Abstract

Background: Globally, health-care systems have undergone significant changes that have increased the demand for autonomous nursing practice. Autonomy is a critical component of clinical nursing and one of the profession's most important aspects. The autonomy of nurses being influenced by increased workload and patient acuity demands. The ability to make judgments and take action based on professional competence and judgment is referred to as autonomy. Aim: The aim of this research is to examine the factors that influence on the autonomy of nurse's work at King Abdullah Medical City and to examine how much the organization's relationships and cooperation, as well as training and development, are all aspects of culture and climate. are affecting the nurses' perceptions of their work autonomy. Methods: It is a descriptive cross-sectional design. Undertaken in specialized hospital, “Makkah, Saudi Arabia”. The study adopted the following independent variables (organizational culture and climate, relationships and cooperation, and training and development) as independent variables, and autonomy of nurse's work as dependent variables. A self-administered questionnaire was used to collect data from 343 nurses. Results: The findings indicate a significant relationship between nurses' work autonomy and independent variables such as organizational culture and climate, relationships and cooperation, and training and development. The results show that all of the factors have an elevated mean rating, indicating that the participants agree with each statement in the variables. Conclusion: The autonomy of a nurse's job is viewed as a strength and one of the areas that must be considered to deliver maximum patient care while also increasing patient satisfaction on various levels. Moreover, further study is needed, that include all healthcare employees' job autonomy in hospital settings, as well as research that examines autonomy in a wide survey of all Saudi Arabian government hospitals.

1. Introduction

The professionalism of nurses is significant credence in autonomous nursing practice to take a right clinical decision. A part of education for nurses to improve nursing value is autonomy as the patient-care authority, the ability to make a medical judgment based on professional judgment and collaboration within the interprofessional team by improving the skill and knowledge to solve the problem and critical thinking ¹. Change in nursing profession is part to improve understanding of what it means to care for patients with expansions and Latest technique in the clinical area meets patient care standards ².

In 1981, In investigate the factors in facilitating professional nursing practice the magnet study in the American Academy of Nursing formed a team. The result organization's achievement to improve nursing practices will serve as a Magnet achieve maximum care and increase to attract nurses and retain ³. The Saudi ministry of health focuses towered a culture of excellence on the Magnet journey by American nurses’ credential center ANCC ®. (“ANCC Magnet Model,”) The organization's total number achieve or initiate the excellence journey to Magnet 530, in Saudi Arabia 3 hospital certified for Magnet “King Faisal Specialist Hospital and Research Center” in “Riyadh and Jeddah”, recently 2020 King Fahad Specialist Hospital in Dammam. Considerable achievement started in 2018 for Magnet accreditation to serve patients, nurses, and health care at King Abdullah Medical City KAMC. Patient care will improve the quality of care, safety from any potential risk, and increase patient satisfaction. Increase nurses' empowerment by increasing nurse retention, involvement in decision-making within the multidisciplinary team, improving nurses' efficiency and effectiveness, and developing the skills and knowledge to achieve the nurses' satisfaction (ANCC ®). As a result, care must provide both increased and expense care. It increases the outcome of critically ill patients with nursing accountability. Nursing autonomy global is supporting critical nurses with caring responsibilities by evidence-based and quality ⁴.

The nursing managers seek and maintain contributing the staff value and promote the climate is shared effectively and improve decision making with a base of staff level and position ⁵. Another definition for autonomy is a predictor of nurse’s job satisfaction will reflect nurse’s retention ⁶. The nursing managers enhance nurses' autonomy to influence job satisfaction and continue in their work ⁷. Furthermore, finding the nursing managers have input on values nursing autonomy, work environment and quality of care ⁸ and promote the education for improving the professional development and adequate training ⁹.

It was found in several studies that a strong significant relationship between organizational culture and nurse autonomy ¹⁰. Furthermore, study the factors that find a correlation between nurses' cooperation with a high perception of teamwork and nurse autonomy ¹¹. Additionally, the factor can affect the nursing perception of autonomy and work to facilitate and availability of adequate resources ¹².

Currently the Saudi Arabia facing a significant shortage of and high turnover among nurses. The health care environment increasing the role of the nurses’ responsibilities. Globally in health care systems have taken major changes that increase the autonomous nursing practice needs. The autonomy of nurses is influenced by increasing the workload and patient acuity requirements ¹³.

The Saudi healthcare system suffers from a serious problem that negatively affects health care outcomes, which is the independence of nurses. There have been few studies in the “Kingdom of Saudi Arabia” on independence nurses, which may lead to a limited understanding of these factors. An number of revisions have evaluated independence nurtures in the Kingdom Saudi Arabia and investigated the contributing factors ⁵. The learning delivers novel visions independence of nurses in Kingdom of Saudi Arabia. The factors that may affect the independence of nurses while working. The revision anticipated inform primary health care work environment by developing knowledge on the subject, which in turn increases the independence of nurses. The exercise could also benefit existing healthcare providers by improving their understanding of how nurses' independence affects.

Assess the factors affecting on the autonomy of nurse's work at King Abdullah Medical City and enhance the best practices to benefit the patient, quality care, and workplace structure.

To identifying the factors influencing nurses' work autonomy and to examine how much the organization's relationships and cooperation, as well as training and development, are all aspects of culture and climate, are affecting the nurses' perceptions of their work autonomy.

1. There is a statistical relationship between organization culture and climate and nurses’ autonomy.

2. There is a significant relationship between relation and cooperation and nurses’ work autonomy.

3. There is a significant relationship between training and development and nurses’ work autonomy.

2. Subjects and Methods

The study's structure was a “descriptive cross-sectional design. The total sample population included permanent nursing staff in King Abdullah medical city, Makkah who is caring patients at the period of numbers pool working in-patient, critical, and ambulatory units. The expected number of total populations was 675 nurses.

This study was carried out in King Abdullah medical city, which is specialized hospital, Makkah, Saudi Arabia.

The total sample population included permanent nursing staff in King Abdullah medical city, Makkah who is caring patients at the period of numbers pool working in-patient, critical, and ambulatory units.

The nurses who are working in in-patient, critical care, and ambulatory units. The minimum sample size by total nurses 278 supposing a minimum rate of response of 50 percent and a confidence level of +/- 5%. The whole example number was 343. The nursing staff response was taken to identify the factors affecting autonomy of nurse’s work.

The researcher created the data collection tool, which included the most appropriate variable to measure the factors influencing nurse work autonomy. The survey tool is divided into two sections, which are as follows. Section A contains information about the nurses' demographics, such as their gender, nationality, education, and years of experience. Section B contained questionnaires pertaining to factors influencing the autonomy of a nurse's work. The tool consists of Quality of work life (QWL) adopted with permission from Abuseif, Ayaad, Al-Haijaa, 2018 by email which is used to measure the factors affecting nurse autonomy composed of four domains: organization culture and climate domain (seven questions), the cooperation and relationship domain (six questions), training and development domain (four questions), and autonomy of work domain (six questions). The questionnaire was rated by the nursing staff using a five-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). The questionnaire survey distributed electronically to study sample by online.

The questionnaire was pre-tested numerous times on a minor example (5-20 people) to ensure that the phrasing, set-up, span, and sequencing were appropriate based on skilled view (e.g., nursing professionals, and researcher experts). The reliability test is performed using the “Cronbach's Alpha” process to ensure that the tool is reliable in measuring the study's objectives.

“Cronbach’s alpha” for the questionnaire is ranging from 0.667 – 0.789. The result confirms the questionnaire's dependability, implying that the instrument can measure the study's objectives, and suitable to researchers, and we can rely on the results obtained as a result of it.

KAMC Research Center 21-777 granted Institutional review board approval on 08/04/2021. Following official approval from the IRB. The researcher was committed to adhering to all ethical considerations necessary for conducting research. The study's participants were not identified. The participants kept the researcher anonymous and confidential in this manner.

In order to generalize the results, the study will begin with demographic data from the nurses. The investigator used an online questionnaire to collect data from the participants. A portion of the invitation was included in the study to help participants understand the purpose of the study and to gain their cooperation. Before beginning to answer the questions, a data sheet with a description of the study's objectives was provided. The survey tool is divided into two sections, which are as follows. Section A contains information about the nurses' demographics. Section B contained questionnaires pertaining to factors influencing the autonomy of nurses at work. This section included questions representing independent variables such as organizational culture and climate, connections and collaboration, and training & development, as well as dependent variables such as nurse work autonomy. All of this data also collected from nursing staff by using the questionnaires.

The researcher used the program statistical package for social science to conduct the statistical analysis version 25. The demographic characteristics of the participants were outlined using frequency and percentage distribution. Data analysis is carried out by calculating the variance of responses to each predictor variables axis. Cronbach alpha coefficient was calculated for reliability testing. Chi square (“x2”) utilized see if there was a statistical relationship between each independent variables with nurse’ work autonomy in KAMC as required in the hypotheses and research questions. P-value < 0.05 is considered significant. Pearson correlation was used to see whether there's a link between the variables.

3. Results

Table 1 revealed that two hundred twelve nurses were female (61.8%) and one hundred thirty-one were male nurses (38.2%), Most of the participants (75.9%) were in between the age of 30-39 years. Majority of the participants were non-Saudi nurses (87.2%) and Majority of the participants have bachelor degree (85.5%) remaining diploma in nursing (9%) and master degree (5.5%). In professional experiences 43.4% have experience between 6 years to 10 years and remaining 25.1% have 1 year to 5 years and 11 centuries to 15 and 6.4% have practice more than 15 respectively, finally most of them are from the different departments in critical care areas and remaining included inpatient areas and ambulatory areas.

Table 2 demonstrates the frequency count for each aspect nurses work autonomy, the following are the outcomes: The larger mean value of this aspect was (4.14) for item (All departments work together to achieve the goals), but the lowest value was (3.46) for item (am discriminated on my job because of my gender). The p value shows that all of the statements are related to nurses' work performance. Therefore, it is factor that influence “nurse’s work autonomy” in KAMC.

Table 3 illustrates the distribution of each statement of the Relation and Cooperation dimension, the results obtained are as follows: The larger mean value of this dimension was (4.01) for item (I have a harmonious relationship with my colleagues), while the lowest mean value was (3.78) for item (I have a harmonious relationship with my colleagues) (The relationship between managers and nurses are very good). The p value means that all of the remarks are related to nurses' job involvement. Therefore, it is factor that influence “nurse’s work autonomy” in KAMC.

Table 4 illustrates the frequency analysis of each statement of the Learning & growth dimension, the results obtained are as follows: The larger average value of this dimension was (3.89) for item (Programs in our hospital assist nurses in achieving the required skill for performing the job effectively.) and the lowest value was (3.72) for item (The training programs aim at improving interpersonal relationship among nurses). The p value shows that all of the disclosures are related to nurses' role ambiguity. Therefore, it is a factor that influence “nurse’s work.

Table 5 shows the “Pearson correlation” to regulate the connection among independent variables with nurses’ work autonomy. The outcome reveals a strong link between the two variables about of the training variables at 0.01 near.

Table 6 illustrates that the relationship and cooperation received the highest mean score (3.88) in this study, indicating that they are the most influential independent variables on nurses' work autonomy. The second mean score was Organization culture and climate (3.84), indicating that it is also a factor influencing nurses' work autonomy. in KAMC. Remaining variables Training and development (3.79) showing influence on nurses’ work autonomy in King Abdullah medical city.

4. Discussion

The study's goal is to figure out what's going on the factors that affecting nurses’ work independence in KAMC. The professionalism of nurses is significant credence in autonomous nursing practice to take a right clinical decision. Self-sufficiency is significant component of nursing practice profession's most important characteristics. Independence is described as the capability to type results and take action based on professional expertise and judgment ¹⁴. Assess the factors affecting on the autonomy of nurse's work at King Abdullah Medical City and enhance the best practices to recover patient care and excellence of the repair and organization culture.

The results show that the autonomy of nurse’s work from nurse’s point of view is considered zone asset and person’s extents that want to be improved spread across numerous points. The outcomes grasped most of the respondents were female (61.8%) and remaining were male nurses (38.2%), Most of the participants (75.9%) were in between the age of 30-39 years. Majority of the participants were non-Saudi nurses (87.2%) and most of them are from the different departments in critical care areas and remaining included inpatient areas and ambulatory areas. The majority of the participants have bachelor degree (85.5%), remaining diploma in nursing (9%) and master degree (5.5%). Finally, in regard to years of experience 43.4% have experience between 6 to 10 years, the remaining 25.1% have 1 year to five, and 11 to 15 years and 6.4% have experience more than 15 respectively.

The result regarding each statement of the study variables reported by the frequency of distribution. In the variable organization culture and climate. The larger means of this aspect were for the item there is collaboration among all divisions in order to achieve the goals, but the least mean value was for the item prejudiced on my job because of my gender. These findings are consistent with the previous factors that may influence professional autonomy and perceived organizational culture ¹⁵. One of the published studies reported that there was a strong association between teamwork and autonomy ¹¹. Similar result also given another study the impact of practice-level autonomy, as well as the relationship between teamwork ¹⁶.

In the next variables, Relation, and Cooperation the superior resources of this aspect for item there a harmonious relationship with my colleagues, but the lowermost nasty value stood for piece the relationship between managers and nurses are very good. A few analyses came to the same conclusion: hospital staff nurses have moderate autonomy, which could be increased through more proper assistance from relationships and collaboration with nurse managers ¹⁷. Another study supporting this finding those Executives in hospitals and nurse managers should work together to improve job autonomy by improving the working relation and cooperation with their colleagues ¹³.

In the third variable training and development, the superior resources of this length were for item plans in hospital aid nurses to acquire the necessary skill for effective job performance. In addition, lowest mean value was for item the Training programs are designed to help nurses improve their interpersonal relationships. According to some studies, professional training focuses primarily on their initial area of expertise, and their mean values in autonomy-related factors are low to moderate ¹⁸. According to one study, nurses who invest in continuing professional development and training opportunities ensure continuous growth in their practice, provide optimal quality patient care, and develop autonomy in their work environment ¹⁹.

The existing study also looked at the relationship between the independent variables on nurses’ work autonomy variables and the outcome reveals a strong link between the study variables with nurses’ work autonomy. One study concluding that nursing staff' definitions of their perceptions with autonomy in the workplace were classified into four variables: 'to have a comprehensive view,' 'to evaluate the person,' 'to know that user know,' and 'to aspire.' ²⁰. Another study found six variables: acting separately; encouraging teamwork; having professional knowledge and skills; participation throughout autonomy; limits around autonomy; and working to develop autonomy requires support ²¹. Some other study showed that NPs rated their collaboration with physician colleagues and their levels of autonomy as high. Nonetheless, there was no important relationship between these variables ²². All these findings have link between the autonomy of nurse’s work.

Finally, when assessing asset in effect of all free variables with factors affecting the nurses work autonomy. The result shows that relation, cooperation, and is greatest inducing independent variables nurses work autonomy. Another mean notch stood organization culture, climate, and result representing that it also inducing aspect in nurses work autonomy in KAMC. Remaining variables training and development showing influence on nurses’ work autonomy in King Abdullah medical city. The supportive study regarding nurses’ work autonomy variables relatively little in primary research some of the studies reported that Nursing decisions about patient care were more autonomous than unit operational decisions, and nurses perceived their autonomy to be moderate ¹⁷. In addition, the concept of professional autonomy is a developmental framework based on a patient's professional competence, with the confidence to provide the best treatment plan to improve the patient's health through professional decision-making and professional interaction with professional members. Achievement. Team ¹. Nurse independence is positively correlated with better cognitive quality and higher job satisfaction. Therefore, organizations should encourage nurse autonomy without fear that teamwork could be undermined ¹¹.

5. Conclusion

The autonomy of a nurse's job is viewed as a strength and one of the areas that must be considered to deliver maximum patient care while also increasing patient satisfaction on various levels. Moreover, further study is needed, that include all healthcare employees' job autonomy in hospital settings, as well as research that examines autonomy in a wide survey of all Saudi Arabian government hospitals.

6. Recommendations

The findings of this study are important for policymakers to focus on quality, process, information, involvement, and communication to increase their independence in the work of nurses. Policymakers need to consider the views and needs of nurses to make significant changes, greatly improving the work environment. This study recommends additional research to include the healthcare practice of health professionals and to find differences between independent measurements and your performance. Health care leaders have to develop a strategy to improve the independence of the nursing profession.

References