Perceptions of Nurse Managers and Supervisors on the Scope of Nursing Practice Following the 2023 National Regulatory Update in Saudi Arabia: A Qualitative Study in Makkah Cluster Hospitals.

backgroundIn Saudi Arabia, nurses have long lacked a formally defined scope of practice, contributing to role ambiguity and role overlap. In 2023, the Saudi Commission for Health Specialties (SCFHS) released the first national Scope of Nursing and Midwifery Practice document. This study explored how nurse managers and supervisors perceived the scope of practice following this update in Makkah Cluster Hospitals.

methodsAs the second, explanatory phase of a larger sequential explanatory mixed-methods study, a qualitative descriptive study was conducted between May and August 2025 with 20 nurses in managerial roles (Nursing Directors, Nursing Supervisors, and Head Nurses) at two hospitals within the Makkah Health Cluster. Participants were selected through purposive sampling, restricted to managerial and supervisory positions to capture a cross-departmental, organizational perspective on scope enactment. Interviews were conducted via Zoom in Arabic, translated into English, and analyzed using inductive thematic analysis consistent with the approach of Braun and Clarke. Trustworthiness was addressed through credibility, transferability, dependability, and confirmability, with reporting guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).

resultsFour themes emerged from the accounts of the 20 participants (10 men and 10 women from both hospitals): (1) expanding the scope of nursing practice, (2) bridging the gap between training and practice, (3) overcoming barriers to full professional practice, and (4) promoting nurse empowerment and accountability. Participants described a tension between a formally defined scope and inconsistent enactment across departments and shifts. Unclear job descriptions, administrative constraints, staffing shortages, and resource deficits were the primary barriers, whereas autonomy and continuous development were identified as essential enablers.

conclusionsThe nurse managers and supervisors in this study perceived the scope of nursing practice as variably enacted and frequently constrained following the 2023 SCFHS update. These findings suggest that regulatory publication alone may be insufficient, highlighting the need to operationalize the framework through revised job descriptions, simulation-based professional development, adequate staffing, and leadership-supported autonomy aligned with Saudi Vision 2030. Because these findings reflect the perspectives of nursing leaders rather than bedside clinical nurses, their application to direct patient care contexts should be interpreted with appropriate caution.