Leadership Experiences of Nurse Managers in a Saudi Ministry of Health Hospital:
A Focused Ethnographic Study
#MMPMID41384222
Alenezi IN
J Nurs Manag
2025[]; 2025
(?): 8033761
PMID41384222
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BACKGROUND: One of the key priorities of Saudi Vision 2030 is to ensure that all
Saudi citizens have access to high-quality healthcare, but this goal is
constrained by international and domestic nursing staff shortages. Nursing
directors have recommended introducing a professional career path focused on
developing nurses' leadership skills. Despite recognition of nurse managers' key
role in recruiting, retaining, and engaging nurses, few studies have explored how
Saudi managers acquire and deploy leadership skills. This study explores how
nurse managers view and experience workplace leadership. METHODS: This
ethnographic study examined nurse managers' perceptions and experiences of
leadership development in a Saudi hospital affiliated with the Ministry of
Health. Qualitative data were collected during periodic visits over eight months,
including workplace and continuing medical education observations, document
examinations, and informal and semistructured interviews with 21 nurse managers.
A framework analysis approach was used to interpret and summarize the data.
FINDINGS: The data were organized into four major themes: imbalanced power
dynamics, no shared vision, workplace rituals and behaviors, and the need for
learning. The findings indicated a power imbalance, consistent with international
studies. The hospital had hierarchical and transactional management structures
and a culturally pervasive leadership approach framed by wasta ("middleman" or
"go-between" in Arabic). Such nepotism, normalized in Saudi business practice, is
officially recognized and condemned as corrupt by state legislators. The Saudi
government is rigorously combating this practice through strict regulations and
enforcement. A climate encouraging adherence with the directorate's guidelines
led managers to comply, even though they employed strategies to subvert some of
its authority. CONCLUSION: Wasta was used to enhance performance, obtain rewards,
secure favorable work assignments, gain meritless promotions, and allocate staff
arbitrarily. Paradoxically, while managers criticized the capricious use of
wasta, they also employed it to secure what they believed they deserved,
sometimes at the expense of their colleagues' careers.
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