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 Table of Contents  
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 46-51

Assessment of professional nursing governance on nurses in a multi-cultural setting in the Kingdom of Saudi Arabia

1 Continuous Education and Professional Development, Ministry of Defense - Health Services, Riyadh, Saudi Arabia
2 Executive Administration of Nursing Affairs, King Fahad Medical City, Riyadh, Saudi Arabia

Date of Submission24-Mar-2022
Date of Decision25-May-2022
Date of Acceptance29-May-2022
Date of Web Publication27-Jul-2022

Correspondence Address:
Dr. Diana Selvamony Lalithabai
King Fahad Medical City, P. O. Box 59046, Riyadh 11525
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/KKUJHS.KKUJHS_17_22

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Background: Health-care institutions constantly strive to enhance the care environment and promote staff satisfaction. Engaging nurses through shared governance helps achieve these institutional goals. Aim: This Saudi study aimed to assess the current status of professional nursing governance on nurses at King Fahad Medical City, Saudi Arabia. Methodology: A cross-sectional study was conducted with 247 nurse participants chosen by the convenience sampling technique. Data were collected using the Index of Professional Nursing Governance tool. Results: Staff nurses practiced the first level of shared governance with a mean score of 196.9 ± 49.7, showing they had primary decision-making responsibilities. The dimension with the lowest score was 'goal-setting and conflict resolution' (19.6 ± 6.12). Years of nursing experience was a statistically significant (P = 0.002) factor in governance. Conclusion: Nurse participants practiced shared governance in their given setting. However, their below-par score for “goal-setting and conflict resolution” underscores the need for professional development.

Keywords: Decision-making, nurses, nursing governance, perception, shared governance

How to cite this article:
Qasim A, Alghamdi KS, Lalithabai DS, Hababeh MO, Ammar WM. Assessment of professional nursing governance on nurses in a multi-cultural setting in the Kingdom of Saudi Arabia. King Khalid Univ J Health Sci 2022;7:46-51

How to cite this URL:
Qasim A, Alghamdi KS, Lalithabai DS, Hababeh MO, Ammar WM. Assessment of professional nursing governance on nurses in a multi-cultural setting in the Kingdom of Saudi Arabia. King Khalid Univ J Health Sci [serial online] 2022 [cited 2022 Nov 28];7:46-51. Available from: https://www.kkujhs.org/text.asp?2022/7/1/46/352519

  Introduction Top

Quality health care is contingent upon a healthy, professional nursing environment, achieved by engaging nurses in decision-making.[1] Shared governance gives nurses control over their clinical Practice,[2],[3],[4] makes them feel valued,[5] extends their employment longevity,[6] and ultimately improves patient-care outcomes.[7] System-level empowerment and alignment of the organization's goals and governance priorities with nurse-generated initiatives help manage the complexities of health-care systems.[8],[9]

Nursing governance structures and processes may need reorganizing to clarify shared governance among all staff.[10],[11] This calls for management support.[12] Prior research shows that nurses perceive decision-making as being controlled primarily by the management with marginal staff input.[13] The present study assesses shared governance as perceived by nurses in the Saudi context and identifies the relationship between the different dimensions of shared governance.


In the health care environment, insufficient work engagement results in burnout, lack of job satisfaction, and increased job turnover[14]. Shared governance promotes work engagement.[15]

Importantly, shared governance promotes evidence-based practice and facilitates incorporating the latest research into the organization's clinical, educational, and administrative processes.[16] A stakeholder committee at the caregiver level empowers nurses and nurse leaders, collaboratively directs and sustains change[17],[18] and allows organizations to make focused interventions.[19]

Shared governance needs to be regularly assessed.[20] Prior studies on nurses in Saudi Arabia have stressed the importance of shared governance.[21] However, they have shown that larger subject samples are needed[22] and that surveys should be spread across different departments.[23]


The present study aimed to assess the current status of professional nursing governance on nurses in a multi-cultural tertiary hospital in the Kingdom of Saudi Arabia.


The present research set for itself the following objectives:

  • To assess the current status of nurses' perceptions of shared governance
  • To discover the association between demographic variables and perceived shared governance
  • To identify the relationship between the different dimensions of shared governance.

  Methodology Top

Study design

The research adopted a descriptive cross-sectional study design, conducted at an acute multi-cultural health-care facility in Riyadh. The population of this study includes registered nurses, shift managers, unit managers, clinical educators, nurse managers, and directors (N = 2800). Considering the population size (N = 2800), confidence level (95%), and acceptable margin of error (5%), the total sample size of 338 was estimated using the Raosoft sample size calculator. Accordingly, 338 nurses were randomly selected and questionnaires were distributed and there were 247 responses, demonstrating a response rate of 73.08%.

Data collection instrument

The Index of Professional Nursing Governance (IPNG), a valid and reliable tool, was used to collect the data.[24] IPNG consists of two sections:

Section A

Demographic data consisted of age, gender, qualification, hospital, working hospital, job title, total years of experience in nursing, experience in the current work setting, and experience in the current position.

Section B

The 86-item tool was structured under six dimensions, comprising Control over Professional Practice (16 items), Influence over Resources (13 items), Control over Personnel (22 items), Participation in Committee Structures (12 items), Access to Information (15 items), and Ability to Set Goals and Conflict Resolution (8 items). A 5-point Likert scale was adopted with a score range from 1 to 5, with decision-making criteria determined as follows:

  1. Nursing management/administration only
  2. Primarily nursing management/administration, with some staff nurse input
  3. Decisions equally shared by staff nurses and nursing management/administration
  4. Decisions made primarily by staff nurses, with some nursingmanagement/administration input; and Decision solely made by staff nurses.

Score ranges reflected the following perceptions:

  • 86–172 => traditional decision-making environment
  • 173–257 => decisions were primarily taken by nursing management with some

nursing staff input

  • 258 => equally shared governance
  • 259–344 => decisions were primarily taken by nursing staff with some nursing management input
  • 345–430 => nurses were the sole decision-making group (self-governance).

Ethical considerations

The Institutional Review Board in the setting approved the study. The research followed the Declaration of Helsinki guidelines, and participation was voluntary.

Statistical analysis

All influences were made at a 95% confidence interval. SPSS version 20.0, IBM Corp., Armonk, New York, USA was used for the data analysis.

  Results Top

Data were obtained from 247 nurse participants to assess their shared governance. Metric data are described as mean ± standard deviation and the categorical data as frequency (percent). Notable participant characteristics are printed in bold font in [Table 1].
Table 1: Sociodemographic characteristics

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IPNG was formulated on 86 items, and the cumulative score was classified into five nonoverlapping decision-making categories [Table 2]. The studied sample fitted into:
Table 2: Professional nursing governance score

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  1. Nursing management/administration only, comprising 80 (32.4) participants, with scores between 86 and 172, and a mean score of 145 ± 20.3
  2. Primarily nursing management/administration with some staff nurse input, comprising 138 (55.9) participants, with scores were between 137 and 257, and a mean score of 208 ± 24.2
  3. Input equally shared by staff nurses and nursing management/administration, comprising 4 (1.6) participants, with the sole score of 258
  4. Primarily staff nurses with some nursing management/administration input, comprising 23 (9.3) participants, with scores between 259 and 354, and a mean score of 286.9 ± 26.7; and
  5. Staff nurses only, comprising 2 (0.8) participants, with scores between 345 and 450, and a mean score of 346.5 ± 2.1.

Internal consistency (or intra-class correlation [ICC]) was measured by Cronbach's-alpha [Table 3]a. ICC for all the 86 items was very strong (r = 0.976).
Table 3:

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Cronbach's-alpha value was very high (α = 0.976) for overall reliability, attributable to loading 86 items together. It thereby considerably increased the ICC, which is not redundant as reported in the literature.

The research tested the six dimensions represented by the respective cumulative scores for internal consistency by Cronbach's alpha. Overall consistency for the six dimensions derived by Cronbach's alpha was ICC = 0.897, which is a perfect estimate and predicts that the inter-related consistency in the dimensions is reliable. ICC measures for the six distinguished dimensions were also reliable. These include personnel (α = 0.884), information (α = 0.873), resources (α = 0.887), participation (α = 0.874), practice (α = 0.866), and goals (α = 0.890) [Table 3]b.

The highest mean score was related to control over personnel (39.75 ± 15.24), indicating that nurses participate in personnel-related decisions. The lowest mean score related to goal-setting and conflict resolution (19.6 ± 6.12) indicates nurses' nonparticipation in these aspects [Table 4].
Table 4: Mean and standard deviation of the six dimensions

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The three classes of governance distinguished in the study sample are traditional governance 80 (32.4), shared governance 165 (66.8), and self-governance 2 (0.8). The only significant (P = 0.002) sociodemographic characteristic associated with governance was Years of Nursing Experience [Table 5].
Table 5: Association of perceived shared governance and demographic variables

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  Discussion Top

This study evaluated the impact of structured shared governance on nurses working in a multi-cultural tertiary hospital setting in Saudi Arabia. The results observed [Table 2] that 138 nurses (55.9%) practiced partially shared governance, indicating that managers primarily take the decisions with some staff nurse input. This finding closely aligns with a previous study. The staff nurses at a medical research institute in Egypt perceived the nursing shared governance where the decisions are primarily taken by nursing management, with some nursing staff,[25] corroborated by another study.[26]

Further, 4 (1.6%) nurses practiced shared governance, indicating that decision-making was equally shared by them and nursing management/administration, which is consistent with a study in Jordan.[7] A second study found that in the majority of IPNG subscales, staff and managers share the nurses' decision-making.[27] Furthermore, 23 (9.3%) nurses practiced shared governance as decisions taken with some nursing management/administration input. Next, 80 nurses (32.4%) practiced traditional nursing governance, supporting the view that decisions were taken only by the nursing management/administration. This finding accords with the results of previous studies.[28],[29],[30] Nurses were only moderately satisfied with their own decision-making power.[23] Similarly, a study revealed that registered nurses who provided direct patient care had low levels of actual and preferred decisional involvement, implying that managers control the decision-making process.[31] Finally, two (0.8%) nurses practiced nursing self-governance as the decisions are taken solely by themselves. A study in KSA found that nurses had the highest mean score on the total autonomy scale and the highest level of autonomy in making decisions.[32]

While reviewing the staff nurses' perception of the dimensions of the professional nursing governance, this study revealed [Table 3]b a mean score of above 30.0 for the dimension “Control over Personnel,” “Influence over Resources,” and “Access to Information,” and “Control over Professional Practice.” Among those dimensions, the highest mean score (39.75) was observed for the “control over personnel” dimension (39.75 ± 15.24), which showed that staff nurses mainly participate in decisions related to personnel. This finding is contrary to an earlier study finding which observed the highest score for “control over professional practice” among the dimensions of shared governance.[25] Furthermore, the current study observed the “Participation in Committee Structures” dimension with a mean score of 27.44. Staff nurses are involved in the decisions related to participation in committee structures. On the other hand, it also observed the lowest mean score for the “Able to set goals and resolve conflicts” dimension (19.6). This result indicated that the staff nurses' self-motivation and thoughts about an ideal future, goals set to achieve, and how to achieve them and resolve disputes peacefully were low. Such dimensions with a lower mean score point to the need for greater emphasis on nursing self-governance. Overall, this study observed professional nursing governance with a mean score of 196.9, which indicated that staff nurses practiced partially shared governance (i.e., primarily nursing management who take decisions with some staff input). This finding indicates the need for a shift to equally-shared governance or self-governance in the multi-cultural tertiary hospital setting of Saudi Arabia.

Notably, all of the demographic variables except years of experience in nursing failed to show significant differences among nurses concerning their perception of professional nursing governance. This finding aligns with a previous study.[7] However, this finding runs counter to those of another earlier study which indicated substantial variation in nurses' perception of governance. Professional nursing governance varied across individual wards, emphasizing the need for tailored interventions.[33] It is also determined in another study that nurses in operating theater and surgical units are perceived as having higher levels of shared governance than their counterparts in critical care units and medical wards.[27]

A recent study on the nurses' job titles stated that managers play a vital role in successfully implementing shared governance.[18] An earlier study also stated that nursing leadership and shared governance explained the variance in 90% of the nursing professional practice environment.[34] However, the present findings run contrary to a few previous studies.[29],[30]

  Conclusion Top

The results indicate that nurses in this study practiced partially shared governance. As the lowest mean score of nurse data related to goal setting and conflict resolution, this calls for specific remedial strategies and training programs. Nurse managers and administrators must pay attention to empowering themselves and their staff. This research provides a foundation for current research at a magnet hospital, a site that promotes the professional nursing practice.

Financial support and sponsorship

This work was supported by the King Fahad Medical City (grant number RFA:019-040).

Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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