The study revealed poor level of awareness about the nursing profession and distrust in Saudi caregivers. Surprisingly, about one third only preferred to get the nursing care by Saudis. Moreover, the rating of Saudi caregivers was deemed excellent by only 40%. In addition, nearly three quarters would be ashamed if they have a nurse in the family, and less than 50% of males prefer to marry a nurse. The study highlighted numerous barriers including; mixed working environment, delayed marriage of female nurses, and the negative effect of the nursing profession on social life. Regression analysis revealed no gender difference in the level of awareness, while those with low level of education, and un-married participants were more likely to have poor knowledge. Perceived barriers are more likely among less educated, while it was less likely among those reported that there were no nurses among their family members.
The low preference for Saudi caregivers might reflect poor image and distrust in the national caregivers; this would be very distressing and de-motivating for Saudi nurses and for those who might consider a nursing career in the future. In addition, nearly three-quarters of participant perceived that they would be ashamed of having a nurse among their families. In accordance with our results, a Study in Saudi Arabia revealed that nursing as a childhood dream was not appealing, nor family support was influential to pursue a nursing career [21]. One study reported that as much as 87.8% of Saudis didn’t prefer a nursing career for their family members [29]. Surprisingly, a Chinese study demonstrated that parents would not encourage their children to enroll in nursing education [30]. The observed positive perception of Omani university students about the nursing profession might reflect a reporting bias, since the numbers of the nursing students outweigh those from other disciplines [31]. Secondly, other factors concerning the heath care policies to recruit nationals and media marketing of the nursing profession in Oman should not be ignored. Of note, underestimating the skills of Saudi nurses should gain more attention by Saudi leaders and educators in the health care sectors as it might reflect a real gap between theory and practice as highlighted in a recent study [16].
However, in this study, the preference of females as caregivers stems from the perception that nursing is women’s occupation. In addition, cultural norms reject getting care by opposite gender especially for females.
Regarding the level of awareness about the nursing profession, it is striking that most of participants in the present study viewed the role of nursing in health care settings as complementary to physicians, and about one third do not know the exact job title of graduates from nursing college or institutes. Additionally, participants don’t know even the duration required to get a bachelor’s degree in nursing.
The level of public awareness about the nursing profession is critical for how they view the nursing career. Previous studies across different cultures confirmed the perceived attenuated role of nurses compared to physicians. These negative stereotypes view nurses as having no status and describe them as physicians' assistants and ancillary workers [26, 30, 32]. In a study conducted in Iran, students emphasized that the social status of nurses is not desirable, as they are considered handmaidens of physicians and dutiful hospital employees. For example, one student mentioned: “although nurses are sometimes perceived as educated, their main task is to obey and follow physicians' orders and their caring skills are not appreciated” [22].
Similarly, a recent study in Saudi Arabia which included over 700 participants of both genders, revealed that more than one-third of participants perceived nursing as a profession that is auxiliary and subservient to physicians, and therefore study participants claim that there is no need for higher academic qualifications [21]. This means that the community in Saudi Arabia doesn’t value the skills and competencies acquired through higher academic education.
Despite the sincere efforts of Saudisation of the workforce in the KSA, expatriates remain to constitute a considerable proportion of the nursing workforce [25]. Saudi culture may regard the nursing profession unfavorable work atmosphere and hence discourage their children to pursue a nursing career. The present study revealed that a considerable proportion of the study sample amounted to 64.5% claimed negative consequences of the nursing profession on social life because of long working hours and night shifts, other barriers include delayed marriage and gender-mixed working environment. Regression analysis showed that less educated individuals were more likely to perceive barriers, probably because of lack of knowledge. The observation that barriers were more likely if there were nurses among the family further indicates the challenges faced by Saudi nurses.
It is likely that the global image of the nursing profession is negative. Previous studies demonstrated that nursing is viewed as a less desirable profession because of difficult working conditions, inadequate financial compensation, low level of autonomy, limited career opportunities, and being viewed as ancillary members of the healthcare team [33].
Finally, this study demonstrates low level of public awareness and reflects poor public image of the nursing profession. Such information is paramount for effective interventions to raise community awareness and modify the negative image of the nursing profession. Hopefully, the nursing identity will be improved leading to recruitment of high achievers and retention of candidates into the nursing career.
Limitations of the study
The study was conducted in Riyadh the capital city of the KSA, so generalizability of the study is limited to similar settings. Should we consider sub-urban and rural communities, the data collection tool needs further validation and reliability testing. The convenient sampling technique, and the unbalanced gender representation add to study limitations.