Investigating work-life balance challenges and occupational stress of nurses in Saudi Arabia: Perspectives of border management challenges

Abstract

Nurses constitute the largest occupational group in the global health workforce, yet the profession remains vulnerable to occupational stress, burnout, and chronic work-life imbalance. While a substantial body of research has examined these phenomena in Western contexts, the lived experiences of nurses in Arab, Islamic, and Middle Eastern settings remain conspicuously undertheorised. This thesis addresses that gap by investigating the work-life balance (WLB) challenges and occupational stress of nurses in the Kingdom of Saudi Arabia (KSA). Guided by three research objectives, the study explores how nurses conceptualise occupational stress and WLB, examines the agency factors that produce boundary management problems, and investigates why cultural and regional peculiarities exacerbate stress and work-life imbalance in this setting. Grounded in an interpretivist philosophical orientation and adopting a social constructionist epistemology, the study employed an inductive, qualitative research design. Primary data were collected through semi-structured interviews with 70 registered nurses recruited from three hospitals in Mecca — one private specialist hospital and two public general hospitals — using purposive and snowball sampling strategies. Interviews lasted between 45 and 60 minutes, were audio-recorded with consent, and subsequently transcribed using a naturalistic transcription approach. Data were analysed using thematic analysis framework. The analysis yielded three clusters of findings corresponding to the study's research objectives. First, nurses conceptualised occupational stress across three established theoretical frameworks: as a stimulus (external environmental conditions), as a response (physiological and psychological reactions), and as a transactional interface between demands and individual resources. Four prevalent conceptions of WLB also emerged: as time for family, as attention to personal health, as space for leisure and religious observance, and as access to flexible working arrangements. Second, five agency factors were identified as producing work-life boundary management difficulties: work-home boundary violations arising from the intensity of clinical demands; person-environment incongruence; labour-reward disparities; managerial ignorance of family-friendly policies; and nurses' fears of career damage from utilising WLB entitlements. Third, broader contextual and societal factors, principally masculine hegemony, ingrained Islamic religious norms, and perceptions of preferential treatment and favouritism, were found to constrain nurses' discretionary capacity to construct and maintain satisfactory work-home boundaries. The findings demonstrate that stress and boundary management are deeply embedded in socially constituted, culturally specific realities; advances border theory through systematic application in an Islamic institutional environment; introduces boundary violation as an analytically distinct phenomenon; and theorises work-life boundary incongruence as a multi-dimensional construct shaped by structural and cultural forces. Practically, the study recommends legislative reform introducing working time protections comparable to global best practices; the development of dedicated WLB functions within hospital HR departments; mandatory training for managers on family-friendly policy implementation; and a wholesome shift toward gender-sensitive, culturally responsive HR practices in Saudi hospitals. The findings challenge policymakers and practitioners to move beyond individual-level coping solutions and address the structural and cultural determinants of nursing stress and work-life imbalance in the KSA and comparable Middle Eastern contexts.