Work

Exploring leadership skills development in nursing: a qualitative investigation into the excellence in care program in the Kingdom of Saudi Arabia

Year: 2025

Type: article

Abstract: BACKGROUND: Leadership 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. AIM: To 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. METHODS: A 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. RESULTS: Four 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. CONCLUSIONS: EiC 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.

Source: BMC Nursing

DOI: 10.1186/s12912-025-04239-7

Authors: Monirah Albloushi, Abdulaziz M. Alodhailah, Thurayya Eid

Institution: King Saud University

Language: English

Topic: Nursing education and management

Subfield: Research and Theory

Field: Nursing

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090