The Impact of Residency Programs on Clinical Decision-Making and Leadership Skills Among New Saudi Graduate Nurses




Al-Dossary, Reem Nassar

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Saudi Arabia is challenged by a nursing shortage as are several other countries. Due to the intense working environment, increasing patient acuity, and complex technologies, health care settings create challenges for new graduate nurses. Thus, health care institutions have adopted residency programs to help new graduate nurses to become fully competent and transition from student nurses to independent practicing nurses and bedside leaders. Nurse residency programs are reported to have proven beneficial and positive effects on new graduate nurses. The purpose of this exploratory, descriptive study was to assess the impact of residency programs on the clinical decision-making and leadership skills of new Saudi graduate nurses who had completed a residency program within 1 week to 3 months of the time this study was conducted, and new Saudi graduate nurses who did not participate in residency programs. The conceptual framework that guided this study was Benner's Novice to Expert model. A convenience sample of n = 98 new graduate nurses was collected from three hospitals in Saudi Arabia. A self-administered questionnaire was used to collect data. Clinical decision-making skills were measured using Clinical Decision Making in Nursing Scale and clinical leadership skills were measured using the Clinical Leadership Survey. An independent t-test, bivariate association, and multiple linear regression analysis were utilized to test hypotheses concerning different groups. The findings revealed a significant difference between the residency program group and the nonresidency program group in clinical decision-making (t = 23.25, p = 0.000) and leadership skills (t = 10.48, p = 0.000). However, there were no significant differences in the average number of clinical decision-making and leadership skills based on the length of their residency program (6 months vs. 12 months). In addition, a moderate positive correlation was found between overall grade point average (GPA) and total clinical decision-making scores (r = 0.365, p = 0.000), and overall GPA and total clinical leadership skills (r = 0.440, p = 0.000). The clinical decision-making regression model explained 86.9% of the variance in total clinical decision making by the differences in age, overall GPA, and enrollment in a residency program. In addition, the clinical leadership skills regression model explained 60.6% of variance in total clinical leadership skills by the differences in age, overall GPA, total clinical decision-making scores, and enrollment in a residency program. This study is one of the first such studies that examined the impact of residency programs on clinical decision-making and leadership skills' of new Saudi graduate nurses who completed a residency program. The findings of this study indicate that there is a need to implement more residency programs in hospitals of Saudi Arabia. It is imperative that nurse managers and policy makers in Saudi Arabia consider these findings to improve nurses' clinical decision-making and leadership skills, which will in turn improve patient care.


This work was embargoed by the author and will not be publicly available until May 2016.