It was a pleasure to interview Natalie Smith about her time overseas nursing – she has more than 30 years of experience. Natalie has written for us about a range of topics. “Reflections on leadership and nursing education after 30 years” is a great article and so is “My tips after more than 30 years of nursing“.

Working in Saudi Arabia and England in the 90’s

Nursing in Saudi Arabia in the 90’s was different than anything I imagined. Prior to moving, I spent months preparing for the cultural change, but the shock was profound. I met a fellow Aussie Karen*, on the flight over; we were surrounded by a plane full of men bound for Hajj (an annual Islamic pilgrimage to Mecca).  The only two Caucasian women on the plane became buddies who supported each other through some of the most challenging times of our careers. (*name changed to protect identity)

After arriving at Jeddah airport late in the evening, we eventually made it back to the compound where we were to stay. Karen and I were to live in different apartments. My flatmates were not home at the time of my arrival, so the next few days were a blur as I tried to orient myself to my surroundings and compound expectations. As challenging as home life was initially, it became my salvation during my time off. The complex had swimming pools, tennis courts, hair salons, shops and restaurants. Buses and cars were available to take you off site to shops and beaches. I took horse riding and tennis lessons and joined a group called the Historical Society of Jeddah, where we explored the landscape and culture.

Work on the other hand continued to test my resilience and ethical standing. A day in the life of an Intensive Care nurse in Saudi Arabia varied enormously. The unit provided critical care to adults and children in Jeddah including Royalty. All employees including medical and nursing staff were from across the globe. Respiratory Therapists were employed similarly to the United States health system, whereby, respiratory care including intubation, extubation, ventilation, chest physiotherapy, suctioning, nebulisers and blood gas monitoring was provided. As you can imagine, standards of care varied considerably, as the hospital staff were trained in different health systems. As with all astute healthcare professionals, you quickly identify knowledge gaps and monitor care to ensure patient safety.

During my time, there were many situations that tested my professional integrity. Withdrawal of therapy or palliative care was not an option. Patients were ventilated for months or years as turning off the ventilator went against the cultural requirements at the time.  Expectations by relatives that the patient would live regardless of their condition became very stressful. As a foreigner, our passports were held by the hospital administration, and we were restricted in our movements nationally and internationally.

I remember a relative of a patient saying that if the patient died then someone would ‘pay’. If this occurred, then an investigation would be held into the patient’s death, resulting in an extension of your stay until review and innocence determined.”

 Unfortunately, the patient had multiorgan failure so was not long for the world. An adrenaline infusion was my best friend that day, and the patient survived until after I went home.

After finishing my contract in Saudi, I moved to England. At the time, England loved Australian nurses and finding a job was very easy. There were very few differences, so fitting in was straightforward. I was so glad to be free to practise nursing in the way I was taught, and with ethical and moral beliefs similar to my own. Within the health system in Saudi, I was stressed while at work as the repercussions of making mistakes impacted your future freedom and potentially your life. After moving to England, there were no longer threats from relatives while trying to provide health care to our patients. I found this constant stress in Saudi impacted my health and I was often sick with a cold or gastro virus. Nursing overseas provided a personal insight into my nursing practice and helped me to reflect and develop my emotional intelligence (EQ) for many years to come.

Operation Open Heart – Vanuatu 1994

Operation Open Heart (now referred to as ‘Open Heart International’) is a humanitarian program established in 1985 by Mr Russell Lee, Mr Rudi Morgan and Dr John Wallace from the Sydney Adventist Hospital. This program initially provided open-heart surgeries to Tonga residents in need, but later have gone on to help so many other countries with not only heart surgery but other surgical procedures improving lifestyle and health outcomes. They also supply specialised equipment and provide education to develop a more sustainable health system within the country. I encourage you to check it out at  

In October 1994, I joined an amazing team of 26 health professionals from Canberra, Sydney, Melbourne and Brisbane and headed off for 2 weeks as a volunteer Intensive Care Registered Nurse. We set up an acute care environment at Vila Central Hospital in Port Vila, Vanuatu. Everything we needed to provide care was imported in – including ventilators, monitors and all consumables. For the first few days we set up our new Operating Theatre, Intensive Care Unit (ICU) and step down ward. Patients were screened during this time to make sure they were fit for surgery. Over the course of our stay, we cared for 15 patients ranging in age from 1 year to adulthood.          

I remember this time as a pinnacle of my career. The experience I gained caring for cardiothoracic patients of all ages reinforced my interest in this specialty. It also drove home how lucky we are living in Australia. We take so much for granted.

Resources and timely access to health care are expectations in Australia. But in some countries, people are lucky to have the basics

During this time, on reflection I acknowledge that life is precious and we should never take it for granted. Love is a universal language, and in some countries expressed in kind. Access to equipment and consumables are not guaranteed and sometimes you need to be resourceful and create your own solution (see photo of baby in makeshift nappy and arm boards).”

In Vanuatu in 1994, patients would not have been able to have such complex surgery and post op care required to ensure a good outcome. Our patients and their families were so thankful for the opportunity of a new chance of life. Their love and gratitude will be always embedded into my soul.

How can nurses work or volunteer overseas and are there any requirements?

There are so many volunteer programs available but how do you choose the right one? Reputable charities with ethically sustainable programs are essential to ensure your safety and the longer term benefits to the community you are helping. The Australian Charities and Not-for-profits Commission ( is the regulatory authority for charities and not-for-profit organisations within Australia. Before you embark on a volunteer assignment, make sure you do your homework. Choose the right program for you and understand the risks associated.

Just like applying for a job, you need to apply for a position as a volunteer. You will require a resume, referees, police checks, health and psych assessments, and an interview. Your assignment will be similar to a job, with expectations you will need to meet. There are training courses, guides and policies that are available through each volunteer group, but more specifically the Australian Volunteers Program Code of Conduct and Child Protection Policy/Code of Conduct (Australian Volunteers Program, 2021). You will be expected to work within your scope of practice and skills set and abide by the laws of the land where you will be assigned.

Why should nurses consider working in other locations and how has it benefited your career?

To say I have been fortunate working in a variety of roles and locations would be an understatement. Even though some experiences were not optimal, I still feel blessed to have had these opportunities.

The famous quote from Friedrich Nietzsche in 1888, translated into English, “What doesn’t kill you makes you stronger”, may be reflective of some experiences. Working in different jobs broadens knowledge, skills, develops adaptability and builds resilience.”

The benefit of working in other states and territories in Australia, and other countries opens your mind to a multitude of clinical, cultural and religious practices, and provides exposure to diverse workplace culture, ethics and laws. Employment opportunities develop EQ particularly by improving empathy, communication and social skills. Work and life experience enrich your character, cultivating tolerance of others and enhancing your social and professional networks. Some relationships may even last the test of time.


  • Australian Volunteers Program. (2021). Australian Volunteers Guidebook. Australian Volunteers.
  • Cuddy, A. (2012). Your body language may shape who you are. TED.
  • Open Heart International, a division of ADRA Australia Limited. (2021). Open Heart International. OHI.