally.

The second author is the co-supervisor of the first author. She has worked in Saudi Arabia as an educationalist and researcher. She has a wide-ranging interest in the contemporary development of nursing education in Saudi Arabia as it takes place within the global arena. During her time in Saudi, she had extensive involvement in the Saudi nursing profession, the Saudi Nursing Council and the Saudi nurses themselves.

Authors

Kolleen Miller-Rosser, E.N., R.N., Graduate Diploma (Pediatrics), MSN, PhD Candidate
E-mail: konky40@yahoo.com

Ms. Miller-Rosser has worked in Saudi Arabia for the past 10 years. In her capacity as Nurse Educator and Education Coordinator for Maternal Child Nursing at the King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, she has had the opportunity to work closely with the Saudi Nurses - hence her interest in the Saudi nursing profession. She is currently working on her PhD, which involves utilizing the Historiographical methodology to research the Saudi nursing profession.

Ysanne Chapman PhD, MSc (Hons), BEd (Nursing), GDE, DNE, DRM, MRCNA
E-mail: Ysanne.Chapman@med.monash.edu.au

Dr. Chapman has experience as an Assistant Professor and Head of Nursing Department in a nursing college in Saudi Arabia. She is a Senior Research Fellow at Monash University in Churchill, Victoria, Australia and is currently researching in several areas of nursing including education, acute care, midwifery, and rural practice. Her experience in the Middle East has helped her develop a penchant for overseas students and she supervises several postgraduate students who are engaged in research in their own countries. In conjunction with Professor Francis she has published articles that feature research issues in the Middle East.

Karen Francis, RN, PhD, MHlth Sc (Nsg), MEd, Grad Cert Uni Teach/Learn, BHlth Sc, Dip Hlth Sc
E-mail: Karen.Francis@med.monash.edu.au

As Professor of Rural Nursing at Monash University in Churchill, Victoria, Australia, Karen Francis is engaged in research activities that promote the global agenda of rural nursing. She has supervised several students from the Middle East and has developed a cultural awareness of the needs of overseas nurses as they study for their higher degrees. Professor Francis is a member of the Nurses Board of Victoria and shows a keen interest in recruitment and retention issues of a global nature.

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