The Nexus of Practice Environment, Management, and Nursing Competency: A Cross-Sectional Study of Community Nursing Services in Saudi Arabia's Northern Border Region.

چکیده اصلی

AIM: This study aimed to examine the associational role of the nursing practice environment (NPE) in the relationship between nursing management practices (NMP) and community health nursing competency (CCNC) among primary healthcare (PHC) nurses in Saudi Arabia. BACKGROUND: Although the NPE is established as a determinant of care quality and patient safety in hospital settings, its function as an organizational mechanism linking managerial practice to nursing competency in community and PHC contexts remains underinvestigated, particularly within administratively peripheral regions undergoing health-system transformation. METHODS: A descriptive, cross-sectional, correlational survey was conducted with 205 registered nurses working in PHC centers across the Northern Border Region (Arar), Saudi Arabia. Data were collected using a structured questionnaire incorporating an adapted quality of nursing work life subscale set, the practice environment scale of the nursing work index (PES-NWI), and the community care nursing competence (CCNC) scale. Reporting followed the STROBE guidance. Normality was assessed via the Shapiro-Wilk test; parametric analyses were supplemented with nonparametric checks. Pearson correlations, hierarchical multiple regression, and bias-corrected bootstrap mediation analysis (5000 resamples) were performed. Common method bias was assessed using Harman's single-factor test and a marker-variable procedure; variance inflation factors (VIFs) were computed for all regression models. RESULTS: All three constructs were strongly and positively associated (r = 0.76-0.79, p < 0.001). The NMP and NPE composites jointly explained 71.5% of the variance in CCNC (F [10, 191] = 44.62, p < 0.001), with NMP (beta = 0.47) and NPE (beta = 0.38) as substantial independent predictors. VIF values did not exceed 4.2, indicating acceptable multicollinearity. Harman's single-factor test extracted a first factor accounting for 43.6% of the total variance, below the 50% threshold, and the marker-variable test yielded a change in fit of delta R2 = 0.002, suggesting that common method variance did not critically inflate observed associations. The NPE significantly and partially mediated the NMP-CCNC pathway (indirect effect = 0.33, 95% CI [0.11, 0.52]; Sobel Z = 6.15, p < 0.001), accounting for approximately 38.4% of the total effect. Consistent with the cross-sectional design, these findings reflect association rather than causal pathways. CONCLUSIONS: CCNC is associated with both NMP and the practice environment, with the NPE serving as a significant statistical intermediary in this pathway. These associations are consistent with organizational frameworks positing that work context conditions translate managerial inputs into professional capability. IMPLICATIONS FOR NURSING MANAGEMENT: Strengthening unit-level management capacity and the practice environment represents a potentially feasible and evidence-informed strategy for advancing community nursing competency in PHC settings, particularly in geographically peripheral regions undergoing reform. Longitudinal and experimental designs are needed to establish directionality.

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