ArticleBMC nursing2025
Exploring leadership skills development in nursing: a qualitative investigation into the excellence in care program in the Kingdom of Saudi Arabia.
Article in BMC nursing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLeadership at the point of care is pivotal to safety, flow, and patient experience in ambulatory settings. In Saudi Arabia, the Excellence in Care (EiC) program is a multi-component initiative that uses workshops, simulation, quality-improvement micro-projects, and mentoring to strengthen nurses' leadership behaviours, yet the mechanisms by which this learning transfers to everyday practice remain underexplored.
aimTo explore how the EiC program shapes nurses' leadership development in Saudi ambulatory clinics and to identify contextual factors that enable or hinder the transfer and sustainability of these behaviours.
methodsA qualitative phenomenological study was conducted with 24 nurses and nursing leaders working in King Saud University-affiliated polyclinics. Using purposive, maximum-variation sampling, participants who had engaged with EiC within the previous 24 months took part in semi-structured interviews (35-60 min). Interviews were audio-recorded, transcribed in Arabic and/or English, and analysed using Colaizzi's phenomenological method, supported by Braun and Clarke's reflexive thematic analysis and NVivo 14.
resultsFour interwoven themes described leadership-in-practice after EiC: (1) Leading in the flow of ambulatory care-micro-leadership moves such as brief huddles, explicit role calls, SBAR, and closed-loop confirmation that stabilised throughput and escalations; (2) From course to clinic: conditions for transfer-proximal coaching, micro-simulation, and brief debriefs that enabled enactment despite workload pressures; (3) Culture, hierarchy, and voice-shared scripts that legitimised speaking up across professional and seniority gradients, modulated by gendered and multicultural dynamics; and (4) Systems and signals: making leadership visible-alignment with KPIs, local dashboards, recognition, and communities of practice that sustained behaviours beyond individual champions.
conclusionsEiC provided nurses with shared language, tools, and confidence for point-of-care leadership. Durability of these behaviours depended on coaching, micro-time protection, strategies for navigating hierarchy, and organisational visibility. Embedding standardised artefacts, proximal coaching, balanced dashboards, and peer learning can help convert personal initiative into shared clinic routines.
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