The purpose of the study was to explore the relationship between demographic and work environment factors and hospital characteristics (linked to job satisfaction) and burnout among foreign-trained nurses (FTNs) living and working in Saudi Arabia. A mixed-method study using correlation and triangulation designs explored the associations between demographic factors and work environment factors and the subscales for job satisfaction (Nursing Work Index-Revised and the Practice Environment Scale) and burnout (Maslach Burnout Inventory). Four hundred and fifty-three FTNs participated in the surveys and 25 FTNs participated in focus group sessions. The theoretical framework for the mixed-method study was Herzberg's motivation-hygiene theory. The results identified that FTNs with a diploma or associate degree, newly registered nurses (after 2001), and FTNs on a married contract had a higher perception of job satisfaction for 4 of 9 subscales. Overall scores indicated higher burnout for emotional exhaustion and depersonalization and an average feeling of burnout for personal accomplishment. Scores also indicated FTNs had neutral feelings of a professional work environment. Triangulated analysis corroborated the qualitative and quantitative findings. Important issues for FTNs included staffing, policies and procedures, status, security, support for nursing, continuing education, and communication. Foreign-trained nurses also raised issues unique to the nature of work in Saudi Arabia as areas of improvement. If the work environment improves, job satisfaction may increase, burnout may decrease, and tenure may improve. Nursing leaders in all sectors must be empowered to effect change in the professional nursing work environment through collaboration, cooperation, and transformational leadership in order to recruit and retain qualified FTNs.
