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A British Nurse's Exprience in Saudi Arabia and KFSH&RC

I have only been here five weeks, but I'm absolutely loving it so far! Feelings on embarkment I was more apprehensive about travelling than actually coming here. I was worried about the connection flights - making them and so forth. Otherwise, I wasn't nervous, I didn't have any bad thoughts. I just kept an open mind. I really didn't know what to expect. I think that sometimes when you have expectations, you become dissappointed. I think that this - unrealistically high expectations - is precisely why a some people find themselves unhappy here. I don't mean to say that it isn't good over here - it is very good. I just didn't create expectations myself. Maybe this is due to being a more mature person already - I am 46 years old. I think that the younger ones might have less life experience, and this can result in unrealistic expectations.

Culture shock? I attended an presentation when the hospital interviewed me. They told us about life and working in Saudi Arabia, and I felt that everything that they told us has turned out to be correct. It is true that you have to wear an abaya over here. You don't need to cover your head, but if someone asks you to do this, then you just do it. If you follow these examples, then you won't have a problem. I think the problems arise when somebody begins to be challenging. But other than that, there really aren't any problems. You will find that you can go to some restaurants here where you can take your abaya off and where you can mix with both males and females. The restaurant rules are at the manager's discression.  You will see the Saudi women covered up in these same places, as they will always choose to do so.If you go to the Kingdom Mall  you won't find the religious police in there, as they are not allowed in. You'll find more educated people in these settings and the deep rooted cultural traditions are a bit more lax in such environments. So if you go to these bit more "upper class" places, you'll notice that they aren't that far away from what we are used to back home. These nicer restaurants aren't of course the cheapest ones, but they cost about the same amount as what we would pay in England - around £30-£45.

You will make friends and find out which places to go to if you want to have a more Western experience. If you choose to go to the more local venues, you just have to respect the rules and wear your abaya. I like going to these places as it reminds you of the Western culture. Alcohol is, of course, prohibited in any restaurant, but you can get these lovely "mocktails", which are alcohol-free coctails. But if you go to the souks (market place), for example, you would always wear your abaya.I came from a very big Muslim community, so I was used to seeing women covered. So I don't think that this aspect caused that much of a culture shock for me. When I worked in Preston, I dealt with a lot of Muslim patients. They are lovely people, and you'll get used to the covering up quickly. The covering up is cultural rather than religious - it's just the way it is here. They want to do it - they have grown up in this environment and it is the norm here.

I have found the people here absolutely lovely. If you have the same patients, they always remember you. You can actually see if somebody is smiling even if you can only see their eyes.All in all, the culture shock didn't hit me that hard. It's mainly the abaya that's different. But you soon learn that it's like going out with a big long coat. You carry your head scarf in your bag in case you are asked to cover your head. As long as you respect the rules, everything is alright.  

Working as a nurse in Saudi ?

Initially there is an information overload. Everything is new - the country, the people, the country. Nothing is familiar at all. There is a lot to take in. It is a good thing that you have some information written down, because you just can't remember everything. You got your transport services that you need to remember, your pay details (when you get paid), telephone numbers (work, housekeeper, maintenance etc.). I have pinned some of these details onto my wall, where I can find them quickly.You meet so many people in your GNO (General Nursing Orientation). There were 70 nurses starting at the same time as me. Not only do you meet all the new nurses starting at the same time as you, but you meet a lot of the hospital personnel all across the multidisciplinary team. You learn about the hospital policy and procedures, the multidisciplinary team, about the prayer times. You got to realise that religion comes before health over here. This is something that I had trouble with. I found it very difficult to treat people who want to pray first even though they are very poorly. So I have to wait until they have prayed, which can take about 30 minutes, before I can treat them. This of course differs from my background as I was trained to treat patients as quickly and as smoothly as possible. Obviously, if they are extremely unwell, they aren't able to pray. Each patient will have either a sitter or a relative with them at all times. The women, of course, can't go anywhere on their own, so they will have a family member. But the men might have a sitter in stead.

Meal breaks?

The canteen at the hospital is very good. It is extremely cheap and the food is very decent and you get lots of different cuisine. The staple food is the same mostly, but they just do it with a differnt twist from day to day. You will get an hour for your lunch (this is paid for), which I was positively surprised by as back home we only got 30 minutes. In addition to the hour lunch, you get a 15 minute break in the morning and the evening. 

Support from HR and other Departments?

The hospital is very good with facilitating you sorting out your paperwork (sort out your bank account, if there is any problem with your iqama etc.). If you have to get something done and the ward is covered, they'll let you go and do it. You just have to notify the nurse in charge/your perceptor. They are very helpful in the beginning with these compulsory things that you need to get sorted out. Usually you will try to get things sorted during your lunch hour, but you need to notify the ward that you might be running late, because these things can take time.

Can you tell about your ward?

My ward I work on the day medical unit. It. It's a walk in unit. We get referrals from all areas from the hospital. So we can get endocrine, growth hormone, cardiac, palliative for chemo, angio patients etc. We do treatments and procedures on this unit. The procedures can be done with local anaesthesia or they can have sedation. The majority will have only local sedation, but on occasion we do general sedation as well. We have 10 nurses on.  At the moment it is pretty quiet as it is Ramadan - now we have only about 40 patients coming in per day. The patients are split equally amongst the nurses. And the treatments and procedures are divided equally among the nurses. Our unit is run very well. The nurse patient ratio is smaller here than back home. We don't have healthcare assistants here, so you take care of the patient more holisitcally than back home. I think this is a good thing as you get to assess the patient better. As you have less patients here, you have time to do the whole care for the patient.Our ward is moving towards all elctronic documentation, but we do have paper as well still. I think I have learned our computer system quite well already. We still have a paper where we write the baseline observation once the patient comes in, but then we transfer this information on the computer. So sometimes we are basically doing double work on somethings. The medical management is all online.We also use the PYXIS machines for the medicine. I think that this is a good thing as it stops the errors. I have heard that on in-patient wards there might be quite a queue at the PYXIS machine, but on our outpatient ward it works very well.There are quite some differences between my work here and my work back home. In England, I was working in an acute medical short stay unit (in patient), where everybody was admitted from A&E, medically - nothing surgery. So if they weren't acceptable to ITU/HDU they would come to us. We only did treatments, there was no procedures, unlike here. You do need to learn to know the policies and procedures well as they do differ from back home - even if only slightly different. So you want to get to know them as soon as possible. But they are extremely supportive on the unit, so if you don't know something, don't hesitate to ask. But you do need to know what happens within the procedures. One difference is that over here they always prime the giving sets with normal saline, while back home we just run the antibiotics through and give it to the patients. They also flush it after with saline. They do a lot of these kind of things differently from what I'm used to. I think this is a good thing, because back home we still have medicine in the set when we throw it away. It's just little things that are different. They follow the American way quite closely here.After your nursing orientation, you work on the ward with your preceptor. Your preceptor might be of different nationality than you and you may feel that there is a bit of a language barrier between you. You might just have to ask your questions in a different way so that they will know what you want to know. It's not that they can't answer that question, it's just that they might not directly understand what you're asking them. This is something I encountered. So you just need to brace yourself to a bit slower communication. So you just have to be patient with one another.There are only three British nurses on my ward. We have an A team and a B team working alongside so that one team is always working while the other is off. I was put on the B team. I was a bit disappointed with this as my two friends, two British nurses, were put on the A team. This means that I will miss out on a lot of the socialization as once they are off, I will be working and vice versa. I have requested the move to the A team, but I can't because two other people have requested this before me, and I will have to wait at least 12 months, before this is possible. This is the only thing that I have found a little disappointing.  I am not complaining, in fact, it will probably do me good.

The nurses are not as autonomous as back home. If you ask for a rationale for things, they don't really want to hear you - they see this as you questioning things and they don't really like it. On your preceptor sheet - the checklist that you go through with your preceptor - they assume that you know nothing. It made me feel like I was a student nurse again. But you just bite your tongue and get on whit it. I worked together with my preceptor for the first week on the ward. Now that I have my own patients, my preceptor has actually come up to me and said "I didn't realise that you were so good at doing cannualtion" or "I didn't realise that you were so good with patients". But obviously I had told her that I knew this stuff during my preceptor orientation. But they really don't listen - they hear, but they don't listen. I think it is this language barrier that is a little bit different. Also, they have this mode of doing things and everything is done "just so". They are like robots when it comes to your initiation - I don't want to sound horrible - but it's just that they literally tell you how to put a plaster on and take it off a patient (I was taught that the correct way to remove a plaster is to first lift the left corner and so on). If I said that I had taken a plaster off in various ways before, the answer is "but this is the KFSH way". I found this rather fustrating at times. This kind of thing is what people here complain about the most.

I have some responsibilities here that I didn't have back home. One is that we have to do a complete adult physical assessment. This is done only by the doctor in England. This means checking the head the head, the hair, the eyes, the nose, the mouth, the teeth, if there are any lumbs or bumps, that the swallowing is normal, listening to the lungs, listen to the heart and make sure that there is no murmur. I can't distinguish murmurs, I can't distinguish whether the heart is beating normal or abnormal - this is something that is a doctor's procedure where I was trained - and I have no wish to be a doctor. I informed them that I had never listened to the lungs or heart in my professional capacity. As a student I did, but not as a practising nurse. We also have to check the patients blood results and inform the doctor if the results are abnormal. Back home this is the doctor's job. Another new responsibility is taking care of paediatrics - I didn't do this back home. I have to take a course on paeds. I need to get to know the parameters. The heart rate higher and BP is very different, I need to know which reflexes work, on the fontanel - how far it has closed etc. We have paeds from all ages, from new borns to 13 mainly. I am not bothered, because I see it as a new feather in my cap. I'm just panicking that I need to know it. I felt like they were a bit slow with coming up with the parameters. I tried telling them that I can't look after the child if I don't know the parameters - I need to know these first, before looking after the child. I think that if you explain to them, they'll help - but you got to learn to speak up. I think you might have a harder time with these kind of things if you're a quiet nurse .My colleagues are very nice, they are absolutely fantastic - they can't do enough for me! Even though I think there is a minor language barrier, they are very supportive. We have also Saudi nurses on our ward.

Some of our patients can speak a little bit of English. I have learned a little bit of Arabic as well. I am teaching myself, and all the people on the ward are teaching me also. I've been doing this online. Our receptionists works as an interpreter on our ward. But we have quite a few Saudis working on the ward as well. So what is the quickest way to ask a patient eg. how theylong  have they had the canulla in, is to ask "how long" in Arabic (I have learned this already) and tap your arm where the canulla is and they understand. Then they'll put their fingers up to indicate how many days they've had it in. So a lot of the communication is "sign language" and short sentences or phrases actually. I haven't found it difficult at all. I might also ask a Saudi nurse to tell the patient that I am going to put a blood transfusion on and they have to tell me if they are having any reaction, if they feel funny in anyway. So the Saudi nurse will come and tell this and then the patient puts their thumbs up. Then I'll just tell them to press the buzzer if they need me - if you just point toward the red light, they know what to do. I know enough Arabic already to introduce myself, I can ask their name, hospital number, date of birth, if they have any allergies etc. I am proud of it, because it's lovely to get a response from the patients. The repetition facilitates the learning as you are repeating it to each patient - I ask the same questions to all my patients. So when I learn one thing, I move on to something new. 

Can you tell your thoughts on "Magnet "

Magnet is an American accreditation programme. We have to build portfolios for ourselves and do reflective writing as well. We did reflective writing back home as well, so this wan't really anything new. To me, Magnet is not looking at how you work, but what is written on paper and if there is good management/managers. This is what I have gathered from the explanations, but I must admit that it hasn't been explained that well and I have no experience of it yet. So what happens is that you have to fill in all the paperwork correctly - as you did back home as well - and they come around and check it. The Magnet reviewers are only coming next February so I don't really know what to expect. But as far as I've understood, Magnet is more concerned with management - the financial aspect of things; how the nursing is done on time and how well the ward/staff is managed and coordinated. So what I have gathered Magnet has to do with statistics more than anything else. They are concerned with paperwork, not how the nurse works with the patient or communicates to the patient or how the team works as a unit. I am not sure if they look into patient satisfaction - I don't know if they talk to patients, but come February, I believe I'll know more. Magnet is very much present on our daily life as you will hear continuously how something must be done absolutely correctly or "this and that way" because the reviewers are coming in February. I don't want to make it sound horrible, as it really isn't. When they come in February, I just need to talk with them and ask exactly what they are looking for. We had similar audits back home - care bundles and quality controls.

Accommodation and leisure time?

My apartment and compound I like my appartment, it's very nice. I live with one other nurse, a Filipino-Australian woman. We have our own bedroom and our own bathroom. We share the kitchen and the laundry room (within our appartment), and we share the lounge diner, which is very comfortable. I think it is very nice. My house mate is almost never here, she stays with  with her friends a lot at the American compound. So mainly I have the apartment to myself. Our compound is very nice. We have a pool, gym and a tennis court. We don't have a shop on our compound, but there is a shop on the hospital grounds - there is a grocery store, a pharmacy, two beauticians, there is a Subway, there is a computer shop, there is a jewellers. The closest big shopping centre is about 15 minutes away by car. But there is also the Hyper Panda supermarket, which is just across the road from the compound, so you can walk there easily. But there is also a free bus service offered to the Hyper Panda from our accommodation - this is good if you have a lot to carry. My accommodation is located a bit away from the hospital, but this isn't a problem. It takes me about 20 minutes to walk this distance. I usually walk, but if I have something to carry I might take a taxi. We do these joint picnic lunces at work sometimes, so I might be carrying quite a bit of food with me. We also have a bus service that takes you to and fro from home to work. I don't really use this as I think it works on a bit tight schedule. The bus will get to work about 15 minutes before the shift starts and I like to be well in advance. Also, it also leaves the hospital pretty soon after the shift ends, so if your shift runs long, you won't really make it. I really don't mind walking this distance. My accommodation is not on hospital grounds. It is manic trying to cross the busy roads, but there is a tunnel, which makes it possible to get across the road. The traffic is really terrible here. I feel comfortable walking by myself - often I will walk with another nurse as well.

Security?

There are cameras everywhere and I feel that it's secure. Sometimes I come home in the dark - I don't find it scary at all, absolutely no problem. 

Shopping?

The shopping centres or malls are absolutely enormous here. They are great, I like going to them. You can also go to the gold souks, the abay souks the herb souks, the clothes souks etc. and you can find lovely things there. For example, the diamonds are very cheap here. The souks are like little markets. You definitely need to be covered when you visit the souks - you want to also have your scarf around your neck -ready to pull it up. The market is a very "local" area and you might get a lot of looks so prepare to be stared at. But it is worth visiting them!

Recreational activities?

It is Ramadan at the moment, so a lot of the recreational activities have dwindled down. Everything closes during the day and opens in the night. They turn the day into the night and the night into the day. You will notice that during Ramadan all the cafes and restaurants are closed. There is nothing to do during the day on your day off. If you want to do food shopping, the Hypermarkets are open 24 h, even during Ramadan. But the malls, the restaurants and your Starbucks etc. are closed. You have to remember that during Ramadan you can't walk around with a bottle of water or eat and drink in public. You got to basically go to the toilet to have a drink - even at work. The Muslims work reduced hours during Ramadan - 6 hour days. The rest of us work normal hours.

I have attended some social gatherings. I went to the "patriotic evening" for the Olympics - we watched the opening ceremony. We all had to wear red, white and blue. We had face paint and flags painted on our face. This occassion took place on the compound. I haven't been to the embassy gathering yet, you have to be invited in order to go to them.

The hospital organises these desert walks - the hash- every Friday. But is starts at 3 pm and it is really too hot for me. I can't stand the heat. I've been asked to go, but I just can't do it - it has been 50+ here, so it's really too hot. But I think I'll go in the end of September, when it gets a bit cooler. Apparently many have dropped out and I'm guessing it's because it's just too hot.

We have a cinema here, at the hospital grounds, and there is a movie night on Wednesdays. However, it is closed now for Ramadan.

The travel opportunities are good. Once I get my holidays, I have planned on going to visit Bahrain. It is a great opportunity to get to see the neighbouring countries as well. Tips for newcomers- Everything that Profco told me to bring was right. There is nothing additional really. I was told to bring a certain amount of photos, which was good. Some of the girls in my orientation that came through some other agency didn't have these photos and they had to get a photographer to take them outside as there are no photo booths here. So, these girls found it quite difficult to get sorted.

Just come with an open mind! This is important. Don't expect anything, then you won't be disappointed.

Don't get insulted if you are treated like a student nurse at first, and definitely don't get into an argument.

Be patient - once you get to work independently, it gets better. Your autonomy is compromised over here, but that is just the way it is. It is just different - it is not all negative, just different. If you are adaptable to change, then you embrace it. It is an experience, and this is probably one of the resons you are coming here in the first place.

You have so many opportunities to travel or save, or do whatever you want. There are so many positives that weigh the negatives. The differences are mainly cultural - don't take them personally.

I would definitely say "come" - just come over! You can just pop out for a swim at the pool. This is something that you couldn't do back home.

Maybe bring your own abaya if you are able to find one. I didn't have one prior to arrival and borrowed one from the hospital, the nursing affairs office. I had to go several times, because the office person was out and about for business. So it was a bit of a nuisance. You can't go out without an abaya, so if you have one, you can go exploring immediately.  

August 2012


Last updated: 31.03.2013

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