The recent Saudi Arabia's "Vision 2030" including the National Transformation Plan has renewed the debate on the efficiency of government spending. The aim of this paper was twofold. First, to measure the relative efficiency of Saudi Arabia's public spending over the period 1988-2013 using non-parametric approach. Second, to explain the inefficiency scores using a DEA-Bootstrap analysis by incorporating environmental variables. The empirical results show that, on average, the public spending is inefficient, implying that Saudi Arabia can improve their performance on health, education and infrastructure without increasing spending. The empirical explanation of the inefficiency scores using a DEA-Bootstrap analysis shows that the unemployment and broad money negatively impact government expenditure mainly in the case of infrastructure and health. Our findings can be useful for policymakers in order to set out a structural adjustment plan to improve the efficiency level for education, health and infrastructure expenditures.

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Stress is common among nursing students and it has been exacerbated during the COVID-19 pandemic. This study examined nursing students’ stress levels and their coping strategies in clinical practice before and during the COVID-19 pandemic. A repeated-measures study design was used to examine the relationship between nursing students’ stress levels and coping strategies before and during the pandemic. Confirmatory factor analyses were conducted to validate the survey and a student T-test was used to compare the level of stress and coping strategies among 131 nursing students. The STROBE checklist was used. During COVID-19, there was a reliable and accurate relationship between stress and coping strategies. Furthermore, both stress and coping strategy scores were lower before COVID-19 and higher during COVID-19. Nursing students are struggling to achieve a healthy stress-coping strategy during the pandemic. There is a need for the introduction of stress management programs to help foster healthy coping skills. Students are important resources for our health system and society and will continue to be vital long term. It is now up to both nursing educators and health administrators to identify and implement the needed improvements in training and safety measures because they are essential for the health of the patient as well as future pandemics.