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

Abstract

Highlights What are the main findings? In a survey conducted more than two years after the 2023 SCFHS Scope of Nursing and Midwifery Practice update, nurses in Makkah Cluster Hospitals reported a mean actual scope-of-practice score of 5.55 (SD = 0.61) on a 6-point scale, a mean organizational commitment score of 4.20 (SD = 0.66) on a 7-point scale, with affective commitment highest among the three subscales, and a mean nursing work environment score of 3.60 (SD = 1.00) on a 5-point scale. The nursing work environment score was positively associated with overall organizational commitment (r = 0.56, 95% CI 0.47–0.64, p < 0.001) and with each of the three commitment subscales. Because the data are cross-sectional, the findings indicate associations and do not establish direction or causality. What are the implications of the main findings? This study describes enacted scope of practice, organizational commitment, and the nursing work environment among Saudi nurses following the 2023 SCFHS update. Because the design includes no preimplementation baseline, it cannot determine whether the update changed any of these outcomes. Efforts should focus on broadening nurses’ scope of practice and strengthening the nursing work environment. Abstract 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.