Relation between socio-demographic factors and professionalism among nurses in Saudi Arabia: A comparative analysis

Background

Nurses significantly possess a critical role in improving health outcomes, service designs, redesigns, and decision making at all levels of policymaking and providing services in a particular health care institution. Professionalism is characterized by independent decision-making using the best evidence available. This is made by realizing purposeful relationships and an environment in which professional practice is fostered (Nursing and Midwifery Council, 2015). Additionally, professionalism in nursing entails applying knowledge and skills, fulfilling activities based on standards, displaying leadership, possessing self-discipline, having professional commitment or being loyal to the profession, and adhering to social values and norms (Chitty & Black, 2010).

The concept of professionalization has evolved due to many political, economic, and social changes (Shohani & Zamanzadeh, 2017). Ghadirian et al. (2014) claimed that nursing professionalism is determined by attitude, cognitive, and psychomotor attributes. Also, professionalism in nursing has a complex nature, and it is multidimensional. The word professionalism is a complicated notion. It is difficult to describe and quantify because there is no scientific basis. However, there are studies on professionalism. In such studies, institutions or organizations are the main topics rather than the qualities of the professional. The common understanding of professionalism is generally understood as the adherence of a person to a set of norms, code of conduct, or selection of qualities. It also regards how professionals conduct themselves at work and represent their values. Because of its multidimensional concept, most discussions about professionalism include implicit assumptions and varying incomplete uses (Khan & Khan, 2018).

Nursing professionalism has a bearing on various factors. For example, total years of nursing experience predicts professionalism (Dikmen et al., 2016; Kim-Godwin et al., 2010); gender-related attitudes have been found to be significantly related to nursing professionalism (Park et al., 2019), higher educational preparation (Tanaka et al., 2014), and updated training were significantly related to professionalism (Tola et al., 2020). Moreover, marital status has not been significantly associated with professionalism, according to an earlier study (Rabie, 2021). Older workers appear less likely to be related to professional development (Pool et al., 2013). Although the aforementioned factors contribute to strengthening the image of professionalism, they may differ from the nurses’ perspectives. To the best of our knowledge, this study is the first conducted in Saudi Arabia to view professionalism in the context of nurses’ demographics.

The rapid changes in the current health care system and other related factors cause nurses to respond in a more different and challenging way (Bloom et al., 2018). It involves a more ethical and professional manner of solving issues related to the field. Hence, analyzing how nurses handle professionalism in their careers will help all concerned individuals to achieve or maintain a high degree of professionalism. Although there are assumptions in the understanding of nursing professionalism, it is necessary to explore the understanding of nursing professionalism. Therefore, this study aimed to investigate the socio-demographic factors affecting professionalism among nurses in Saudi Arabia.

Methods

Results

The percentage breakdown of the different profiles of respondents is shown in Table 1.

This study enlisted the participation of 305 nurses from around Saudi Arabia. Females made up 71.1% (n = 217). The age categories of the respondents varied, with most of the workforce falling into the 20–30 age range (42.6%). The number of participants decreased as the age range increased: and 42.3% of the participants were between 31 and 40 years old. Still, the number of participants with 21 years and above of experience declined as they became senior nurses. A considerable number of respondents (n = 156; 51.1%) had a baccalaureate degree in nursing, followed by a diploma in nursing (n = 105; 34.4%). The bulk of the 305 respondents were staff nurses (n = 197; 64.6%) and head nurses (n = 36; 11.8%). A sizable percentage of the respondents (n = 202; 66.2%) worked in hospitals, while 3.6% (n = 11) were from universities.

The level of professionalism was reflected on the basis of adaptations from Hall’s professional attitude questionnaire among nurses working in the Kingdom of Saudi Arabia, as shown in Table 2. All five dimensions measured were interpreted as equally high levels in terms of the professionalism of the nurses. Nonetheless, variations in the level of average means (professional organization (3.94), belief in public service (3.91), belief in self-regulation (3.97), sense of calling (4.01), and belief in autonomy (3.71)), were observed.

The differences between socio-demographics and professionalism are presented in Table 3. There was no significant difference between gender and professional organization, belief in public service, self-regulation, and belief in autonomy, but a significant difference between gender and belief in public service (t = 2.794; p = 0.006) and sense of calling (t = 4.290; p = 0.001). Regarding age, there was a significant difference only in the belief in self-regulation (t = 5.984; p = 0.003). Moreover, there was no significant difference in educational qualifications regarding professionalism. Conversely, there was a significant difference in the type of facility with a professional organization (F = 3.057; p = 0.029), belief in public service (F = 4.130; p = 0.007), beliefs in regulation (F = 3.452; p = 0.017), sense of calling (F = 3.211; p = 0.23), and belief in autonomy (F = 5.99; p = 0.001). Finally, there was no significant difference between the current position of nurses and professionalism.

Discussion

This study aimed to determine the level of professionalism among Saudi Arabian nurses and its differences according to socio-demographic factors. Nurses in the Kingdom of Saudi Arabia are highly professional. Solomon et al. (2015) found that a prominent level of professionalism is associated with a positive self-image and organizational culture. Moreover, a moderate level of professionalism among nurses is related to their experience level (Hasandost, 2016). Nurses believe that professional organizations must be supported, and they should be encouraged. This finding is an indication that nurses believe the organization can assist them in improving their working standards and professional skills through ongoing education. This current finding is supported by the study of Shohani and Zamanzadeh (2017). Furthermore, nurses who belonged to a professional association had an increased definition of nursing professionalism.

The nursing profession is still considered a calling for most of the respondents in all five dimensions as measured according to the attitudes of nurses. Sense of calling ranked the highest, entailing that nurses always believe that nursing is a calling. Moreover, respondents also view nursing as a profession in line with public service (Shohani & Zamanzadeh, 2017). Furthermore, this present finding is related to Hall’s belief that employees must believe that their work benefits themselves and society. This is also in coincidence with the claim of Wiles (2022) that employees nowadays have developed a new sense of consciousness in terms of their role, and they are worth becoming more attached to the world where they live. There, it was claimed that when professionals and society are at odds, professionals should put their interests aside for the good of society. According to Thompson (2021), the concept of self-regulation entails how well an employee manages their thoughts and actions. Self-regulation can help shape your flexibility when unhappy actions happen outside of your control.

Moreover, a sense of calling is defined as the vocation and obligation, which includes the purpose and meaning of the profession with its highest desire to serve (Ponton et al., 2014). Being called to the nursing profession is the inherent characteristic that influences the meaningful engagement with their work. This attribute has been found to affect nurses’ motivation in working (Ziedelis, 2019). Also, this will help nurses achieve job satisfaction (Xu et al., 2020). This intense feeling compelled them to put much effort into their tasks and made them less likely to abandon them (Alshammari et al., 2020). In the process of self-realization, calling is a powerful personal resource and motivator. Those who have a calling are willing to face various obstacles and difficulties, even if the working environment is challenging.

Professionalism is a person’s conduct at work (McKay, 2019), which is determined by three characteristics—cognitive, attitudinal, and psychomotor (Ghadirian et al., 2014). In this study, nurses agreed that they have their own choices during work and that there are times when their decisions are subject to review. Both may occur due to a lack of consensus or ambivalence among the participants regarding the concept of autonomy (Oshodi et al., 2019). Furthermore, nurses saw the autonomous practice as acting exclusively on their judgments, while others sought clarification or confirmation from more senior personnel. This occurs in an emergency when staff nurses are forced to work in the wards on weekends while the head nurses are unavailable. The results of these studies are inconsistent with the research previously conducted that the five attributes showed low scores in autonomy and public service and an average score in self-regulation (Shohani & Zamanzadeh, 2017). However, a sense of commitment and professional organization displayed high scores, which coincides with this study. Earlier studies showed that professionalism demonstrated an average score compared to this study with a high-level perception (De Braganca & Nirmala, 2017) and empowerment (Alsaqri et al., 2020) on professionalism.

The gender of the nurses was found to have a significant difference in the sense of calling, suggesting that male nurses have a higher level of professionalism than female nurses. This means that male nurses regard quality nursing care more by upholding principles of respect, strong commitment, and displaying the utmost attitude required. According to Paskaleva et al. (2020), male nurses chose the nursing profession for two major reasons: willingness to help other people and career opportunities. In addition, male nurses consider nursing a decent place for men, and many are satisfied with choosing nursing as a profession. This is an indication that the strong dedication and commitment of male nurses reflect their intense professionalism. Furthermore, it has been found in a recent study by Budu et al. (2019) that male nurses are more professional in their duties and cooperative with male nurses as perceived by patients.

Meanwhile, there was no significant difference in professional organizations, belief in public service, belief in regulation, and autonomy. These findings are suggestions that age has no bearing on the mentioned variables when compared. Both genders regard the importance of such variables equally. Such a finding is in agreement with the conclusions of Matthews (2012). Matthews (2012) stated that “by encouraging all nurses to engage in their professional organizations and associations, noting how these organizations contribute to the accountability and voice of the profession to society.” Nurses remain in their hearts the belief that nursing is a public service, which is notably a part of their orientation about the profession. Moreover, Riley and Beal (2010) stated that the concept of public service had been regarded as an integral part of the profession.

There was also no significant difference between age and professional organization, belief in public service, belief in self-regulation, sense of calling, and belief in autonomy. This means that the beliefs of the respondents were not influenced by their age regarding the mentioned variables. Pool et al. (2013) detected no clear age patterns for enthusiasm in professional development activities. However, younger members of the nursing profession have the least participation in professional organizations (Lammintakanen & Kivinen, 2012). Indeed, personality growth and maturity advance career developments and amplify career abilities among professionals. This shows that young adults tend to display a higher degree of professionalism because they acquire a personality maturity level that evokes job satisfaction and career satisfaction.

Regardless of their educational qualifications, no significant difference in the professionalism of nurses was found. This finding implies that a graduate nurse is clothed with professional values assimilated during formative academic years. Nurses are equipped with this attribute as they graduate from the nursing program. However, in a systematic review by Sibandze and Scafide (2018), there was a reflection regarding contrasting results. Nonetheless, it is remarkable that the studied respondents proved that educational qualifications do not affect their sense of professionalism. This could be a good indicator of a desirable organizational climate in a particular institution. Another viewpoint is that professionalism is achieved depending on the personal values of a particular individual. Culture, morality, traditions, and religious values would be incorporated into personal values. It only implicates that professionalism is seen not only by highly educated people but also by those who own personal values in the working world. Mashlah (2015) found a strong link between personal values and how workers think, feel, and act, which is engulfed in displaying professionalism. With this, it was then shown that nurses see the importance of possessing personal values affected by their excellent culture and morality to be professionally upright in the profession.

The significant difference found in the type of facility and belief in autonomy suggests that the nature of the job nurses makes them have at least some decisions on their own. In this event, job satisfaction was fostered and felt, which led to highly motivational feelings and indicated a sense of professionalism. According to Saragih (2015), job autonomy and job satisfaction are significantly related, and job performance is affected by job satisfaction. This is an indication that a nurse has given a work assignment that evokes job satisfaction, hence affecting job performance, especially in the way they are becoming autonomous. Additionally, the feeling of entitlement to their decisions and duties pushes them to be satisfied at work. Moreover, the non-significant differences found in the work assignment and professional organization, belief in public service, belief in self-regulation, and sense of calling suggest that the nurses will continue to engage in professional organizations regardless of their job assignment. This also means that the views of the nurses that nursing is rooted in public service and a calling do not change.

There was no significant difference between the current position and the professionalism of the nurses as a whole. This finding is an indication that nurses uphold the attitude required to be observed in the profession on whatever assignment is given to them. This finding is also a reflection that nurses express professional attitudes as expressed in their professional behaviors through relentless quality care by upholding ethical and legal standards. During the training in their baccalaureate program, nurses were developed and evaluated in three significant taxonomies. Those taxonomies included cognitive, psychomotor, and affective, by which nurses were pushed toward upholding professional behavior as they render services to their patients. According to Ghadirian et al. (2014), professionalism in nursing is committed to three dimensions: cognitive, psychomotor, and practical. Hence, professional behavior is produced due to the retained values taught to these nurses, which were acquired in their formal educational training.

Conclusion

Nurses in the Kingdom of Saudi Arabia perceived themselves as highly professional, and male nurses were found to have a higher sense of calling than their female counterparts. However, there were no significant differences in professionalism caused by the age, educational qualification, and current position of the nurses. Conversely, significant differences regarding the belief in autonomy were caused by the type of facility. Such findings support and sustain the role of nurses in 21st-century health care, which is significantly needed to provide the most quality care.