The impact of Saudi Arabian Vision 2030 on the evolution and growth of the nursing profession

From 2010 to 2016, the proportion of Saudi nursing staff began to decline due to various factors, including the life expectancy of the Saudi population, which has increased from age 69 in 1990 to age 76 in 2012 Also, from 1990 to 2012, Saudi Arabia’s population increased by 2.5% annually, which would result in a rise in healthcare demand. Moreover, the bad image about nursing profession, and the perception that is insignificant profession and less efficient than other occupations, influence the public views to join the nursing discipline. When The Saudi Arabian Vision 2030 was implemented, it positively affected the Saudi economy. Therefore, this study aimed to describe the influence of the Vision on the nursing profession. Secondary data was pulled from the Ministry of Health was used to do a Descriptive Comparative Research Design to compare between the number of nurses when the Vision was implemented with the years after that. Results revealed that the growth rate of the number of nurses increased by 9% to 10% after the implementation of the vision. These findings underscore the well-established policies of the Saudi Arabian Vision 2030 that have a positive impact on the nursing profession.


Background
Until 2017, Saudi Arabia's economy was heavily dependent on petrochemicals.
However, the government introduced a comprehensive plan known as the Saudi Arabian Vision 2030. The primary objective of this vision is to strengthen, prosper, and stabilize Saudi Arabia. It has garnered widespread support from all segments of society, particularly the Saudi youth [1]. The vision encompasses various areas, including pollution reduction, education improvement, tourism development, promotion of responsible citizenship, and enhancement of the healthcare sector. Its underlying message is clear: to build a better future for generations to come [1].
In the past, major developed countries such as the United States and Britain have shown support for nursing across all levels, without differentiating it from other healthcare specialties. These countries implemented numerous reforms, most notably increasing nurses' salaries, in response to a significant workforce shortage. Nursing plays a vital role in healthcare institutions overall, but its importance was not fully recognized in the past. It was often perceived as practical experience without acknowledging its scientific evidence-based practice, as it is today. Nursing is just as crucial as other fields and disciplines involved in patient care in hospitals, emergency rooms, psychiatric clinics, etc., as it contributes to epidemic preparedness, primary care, and health education. Among all healthcare providers, nursing shortages were reported as the most severe. Eighty-one percent of CEOs identified nursing shortages as a problem in their hospitals, with forty-five percent rating it as the most severe issue [2].
Nursing education in Saudi Arabia began in 1960 through health institutes, without proper planning, organization, or methodology. In 2002, it was officially approved by the Saudi Commission for Health Specialties. In 2007, the Kingdom of Saudi Arabia issued a Royal Decree to close all health institutes, requiring nurses in health specialties to obtain a bachelor's degree. However, there was a lack of specialists in micro-disciplines such as intensive care, emergency, and neonates due to the limited clinical study opportunities in Saudi Arabian medical specialties and universities. As a result, the kingdom sent some nurses to study abroad, or they were going on their own to study these specialties. Since the initiation of Vision 2030 in 2017, Saudi universities have been offering education in these subspecialties [3].
Although Florence Nightingale is widely recognized as the founder of modern nursing, historically nursing services have a long history of evolving through the care provided to the sick and wounded. During the early Islamic era, nursing gained prominence when a group of women served in Muslim armies, providing care to the wounded and sick [3]. Nursing was well-established in Islam, and one notable figure, Kuaibah Bint Sa'ad Al-Aslamiyah, also known as Rufaidah Al-Aslamiyah, is acknowledged as the first Muslim nurse and a pioneer in nursing during the Islamic era. Rufaidah not only practiced nursing during times of peace by treating the sick, her practice was not limited to that, as she also actively taught and trained other nurses [4].
Before 1960, the Saudi government was compelled to recruit nursing staff from various non-Arab countries due to the lack of Saudi nurses. However, due to the communication difficulties faced by patients in interacting with non-Arab nursing staff, the government opened numerous health institutes in 2002. Additionally, the proportion of Saudis in the nursing field started to increase between 2004 and 2009 until the percentage of Saudis exceeded that of foreigners.
According to the minister of health, nursing is a crucial target for achieving the vision of the Kingdom of Saudi Arabia. The minister further emphasizes that 50% of the total workforce in the health sector are nurses [5]. Furthermore, the Ministry of Health (MOH) has announced some promising news regarding the focus on nursing this year, such as the establishment of a system to measure nursing productivity, projects to reduce the proportion of clinical pressure sores, the development of nursing care for the elderly, the application of the Midwifery Guidelines, and the implementation of the Midwifery Workforce Restructuring Project, Pre-Medical Workers Compliance Measurement Project, Out-of-Occupation Reduction Project, Development of Nursing Departments in Regions and Governorates and Saudi Nursing Research Capacity Building Project [6].
Several countries have successfully implemented health workforce reforms. A noteworthy example is New Zealand, which had to modify its marketing strategy and policies to address the shortages of doctors and nurses. The 30-year reform in New Zealand's health workforce has resulted in a new integrated workforce policy and governance [7].
According to the Scottish Nursing 2030 Vision, given the ongoing changes in health, society and technology, nurses are now more crucial than ever in delivering professional care. It is essential for nurses to function within an integrated healthcare system and collaborate in multidisciplinary teams. Similarly, the nursing workforce in Saudi Arabia envisions shaping similar goals and plans to ensure the availability of the right staff levels, numbers and skills for future care.

Purpose of the study
This study aims to compare the number of Saudi nurses during the year of the implementation of the Saudi Arabian Vision 2030 and the subsequent years. By obtaining information about the number of nurses, who are typically the frontline healthcare providers, it will be possible to design future policies that can benefit the healthcare system in Saudi Arabia.

Research question
The objective is to identify how many Saudi nurses continued working in the nursing profession after the implementation of Vision 2030.

Hypothesis
Promising advancements have been observed in the nursing profession following the implementation of Vision 2030.

Study methodology
The data used in this study were secondary data, which refers to the utilization of existing data to address new research questions. This methodology has been widely recognized across various disciplines, including nursing [8].
For exploratory analysis, data from the MOH spanning the period from 2007 to 2019 were aggregated [9]. The primary objective of this secondary data analysis was to generate a statistical report on the nursing workforce operating under the purview of MOH.
The researchers employed this dataset to conduct a descriptive comparative research design, aiming to illustrate how the 2030 vision enticed Saudi individuals to pursue nursing careers. The goal was to compare the number of nurses before and after the implementation of the Vision.

Identify the growth rate of the Saudi nurses practicing in Saudi Arabia after the Vision 2030 were implemented?
Upon examining Table 1 and Figure 1, it is evident that the nursing workforce experienced a significant decline in the year of Vision implementation. This decrease stands as the sole decline in the nursing workforce's history in Saudi Arabia since 2007. The growth rate declined by 1% in 2016, resulting in a decrease of 61 nurses, leaving a total of 66,000 nurses that year. Subsequently, the growth rate rebounded with a 10% increase in 2017. This led to an addition of 4,964 nurses, bringing the total count to 70,964. In the following year, 2018, the growth rate further increased by 9%, resulting in the addition of 4,792 nurses, making the total count 75,756. Lastly, for 2019, the growth rate rose by 9%, accompanied by an increase of 4,988 nurses, resulting in a total count of 80,744 nurses.

Disscussion
The aforementioned data indicates a sharp decline in the count of Saudi nurses during the year of the Saudi Arabian Vision 2030 implementation. Nonetheless, owing to the presence of robust policies pertaining to the nursing profession, the number of Saudi nurses experienced rapid growth. This serves as a testament to the successful vision of Crowned Prince Mohammed Bin Salman for our nation, particularly within the nursing field. It is worth noting that the secondary data used in this study covers until 2019, but there is a high expectation that the number of Saudi nurses will continue to increase in order to address the staffing shortages faced by healthcare organizations. Due to well-established polices in the nursing profession, the number of Saudi nurses has increased very rapidly. The COVID-19 pandemic was like a message to open our eyes to the need for a fundamentally strong healthcare system. The Vision implemented new policies and procedures to shed light on the importance of the nursing profession and that happened by unifying the nursing staff, nursing leaders, and educators [10]. Healthcare is not like any other discipline; they are dealing with life and death situations [11]. When a patient dies, there is no way for him to come back to life. For example, any financial crises could be corrected with many ways unlike the patient's life It could lead to severe complication or death. World Health organization WHO named the year of COVID-19 "Nursing and Midwifery year" due to the high shortages that were revealed during the pandemic. Many hospitals could not accept patients because they did not have enough nurses to cover [12]. That is an indication that Saudi Arabia had a successful plan toward the nursing profession. The secondary data was taken until 2019, but the expectation is very high that the number will increase for the Saudi nurses so they can fill the shortages that the healthcare organizations are struggling with.

Limitations
The vision was implemented on 2016 and the researcher done the study on three years after the implementation of the vision. It would be beneficial if the data was until today, but the researcher did not have access to up to date data. The researcher believes that adding data till 2022 will have bigger picture about the effect of vision on the nursing profession in Saudi Arabia.

Recommendation
What makes this study particularly intriguing is its timing, which coincided with a significant political shift that resulted in more lenient policies regarding Islamic rules (source-apart from 60 minutes). Presently, Crowned Prince Mohammed bin Salman is advocating for "Moderate Islam", a stance that is likely to attract women to pursue nursing careers. Previously, some families were reluctant to allow their daughters to work as nurses. However, the scenario has evolved, with Saudi women now able to participate in marathon runs and drive cars, activities that were previously prohibited.
The researchers recommend conducting a follow-up study after several years to assess the progress and observe the increased number of Saudi nurses following the implementation of Vision 2030. This initiative supports not only the nursing profession but also the overall labor market, contributing to the growth of the Saudi economy.

Conclusion
Over the centuries, the nursing profession has undergone significant evolution, transforming into a scientific discipline that entails specialized education and the application of highly clinical skills. In line with the Saudi Arabian Vision 2030, the Kingdom of Saudi Arabia has placed great emphasis on the nursing field as one of its key objectives. This vision has provided an opportunity for nursing staff to actively contribute to healthcare management decisions while also facilitating the establishment of graduate academic programs aimed at enhancing the proficiency and quality of nursing in Saudi Arabia. The primary objective of this vision is to address the issue of unemployment, as the demand for nursing professionals is high on a global scale, not just within the local context. The study presented herein highlights the progress achieved within the nursing profession,