Succession planning is crucial for nursing to sustain leadership and ensure the continuity of effective healthcare management and high-quality patient care This research aims to assess the perspectives of participants regarding the succession plan initiative, its influence on leadership capabilities, and its role in enhancing career advancement prospects. Methodology: The study uses a qualitative descriptive research design to investigate whether a succession plan educational program previously implemented has been effective in developing nursing leadership competency. Analysis/ Results: The qualitative analysis revealed three main themes that emerged from the focus group data: career opportunities, personal perceptions, and value of the succession plan program. Recommendations: There is strong need to continue the succession planning programs as it will support nurse leaders career progression for promotion or strengthening capabilities through mentorship and competencies as healthcare systems continue to evolve, organizations must prioritize succession planning to secure a stable and competent nursing leadership pipeline. Limitations: Despite the triangulation methodology that was used for reliability and validity, the study relied on self-reported perceptions, potentially introducing personal biases. Another limitation is related to the sample size. the response rate was only 22.5 % that could impact its generalizability. The small sample size of nine participants means findings may not fully represent all nursing staff within the EHC. Furthermore, as the research was conducted within one specific healthcare cluster, its findings might not fully apply to other healthcare settings or regions. There is thus a requirement for further studies to be conducted in this nursing population in Saudi Arabia which is currently under-researched. Conclusion: The study highlights the positive role structured succession planning programs play in fostering capable and motivated nurse leaders in Saudi Arabia. Continued investment in leadership training, effective mentorship, and strong organizational support is critical for sustaining leadership growth that can help healthcare organizations building a robust leadership pipeline, ultimately improving patient care quality and organizational effectiveness. The impact of succession Planning programs provide an effective strategy to support Nurse Leaders professional development and has a positive impact on job satisfaction. However, further research should explore the long-term impact of succession planning on nursing leadership and patient care outcomes.
Sustaining nursing leadership through succession planning is crucial for ensuring the continuity of effective healthcare management and high-quality patient care. Succession planning involves identifying and developing potential successors to fill leadership positions when current leaders retire or move on. This strategy has gained significant attention in Saudi Arabia and other countries as they recognize the need to address the foreseen shortage of nurse leaders 1.
In Saudi Arabia, succession planning aligns with national initiatives such as Saudi Vision 2030 and the National Transformational Plan 2020, which emphasize the development and advancement of healthcare services. The implementation of structured succession planning programs can help overcome challenges associated with retiring nurse leaders and ensure smooth transitions between generations of leaders 2.
The healthcare landscape is undergoing a substantial transformation driven by Saudi Vision 2030 as its cornerstone. This comprehensive vision aims to elevate healthcare quality and accessibility for citizens 3. However, these ambitions are associated with intricate challenges including nursing shortages, burnout, and retention struggles 4.
The role of nurse leaders in Saudi Arabia is evolving from traditional administrative functions to more strategic and transformative roles 5. The shift requires nurse leaders to possess competencies aligned with the demands of the evolving healthcare landscape. Additionally, the privatization of healthcare services in Saudi Arabia adds a layer of complexity, emphasizing the need for nurse leaders to navigate new challenges such as autonomy and competition 6.
The main objective of this research project is to explore whether a previously executed educational program for succession planning was effective in cultivating nursing leadership competence. Furthermore, the study aims to assess the perspectives of participants regarding the succession plan initiative, its influence on leadership capabilities, and its role in enhancing career advancement prospects.
Nursing leadership plays a pivotal role in ensuring the delivery of high-quality patient care and the effective functioning of healthcare systems. As the demand for quality nursing leaders continues to grow, succession planning has emerged as a strategic approach to sustain nursing leadership capacity 7.
Succession planning is defined as a deliberate and systematic process of identifying, developing, and promoting individuals who possess the potential to fill key leadership positions within an organization 8. It involves creating a channel of qualified candidates who can seamlessly assume leadership roles when vacancies arise due to retirements, promotions, or other reasons. While succession planning is widely recognized as essential in various institutes, its importance within nursing has gained significant attention due to the critical role nurses play in healthcare delivery 9.
Studies have emphasized the importance of succession planning for effective leadership continuity in the Middle East. highlighted the significance of succession planning for nurse managers in Saudi Arabia, emphasizing the need to cultivate leadership skills among emerging leaders. Additionally, identified determinants linked to executive succession planning in public sector organizations in the United Arab Emirates, shedding light on the organizational factors that influence the successful implementation of succession plans 10, 11.
Succession planning is essential to promote a deliberate and strategic transition of leadership 12. Valuable perspectives on talent management and succession planning highlight the need for organizations to take a strategic approach in identifying and preparing future leaders. In the field of nursing education, a structured framework has been introduced to guide the leadership development of nurse educators, supporting the growth of leadership capacity within educational institutions 13, 14.
Gordon and Overbey discussed how succession planning contributes to organizational sustainability, emphasizing the need for alignment between leadership development and organizational goals 15. Griffith conducted a literature review on effective succession planning in nursing, outlining various strategies and best practices for leadership continuity 16. Klein and Salk explored presidential succession planning in private higher education, offering insights into the dynamics of leadership transition in academic institutions 17.
Alomairi, El Seesy, and Rajab explored the managerial and leadership competencies of first-line nurse managers in Makkah City, underscoring the need for tailored leadership development programs 18. Brown et al., conducted a systematic review of factors influencing intentions to stay and retention of nurse managers, highlighting the role of job satisfaction, work environment, and leadership support in retaining nursing leaders 19.
In recent years, Saudi Arabia has witnessed rapid advancements in healthcare services as part of its ambitious Vision 2030 plan. The need for competent nursing leaders capable of driving positive changes aligns with this national transformation agenda. Consequently, several studies have focused on exploring how succession planning can be effectively implemented to develop and sustain nursing leadership competency specifically within Saudi Arabia's healthcare system 20. A study conducted by Harb et al., aimed to explore the development and sustainability of nursing leadership competency through succession planning in the Eastern Healthcare Cluster in Saudi Arabia 8. The researchers utilized a qualitative descriptive design and identified potential candidates for their succession plan program through purposive sampling. The findings revealed that 31 out of 46 completed competencies aligned with the workshop requirements were suitable for succession plan positions. The remaining 15 participants demonstrated leadership potential but required additional time for competency development. The study recommended the continuation of the succession plan program in 2021, with additional workshops and mentorship programs to further develop nurse leaders.Another study conducted by Shahin, M.A., & Al Suliman, A.S. examined the perception of employees at various managerial positions regarding the implementation of succession planning in a private medical college in Saudi Arabia. Using a mixed research method, the researchers found that most participants preferred a structural succession planning program with mentors before moving into future managerial positions. Multitasking and miscommunication were identified as major obstacles to successful succession planning. The study concluded that effective succession planning requires designing a structural program within educational institutions 20.
In the nursing context, effective succession planning guarantees and preserves organizational continuity by ensuring that qualified individuals are prepared to assume leadership roles when current leaders transition out. Hosis & Fahad, emphasize that succession planning is an integral part of developing nursing managers in Saudi Arabia, contributing to organizational stability and growth 10.
The literature highlights various factors that are linked to successful succession planning. Al Suwaidi et al, emphasize the importance of executive succession planning in public sector organizations and underscore factors such as leadership development, talent identification, and alignment with organizational goals. Brown et al., discuss factors influencing nurse manager retention, which can be utilized to inform succession planning strategies. Managerial and leadership competencies, as explored by Alomairi et al., are crucial in identifying potential successors and tailoring leadership development programs 11, 18, 19.
Succession planning in nursing leadership faces unique challenges, including the scarcity of qualified candidates and the complexity of healthcare environments. Rothwell emphasizes the need for a comprehensive approach to succession planning that encompasses leadership development, performance evaluation, and alignment with organizational goals 21. Trepanier and Crenshaw highlight the urgency for nurse executives to take action in implementing robust succession planning strategies 22. Wang, Zhao, and Lim stress the role of mentorship as a key strategy to facilitate effective leadership development and succession planning 23.
Mentorship has emerged as a crucial aspect of effective succession planning. Gisbert-Trejo et al., discuss the characteristics of effective mentors, emphasizing the role of experienced leaders in guiding and nurturing potential successors 24.
Meyer and Griffith further advocate for the mentorship of executives and the use of mentorship programs to bridge the knowledge and experience gap between existing leaders and future leaders. 16, 25
The challenges and strategies associated with nursing leadership succession planning are not limited to specific regions. While the literature review predominantly focuses on Saudi Arabia, the insights drawn from international studies are highly relevant. Cannon and McGee emphasize that talent management and succession planning are global concerns, urging organizations to adopt a proactive stance in developing future leaders 13. Rothwell provides a starting point for succession planning and talent management that transcends geographical boundaries 26.
Sustaining nursing leadership through succession planning is a critical endeavor to ensure the continuity of quality patient care and organizational success. The integration of mentorship as a strategic component of succession planning has been underscored as a means to bridge the gap between current and future leaders. As healthcare systems continue to evolve, organizations must prioritize succession planning to secure a stable and competent nursing leadership pipeline.There is a large body of literature that identifies the importance of nursing succession planning initiatives in healthcare systems globally if they are to meet the demands of health care organizations. Although the requirement to develop Saudi nurse leaders is well substantiated in the literature there is limited evidence which suggests that initiatives are ongoing within the Kingdom. Studies available are minimal, they tend to focus on succession planning processes and there is a lack of evidence to suggest how effective programs maybe in developing leadership competence.
This study therefore seeks to add to the body of research about succession planning by providing valuable evidence about how nursing leadership practice in Saudi Arabia can be developed and strengthened towards achieving the 2030 vision of delivering excellence in health care.
The study uses a qualitative descriptive research design to investigate whether a succession plan educational program previously implemented has been effective in developing nursing leadership competency.
The succession plan program was developed in 2020 by the Eastern Health Cluster (EHC) Nursing Affairs Leadership to develop Saudi nurse leaders and has been conducted on an annual basis since conception 8. The duration of the program is one year and consists of three one-day workshops which integrate the Transformative Learning Theory, Experiential Learning Theory and Gibbs Reflective Cycle, to support the learning process 27, 28, 29. The Program content was aligned with AONE Nurse Executive Competencies to evaluate learning outcomes 30. while Benner’s Novice to Expert Rank was also utilized as a framework to assess nurses at different levels of expertise 31. On completion of the workshop candidates returned to their clinical areas where they worked with a dedicated mentor to develop their leadership competency through experiential learning opportunities. After completing the first program in 2020 the content was evaluated and strengthened according to feedback received from participants and a policy was developed to formalize and support the nursing succession plan process within the Eastern Health Cluster.
The study took place in the EHC which consists of 22 hospitals: 5 Specialist, 5 Health Network and 12 Rural Healthcare network and 137 Primary Health Care centers that provide primary, secondary and tertiary level care to Saudi Nationals and citizens of the Gulf States, which is situated in the Eastern province of Saudi Arabia.
The study was conducted over a six-week period from June 4th until July 13th 2023. It used a purposive sampling technique to identify whether leadership competency has been meaningfully improved in EHC facilities following completion of a succession plan program.
A total of 40 Saudi nurses and midwives were invited to participate in the study, which represents the total number of nurses that had successfully completed the 2022 succession plan program. The aim of recruiting a total population sample was to ensure that gathered data would provide insight in to the level of leadership competence and the effectiveness of the succession plan program in developing competent leaders in nursing practice.
The study used the nursing leadership development questionnaire developed by the EHC Nursing Leadership team. The tool, Table 1 below, comprises of nine semi-structured open-ended questions. These aimed to examine views of participants in relation to the succession plan program, its impact on leadership performance, and career development opportunities. Focus group discussions were also held to gather further qualitative data and in-depth insights about the program.
A panel of expert nurse practitioners evaluated the quality of the questionnaire. They assessed construct validity to ensure that it met its objectives in exploring whether the succession plan program had been beneficial in developing and strengthening leadership competence. A pilot study was conducted on five succession plan participants to confirm reliability through the clarity of questions amongst Saudi nurses 32. No variables were identified which might impact on the study 33. However, as the pilot size was small, the possibility cannot be excluded that certain problems may not have been detected.
After completion of the pilot study, a cover letter was distributed in the first week of June 2023 to all nurses and midwives that had completed the 2022 succession plan program inviting them to participate in the study. This was personally distributed by the researcher, through the Director of Nursing in the facility, in an effort to achieve a high response rate 33, 34. The cover letter was written in English and Arabic to ensure understanding amongst participants given that they were all of Saudi nationality. It explained the nature of the study, why it was being conducted and that the data would only be used to improve leadership competence amongst nurses in the Eastern Health Cluster. Staff were requested to participate in the study on a voluntary basis with waiver of consent, as it was perceived that the research involved minimal risk. The cover letter was distributed with a demographics questionnaire and the Nursing Leadership Development Questionnaire which practitioners were requested to complete and return prior to the focus group discussion.
Approval for the study was obtained from King Fahad Specialist Hospital Institutional Review Board, Dammam.
The study was conducted based on the theoretical assumption that succession plan programs can develop and enhance leadership ability. A total of nine nurses participated in the research study from a total of 40 nurses that were invited. A descriptive analysis was undertaken to highlight the demographic characteristics of the group relating to gender, position, years of experience, and facility. The demographic data sheet was received completed in all categories with a 100% response, shown in Table 2 below.
The analysis showed that all the nurses that participated in the study were female (100%). Most of the staff were employed as Manager’s (77.8%), with a small percentage working at Charge Nurse (11.1%) or Director level (11.1%). The majority of nurses had 5-10 years’ experience (67.0%) compared to the remainder of the group with 11-15 years’ experience The majority of nurses in the group worked in secondary level hospitals (44.4%), however all levels of facilities were represented.
Focus group sessions were conducted over a maximum of 90 minutes amongst EHC nursing staff to explore their perceptions in relation to the succession plan program. Debriefing sessions were held after the focus group discussions to reflect on the focus group process and the significance of the data. One research member transcribed, reviewed and analyzed the contents of the discussion. Data triangulation was then completed by comparing data entered on the questionnaire. This was done to provide a better understanding regarding nurses’ views relating to the succession plan program and its possible impact on their performance 35.
The focus group discussion data was systematically categorized by content analysis using illustrative quotes from ‘raw data’ collected in relation to each question. It was then analyzed by comparing and contrasting responses against the data obtained from the questionnaire to enhance data richness and increase the credibility and validity of research findings. 36, 37. The qualitative analysis revealed three main themes that emerged from the focus group data: career opportunities, personal perceptions, and value of the succession plan program.
Career opportunities
When asked about promotion opportunities since completing the program, it was determined that all respondents attended the program to strengthen their leadership performance. Four wanted to enhance their performance in their current role by completing the program and they did not expect to progress to a more senior position. Four respondents attended the course to meet requirements for promotion in the future and one respondent was promoted to a more senior position on successful completion of the program.
In terms of support and guidance to develop their performance during the program, respondents unanimously believed that their mentor was accessible, approachable and well qualified to meet their needs. On completion of the program, the majority of respondents continued to receive ongoing support from their mentor. Two respondents noted a lack of support from the organization:
“I expected more appreciation from hospital nursing administration”
All respondents agreed that the succession plan documentation package developed to support the program provided guidance and structure for the mentor and mentee to ensure that the mentorship process remained on track and achieved its objectives. One respondent suggested that the course could be improved in the following way:
“It would be beneficial to establish a support group for succession plan program participants on completion of the course so that we can continue to enhance competency by sharing struggles and successes with peers.”
Responses suggest that this succession plan program did provide an effective mechanism to support career progression.
Personal perceptions
When asked about their performance as a nurse leader since completing the succession plan program all respondents perceived that their performance had improved and one further expanded this by stating “ I am now a good leader”. This was attributed to an increased level of self-awareness that facilitated a higher degree of professionalism. In particular, the group acknowledged that they had developed a broader knowledge base and improved communication skills. Three respondents also identified increased emotional intelligence as a main factor for their improved performance. Additionally, respondents acknowledged that the development of leadership competency is an ongoing process beyond the duration of the program.
The majority of respondents (8) identified that their own satisfaction with their performance had increased. Two respondents noted a difference in their leadership ability compared to before they attended the program:
“I have more power and control.”
“I am able to deal with challenges in new ways.”
One respondent identified the need to continue to improve her performance:
“I am satisfied with my performance but I am still looking for more opportunities.”
Respondents believed that their satisfaction had increased because they felt more confident and had been provided more opportunities by nursing management.
One respondent identified that her level of personal satisfaction had decreased which was attributed to being transferred recently from a specialized hospital to a small general hospital where there were limited opportunities to develop and strengthen leadership competence.
Responses suggest that participants perceived that the succession plan did have a positive impact on their performance and level of satisfaction in relation to it.
Value of the succession plan program
When asked about whether the succession plan program had a positive influence on their professional development, respondents agreed that the succession plan was beneficial. Several reasons were identified by respondents for this:
“The program contains many competencies that all leaders need.”
“Able to share experiences and challenges, solve problems together – with both expert
speakers and with peers.”
“Provided a forum to develop new knowledge and also refresh previous knowledge.”
“Improved quality of work and safer work environment due to better decision making ability.”
Two respondents identified that the program had provided an opportunity for them to strengthen their professional relationships with their Directors as they had been assigned in an additional capacity as their mentor. They believed that their Directors developed more trust and belief in their abilities as a result of the mentorship relationship. This led to their empowerment as they were delegated more responsibilities and started to be engaged in decision making, planning and quality improvement projects.
Seven respondents identified that their job satisfaction had increased as a result of the succession plan program. Two respondents stated that their levels of job satisfaction were unchanged. One respondent perceived this to be due to the fact that she had not been promoted despite her expectation and the other attributed it to being transferred to a new location where she needed support and guidance which was not available.
Respondents whose job satisfaction had increased believed that this was because some topics included in program had a high impact on their performance: Communication, Delegation, Time management, Decision making, Problem solving, and reflective practice. In addition to their performance being improved, which led to more fulfillment, they also felt that their job satisfaction had improved because there was more trust between both peers and supervisors, improved teamwork and respect, and more fulfillment as their performance improved.
Respondents noted the following differences in their performance after completing the succession plan program:
“Able to apply and integrate theory into practice.”
“More assertive, able to deal with all personalities.”
“Managing staff and patients more effectively.”
When asked about the comprehensiveness of the succession plan program, the respondents’ believed that it covered a wide range of content. One respondent suggested including research as an additional topic although there is a dedicated research workshop.
Two respondents identified that they were unable to absorb all the information and suggested increasing the program from three to six days in order to decrease the number of topics in one day and dedicate more time to each topic.
Two additional respondents also suggested that as the program content is largely theoretical, it might be further strengthened by providing more opportunities to participate in activities / simulation in the classroom before returning to the workplace.
When asked whether opportunities were taken to develop their own staff since attending the succession plan program, respondents agreed that they now take opportunities to develop staff. They believe they are more aware of the importance and need for staff education as well as being more motivated, confident, and competent to develop and empower staff.
Respondents identified a variety of different strategies that they adopted to develop staff as a result of the course. These comprised of fostering an effective learning environment, providing learning opportunities in the workplace, delivering in-service education and training, participating as speakers in workshop and providing mentorship to staff.
Respondents verbalized:
“I actively motivate, empower and support staff to attend courses including the succession plan program. “
“More learning opportunities in the workplace are provided to staff through thoughtful delegation and involvement in decision-making processes.”
“I provide support to the Clinical Nurse Educator to improve staff performance through training and competency assessment programs.”
Responses suggest that this succession plan program did provide an effective strategy to support their professional development and that it had a positive impact on their own level of job satisfaction. The program also indirectly supported the professional development of other staff in the department who were provided increasing learning opportunities by their nurse leaders after attending the program.
This study explored the impact of a structured succession planning program aimed at developing nursing leadership skills within the Eastern Health Cluster (EHC) in Saudi Arabia. The results clearly showed participants experienced significant benefits from the program, including better career advancement, stronger leadership skills, and increased overall job satisfaction.
Participants shared that they felt genuine improvements in their leadership abilities after completing the program. They highlighted noticeable growth in key areas such as communication, emotional intelligence, and self-awareness. Participants felt these skills helped them handle difficult situations more effectively, communicate clearly with their teams, and better understand their own leadership styles. These findings are consistent with existing research highlighting the importance of emotional intelligence and clear communication in successful leadership roles 16, 24.
1. Mentorship emerged as one of the most valued aspects of the program. Participants spoke warmly of their mentors, describing them as approachable, experienced, and supportive. They credited mentorship for helping them translate theoretical leadership concepts into real-world practice. This finding echoes previous research that underscores mentorship as a vital element in successful leadership development 23, 25.
2. Despite the overall positive feedback, participants suggested some areas where the program could be improved. Many felt the program duration could be extended to provide more time to deeply explore complex topics. Additionally, participants recommended adding more practical, hands-on simulation exercises to help bridge theory and practice. They also expressed a desire for ongoing support groups after program completion to continue exchanging experiences and solutions. These suggestions highlight the need for ongoing enhancements to leadership training programs to better match participants’ practical needs 28.
3. Another important area participants identified was the need for greater organizational support. Some participants felt disappointed by the lack of recognition and support from their institutions after finishing the program. Without strong organizational backing, participants worried about the long-term sustainability of their leadership growth. This aligns with previous studies emphasizing the critical role of institutional support in retaining and motivating emerging nurse leaders 19.
4. Participants also reported a noticeable increase in job satisfaction after participating in the program. Improved relationships with colleagues, enhanced teamwork, and greater professional empowerment contributed to this heightened sense of fulfillment. Participants felt more confident, supported, and valued within their workplaces. These insights align with past research that highlights the importance of supportive leadership, professional autonomy, and positive work relationships in job satisfaction 18, 19
5. An additional significant finding was participants’ active commitment to staff development post-program. Many reported proactively creating learning opportunities, providing targeted training sessions, and offering mentorship to their teams. This shift towards empowering and investing in staff indicates a positive cultural change toward proactive leadership and continuous professional growth.
Sustaining nursing leadership through succession planning is a critical endeavor to ensure the continuity of quality patient care and organizational success. The integration of mentorship as a strategic component of succession planning has been underscored as a means to bridge the gap between current and future leaders. As healthcare systems continue to evolve, organizations must prioritize succession planning to secure a stable and competent nursing leadership pipeline through the following recommendations:
• Healthcare organizations should formalize succession planning programs to continually develop skilled nursing leaders.
• Incorporating structured mentorship within succession planning is essential to maximize leadership development outcomes.
• Extending program length and including practical simulation activities will enhance the effectiveness of leadership training.
• Establishing ongoing peer-support groups can sustain leadership development and facilitate continued professional growth.
• Organizations should actively recognize and support nurses completing leadership training to enhance motivation and retention.
The study has several limitations. Despite the triangulation methodology that was used for reliability and validity, the study relied on self-reported perceptions, potentially introducing personal biases. Another limitation is related to the sample size. the response rate was only 22.5 % (9 out of 40 nurse leaders had voluntarily participated in the study) that could impact its generalizability. The small sample size of nine participants means findings may not fully represent all nursing staff within the EHC. Furthermore, as the research was conducted within one specific healthcare cluster, its findings might not fully apply to other healthcare settings or regions. There is thus a requirement for further studies to be conducted in this nursing population in Saudi Arabia which is currently under-researched.
1. The study suggests the strong need to continue the succession planning programs as it will support nurse leaders career progression for promotion or strengthening capabilities through mentorship and competencies. It highlights the positive role structured succession planning programs play in fostering capable and motivated nurse leaders in Saudi Arabia. Continued investment in leadership training, effective mentorship, and strong organizational support is critical for sustaining leadership growth.
2. Implementing these recommendations can help healthcare organizations build a robust leadership pipeline, ultimately improving patient care quality and organizational effectiveness. The impact of succession Planning programs provide an effective strategy to support Nurse Leaders professional development and has a positive impact on job satisfaction. However, further research should explore the long-term impact of succession planning on nursing leadership and patient care outcomes.
The authors would like to thank Nursing Administrative services in all E1 Healthcare Cluster facilities for their support and encouragement with this study. The Hospital Research Committee at King Fahad Specialist Hospital is also appreciated for their approval of this study.
Conflict of Interest Disclosure: There are no conflicts of interest
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