Scope of Nursing Practice, Organizational Commitment, and Work Environment Following the 2023 National Regulatory Update: A Cross-Sectional Study in Makkah Cluster Hospitals, Saudi Arabia.

BACKGROUND

The 2023 Saudi Commission for Health Specialties (SCFHS) Scope of Nursing and Midwifery Practice document was Saudi Arabia's first formal, category-differentiated scope framework. Nurses' enacted scope of practice, organizational commitment, and work environment have not been described since its publication. This study described these three constructs among nurses at Makkah Cluster Hospitals following the 2023 SCFHS update and examined the associations among them.

METHODS

In this cross-sectional study, 259 nurses at Makkah Cluster Hospitals completed an anonymous online survey during May-August 2025 using three validated instruments: the Actual Scope of Nursing Practice questionnaire (ASCOP), the Organizational Commitment Questionnaire (OCQ), and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Scores were reported as mean item scores. Data were analyzed using descriptive statistics, independent-samples t-tests, and Pearson correlations in IBM SPSS Statistics, version 29; subgroup comparisons were treated as exploratory.

RESULTS

The mean ASCOP score was 5.55 (SD = 0.61) of a possible 6, the mean OCQ score was 4.20 (SD = 0.66) of a possible 7, and the mean PES-NWI score was 3.60 (SD = 1.00) of a possible 5. Overall scores did not differ by demographic characteristics, and no subscale difference remained significant after Bonferroni correction (all Cohen's d ≤ 0.46). The PES-NWI score was positively associated with overall organizational commitment (r = 0.56, 95% CI 0.47-0.64, p < 0.001). The ASCOP score was not associated with either the PES-NWI (r = 0.11, p = 0.080) or the OCQ (r = 0.11, p = 0.084).

CONCLUSIONS

More favorable ratings of the work environment were associated with higher organizational commitment, whereas enacted scope of practice was unrelated to either construct. The cross-sectional design and absence of preimplementation data prevent the study from establishing change attributable to the 2023 framework or the direction of the observed associations.