Branding of the Nursing Profession in Saudi Arabia: Current State and Future Steps

Roaa Gassas, RN, MSN

King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia

*Correspondence to: Roaa Gassas, RN, MSN, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia. Email: Roaa-sabri@hotmail.com

Copyright © 2021 Dr. Roaa Gassas. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 27 November 2021
Published: 02 December 2021

Keywords: Nursing; Professional Brand; Saudi Arabia; Branding Strategies; Nurses

Abstract

Introduction
The absence of a proper professional brand had affected the status of nursing nationally. Many of the current issues require reconceptualisation instead of radical solutions. Transforming the roles of nursing management and staff nurses can positively influence career branding. Leadership, knowledge and career path development constitute the core of the professional brand. Focusing on active branding will automatically sort out major local issues in addition to promoting global health coverage.

Aim
This paper presents the current situation of professional branding in Saudi Arabia and offers potential solutions for enhancing the professional brand for nurses.

Methods
Discussion paper

Conclusion
Active marketing of the nursing profession would begin with changes in the paradigm of nursing leadership and the redesign of nurses’ work, which will help the public and other health care providers to accept the role of nurses as independent professionals. Creating and communicating their brand on the national level is essential as many new nurses’ roles have redefined nursing, requiring active input from the nurses, nurse associations and nurse legislators with significant focus on visibility. The dissemination of nurses’ work is expected to complement the brand.

Introduction
Several issues persist in the nursing profession, many of which were recognised a long time ago yet remain to be unsolved. Historically, Florence Nightingale had succeeded in building a nursing career from scratch. At that time, she had her vision and a supply of many wounded soldiers who needed to be taken care of. Despite her limited resources at that time in terms of knowledge resources, professional associations and even a lack of nursing expertise, she managed to build a professional nursing brand through her actions. As her constructed brand was, in essence, an excellent product, it ultimately gained a respectable amount of publicity and reputation. Therefore, branding can be defined as “a process that builds knowledge about a brand leading to brand loyalty or equity” [1].

Nowadays, situations exist where we have all the resources and expertise but no nursing career brand. The evidence of low levels of branding is proved by the high turnover rate among nurses in Saudi Arabia. Al- Ahmadi (2014) [2] reported a turnover intention rate of 60%. Further, the lack of branding is proven by a low desire to enter the nursing program. Al Awaisi et al., (2015) [3] showed that nursing is not an attractive choice among Omani students and students often enter the program for the purpose of job availability only. A recent qualitative study reported that the reasoning behind the inconsistent nursing image as mentioned by nurses is that they have often not invested proper efforts to maintain and create a good image [4]. Despite the fact that nurses have public respect and trust, they are not seen as professionals who may influence the direction of health care [5]. The World Health Organization’s State of the World’s Nursing Report (2020) [6] emphasised several issues that threaten the stability of the profession. Although encouraging more candidates to join nursing schools seems like the ultimate solution, it might not translate to significant effects in reality due to low branding, especially given that good branding brings about a greater sense of security and satisfaction among nurses [7]. Currently, there is no solid information about the brand image of nursing, despite the growing number of nurses around the world [8]. The absence of such information can negatively affect public perception, which might in turn limit the number of new applicants to nursing schools.

Local and Global Professional Branding
In Saudi Arabia, the state of nursing working hours and conditions has led to a low number of nursing applicants and/or higher turnover rates among established nurses. Findings attributed nurses’ abandonment of bedside and large hospital practices to family commitments and the need for child care [9]. The reality shows women working at several professions with longer working hours, including nights and weekends, with less pay and limited professional growth opportunities. At the same time, many of these women hold college degrees in well-known specialities such as business administration. They depend on that job to support their families or to be financially independent. This situation proves that Saudi women can survive in unusual work conditions. The question is, is it work conditions that hold nurses from progressing in their career or something else? The vision of 2030 has enabled and inspired women to pursue careers in different political, education and business sectors, which has eliminated the traditional limited role of women’s participation in the workforce. Moreover, the vision of 2030 had addressed the need for specific support for the role of nursing in the Kingdom [10]. So, the question is, what is pushing nurses away from their profession?

Globally, many published pieces of research document negative behaviours in nursing practice, including, for example, bullying [11,12]. While some believe this is happening only in the nursing profession. A simple reality check will show that such behaviours are human nature and exist to some degree in all professions. Instead, the only difference is that some do not talk about it. As they managed to show the right side of the profession with smart justification of all actions which reflects good publicity. However, I believe we as professionals nurses might be guilty of propagating the negative image by disseminating evidence that nurses face all this negativity yet little support for the many other prominent aspects of the profession. How will this impact nursing students or novice graduate? Sorrowfully, we seem to have focused on a negative aspect that exists in any profession and the intense marketing focusing on addressing that issue has led people to believe that nursing is an undesirable profession.

The second reason for failing to build a professional brand is the focus placed on the number of staff nurses. Some leaders may think that the main problem with Saudi nurses is turnover from bedside care to other forms of nursing jobs like education, management and quality because they dislike the duties of staff nursing jobs [13]. However, those leaders have missed two major important concepts: first is the importance of having many qualified nurses, not just a high number of staff members, because the real aim is to improve the quality of care. Second is the need to enhance the job design to appear more attractive. The Institute of Medicine (2010) [14] recommended that nurses should be enabled to practice to the full reach of their education and training. Limiting nurses’ abilities and forcing their overreliance on physician leads to low branding. Instead, nurses’ practice should be based on innovation, creativity and independent decisionmaking.

Quality in medical practice comes from a well-designed educational structure. Regrettably, some nursing schools’ curricula may be outdated, overwhelming students with rare conditions and lacking focus on essential topics. Also, students’ transition to practice is influenced by the clinical instructor’s role and the preceptorship, which affects the nurse’s competency and retention as primary care providers [15,16]. It is true that the nursing image is affected when the nurse has limited knowledge of pharmacology and physiology as it lowers the level of trust among patients and other health care providers [17]. As such, nurses’ feelings of incompetence may be related to the broken educational system. Some students may become thoroughly disappointed and frustrated, which can lead to resignation in the first year of employment. Therefore, empowering nurses at the bedside is the key to building a strong professional brand. Knowledgeable nurses will perform excellent spontaneous marketing daily as they will practice with accurate knowledge. In saying this, I’m not referring to blind obedience to orders or medication administration roles; instead, I’m referring to the existence of nurses who know the pathophysiology of the diseases among patients they are taking care of, who can interpret symptoms and understand management plans, who know about medication interactions and disease complications and who have the ability to provide counselling and direction for families with respect to disease phases. Thus, the educational system should teach students how to adopt self-learning strategies instead of simply requiring that they adhere to a rigid curriculum approach, which will better serve to continually enhance the patient care they deliver.

Leadership
Godsey et al. (2020) [4] reported that the poor support shown by nursing leadership is one of the leading factors behind inconsistent nursing branding. Therefore, aside from clinical knowledge, nursing leaders must build a clinical ladder at the bedside where nurses can professionally progress in their career with different titles and benefits, yet remain at the bedside. This action will help with retaining more nurses, especially as they will feel they are continuously growing. Locally, many nurses believe that professional growth happens through official certifications like a master’s or doctorate degree. Likewise, many nurses who work in the quality department are entirely detached from the clinical side, which is a source of confusion. Quality is driven by the daily tasks performed by nurses who work in the unit and who know how things are done. Thus, reforming jobs and introducing dualism concepts to connect some forms of administrative jobs to the clinical practice is warranted and, in return, will increase the value of staff nursing roles.

Impact of the Research on Professional Brand
Furthermore, nowadays, nurses are highly encouraged to be active researchers. However, this recommendation is not realistic at this time because many lack the foundation to effectively read and interpret research reports [18]. Whereas nurses must be turned in to researcher consumers. By consuming research, nurses will automatically become more interested in the profession, find answers and gain interest in developing evidence-based solutions in response to observations made at the bedside. Additionally, in redefining the pre-established role for nurse researchers. It is notable that most of the research performed by nurses is mainly descriptive as the studies may involve issues that are mainly psychosocial or only describe the situation in the context of nursing care outcomes. In this way, the limited scope of research is affecting the nursing brand because it limits nurses’ exposure to only limited types of research. Also, it is time now for nurses to begin participating in and conducting clinical trials. Many nurses may believe that performing clinical trials is difficult and can be conducted by physicians only, but it is true that any intervention can be tested by a qualified health care professional and reported on. Other important forms of research include the application of scientific evidence in the clinical area and subsequent reporting of whether it was appropriate or not. Clinical practice nurses are the ideal individuals to report such outcomes as they remain with patients all the time. Moreover, nurses are the best choice to report and discuss forms of ethical dilemmas they face on a daily basis either during interactions with physicians or with families, which can be done through case reports or discussion papers. Also, case reports are excellent methods if nurses would like to report and discuss how nursing care or a certain intervention impacted patient care. All types of outcomes should be reported, whether positive or negative, especially in caring for patients with rare conditions or who are critically ill. The accumulation of different types of nurse involvement in research is crucial for branding the nursing career in Saudi Arabia.

Branding Strategies
The correct step to enhance the professional branding of nursing is to remodel the paradigm of nursing management. Many managers lack knowledge of different leadership styles and adopt a single style for the entire scope of their appointment. Providing knowledge of several leadership styles may help these individuals to embrace more variable styles. Additionally, leaders may be distanced from the work reality of staff nurses, unaware of the true state of nurses’ roles and their influence on directing patient care and managing units, which may make legitimising policies and rules ineffective as they may be mismatched from reality [19].

Leaders may fail to show vulnerability due to several incorrect concepts they hold about displaying weakness to others and may believe it is the way to gain greater respect and obedience from the staff. It is true that, over many years, this had been the traditional leader image [20]. However, there are several benefits being vulnerable with their staff that these leaders may not be aware of. Brown (2011) [21] expressed that vulnerability is a core driving force for creativity and innovation, which leads to organisational success. When leaders show the willingness to exhibit imperfection and admit their mistakes, it triggers staff to reach for higher levels of productivity and reliability in the workplace.

The introduction of new forms of leadership is essential for nursing leaders to build a professional brand. A single leader should be able to embrace multiple leadership styles depending on the situation. Also, following a critical situation or crisis, leaders tend to analyse the reasons behind the failure so as to prevent or avoid them in the future; however, during prosperity and success, leaders neglect to discern the reasons behind the success for replication. Not also acknowledging the reasons behind success is dangerous because it promotes the attribution of success to invalid factors, which stymies the creation or replication of the same environment in different nursing areas.

Another critical factor affecting professional branding is wages. In Saudi Arabia, the pay scale is unified, nurses who work in the emergency room or the clinic receive nearly the same benefits. Nurses who have managerial positions or office jobs also follow the payment scale, which depends upon their years of experience and official certifications [9]. However, this form of equalisation in payment hinders the branding process; instead, the greater workload of nurses who work closely with severely ill patients should be reflected in their payment.

The professional brand for nursing will rise when there is an increase in the visibility of nursing work; because branding evolves in conjunction with successful marketing [22]. Visibility in this context may include several aspects. First, global communication is essential. Most researchers communicate findings in the English language since it is a universal language. Meanwhile, nurses in some countries may speak their local language only, which limits research visibility. The translation of abstracts and clinical guidelines can draw nursing work toward greater visibility internationally. The second way to attain proper visibility is to engage the public concerning nurses’ work, which could be done by producing movies or television series that focus only on nurses and show the scientific and humanistic sides of their daily job. The media have largely been unfair to nurses’ regarding their roles and work nature [23]. As nurses have often been portrayed as marginal services providers and their significant role in patent care poorly conveyed to the public. Also, documentary movies could be produced to depict scenes of nurses’ lives. The great advantage of movies or television shows is the ability for the audience to travel the world fast and cross all borders for positive publicity.

Another vital aspect is the increased dissemination of nursing work by collaborating with other health care disciplines like nutrition, rehabilitation and dentistry. Nurses are involved in all aspects of patient care. Nevertheless, their involvement with other disciplines may be limited, reducing the visibility of nurses as a scientist and blocking the dissemination of nurses’ scientific production. Such cooperation will facilitate publication in non-nursing journals, which will promote the nursing brand in professional health care societies. Moreover, chances for dissemination extend to nurses’ participation in events at conferences, public areas and schools, which will build trust in people’s minds and hearts about nurses’ knowledge and competence.

Finally, philosophy should be as part of the undergraduate curriculum, even as an elective course. Although this course might seem superfluous at first, through philosophy, different thinking patterns can be introduced, which promotes the embracing of multiple paradigms. Further, philosophy aids in addressing ethical issues and locating the map behind research designs and policy development [24]. Subsequently, it is linked to the enhancement of scientific knowledge because nurses are the only health care professionals who can tie and connect different specialities for the purpose of holistic care [25].

Conclusion
Professional branding is not a one-person job or a single institution’s mission. Instead, it is composed of multiple components that students, leaders and organisations need to embrace. The lack of cooperation between nursing schools, hiring organisations and nursing leaders had led to a poor professional brand. Moreover, it is crucial to question nurses upon employment about their envision of their future pathway. Knowledge of future interest and plans will help employers to match or create local opportunities to provide more desirable workplaces. Value creation is the key player. Employers should refrain from positioning staff nurse’s role as complements or assistants to higher positions and instead make staff nursing an attractive position itself. In effect, the staff nurse should be the cornerstone of patient care. Such a redesign of nurses’ work will help the public and other health care providers to accept the nurse as a competent, independent professional. As such, proper professional branding begins with the awarding of appropriate value to a role. Undoubtedly, enacting policies is effective, but introducing new concepts as well is ultimately essential to develop a stronger brand.

Bibliography