Transactional Stress and Adaptation among Filipino Acting Nurse Managers in Selected Hospitals in the Kingdom of Saudi Arabia: A Mixed Method Study

Abstract

Background: Saudization policy in the Kingdom of Saudi Arabia prioritizes the employment of Saudi nationals in leadership roles like in the healthcare sector. This is their way to reduce reliance on expatriate workers, resulting in other nationals like Filipinos to get offers only on temporary positions like acting nurse managers that causes them to feel stress due to role ambiguity, lack of formal authority and workload. Aim: To determine the transactional stress of Filipino acting nurse managers and their level of adaptation strategies in the multicultural healthcare setting of Saudi Arabia, as well as areas of integration.  Methodology: A mixed-methods sequential explanatory design is used for this study, where 150 out of 279 Filipino acting nurse managers in the selected hospital in Saudi Arabia are chosen for the quantitative phase—purposive sampling is used. Ten participants are selected for the qualitative phase—based on their years of experience as acting nurse managers.  Results: Findings reveal that Filipino acting nurse managers face high workplace stress due to role ambiguity, inconsistent policies, and heavy workloads. Stress also arises from overlapping duties, unclear directives, and limited authority in multicultural healthcare settings. Despite perceiving transactional stress’ level as positive, there are still areas that could be improved such as Filipino acting nurse managers’ confidence, management capability, and emotional resilience.  Conclusion: The Leadership Resilience Enhancement Program (LREP) was formulated to address areas that need improvement for Filipino acting nurse managers to better cope with stress and boost their confidence.