The Healthcare system is an essential work environment that impacts the patients' and society's healthcare. With the dramatic population increase, professional nurse retention is necessary. One of the main principles of a sustainable Vision 2030 that Prince Mohammed bin Salman announced in 2016 was to support and improve the healthcare sectors [1]. Leaders and managers have significant roles in the healthcare system at the professional and environmental levels. Leadership plays a vital role in nursing, shaping nurses' work performance, autonomy, and decision-making abilities [2 ,3]. The nurse manager's leadership style significantly impacts the professional work environment and nurses' satisfaction. The nature of the healthcare environment requires nurses to have the ability to make decisions to respond to clients' needs. As a result, nurses require greater autonomy and participation in decision-making, which results in creativity and promoting critical thinking.
A crucial determinant of the sustainability of nursing leadership is the standard of nursing work performance [2]. As a result, nurse leaders must implement various leadership strategies and behaviors that enhance nursing performance, particularly those that promote nurses' willingness to perform better. Motivational leadership techniques impact an organization's goals and practices [4].. The efficacy of nurse leaders may be adversely affected by their heavy workloads, which can provide obstacles and difficulties in achieving optimal nursing performance and, eventually, delivering high-quality care. Therefore, managing the workload of nurse leaders is essential to improving overall nursing performance and the capability to influence and motivate nurses [5].
Autonomy in nurses' decision-making is vital to professional nursing care. Nurse decision-making is the most important feature that affects the quality of care needed for everyday tasks [3]. Nurse managers' roles are increasingly important in today's complex and continually changing healthcare organizations. Thus, the function of their practice has evolved, increasing their accountability, authority, and responsibility for unit management, patient care, and staff development in all aspects of their professional lives. A critical element of the professional role of nurses is the belief in autonomous nursing practice that can be expressed as more significant participation in clinical decision-making.
Leadership style can be defined as the ability to persuade others to help them accomplish a goal. Leadership and its styles have significant impacts on healthcare organizations and patient safety [6]. These styles affect everyone, from seniors to the newest manager. Furthermore, leadership style may affect the decision-making style and skills of the nurse manager, which is a crucial feature of the nurse role in healthcare organizations [7]. Decision-making is described in the literature interchangeably and uses several terms, such as clinical reasoning, clinical judgment, and decision-making. Autonomy in clinical decision-making is a process that requires nurses to be more knowledgeable, work within a supportive environment, and access appropriate information sources.
Leadership is present at every level of an organization, and its purpose is to enhance client care and services by advocating for professional practice. Staff engagement in decision-making, the organization's philosophy, and leaders' leadership style are indicators of effective leadership. Effective leadership styles have been shown to influence nurses' work performance positively. When nurse leaders exhibit strong leadership qualities, such as clear communication, vision, and support, it fosters a positive work environment that promotes collaboration, motivation, and engagement among nurses [2]. Studies have shown that the leadership style employed can significantly impact autonomy in nurses’ decision-making processes and overall work performance, leading to more effective nursing care and improved healthcare outcomes. The main results in these studies were a correlation between leadership style and job satisfaction, performance, and commitment among healthcare staff working in healthcare settings [2, 8, 9].
Background
Several research studies investigate the impact of managers' leadership styles and its impact on nurses, patients, and organizations. It influences employee engagement and job satisfaction, patient outcomes, organizational performance, leadership skills development, and nursing staff integration. Performing effective leadership styles and practices, nursing managers can create an empowering and supporting environment that enhances patient care, promotes professional growth, employee satisfaction, and retention, and drives organizational success [2, 4, 6, 10, 11]. Managers' leadership styles play a significant role in the involvement and commitment of nurses, making effective decisions, and improving nurses' autonomy and quality of nursing performance for the organization's benefit.
The relationship between managers or leaders and nursing staff had been tense and caused a communication barrier; therefore, nurses could not express their concerns regarding the care decisions needed for patients [12].. Leadership aims to influence and encourage followers to change [10]. The director, manager, and nursing leader are responsible for providing a work environment in which the nurse feels supported and motivated to provide high-quality work [13]. Providing high-quality nursing care to patients requires a compelling and intensely managed leadership style. To have an effective leadership style that motivates others, the manager must build the follower's trust [2]. Individuals, teams, and organizations engaged in decision-making must determine how to use their limited resources best to achieve their goals.
Although nurses are straining to provide high-quality health care to patients, the nurses' limitation of participation in clinical decision-making is ineffective and harmful to the safety of patients [3, 12]. Limited participation in autonomy in decision-making has been shown to have negative impact on staff job satisfaction and work performance in terms of mistrust and resentment in hospital management [14]. As a result, the tension among nurses increased, morale among the staff declined, and job satisfaction and organizational commitment decreased.
Nurses need to be influential decision-makers and have autonomy to meet their patients' demands in a healthcare system that is constantly changing. Healthcare organizations face unpredictability due to shifts in patient demands, medical advances, and available resources, necessitating a rethinking of their organizational structure and treatment methods [15]. Limited research studies have been found focusing on the influence of managers' leadership style on fostering work performance and autonomy in nurses' clinical decisions making. Therefore, this study aims to evaluate the role of leadership styles in fostering work performance and autonomy in nurses’ decision-making in the Hospitals.
Study Aim and Objectives
This study aims to evaluate the role of leadership styles in fostering work performance and autonomy in nurses’ decision-making in the Hospitals. The main objectives were to investigate the impact of leadership style on autonomy in nurses’ decision-making and to identify the impact of leadership style on nurse’s work performance.
Research Hypothesis
The following null hypotheses were tested at α of .05 level of significance:
Ho1 There is no relationship between leadership style and autonomy in autonomy in nurses’ decision-making and work performance.
Ha, there is a relationship between leadership style and autonomy in nurses’ decision-making and work performance.
Significance of the Study
Nursing managers and leaders could impact autonomy in nurses’ decision-making and work performance. Leadership style dramatically impacts how the nursing staff performs at work. Transformational leadership, for example, most often positively impacts work performance through inspiration, motivation, and personalized support. While authoritarian and laissez-faire leadership styles may be unfavorable to productivity and satisfaction among staff members, transactional leadership has beneficial uses. Establishing strong leadership practices is essential for organizations because it empowers workers, creates a pleasant workplace atmosphere, and encourages ongoing advancement and improvement, all of which contribute to improved job performance and overall success [16].