Transcending cultural barriers in nursing education

In my youth, I aspired to be an archaeologist—history, culture, and the arts were my favorite subjects. However, my upbringing was filled with many unexpected incidents that shaped me to be the person I am today. I initially learned about nursing when my brother became ill, and we had to spend nearly a year in the intensive care unit with him. At such a young age, I saw nurses and physicians care for him, and I knew that one day I would be wearing the same white uniform. Much of my drive to be a healthcare professional stems from these early memories. While it is tragic that my brother lost his struggle to his sickness, I am glad for this. He has pushed me to be the nurse I am today.

I started my nursing career as a volunteer nurse in a government research institution and a secondary hospital before transitioning into nursing academia. While pursuing my master’s degree in nursing, my BSN alma mater trusted me to be one of their new instructors. I was young and inexperienced, but full of enthusiasm for my new job.

After earning my master's degree, I had a variety of job choices, which led me to pursue a teaching position as a foreign university professor in Oman. My motivation to teach undergraduate and graduate nursing students abroad was fueled by ambitions to experience a different culture, learn about their nursing practice, and later explore those experiences among foreign graduate nurses. The unique challenge of being immersed in a completely different society piqued my interest and gave me a greater understanding of a culture that I had never encountered before. My first few days on assignment left me feeling excited and apprehensive. My thoughts raced. What happens if I don't do things correctly? Or what if my students don't understand what I'm teaching? A multitude of questions scared me and kept me up at night in the early days.

My first few months seemed like I was walking on eggshells, careful not to do anything that could be culturally misunderstood while yet concerned about how I was carrying out my responsibilities. There was an informal introduction to the policies and procedures, but I was immediately allocated a course to teach alongside a local faculty member. My first task was with first-year students who had some English proficiency. It was difficult to impart lessons to students with limited vocabulary, but I guess my extensive theatrical and movement experience saved me for a while. Arabic is their native language, and while it would be easier for them to learn anatomy by translating the body parts to Arabic, we were advised not to do so to train them in and familiarize them with English. Although it’s good practice, some local language speakers still gave their lessons in Arabic, which can be frustrating to us foreign lecturers. Immersive clinical rotations can also be daunting because of the unfamiliarity with the hospital or community clinic system. In some cases, home visits to families are in rural areas where strict and traditional practices are still prevalent, and that can be nerve-wracking.

I experienced a wide array of emotions while navigating the challenges of the new role, new work environment, unfamiliar culture, and religion as well as the heavy burden of leaving home and being separated from loved ones. Acculturation and adaptation are key to overcoming these barriers. Getting acquainted with the hospital and nursing processes, which are intertwined with religious and cultural practices—such as how fasting during the holy month of Ramadan affects the diet and medication of some patients who wish to fast, the strict same gender care preference for nurses, relaxed work environment, and work ethics—was a separate element of totally immersing myself in the new surroundings. In addition, I had to adjust to new faces, practices, foods and flavors, extreme weather conditions, gender segregation, and navigating the various dimensions and influences of religion and culture. I learned to pick up basic Arabic words through reading and immersing myself more with the locals. My adventurous palate was not a problem because of that incessant desire to try different flavors and foods, something I really enjoy. The presence and involvement with Filipino community groups created a sense of belonging which also created lasting friendships with both expatriates and residents. I have learned that to fully comprehend is to always come to each situation with an open mind and an open heart.

Fast forward 13 years later, and I am an associate professor at Shaqra University, Kingdom of Saudi Arabia. Being based here in the Middle East still presents many challenges but also a wide array of opportunities. The level of trust and respect among the expatriate professors can’t be compared anywhere else. Foreign nurse academics are presented with various incentives, from tax-free compensation, paid annual leave of two months, health insurance for individuals and families, free accommodation, free airfare, and a comparable opportunity for grants, awards, and scholarships. And contrary to stereotypes, the Gulf Cooperation Countries (GCC) is a safe, secure place to rear a family.

Navigating the difficulties of nursing education and the higher education system is rewarding and life changing. It's a one-of-a-kind event that raises cultural awareness and understanding of the essential role foreign professors play in building Middle Eastern countries' healthcare capabilities. Acculturation and adaptation are not a one-size-fits-all process. The different views and the level of openness play a significant role in how an individual fully immerses themselves. In my years of practice, it has been my mission to be instrumental in easing the way for new nurses and nurse academics to fully integrate into this new environment through mentoring. It has also been my life’s mission to explore and understand the acculturation process and adaptation of nurses in their foreign placements through my research. I have published my findings and disseminated them to larger audiences at conferences and seminars. When I’m able to, I lobby for their rights at a local and national level.

I am proud that a good quarter of my academic career was molded in this unique part of the world. For budding nurses who have an interest in teaching and are open to experiencing its unique culture, the Middle East is a trove of experience waiting for you to explore.

The first step is to prepare yourself, craft the path you intend to pursue, and when you are ready to start teaching, go for it. Build a strong foundation of your practice, become an RN, and earn the necessary credentials for a master’s or PhD in your line of specialization. Career opportunities are abundant and are posted through university websites, local agencies in your country, and job sites. Becoming a nurse in a foreign country can be challenging and lonely; at times the sacrifice of being away from loved ones for a while can be overwhelming. Finding a career and teaching opportunity in the Middle East, particularly in the GCC, is a gratifying and enriching experience.