Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
    Users Online: 145
Home Print this page Email this page Small font size Default font size Increase font size

 Table of Contents  
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 55-60

Perceived evidence-based practice competency among Saudi nurse managers

Department of Nursing, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia

Date of Submission30-Jun-2020
Date of Decision11-Nov-2020
Date of Acceptance18-Nov-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
Majed Alamri
Department of Nursing, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_149_20

Rights and Permissions

Background: Nurse managers have a vital part in the integration of evidence-based practice (EBP) in the clinical setting. This study measures perceived EBP competency among Saudi nurse managers. This survey was conducted in four government hospitals in Saudi Arabia. Methods: A total of 308 Saudi nurse managers in four government hospitals utilizing a descriptive cross-sectional method were employed. A survey was used to determine the EBP competency. Nurse managers are somewhat competent in EBP (1.19). This holds true in both subcategories: knowledge (1.15) and activities (1.21). It was observed that the fewer years' experience as a manager the better the EBP competency. Conclusion: There is a need to review the strategies to integrate EBP in actual practice in the Kingdom, especially since EBP is associated with nurses as a researchers' role. EBP competency (1.0) is 0.78 EBP activity and 0.22 EBP knowledge. Only years of experience impacted EBP competency when linear regression was run. Nurse managers new to a unit perceived that they are more competent and show the willingness to learn, implement, and utilize EBP.

Keywords: Activity, evidence-based nursing practice, knowledge, nurse managers, Saudi Arabia

How to cite this article:
Alamri M. Perceived evidence-based practice competency among Saudi nurse managers. Saudi J Health Sci 2021;10:55-60

How to cite this URL:
Alamri M. Perceived evidence-based practice competency among Saudi nurse managers. Saudi J Health Sci [serial online] 2021 [cited 2021 Jul 23];10:55-60. Available from: https://www.saudijhealthsci.org/text.asp?2021/10/1/55/311953

  Introduction Top

Evidence-based practice (EBP) has arisen as foundation for the provision of quality nursing care for patients as well as for the improvement of health outcomes.[1] There are also many benefits of EBP documented in the literature. For example, it can increase the quality nursing care practice, decrease uncertainty experienced by both patients and health-care professionals, and upturn nursing profession.[2] Similarly, EBP is a problem-solving method to scientific decision-making integrating with the finest accessible experiential proof both for the patient and nurse.[1],[2],[3] EBP in nursing guides nurses to choose the best nursing interventions that provide high-quality, increases confidence in clinical decision-making and research-based health care to patients. Several evidence in terms of nursing research scope is surging exponentially internationally received increased attention, and highly influenced by leadership.[4] Studies have shown that EBP relies on both leadership and administrative support for implementation in practice settings.[5],[6] Nurse managers are nurses who supervise unit-level actions and uphold accountability for clinical delivery care by nursing staff.[7],[8] It is believed that nurse managers' role-modeling behavior and implementation support efforts influence EBP implementation.[9] They are also accountable for the guidance of each department, containing staffing, warranting outstanding nursing practice, budgeting, assisting quality improvement, and patient safety. Other actions nurses' managers action like contributing response-feedback, role exhibiting, and delivering resources, are considered to encourage EBP implementation.[9]

Just like the implementation of any other models or frameworks, the leadership of nurse managers is essential to the success of EBP implementation.[10]

Although the use of EBP is significantly vital in nursing practice, and nurses' positive attitudes toward it, nurse managers still face challenges to using the existing evidence. Several studies have identified difficulties that prevent nurses from using EBP in clinical practice.[5],[6] and the process of implementing EBP is slow. Some barriers were lack of available time to exploration for evidence, limited access to information technology, and lack understanding and interpreting skills for research findings, are examples of these barriers.

In Saudi Arabia, there has been a dramatic shift in nursing service from being comprised of a few nurses with basic nursing skills to being comprised of qualified nurses with advanced skills in nursing practice which created a problem in clinical settings.[11] The burden in providing quality health-care services has directed the Saudi government to establish a Vision 2030 (National Transformation Program) in which most of the vision in health care might be accomplished by the EBP implementation. The challenges are that Saudi nurses are comfortable to the traditional way of providing care[12],[13] which has been not evidence based. Since it is not scientific, it might imply that more efforts to improved quality nursing need to and in order to provide patient safety.[14]

Although there are government hospitals starting the process of EBP implementation is slow, and some managers reported that they lack confidence, knowledge, and skills,[14] which has not been addressed sufficiently. Furthermore, some researchers describe EBP implementation in the country, however much of the research is on nursing students[15] and nurses, but not nurse managers. Little research focuses on nurse managers' competency with EBP has been reported[16]. Therefore, research on nurse managers in EBP implementation is warranted. Hence, it is important to assess nurse managers' EBP competency to identify any issues or concerns that need to be addressed to facilitate the managers' leadership in the implementation of EBP in their units. This study acts as a groundwork for future studies that focus on the EBP significance implementation. The main objective of this study is to assess perceived EBP competency among Saudi nurse managers. Furthermore, this study will determine how demographics (unit type, years as nurse manager on the current unit, total years as nurse manager, and education level) affect EBP competency.


This study determines the EBP competency of Saudi nurse managers.

  Methods Top

Research design

This investigation utilized the descriptive cross-sectional method of research, which is a widely accepted fact-finding technique in research.[17] This method is appropriate to this study because it aimed to examine the relationship between demographics and EBP competency of Saudi nurse managers.

Population and research locale

Saudi nurses working in public hospital hospitals in Saudi Arabia. Inclusion criteria: (a) registered Saudi nurse; (b) had responsibility for unit-level operations; and (c) direct supervision of nursing staff on the unit. Initially, all 496 Saudi nurse managers were included from the four hospitals in Saudi Arabia. 482 consented to participate, however 174 surveys were excluded because of incomplete data. Therefore, 308 were included in the final analysis (63%).

The study was conducted in four tertiary government hospitals in Saudi Arabia. This hospital is composed of varied specialties such as forensic medicine, maternity/labor room/delivery room, emergency room, surgical/OR, intensive care unit, administration/quality department/academic affairs, primary health centers, outpatient department, mental health, hemodialysis, and oncology.


The first part of the survey in this study is a checklist to determine the demographics of respondents such as age, gender, type of unit assignment, total years as nurse manager, and highest educational level.

The second part assessed the perceived EBP competency of nurse managers. The researcher adopted the EBP competency scale developed by Shuman et al.[18],[19] which contains a 16-item scale. It has a 3 Likert-type scale (0 = not competent; 1 = somewhat competent; 2 = fully competent; and 3 = expertly competent). The tool contains two subscales: EBP knowledge and EBP activity. EBP knowledge refers to what nurse managers know about EBP, whereas EBP activity refers to what they do in relation to EBP. The tool is summated of total scores and dividing by 16 in each respective scale. The tool has previously demonstrated content validity and internal consistency reliability (Cronbach's α = 0.95 [total scale]; 0.90–0.94 [subscales]).[18],[19] Cronbach's alpha for the entire scale was 0.95.

Data gathering procedure

Ethical approval was sought and obtained (MUREC-Nov. 04/COM-2018-10) from Majmaah University Ethical Board with attached approval letter from the author utilizing the tool. After, the approval was sought according to the protocol of participating health centers and hospitals and was completed before collecting data. A signed informed consent was obtained from all respondents before they participated in the study. EBP competency data were collected only from those who satisfied the inclusion criteria. The questionnaire was distributed on the selected units by nurse managers who were present in their respective wards or units. Respondents were also given instruction to answer at any time of the day or after working hours convenient for them. Nurse managers completed the survey in private on their units during the period of data collection. Completed survey forms were sealed in envelopes and deposited into locked collection boxes.

Statistical analysis

SPSS statistics 23 was used to analyze the data findings. Descriptive statistics were utilized to illustrate the demographics of nurse managers that include unit type, years as nurse manager on the current unit, total years as nurse manager, and education level. The mean and standard deviation was exploited to determine EBP competency level. Moreover, F-test was utilized to determine if EBP competency differed significantly when respondents were grouped according to their demographic variables. The P = 0.05 α will be used to signify statistical significance. Linear regression was achieved to establish which variable has a relationship to EBP competency and automatic linear modeling was forced to predict the EBP competency when categories (profiles) are merged to maximize the association with the target (EBP competency).

  Results Top

[Table 1] shows the evidence-based competencies of Saudi nurse managers vis-à-vis their Profile. The age range between 30 and 35 years has the highest respondent's frequency (n = 143; 46.4%) with a mean score of knowledge 1.13 (standard deviation [SD] = 0.42), activity 1.18 (SD = 0.48), and EBP competency 16 (SD = 0.43), respectively. Meanwhile, the age range between 46 and 50 years has the lowest frequency (n = 143; 46.4%) with a mean score of knowledge 1.13 (SD = 0.42), activity 1.18 (SD = 0.48), and EBP competency 16 (SD = 0.43), respectively. Overall, indicating somewhat competent regards to knowledge, activity, and EBP competency. In terms of gender, more than half of the respondents are male (188, SD = 61.0) compared to female (120, SD = 39.0).
Table 1: Evidence-based competencies of Saudi nurse managers vis-à-vis their profile

Click here to view

In terms of the type of unit assignment, both respondents working in the emergency room 60 (19.5) and administration/quality received the same highest frequency score 60 (19.5), whereas respondents working in forensic medicine received the lowest frequency score. More than half of the respondents (199; SD = 64.6) have <5 years as nurse manager on the current unit, whereas 31 (SD = 10.1) respondents have 10 years and above. More than half of the respondents (235, SD = 76.3) were bachelor degree graduates, whereas 17 (SD = 5.5) have diploma degree.

[Table 2] presents the evidence-based competencies among Saudi nurse managers. The overall mean score EBP competency knowledge has 1.15 (SD) which is interpreted as somewhat competent. Knowledge statement “Recognize ratings of strength of evidence when reading systematic reviews and evidence summary reports” has the highest mean score 1.2078 (SD = 0.51), whereas the statement “Critically appraise original research reports for practice implications” has the lowest mean score 1.032 (SD = 0.57). Then, the overall mean score EBP competency activity has 1.20 (SD = 0.45) which was interpreted as somewhat competent. EBP competency activity statement “Use evidence to inform clinical decision-making” has the highest mean score of 1.39 (SD = 0.65), whereas the statement “Use criteria about evidence-based practice in screening and hiring staff” has the lowest mean score of 0.83 (SD = 0.62). Results showed that years as nurse manager on the current unit influenced EBP competency. Specifically, 1 year increase in the years as nurse manager on the current unit was associated with 12 point increase in the EBP competency scores [Table 3].
Table 2: Evidence-based competencies among Saudi nurse managers

Click here to view
Table 3: Relationship between profile and evidence-based practice competency

Click here to view

  Discussion Top

The study findings examined the association between demographics and EBP competency of Saudi nurse managers. Result revealed that nurses' managers are competent in EBP. It is worth noting since nurse managers are accountable for employing new clinical practices and play an essential key role in the development of EBP implementation. In addition, managers are also in unique situation to in an effort for the EBP translation practice. This result is congruent to other international studies describing nurse managers are expected to be EBP competent since they are responsible for providing sources of information to nursing staff, supervising, and warranting health care safely delivered.[20],[21] Conversely, there appears to have some empirical findings nurse managers have difficulty in EBP implementation.

For example, one of the earlier studies reported that nurse managers were passive in EBP implementation and lacked competency skills.[14] It could be argued by the fact that the main concern of nurse managers is quality care and security, while EBP was not included as priority because of the lack of time and lack of budgets to implement EBP implementation to clinical practice. This implies that in order to implement EBP, adequate resources, additional time, and financial investment are needed. This result was also verified by other international studies.[22],[23],[24],[25] Nevertheless, nurse managers play an important role in shaping EBP implementation in clinical settings, in which they needed to be highly skilled in order for the EBP to be successful.[15] It is vital for them to enrich their own competency skills in EBP through training and workshop implemented.

Another highlight of the study is that years as manager in the current unit and EBP competency. This study revealed that the fewer years of nurse manager experience, the better the EBP competency. This interesting result can be attributed to the drive among newly minted managers. Their willingness to learn puts them in a better position compared to those with more years of experience. This result negates to the previous study the longer unit leadership experience the better EBP implementation.[25] According to Warshawsky and Cramer,[23], positive nurse leadership behaviors could be achieved for EBP implementation only when they have longer clinical experience in order to facilitate EBP implementation efforts and increase EBP competency skills; if they have less work experience, it is expected that they have not fully understand EBP competency which is crucial for identifying and developing implementation strategies that address these factors. Therefore, managers are expected to learn and implement EBP and improve their EBP competency. This suggests that EBP implementation in hospitals or institutions will more likely occur by hiring or promoting new managers who are more willing to take the challenge. Another strategy to consider is to orient and reorient long-term managers to the importance of EBP. It is key to focus on motivation, attitude, and appreciation of EBP utility, and not on skill development. When motivation, attitude, and appreciation are established, that is the right time to proceed with both EBP skills mentoring and coaching.

Limitations of the study

The study only determines self-perceived competence in EBP.[18],[19] This instrument does not determine actual competency. A separate study is in order to compare both perceived and actual competence. A convenience sample using a cross-sectional design was used for the study, which may affect generalizability.

  Conclusion Top

In a nutshell, nurse managers in the Kingdom perceived that they are somewhat competent on EBP. Nurse managers new to a unit perceived that they are more competent and show the willingness to learn, implement, and utilize EBP. Training and motivational strategies need to be implemented to increase competency skills toward EBP in the hopes of increasing its implementation and potentially reaping positive patient care outcomes.

A review of the curriculum is necessary to integrate EBP that suits the specific needs of a Saudi audience and includes specific research and technical skills to support the EBP implementation in the clinical setting. Finally, mentoring and coaching strategies in academic and health-care institutions must fit the specific needs of the audience.


The author would like to thank all nurses who participated in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

DiCenso A, Guyatt G, Ciliska D. Evidence-Based Nursing: A Guide to Clinical Practice. 1st ed. Philadelphia (PA): Mosby; 2005.  Back to cited text no. 1
McKinney I, DelloStritto RA, Branham S. Nurses' use of evidence-based practice at point of care: A literature review. Crit Care Nurs Q 2019;42:256-64.  Back to cited text no. 2
Stevens KR. The impact of evidence-based practice in nursing and the next big ideas. Online J Issues Nurs 2013;18:4.  Back to cited text no. 3
Tang JH, Hudson P. Evidence-based practice guideline: Nurse retention for nurse managers. J Gerontol Nurs 2019;45:11-9.  Back to cited text no. 4
Aarons GA, Ehrhart MG, Farahnak LR, Hurlburt MS. Leadership and organizational change for implementation (LOCI): A randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implement Sci 2015;10:11.  Back to cited text no. 5
Birken SA, DiMartino LD, Kirk MA, Lee SY, McClelland M, Albert NM. Elaborating on theory with middle managers' experience implementing healthcare innovations in practice. Implement Sci 2016;11:2.  Back to cited text no. 6
Birken SA, Lee SY, Weiner BJ, Chin MH, Chiu M, Schaefer CT. From strategy to action: How top managers' support increases middle managers' commitment to innovation implementation in health care organizations. Health Care Manage Rev 2015;40:159-68.  Back to cited text no. 7
Kueny A, Shever LL, Lehan Mackin M, Titler MG. Facilitating the implementation of evidence- based practice through contextual support and nursing leadership. J Healthc Leadersh 2015;7:29-39.  Back to cited text no. 8
Reichenpfader U, Carlfjord S, Nilsen P. Leadership in evidence-based practice: A systematic review. Leadersh Health Serv (Bradf Engl) 2015;28:298-316.  Back to cited text no. 9
Innis J, Berta W. Routines for change: How managers can use absorptive capacity to adopt and implement evidence-based practice. J Nurs Manag 2016;24:718-24.  Back to cited text no. 10
Alshehry AS, Alquwez N, Almazan J, Namis IM, Cruz JP. Influence of workplace incivility on the quality of nursing care. J Clin Nurs 2019;28:4582-94.  Back to cited text no. 11
Al Mutair A. Quality of nursing care in Saudi Arabia: Needs for improvement mutair. J Nurs Care 2015:4:6.  Back to cited text no. 12
Alshehry A, Alquwez N, Almazan J, Namis I, Moreno-Lacalle R, Cruz JP. Workplace incivility and its influence on professional quality of life among nurses from multicultural background: A cross-sectional study. J Clin Nurs 2019;28:2553-64.  Back to cited text no. 13
Gifford W, Lefebre N, Davies B. An organizational intervention to influence evidence-informed decision making in home health nursing. J Nurs Adm 2014;44:395-402.  Back to cited text no. 14
Labrague L, McEnroe-Petitte D, D'Souza M, Cecily H, Fronda D, Edet O, et al. A multicountry study on nursing students' self-perceived competence and barriers to evidence-based practice. Worldviews Evidence Based Nurs 2019;16:236-46.  Back to cited text no. 15
Alqahtani N, Oh K, Kitsantas P, Rodan M. Nurses' evidence-based practice knowledge, attitudes and implementation: A cross-sectional study. J Clin Nurs 2020;29:2274-83.  Back to cited text no. 16
Babbie ER. The Practice of Social Research. Wadsworth (London): Cengage Learning; 2010.  Back to cited text no. 17
Shuman CJ, Ploutz-Snyder RJ, Titler MG. Development and testing of the nurse manager EBP competency scale. West J Nurs Res 2018;40:175-90.  Back to cited text no. 18
Shuman CJ, Titler MG. Development and Testing of the Nurse Manager EBP Competency Scale. Poster Submitted to the Virginia Henderson Global Nursing e-repository; 2017. Available from: https://sigma.nursingrepository.org/bitstream/handle/10755/621238/11_Shuman_C_p83264_1.pdf. [Last accessed on 19 March 2020].  Back to cited text no. 19
Caramanica L, Spiva L. Exploring nurse manager support of evidence-based practice: Clinical Nurse Perceptions. J Nurs Adm 2018;48:272-8.  Back to cited text no. 20
Birken S, Clary A, Tabriz AA, Turner K, Meza R, Zizzi A, et al. Middle managers' role in implementing evidence-based practices in healthcare: A systematic review. Implement Sci 2018;13:149.  Back to cited text no. 21
Schaefer JD, Welton JM. Evidence based practice readiness: A concept analysis. J Nurs Manag 2018;26:621-9.  Back to cited text no. 22
Warshawsky N, Cramer E. Describing nurse manager role preparation and competency: Findings from a national study. J Nurs Adm 2019;49:249-55.  Back to cited text no. 23
Trus M. Nurse Managers' Work-Related Empowerment: Evaluated in Connection to Power issues and Organizational Social Context. Tampereen Yliopisto; 2019. [Last accessed on 2020 Apr 12].  Back to cited text no. 24
Shuman CJ, Ehrhart MG, Torres EM, Veliz P, Kath LM, VanAntwerp K, et al. EBP implementation leadership of frontline nurse managers: Validation of the implementation leadership scale in acute care. Worldviews Evid Based Nurs 2020;17:82-91.  Back to cited text no. 25


  [Table 1], [Table 2], [Table 3]


Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded67    
    Comments [Add]    

Recommend this journal