Leadership experiences of nurse managers in a Saudi Ministry of Health Hospital: A focused ethnographic study

Abstract

Abstract Background: Vision 2030, which aims to provide all Saudi citizens with high-quality healthcare, is constrained by international and domestic shortages of nursing staff. Therefore, nursing directors have recommended the introduction of a professional career path, focusing on developing nurses’ leadership skills. However, despite widespread recognition of nurse managers’ key role in recruiting, retaining and engaging nurses, few studies have explored how Saudi managers are trained and acquire leadership skills and how they deploy them. This study aimed to explore how nurse managers view and experience leadership within their workplace. Methods: An ethnographic study into the perceptions and experiences of nurse managers regarding their leadership development was undertaken in a Saudi hospital affiliated with the Ministry of Health. Periodic study visits to the hospital over 8 months were undertaken to collect qualitative data. They involved workplace and continuing medical education observations, an examination of relevant documents, informal interviews/discussions, and semistructured interviews with 21 nurse managers. A framework approach analysis was used to interpret and summarise the data. Findings: The data were organised into four major themes: imbalanced power dynamics, no shared vision, workplace rituals and behaviours, and the need for learning. This paper discusses the imbalance of power, which was also in line with other international studies. The hospital had hierarchical and transactional management structures and processes and a culturally pervasive and normalised capricious leadership approach that was framed by Wasta. This is aform of nepotism normalised to Saudi business practice but now officially recognised and condemned as corrupt by state legislators. A climate of fear and intimidation induced compliance, conformity, and adaptation by managers to the directorate diktats. However, they also used other strategies to subvert and avoid some of the directorate’s authority. Conclusion: The notion that wasta was everywhere was pervasive within the hospital organisation and reported to be the root cause behind most of the dubious directorate decisions. It was used to enhance performance, obtain financial rewards, secure favourable work assignments, obtain meritless leadership promotions, and allocate staff arbitrarily. Paradoxically, while managers disparaged their experiences of the capricious use of wasta, some more vehemently than others, they also used it to get what was they assumed should be their due and occasionally at the expense of their colleagues.