Posted: March 12th, 2023

Homework

Reduce word count in the attached file to be 2000 words without any change in the meaning, excluding references. 

King Saud University, College of Nursing

Title in English

The Impact of Stop Hiring Saudi Nursing Diploma Holders and Close Public and Private Health Institutes on Nursing Profession.

تأثير إيقاف توظيف دبلوم التمريض السعوديين وإغلاق المعاهد الصحية الحكومية والأهلية على مهنة التمريض

by:

Ahmed Hassan Shujaa

Amira Alanzi

Ibrahim Alhakami

2

（1444H）－（2023G）

Building the health workforce: Saudi Arabia’s

challenges in achieving Vision 2030

Fahad Albejaidi | Kesavan S. Nair

Background

The nursing workforce situation in KSA is precarious due to its low number of nurses trained, high dependence on foreign workers and imminent loss of large numbers of diploma nurses able to provide direct patient care. In 2010, the Ministry of Health (MoH) issued a mechanism to link promotions to the required qualification, a bachelor’s degree, in accordance with the World Health Organization recommendations. Then, the MoH stopped hiring Nurses with diploma, and restricted appointments to holders of a bachelor’s degree only. Despite the urgent need to fill the positions of nursing technicians and auxiliary technical specializations and the lack of Saudi cadres, which made the MoH repeat the phrases “because of the importance of this activity” and “because it is impossible to fill it Saudi nurses” as well as “the constant need for this specialization” in its letters to the responsible authorities when requesting a contract with Who occupies these positions from outside the Kingdom, but the decision of the Board of Trustees of the Saudi Commission for Health Specialties (SCHS) to close health institutes in the Kingdom raises a number of questions in light of these circumstances and the urgent and growing need to fill these positions. Also, there are questions raised about the implementation of the closure decision at a time when the statistics categorically confirm the need of the Saudi health sector, whether governmental or private, for qualified youth in various technical medical specialties. Although the closure decision was not stipulated by Royal Decree No. (A/121) dated 7/2/1432 as a basis for the solution, but rather as part of the solution, the decision stipulated the development of short-term, medium- and long-term solutions to solve the problem, within a detailed plan and timetable. It includes urgent short-term and future solutions to address the increasing number of university graduates who are ready to teach and holders of health diplomas after high school. Where the Board of Trustees of (SCHS) approved, in its third meeting for the year 1432, headed by the Minister of Health, the plan to implement the closure. Through correspondences regarding external contracting with nursing technicians and auxiliary technical specializations (diplomas) to fill vacant positions, it was noted in those letters that the following phrases were repeated “because of the importance of this activity” and “because it could not be filled with male or female citizens” as well as “the constant need for this specialization.” By examining these correspondences, we conclude the following: The numbers of those required to fill health technical jobs from abroad jumped from hundreds to thousands in a short period, specifically since the month of Sha’ban of the year 1432, and the correspondences carried the same justifications for bringing in technicians from abroad.These correspondences also carried directives to repeat advertisements in local newspapers with the abolition of the “experience” condition! From here begins a clear concession to the account of quantity at the expense of quality, and eligibility, and here a negative indicator emerges and a precursor to a dilemma that looms in signs of falling into it before the actual start of the experiment. According to the statistics of the table of categories, doctors, nursing workers and medical assistants during the years 1424-1429, the percentage of working male and female citizens reached Only 29.1% in the field of nursing in government agencies and the private sector, out of the total number of workers in this specialty, which amounts to 101,298 male and female nurses. Increasing nursing availability will result from increasing the inflow of nurses (expanding capacity) and decreasing the outflow of nurses from the labor market (reducing attrition). Continuing skills development should help increase retention, while also addressing the issue of poor performance. Flexibility in recruitment will ensure that nurses can be deployed where they are needed most, and that there is an equitable spread of the workforce across the Kingdom. Lastly, a robust governance environment will ensure that the quality and safety of patient care is prioritized, and that the profession in KSA meets the nation’s needs, now and in the future. An urgent problem facing the profession was the imminent loss of diploma nurses (who have less training than registered nurses) due to changes in their registration. The newly introduced Nursing Practice Act will recategorize diploma nurses as technicians, preventing them from providing direct nursing care.

Opportunities of nursing workforce and the National Transformation Program

The adoption of the new strategic plan “Vision 2030”in 2016 has added new challenges as well as opportunities for the health system. It gives a new direction in identifying priorities, strategic goals, and objectives across all economic sectors in the kingdom. Saudization of workforce is one of the key aspects of the vision. The National Transformation Program (NTP) 2020, implemented as one of the executive programs to achieve the vision, has identified challenges encountered by all ministries and build institutional capacity for realizing the goals. The NTP, adopted for the health sector in 2016, identified 15 strategic objectives and 16 key performance indicators (KPIs). The strategic objectives of NTP related to health workforce development accorded higher priority to medical education and training and recommended establishment of educational institutions and partnering with reputed international universities including the private sector. While emphasizing the role of private sector participation and increase in the share of spending through alternative financing methods and provision of services, the NTP sets a target of 35% to be achieved by 2020. To implement the NTP in desired expectations, the MOH developed a long-term road map called the Health Sector Transformational Plan (HSTP).The Health Sector Transformation Strategy (HSTS) developed by the MOH identifies key policies including health workforce development program and allied them with the challenges they strive to address in the health care sector. The policy goals of health workforce development program aims to support the transformation of the workforce necessary to enable a value-based health care approach, which require a major increase in work capacity, redistribution, and diversification of workforce capacity across different regions. In line with the vision, MOH has also planned to augment an additional 100 000 Saudi workforce by 2030. This study aims to provide an overview about The Impact of Stop Hiring Saudi Nursing Diploma Holders and Close Public and Private Health Institutes on Nursing Profession. It was not easy to obtain opinions or details regarding the decision to stop accepting the diploma in nursing, so the newspapers were referred to because it was a subject that was discussed during that period in press coverage. It was very interesting to know the opinions of experts and stakeholders, so it became an important source in this paper.

Significance of the study

This research will provide new perspectives in dealing with issues of the nursing profession. Where this study spreads awareness in the nursing community about identifying issues that directly affect the nursing profession and its results by Stop Hiring Saudi Nursing Diploma Holders and Close Public and Private Health Institutes. Also, through this research, academic institutions can enhance and develop programs and set up a plan of study (bridging) to accommodate degree holders to develop their skills and knowledge in nursing. Moreover, the result of this research will provide valuable information for decision makers in increasing the absorption of a larger number of students in the profession, spreading the culture of nursing, and graduating bachelor’s degree holders to face the acute shortage in the profession resulting from the decision to stop recruiting diplomas and closing health institutes. Employees (diploma holders) will benefit directly from this research because its results may encourage them to consider continuing their studies and developing their skills. This study will cover information that includes issues that have affected the nursing profession. Thus, the result of this study can be used in future discussions about the impact of Stop Hiring Saudi Nursing Diploma Holders and Close Public and Private Health Institutes on Nursing Profession.

Purpose of the Study

To provide an overview about The Impact of Stop Hiring Saudi Nursing Diploma Holders and Close Public and Private Health Institutes on Nursing Profession.

Research Questions

1. What is the Impact of Stop Hiring Saudi Nursing Diploma Holders and Close Public and Private Health Institutes on Nursing Profession?

2. What are the consequences of stop recruit nursing diploma holders?

Literature review

Difficult choices loom on the horizon in the issue of health institutes. converting to colleges or closing. This solution seems to be the closest if the MOH continues to move forward with its decision and stop hiring graduates with diplomas.

Literature provides an understanding of why diploma holders tend to proceed their career development to get a bachelor’s degree. To find out what is known about nurses’ attitudes and perceptions regarding going back to school, a literature study was done (Altmann, 2011). To find out what is known about nurses’ attitudes and perceptions regarding going back to school, a literature study was done. The importance of nursing continuing education is influenced by four sociocultural factors: In hospitals that employ more educated nurses, patient outcomes are better, according to recent studies. (1) Several more nurses are still working with an associate degree or diploma, and few proceed their formal education. (2) A bad economy during a nursing shortage equals higher demand and less reward for nurses to return to education for schooling. (3) The worsening faculty lack implies a greater need for nurses to pursue their education.

A source in the MOH explained that the ministry required the Ministry of Civil Service to obtain a bachelor’s degree for the applicant for nursing jobs and to stop appointing nursing diploma holders to these jobs. In another matter, MOH directed to stop appointing any technician to an administrative position, and the ministry obligated the directorates to return the technicians to their basic duties in the technical work and to limit the administrative work to those who have a management certificate only, and to prevent the appointment of technicians or assigning them to administrative jobs without the written approval of the minister himself. Director of Health Affairs in Jeddah Governorate, Dr. Sami Badawood, stated that they have already started implementing the decision and returning technicians assigned to administrative work to their basic work. (Almadinah Magazine. 2010).

Academic program and scholarship

Nurses with less than a baccalaureate degree need to be motivated to go back to college for further formal education in order to advance this aim globally. In fact, schools of nursing should support nurses’ smooth transfer to higher levels of education, according to The Future of Nursing report (Institute of Medicine [IOM], 2011).

Abdullah Al-Zahyan, Director of Media and Public Relations at the Commission for Health Specialties, revealed to “Okaz”. The Authority recently met with the owners of private institutes in order to convert them into colleges that grant a bachelor’s degree in nursing, stressing that the Authority will work to stimulate private institutes in order to achieve this goal. He expected MOH to issue, within the next few days, the appropriate mechanism to raise the level of current nurses from nursing diploma holders to a bachelor’s degree, by opening the field of scholarships within the Custodian of the Two Holy Mosques’ external scholarship program. Stressing that the Ministry has begun to oblige current nurses (male and female) in government hospitals to join these institutes, and it is expected that promotions and incentives will be linked to obtaining a bachelor’s degree, by calculating study hours for diploma subjects and completing two additional years for specialized subjects in the nursing profession, with the aim of raising efficiency The profession and the addition of new specializations such as nursing heart patients and intensive care patients. (Almogati A. 2008).

The Secretary-General of the Saudi Commission for Health Specialties, Dr. Abdulaziz bin Hassan Al-Sayegh, confirmed in his statement to Al-Watan that there is a continuous and growing need for nursing and auxiliary specializations, saying: We are aware of the small numbers of graduates of health institutes who are actually appointed in the nursing mission, and who are appointed Under the name of (nursing technicians), they are not qualified to serve as nurses, and with the decision to close the health institutes and convert them into health colleges, this will encourage other parties, such as private and public universities, to find programs that accommodate larger numbers of male and female students in them so that they graduate with qualifications that enable them to carry out their work tasks with full competence. Recent studies have shown that hospitals with higher percentages of bachelor’s degree nurses have lower rates of morbidity, mortality, and failure-to-rescue patients, which is one justification for the demand for BSN nurses (Altmann, 2011). Regarding the decision to close and not resort to development as one of the proposed solutions, Dr. Al-Sayegh said: This took its share of thinking and was subject to study, and the Commission developed a plan of ten items more than a year ago to confront what we found of significant weakness in the quality of students who were attracted to work in this profession due to the low opportunities Training, the quality of training places and their modest capabilities, and by implementing these provisions, we renew our hope that the institutes will improve their services.” He stipulated his acceptance of any percentage or level, but rather his obtaining a high school certificate, and after the Commission took many steps to improve these inputs, acceptance became conditional on percentages, including: the secondary percentage is not less than 75%, the measurement percentage is not less than 60%, and the percentage is not less than 55% in Achievement test, and with time we hope that the outputs will come to a high degree of quality, by intensifying the supervisory role of the authority so that the opportunity is greater and closer in supervision. Success in the Authority’s exams when students graduated from health institutes did not exceed 22%, adding: These graduates deal with human health and must be rehabilitated in proportion to the size and importance of this service. He pointed out that there are 28 thousand male and female students currently studying in health institutes, and that these institutes are obligated to graduate them in the coming years, and the opportunity is available for them to benefit from bridging programs upon their graduation, indicating that with this number that will be added to the qualified university graduates, they will not fill the need and shortage. The need for much more numbers will still exist and continue, but it will decrease with the passage of time. Regarding health investment and its impact on the closure decision, Dr. Al-Sayegh said: We have noticed through experience the lack of seriousness of training in private institutes, which results in non-serious outputs.

The Need for Vocational Training

The Director of the Training Department at the Saudi Red Crescent Authority, Dr. Rashid Al-Eid, confirmed in a statement to Al-Watan that the return to the diploma will inevitably take place. For instance, in the emergency sector, which we are trying to advance in, will be in a real crisis in terms of manpower that outweighs the crisis we are currently experiencing.” Similar to the classic statement of SCHS that we have been hearing for eight years, which is that the institutes are a (damaged legacy) that we have given responsibility to from other parties. This is the importance of graduates of institutes who hold diplomas. Dr. Al-Eid said, “The ambulatory service for the pre-hospital stage was and will continue to be based mainly on diploma graduates, whether developed countries in North America and Europe and even the rest of the world. Countries such as Germany and France have previously launched experiments aimed at reducing Diploma graduates in ambulance work, but this experience did not succeed, and Germany, France, and countries that followed suit returned to follow the English and American systems in qualifying diploma graduates to carry out the emergency service mainly, with regard to the current situation in the Kingdom, the diploma outputs are mostly bad in principle over the years. Currently, there is a nursing shortage that became urgent after 2020 (Fang & Kesten, 2017). Another misconception is that academic semesters for diploma programs are shorter. It is uncertain that diploma programs would disappear anytime soon given the current circumstances. It also implies that there are fewer motivations for these nurses to go back to school in order to find or keep a job (Iheduru, 2021). Long ago and until now, and perhaps the most important reasons for the low level, the scarcity of specialists to legislate systems, curricula and supervisory procedures, and the transfer of responsibility for supervising the institutes between the different parties from the General Organization for Technical Education and Vocational Training to the Ministry of Higher Education through SCHS, closing work in the institutes is like a Merciful killing to a patient who is hoped to be cured.” Regarding addressing this issue, Al-Eid explained that the treatment lies in “closing the training centers that do not adhere to specific standards at the level of the center and the curriculum, qualifying the trainers, equipping the training facilities, and the levels of the trainees.

The need for specific standards for training

There is a lack of clear specific standards as a training basis, and then the extreme weakness in the process.” The supervisory standards of the floating standards that currently exist, if the observer closely notes that the closure is part of the end of the solution after a series of procedures that are summarized in four basic points: Determining the need in each specialty of each educational level (Diploma – Bachelor) determined by the health service providers, each according to The legislating bodies (SCHS – Ministry of Higher Education) meet with health service providers to set accurate specialized standards for each specialty and stage while opening the way to benefit from the experiences of developed countries in this field, establishing a strict control system to apply these standards with the participation of all or from Through the establishment of a specialized oversight body to ensure that the training process proceeds according to the approach set for it, the closure of any governmental or private training institution that does not adhere to the standards and specified systems. And he continued, “The honorable royal decision did not stipulate the closure as a basis for the solution, but rather as part of the solution. The decision stipulated the development of short-term, medium and long-term solutions to solve the problem. The obstacle we face now lies in the implementation of the decision, and then there is an oppressed group that was not taken as a basic factor.” A contributor to decision-making, and they are the students trained in private institutes. In the end, without developing systems and oversight, the student will graduate with a bachelor’s degree, with which he cannot get a job. On the other hand, the owner of one of the private institutes. another stakeholder’ perspective, explains that the low level of qualification of graduates is not only limited to graduates of health institutes, but also to most educational institutions and government universities. It has proven successful and this is one of the main roles of the employed national authorities, and that the percentage of students from government colleges and universities not passing is higher than the percentage of graduates of health institutes, and the outputs of health institutes are subject to the assessment of the authority and it holds exams to classify students and confirm their qualification as health practitioners in their field of specialization and within the framework of their technical tasks If the students fail to pass the classification exams, the health institutes will rehabilitate them free of charge, and then they will take the Authority’s classification exam again. Whereas Dr. Zuhair bin Ahmed Al-Sibai, Professor of Family and Community Medicine, stressed that the closure of private health institutes will have a negative and achieved impact on the future of health care in the Kingdom, and that converting them into university colleges is impossible because the country needs them both. He said, “We currently have 140,000 health technicians, including the nursing staff. The number of Saudis does not exceed 55,000, or only 39 percent of the total, and this is a problem. As for the other problem, we have only three health technicians, including the nursing staff, for every doctor, which is A low percentage by all standards, and this percentage must rise to no less than eight health technicians for each doctor in order for health services to take their correct position.” Dr. Zuhair Al-Sibai said, “After 25 years from now, that is, in the year 2035, if we take into account that the population will double at that time, and therefore the number of doctors, and if we calculate the rate of eight health technicians to each doctor, and if we aim to be 70 percent of the technicians.” The health workers at the time were Saudis. We will need to train more than 500,000 Saudi technicians. I would like to present this information for a quiet discussion, and for colleagues in the Planning Department in the Ministry to come. If this information is incorrect, then let us correct it together. Train 500,000 bachelor’s degrees in 25 years? This is if we really need them to have a bachelor’s degree, and this is not happening neither in America nor in Europe.” Al-Sibai described the transformation of private health institutes into colleges as impossible, asking a question to the Ministry of Higher Education, “How many health workers can the Ministry graduate for us with a bachelor’s degree from government and private colleges together within 25 years or even 35 years?” He said, “The information that was said that the WHO requires that all workers in the nursing profession be holders of a bachelor’s degree is nothing but a rumor that has no truth”. Al-Sibai believes that the closure of the institutes will lead to a decrease in Saudi employment in the health sector, and the decision will force graduates of the institutes to seek job opportunities in the private sector, which represents less than three percent of the total number of health professionals working in the private health sector as Saudis. He said, “The colleges have requirements for accepting students, and he asked about high school graduates who could not meet the admission requirements in government and private colleges. What will they do, will they stay in their homes or travel abroad to study? He added, “Who will invest in private health institutes if they are threatened with closure? And converting them into colleges is impossible because the institutes focus on practical training and the colleges focus on university studies, and our need for trainees practically doubles our need for academic learners, and we need both teams because each of them plays a role that complements the other, meaning that the decision will make most investors in this field They get out of the market. And Dr. Al-Sibai stated that after the decision of MOH was issued a year ago, he contacted the University of Arizona in the United States and asked them for a list of health specializations such as nursing and others that require a bachelor’s degree and those that require a diploma in America, and the university sent him that there are 14 majors that need a bachelor’s degree and 15 majors require a diploma, so it turns out that the number of diploma holders is more than those with a bachelor’s degree, adding that he also contacted Oxford Brookes University in Britain to provide him with the number of years of study required for workers in the nursing profession, so they sent him that there are two ways in Britain for a registered nurse to become RN, which is: to study for three years and then obtain a diploma, or to study for three to four years after which to obtain a bachelor’s degree, which makes us wonder here, “Do we demand more from ourselves than what America demands of its health workers?” Dr. Zuhair Al-Sibai proposed a number of solutions, perhaps the first and most important of which is that the health institutes remain and develop, and the state contribute to supporting them, upgrading their level, increasing their number and increasing their specializations, as the tuition fees in health institutes have remained the same since, they began ten years ago. While salaries and other costs have increased, and institute students are unable to afford any increase, and in order to improve the level of institutes, the state must contribute to helping institute students to pay fees, in addition to the fact that private health institutes do not receive any support from Governmental agencies must pay the fees for training students in government hospitals. Among the solutions, Al-Sibai proposes that the state ensure the establishment of practical training centers in the main cities, which allow students to practice practically on models before going to the hospital for training, and that the Ministry of Higher Education seeks to convert the institutes into community colleges with a period of study and training for three years, as a step towards bridging for those who wish. From the diploma holders, that the bridging be on top of the work for whoever wants, and also with a full-time system for whoever wants, the newspapers recently published that 11500 crowd for 18 jobs in health affairs in Taif! Why don’t we open the way for graduates of literary departments to join health institutes? Those who pass the preparatory year exam continue to study until they obtain a diploma in health sciences, and those who do not pass it will benefit from studying English for a year. Practical experience has proven that many of them pass the preparatory year exam successfully. Al-Sibai also suggested that a dialogue be held between the concerned parties, which are the planning departments in MOH and Higher Education, and representatives from health institutes and governmental and private hospitals, and one or more experts from the WHO may participate in it for future planning (at least 25 years) for our need for health technicians. As Dr. Aisha Al-Manea explained, it is not at all acceptable for private health institutes to be faced with the option of closing or converting to colleges, as this is contrary to the natural progression of educational attainment according to its different stages, which is recognized worldwide.

Educational investment on nursing programs.

The stage of vocational education is an important, decisive, and vital stage. For many students, how can we cancel those educational institutions that incubate health vocational education? Just thinking about this matter shows how wrong the ministry is in its decision, in addition to the fact that the problem here is not in the institutes or colleges. Al-Manea warned that the Ministry of Higher Education made the same mistake that the Commission made in granting licenses to health institutes in bulk, and perhaps this has already begun, and overnight some of those institutes turned into colleges, to the extent that one of those institutes has More than 12 institutes have been transformed into colleges in a matter of a few months, and in my opinion, this phenomenon will reflect negatively on the educational outputs of those colleges. The problem in this case will be transferring from the diploma stage to the bachelor’s stage, and therefore the college students will not be at a better level than the level of the institute students, so will the ministry then decide not to appoint them as well? Dr. Aisha Al-Manea also confirmed that investing in the education sector in general and health education in particular is undoubtedly an expensive investment. Therefore, it is no secret that good institutes that do not meet the conditions for converting into health colleges in accordance with the standards and requirements of the Ministry of Higher Education will be for the decision of MOH. A very negative impact on it that threatens its survival and continuity and causes it serious material damage due to the huge investments and sums spent on it, in addition to the major loss represented by the loss of the basic base that these institutes represented in accommodating the increasing numbers of students. Al-Manea added that the decision will negatively affect investment in the health vocational education sector, rather it is a fatal blow to this sector by MOH, and I do not think that all investors will transfer their investments to the higher education sector due to the very high costs required by this sector and requirements by the Ministry that may not the average investor is strong on it, so it is likely that the education sector will lose many investors in the field of health education, and this is what is considered a loss for this sector. Dr. Aisha Al-Manea suggested that this decision be reconsidered first, and then research into addressing the problem related to the poor level of graduates of private health institutes through the supervision of those institutes by a qualified body that relies in its supervisory work on clear and specific scientific and professional standards, as it is considered the professional classification exam and the success rate of the institute’s students are among the most important criteria for classification, provided that the supervision is real and effective and in a way that helps those institutes to raise the level of their educational outputs, and not that the supervision be fictitious as is the case now by paying attention to collecting fees and formalities at the expense of content, with the interest of health institutions Not to employ any graduate who does not have the required professional qualifications, and thus its responsibility for the presence of incompetent technicians in places where medical errors may occur. Dr. Yahya bin Hamzah Al-Waznah, head of the Institutes for Training Health Personnel Group, stated that the decision to close needs more patience, because if the owners of the institutes close their institutes, they will not consider opening them again if the ministry needs its graduates in the future – and it will need – as for the transition to health colleges, there is no objection to That, and he said, “But I fear after a while that the ministry will say that we will not need bachelor’s graduates, but we want master’s graduates, noting that the licensing of institutes is under the supervision of SCHS, while the licensing of colleges comes from the Ministry of Higher Education and has nothing to do with the institutes.” Dr. Yahya Al-Wazneh said, “We, the institutes’ owners, do not refuse to cooperate with the ministry, rather we want them to listen. Where Dr. Al-Wazneh indicated that the transition to health colleges is not an easy matter, rather it requires more studies from us and requires guarantees and cooperation from the Ministry. Where he added, saying: MOH and the private sector will resort to continuing to bring diploma holders from abroad to bridge the deficit. Dr. Yahya Al-Wazneh said, “What many people do not know is that investment in the health field is less profitable than other fields, and many institute owners accept a small margin of profit in exchange for serving the country in this vital field.” Regarding the proposed solutions, Al-Waznah said, “From our point of view – as owners of health institutes – it is to stay on the health institutes, upgrade them, raise the efficiency of their graduates, and inform us of the specializations that MOH desires. We also hope to employ graduates from diploma holders in the private sector and various health sectors until the burden of hiring them does not fall on MOH alone, and we do not forget that the SCHS has taken serious and important steps to raise the efficiency of graduates, as it added a preparatory year in which students study English for a full semester. In teaching and submitting this to the Central Committee, which takes its decision to close any institute that violates the Authority’s regulations or is not serious about the educational process. Therefore, I believe that all of these are guarantees for good outputs for private health institutes.

While some specialists believe that closing the institutes will negatively affect the future of Saudization as a strategic national project, and on the Saudization of the private sector in particular, and that it was never the actual solution to low educational outcomes, because in the event of effective supervisory controls and standards, it is possible to distinguish between good and bad institutes (Ga’awani K. 2010).

Students’ experiences

Youssef Al-Shammari, one of the students whose steps got lost between the procrastination of medical institutes and the classifications of the Medical Specialties Authority after losing money and effort, says, “students of private medical institutes, do not differ in medical skill and practice from other students of government colleges, and the difference is that we did not have the opportunity to enter government colleges because of the seats limits, but we found specialized qualification and training under well-known trainers and doctors in the field of medicine at the level of the Kingdom. Note that the private health institutes are parallel to the government health colleges, and the outputs of all are similar because the environment is the same and the specializations are close to each other, in addition to that the private health institutes are keen to attract distinguished specialists, whether from inside or outside the Kingdom, based on the principle of competition between institutes in the private sector. ». Youssef added: “The shortage is clear and noticeable in MOH, as it is still in great need for Saudi nurses, and technicians, but the MOH prefers to procrastinate in appointing them and not paying attention to their demands, citing the poor qualification of graduates of private institutes, bearing in mind that a large percentage of those who work in MOH are from Graduates of private health institutes, why does MOH distinguish people from others? Abdullah Al-Enezi says: “I entered a health institute without knowing the institute’s procedures in terms of its accreditation, as I do not know the procedures, and I did not sign any paper proving my knowledge that the institute is not accredited by the specialization authority. Upon my graduation, the certificate was approved by the SCHS, I passed the test, and got my license After my graduation, I applied to the Civil Service Bureau to apply for employment, and they informed me that the program I obtained was not accredited. After more than a year had passed since my graduation, the program was approved by the Civil Service Bureau. Technicians with the same specialization, although it is a prerogative of the Ministry of Civil Service, but MOH stated that to employs graduates of health colleges. It is strange that one of the graduates of my class was appointed six months after our graduation, even though we were studying at the same institute and the same date of graduation. How is he appointed when the program is not accredited?

The role of corruption in the poor outcomes of private health institutes

Dr. Saud Al-Musaibih (media person) asserts that the private health colleges are a case of administrative, financial, and academic corruption that the Anti-Corruption Commission must address and study how it began and why this spread and who allowed it and who implicated society in it. Is it the General Organization for Technical Education and Vocational Training, MOH, or the Ministry of Higher Education, indicating that the result is disastrous and the state pays the bill for the failures of these academies and colleges that paid thousands of girls and boys with weak, unrecognized certificates and a poor level, then demanded them to be employed at the expense of quality and efficiency, and medical errors are witness to Weak outputs, except for the serious and sincere few.” Al-Musaybih added, “These colleges put millions into the pockets of their owners who fled with their skins, and everyone forgot about the cause of this affliction to society. As for the level of these colleges, everyone remembers the famous episode of the Eighth Program with Dawood, in which one of the owners spoke after closing his college and the size of the scandals presented by the program, and the victim from my point of view Male and female students and their parents who paid millions for their children to learn, and then were surprised by unrecognized certificates. And he said, “Health education that deals with people must be purely governmental, away from trade, because the reality of many colleges, institutes, and academies is not easy and lacks equipment and faculty members, and students graduate in some cases without knowing English, medicine, and the basics of specialization, such as nursing or others. He added, “I know the suffering of thousands of parents with their sons and daughters after they discovered their weak outputs, and the concerned authorities repented and closed some of these institutions, but after the ax fell on the head, and they represent severe pressure on the state to employ them, and the owners of the institutes are happy with their money and profits, and what is required is that they undertake the retraining of male and female students from The reality of the huge amounts of money they received from parents under the supervision of reliable and appropriate government agencies. And he continued, “As for the youth’s demand for these colleges, it was great, as they do not know and want a good future for them, so they are exposed to fraud and manipulation from these institutes and colleges that are often supervised by expatriates who do not care about the interest of the country or the education of their children, and the parents want to graduate and obtain a certificate, and this is not generalized.” Because there are good outputs and honest colleges, and as for the fees, they are expensive, and young people should beware of enrolling in colleges until after verifying their level.” Whereas Saeed Al-Khammash, a member of the Respiratory Care Society, adds, “Of course, when we compare the health and private colleges and the extent of efficiency with government colleges, we find that the difference is large. Men and women fall into the problem of unemployment due to the lack of job opportunities commensurate with their qualifications. On the other hand, government colleges are highly sought after by students for two reasons, which are employment and academic security. These two reasons are not provided by private colleges. On the research and community service side, we find that private colleges Its pace has slowed down in this regard, and it has focused most of its attention on the profitability aspects of the institution itself, and this is normal for it, but not at the expense of students and their development. Al-Khammash suggests that the SCHS support the aspects in which the role of community service emerges for private colleges, and also suggests extending ways of cooperation between public and private colleges to exchange experiences and benefit from each other, in addition to testing the quality of private colleges before they appear on the scene so that the learner can From the quality and standards of the college, and finally that the directors of these private colleges are freed by the Ministry of Higher Education, to fill these positions so that they can be creative in their field of work. moreover, the legal advisor, Nayef bin Nashi Al-Dhafiri, mentioned that Royal Order No. 121 / A dated 2/7/1432 AH stipulates the formation of a higher committee to study the increasing number of university graduates who are prepared to teach and holders of health diplomas after high school, and to develop appropriate practical and quick solutions in the government and private sectors in In this regard, it stipulated the approval of the detailed plan and timetable that included urgent short-term solutions and future solutions to address the increasing number of university graduates who are prepared to teach and (holders of post-secondary health diplomas) and that the concerned authorities implement what was stated in the plan according to their timetable and take the necessary regular procedures. In this regard, this step will solve the problem of the approximately 30,000 male and female graduates remaining on the lists of the Ministry of Civil Service who are graduates of private health institutes, in addition to those who were previously nominated in the private sector. Al-Dhafiri stated that the Ministry of Civil Service is in principle to equate graduates in the public and private sectors and not differentiate between them, because it is a neutral body concerned with nomination and taking into account the needs in government agencies and has no right to reject the application of one party over another. Attorney Al-Dhafiri attributed the accumulation of these numbers of graduates from MOH to the lack of localization of technician jobs, with the large number of graduates from private and government institutes. Also, the media spokesman for the Saudi Commission for Medical Specialties, Abdullah Al-Zahyan, confirmed that the commission announces at the beginning of each year all accredited medical institutes and academies. The commission is only for medical institutes and academies authorized by the commission and other than that. It is not the authority’s competence to accept or supervise their outputs.” Al-Zahyan added: “All students are supposed to check the private health institutes accredited by the Saudi Commission for Medical Specialties. Al-Zahyan stated that if one of the institutes accredited by the Commission violates the terms and regulations, the institute must transfer the students to complete their studies in another accredited institute under the same agreement concluded between the student and the previous institute. however, the Director of the General Administration for Private Training at the General Organization for Technical and Vocational Training, Dr. Mubarak Al-Tami, announced that “the administration is not responsible for medical institutes at the present time, as the responsibility of these institutes was transferred from the institution to the SCHS approximately 10 years ago,” explaining that ” The Private Training Department in the institution carries out several tasks, including supervising the application of regulations, regulations, instructions, and rules related to curricula affairs, circulating them, presenting the necessary proposals to amend and develop them according to the work needs and emerging variables, and determining the institution’s needs for curricula, educational technologies, and printing services in coordination with the concerned units in the institution, and following up on their implementation after Approving them, preparing the five-year and annual plans for curricula activities and educational technologies within the framework of the institution’s general objectives and policies, following up their implementation after their approval, issuing rules and foundations regulating curricula activities, educational technologies, printing, circulating them, and following up on their implementation after their approval, and preparing educational and training curricula for technical colleges, technical institutes and vocational training centers in the country. It will use the studies presented in this aspect and work mechanisms and prepare professional standards for the jobs and professions needed by the labor market, in order to find national job standards, such as the general professions required by the labor market. (Althobaity M. 2013).
The issue is not relevant to hospitals run by MOH because it does not employ diploma holders for nursing jobs, said Dr. Khalid Al-Mirghalani, ministry spokesman. “Our male and female nurses, irrespective of the nationalities, do hold a bachelor’s degree in nursing,” he told Arab News
. Sources, cited by local media, said some hospitals have already announced plans to terminate the services of diploma-holding non-Saudi nurses. (Mohammed R. 2015).

Discussion on Literature Review

To begin with, nurses working outside MOH purview are degree holders, which entails completing at least four years of training and being board certified. The first and fundamental criteria ought to have been this proposition. To provide a more relevant and tangible pathway that awards a bachelor’s degree in nursing, Al-Zahyan, and colleagues appear unstoppable in turning private institutes into colleges. Furthermore, the students, and the employed nurses today? What will transpire if they are unable to complete the bachelor’s degree? Arguably, they won’t have jobs or will have to work in another industry.

The fact that Dr. Abdulaziz bin Hassan Al-Sayegh, Secretary-General of the Saudi Commission for Health Specialties, is aware of the ongoing and expanding demand for nursing and auxiliary specializations confirms that they are aware of the small number of graduates from health institutions who are appointed in the nursing mission and who are appointed Under the name of (nursing technicians), even though they are not qualified to serve as nurses. If they discontinue this proposition, this problem will be resolved. And yet, the risk entailing this proposition is time and competency. However, if they do go as planned, the current health professionals will not be able to meet the demands in the healthcare field. Moreover, because the nurses need to be more competent, they are not degree holders, and even technicians cannot deliver expectations in the tasks. Therefore, it is challenging to have a comprehensive image of the nation’s nursing needs, including which skills are needed where and, more importantly, how those needs will change due to ongoing reforms in the health sector and shifting healthcare needs. As a result, we highlight the significance of a thorough needs analysis that evaluates present requirements regarding people and skills, forecasts future needs, and determines the radical solutions and rational sacrifices to wait for the complete transition and achieve them, including through the policy options.

Obtaining a bachelor’s degree and passing the board exam is relevant and detrimental to healthcare. And Al-Eid said that such experiments “need years to prove their failure, and at that time, the emergency sector, which we are trying to advance in, will be in a real crisis in terms of manpower that outweighs the crisis we are currently experiencing.” Dr. Al-Sibai said the country currently has 140,000 health technicians, including nursing staff, but only 39% are locals. This proposal has been the subject of a protracted debate that calls for input from the MOH, the business sector, and other parties involved to balance or negate its significant effects. MOH is committed to putting this unstoppable idea into action. In that case, whether the private sector is ready or not, the closure decision brought about an enormous change success not just in health investment but in the lives of all the citizens. It is essential to have a high level of education and to continue developing one’s talents under the expert guidance of renowned PhD and master educators in nursing, increasing retention and addressing subpar performance. This raise questions whether nursing colleges were prepared for such decision on receiving diploma nurses or the bridging programs were able to receive thousands of newcomers? Lack of faculty is another important aspect when looking back about the impact of this decision. For instance, in U.S. nurse faculty vacancy rate was 7.6% which worsens the nurse shortage (American Association of Colleges of Nursing, 2009). This suggests that faculty staffing issues will affect even the shorter programs like diploma bridging. Even more concerning is the fact that there is a greater need for instructors to teach in these programs as higher education for nurses becomes more of a priority. In 2008, 49,948 qualified applicants for BSN and graduate nursing programs were turned away by U.S. nursing schools due to a lack of nursing faculty (American Association of Colleges of Nursing, 2009).

Here is why. Abdullah Al-Enezi entered a health institute without knowing its accreditation. Still, his certificate was approved by the Saudi Commission for Health Specialties and tested and classified by the Specialization Commission. According to Al-Enezi, after his graduation, he applied for employment, but the program needed to be accredited. He added that after more than a year had passed since his graduation, the Civil Service Bureau approved the program, and submission was stopped through the Ministry of Health and the Ministry of Civil Service. A strange incident came to his knowledge that one of the graduates of his class was appointed only after six months after his graduation, even though he was studying at the same institute and on the same graduation date.

The declaration made by media expert Dr. Saud Al-Musaibih supports Abdullah Al-Enezi’s experience. He declared that because private health colleges are an example of administrative, financial, and academic corruption, the Anti-Corruption Commission must take action against them. Strange cases like that shouldn’t occur again if the intention is to alter the healthcare system today or within the next 25 years using bachelor’s degree holders. Regardless of how far the MOH pushed, there will still be a scarcity. Al-Sibai also made the point that Saudi Arabia will see significant unemployment. It is illegal to fire diploma holders and hire them only after they earn degrees.

Additionally, health education should be entirely supervised, and independent of commerce, and private institutions shouldn’t prioritize financial well-being over students’ educations. Furthermore, because they have a bachelor’s degree and are marketable, nurses—regardless of their nationality—are resilient and capable of handling the situation. Finally, nursing graduates from public and private colleges must pass the eligibility test; else, they will be unemployed in their preferred field. They will be, however, once they meet the criterion.

Conclusion

MOH repeatedly requested from the government agencies thousands of expat contracts, despite the urgent need to fill the jobs of nursing staff and additional technical specializations by Saudi cadres. This caused unemployment, frustrated and corruption case scenarios where graduates doesn’t have similar opportunities and justice when applying for a job.

There were many solutions to improve diploma path for people who can’t continue their degree. The supervision of private health institutes by a recognized organization that bases its oversight on unambiguous scientific and professional norms is thought to improve the low quality of graduates from those institutes. The professional classification exam and the institute’s student success rate are two of the most crucial classification factors, given that the supervision is genuine, efficient, and geared toward helping those institutes improve the caliber of their graduates.

In order to bring nursing education in Saudi Arabia up to par with international standards, adopting a four-year bachelor’s degree, establishing a 1- or 2-year master’s program in nursing science, putting PhD nursing degrees into practice, creating programs for specialized education, developing cooperative university agreements between KSA and many nations.

These changes are helping nursing in Saudi Arabia become a distinct field with its own identity and capacity for self-sufficiency. The competitiveness of Saudi nursing should be improved by this new higher education framework, which will also highlight the contributions and impact of nurses on the health of individuals, families, and communities

.

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