Assessment Of Clinical Leadership Competency Among Registered Nurses Working In Neuro Units Of A Tertiary Hospital, Riyadh, Saudi Arabia: A Cross-Sectional Study

Abstract

Background: Clinical leadership competency is an important aspect of nursing practice, particularly for supporting coordinated care, effective teamwork, and sound clinical decision-making. Understanding the level of clinical leadership competency among registered nurses can help identify areas for further professional development. This study aimed to determine the level of clinical leadership competency and examine its associations with selected demographic and professional characteristics among registered nurses working in neuro units of a tertiary hospital in Riyadh, Saudi Arabia.

Methods: A quantitative descriptive cross-sectional study was conducted among 81 registered nurses. Data were obtained using a structured questionnaire that included a researcher-modified version of the Leadership Practices Inventory (LPI) Self-Assessment developed by Kouzes and Posner. The modified 40-item questionnaire assessed four clinical leadership competency domains: Demonstrating Personal Attributes, Working with Others, Duty Management, and Setting Direction & Making Decisions. Participant characteristics and competency scores were summarized using descriptive statistics. Inferential statistical tests were applied to examine associations between selected demographic and professional characteristics and the clinical leadership competency domains. Statistical significance was considered at p < 0.05. The internal consistency of the modified questionnaire was evaluated using Cronbach’s alpha.

Results: Among the 81 participants, 48 (59.3%) demonstrated excellent overall clinical leadership competency, 32 (39.5%) demonstrated good competency, and 1 (1.2%) was classified as developing. The highest proportion of excellent competency was observed in Duty Management (63.0%), followed by Working with Others (60.5%) and Setting Direction & Making Decisions (53.1%). Demonstrating Personal Attributes had comparable proportions of participants with good (49.4%) and excellent (48.1%) competency. The overall mean clinical leadership competency score was 85.5 ± 6.9, while Duty Management recorded the highest domain mean (86.7 ± 7.8). Shift leadership role was significantly associated with Duty Management (p = 0.022) and Setting Direction & Making Decisions (p = 0.018). Nationality was significantly associated with Setting Direction & Making Decisions (p = 0.048). No significant associations were identified between the competency domains and age, gender, educational level, or years of nursing experience. The modified questionnaire demonstrated high internal consistency, with a Cronbach’s alpha of 0.943.

Conclusion: The participating registered nurses demonstrated a high level of clinical leadership competency overall, with Duty Management emerging as the highest-scoring domain. Shift leadership role was associated with competency in Duty Management and Setting Direction & Making Decisions. These findings support the provision of appropriate opportunities for nurses to undertake clinical leadership responsibilities and participate in structured professional development. As the study employed a cross-sectional design, the observed associations cannot be interpreted as causal relationships. Further longitudinal and interventional research is recommended to determine whether structured leadership opportunities are associated with changes in clinical leadership competency over time.