Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : LC22 - LC26 Full Version

Decision-making Styles and Job Security among Nurses Working at Public Hospitals in Saudi Arabia: A Cross-sectional Multicentre Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55689.16520
Ahmed Alzahrani, Ghareeb Bahari, Kholoud Alharbi, Naji Alqahtani

1. MSN Student, Department of Community Health Nursing, King Saud University, Riyadh, Saudi Arabia; Registered Nurse at Jeddah General Directorate Academic Affair-Jeddah Training Center, Saudi Arabia. 2. Assistant Professor, Department of Nursing Administration and Education, King Saud University, Riyadh, Saudi Arabia. 3. Teaching Assistant, Department of Nursing Administration and Education, King Saud University, Riyadh, Saudi Arabia. 4. Assistant Professor, Department of Nursing Administration and Education, King Saud University, Riyadh, Saudi Arabia.

Correspondence Address :
Dr. Ghareeb Bahari,
P.O. Box 642, Riyadh 11421, Saudi Arabia.
E-mail: gbahari@ksu.edu.sa

Abstract

Introduction: Decision-making and job security have been linked to increased motivation and productivity in nursing. However, research on these variables in the Saudi context is limited.

Aim: To examine the association between decision-making styles and job security among nurses working at public hospitals in Saudi Arabia.

Materials and Methods: A cross-sectional, multicentre study was conducted on a convenience sample of 295 nurses working at four public hospitals in Saudi Arabia from March to June of 2021. Data were collected through an online self-administered survey. The Nurse decision-making instrument was used to measure decision-making style. Job security scale was utilised to measure job security among nurses. An independent sample t-test, Pearson’s coefficient correlation, one-way Analysis of Variance (ANOVA), and multiple linear regression analyses were conducted using Statistical Package for the Social Sciences (SPSS).

Results: Nurses reported intuitive decision-making (Mean=87.85, SD=21.08) and a moderate level in job security (Mean=20.93, SD=7.48). A significant difference was found between average income level and job security (p-value<0.05). Decision-making style was also significantly and positively associated with job security (r=0.450, p<0.05). In a multivariate analysis, income level (β=0.182, p<0.05) and decision-making style (β=0.436, p<0.05) were predictors of job security.

Conclusion: Decision making style was found associated with job security. Improved patient care outcomes require excellent nurse decision-making.

Keywords

Healthcare workers, Job insecurity, Performance, Workforce

Nursing is one of the largest professions and it plays a significant role in healthcare systems’ constant changes. To address these changes and client needs, the healthcare field requires competent decision-makers (1). Healthcare systems depend primarily on healthcare providers, the majority of which are nurses. However, the high demand for nursing care, along with a global shortage of nurses, remains challenging and needs to be addressed (2). Shortage of nurses is a great concern in some countries such as Saudi Arabia. It was found significantly associated with high nurse turnover thus, leading to a lower quality of patient care and poor work performance (3),(4).

Decision-making is “an interaction between a decision maker and a decision-making task” (5). Decisions are necessary in nursing and should be made to advance clinical and administrative work and the overall health system (6). Decision-making is also important in making choices that improve organizations. When faced with multiple patients' needs, the nurse should establish priorities and determine the order in which they assist their patients.

In addition, decision-making is an important part of human and managerial actions, but its processes are often difficult to understand. More importantly, understanding which factors must be taken into account when making decisions is necessary for positive outcomes (7). Important decision-making styles are: analytic and intuitive. Analytic nurse decision-making necessitates combining patient cues to arrive at a logical decision that helps meet the patient's needs. Intuitive nurse decisions are made based on experience and identifying similarities between patient care situations and developing awareness over time (1),(8). Both can be used for making effective decisions. Though experienced nurses are secure in their abilities, this confidence may not translate into competent decision-making (1). One of the causes of dissatisfaction and job insecurity among nurses in Saudi Arabia is the requirment of making decisions that are beyond the scope of nursing (9).

Job security refers to the feeling that a person will be able to keep his or her job in the near future with no pressures or issues. Job security is associated with employees’ quality of work life and contributes to higher productivity (10). Further, it may have a detrimental impact on employees’ job satisfaction and commitment, as well as on their health and well being at work (2). Employees with fewer participatory decision-making opportunities can also have higher levels of job insecurity (11). This highlights the importance of job security for facilitating everyday work and clinical decisions, as well as for providing high quality care.

Several studies have been conducted on factors associated with job security and its importance for employee engagement. For example, research has supported that employees feels more secure and a part of the organization if they are involved in decision-making and revision of goals (12). Further, Achim N et al. reported a positive association between job security and decision making (13). Some research has also focused on the association of job insecurity with perceived work related symptoms, job satisfaction, and employee turnover (14). It is essential to present evidence confirming the potential relationship between decision-making and job security because decision-making is important for contributing to a sense of belonging and security at work. This relationship has not yet been studied in Saudi Arabia. Therefore, the purpose of this study was to examine the relationship between decision-making and job security among nurses working at public hospitals in Saudi Arabia.

Study Objectives

The following aims were addressed:

• Describing the style of decision-making and level of job security among a sample of nurses working at hospitals;
• Identifying factors associated with both decision-making style and job security;
• Determining the predictors of job security among nurses in Saudi Arabia.

Based on the study objectives, there were two hypothesis for the study; A null hypothesis that there maybe no association between the decision-making style and job security among nurses, and a research hypothesis that the decision making style may be positively associated with job security among nurses.

Material and Methods

A cross-sectional, multicentre study was conducted on 295 nurses working at four hospitals between March and June 2021. The hospitals were coded as Type 1, Type 2, Type 3, and Type 4 for confidentiality purposes. The four hospitals were selected based on convenience and operational feasibility. They are located in three different regions of Saudi Arabia: one in the Makkah region (Type 1), one in the Al-Baha region (Type 2), and two in the Riyadh region (Types 3 and 4). The hospitals in the Makkah and Al-Baha region were public hospitals managed by the Ministry of Health to provide healthcare to citizens and foreigners. One of the hospitals in the Riyadh region (Type 3) was a specialized tertiary hospital, while the other (Type 4) was a teaching hospital that serves university students. The study was approved by the Instituitional Review Boards located at King Saud University (KSU-HE-21-194), King Fahad Medical City (21-043E), East Jeddah General Hospital (H-02-J-002), and Health Affairs in Al-Baha region (no number). Participation was voluntary, and informed consent was ensured.

Sample size calculation: A convenience sample was used to find eligible and interested participants (15). Total number of nurses in the four selected hospitals may be around 1200. The minimum sample size estimated was 292 with a proportion (50%), a 95% confidence interval and a margin of error of 5% using the Raosoft sample size calculator (http://www.raosoft.com/samplesize.html) (16). Because the study is multisite, the authors planned to have the sample divided as evenly as possible among the four hospitals.

Inclusion and Exclusion Criteria: Saudi male or female nurses who worked at one of the selected hospitals for at least one year; 2) Who provided daily care to patients; and 3) Who had the ability to respond to the survey in English were included in the study. Nurses holding administrative or educational positions were unable to participate, as they did not make clinical decisions in patients’ daily care.

Study instruments

A structured survey including demographic variables and two selected instruments was created. Common demographic and associated variables included: age, gender, level of education, income level, years of experience, employment status, work ward, and hospital type. The two instruments that measured decision-making style and job security were:

Decision-making style: The Nurse decision-making instrument by Lauri S and Salantera S was used to assess the decision-making style (4). A shortened version of the original 56-item instrument was used, which included 24 items scale and four subscales; each included six items ranged from 1 (never or almost never) to 5 (almost always or always). Even numbered items indicated decision making in unstable tasks. For instance, “I make assumptions about forthcoming nursing problems during the first contact with the patient.” Odd numbered items were about decision making in structured tasks. For example, “On the basis of my advance information, I specify all the items I intend to monitor and ask the patient about (17).” Scores were added up and the sum total was interpreted as follows: <67 points: decision-making was analytically oriented, 68-78 points: decision-making was flexible and it was both analytical and intuitive depending on the situation, >78 points: decision-making was intuitively oriented. Cronbach’s alpha of the shortened version was determined at a satisfactory level of 0.86 (17). Permission to use the scale was obtained (S., Salantera, personal communication, December 11, 2020).

Job security: Job security was measured using a scale developed by Kraimer ML et al., (17). The tool originally included 10 items measured with a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). High scores indicated a high level of job security as perceived by the respondents, while lower scores reflected a sense of job insecurity. Cronbach’s α was reported at 0.90, indicating an excellent internal homogeneity for the scale (18). In the current study, a shortened version of the scale with five items (M., Kraimer, personal communication, December 11, 2020) was used as its α coefficient was determined at 0.82 in a previous study (19). The items were: 1) I will be able to keep my present job as long as I wish; 2) I am confident that I will be able to work for my organization as long as I wish; 3) My job will be there as long as I want it; 4) I am secure in my job; and 5) My job is not a secure one (reverse scored). Scores ranged from 5 to 35, with higher scores indicating high levels of job security. The mild, moderate and severe levels of job security were not explained in the original article. The authors wrote them based on their judgement and to facilitate readers’ understanding of the score/range levels.

Data Collection Procedure

Surveys were collected from March through June of 2021. Due to COVID-19 restrictions, data collection was performed using an anonymous questionnaire created on a secure online platform. The research team was responsible about distributing the survey form to nurses. The study link was sent to unit managers at the selected hospitals to share it with nurses. Further, word-of-mouth and personal references were also used to complete participants’ recruitment process. Estimated time to complete the questionnaire was approximately 15 minutes. The online survey link was closed after responding to the last item and clicking the ‘submit’ icon.

Statistical Analysis

Collected data were analyzed using SPSS (v. 26) (IBM Corp., Armonk, NY, USA). Frequency distributions were applied to determine missing data and identify data entry errors. No more than 3% of data were missing per item. The missing data were replaced with the item mean. Some variables were changed into binary categories for analysis. Descriptive statistics and central tendency measures were run to describe the sample and study variables, respectively. An independent sample t-test, Pearson’s coefficient correlation, and one-way ANOVA were all used where appropriate. A multiple linear regression test was also run to determine the predictors of job security, which was the dependent variable.

Results

A total of 295 nurses from the four hospitals responded to the survey, with the majority (55.3%) from the Type 4 hospital. Of the respondents, 82% were females. A majority of them were working in nursing with permanent employment (52.9%) and for more than 5 years (65%) (Table/Fig 1).

Respondents reported more intuitive decision-making (mean=87.85, SD=21.08, range: 33-120) and a moderate level in job security (mean=20.93, SD=7.48, range: 5-35).

No significant differences were reported in the means of the selected demographic variables and decision-making style (p-value>0.05). However, a significant difference was found between average income level and job security (p-value<0.05) (Table/Fig 2).

For the Pearson coefficient test among continuous variables, only decision-making style showed a significant, positive, and moderate relationship with job security (r=0.450, p-value <0.001) (Table/Fig 3). For ANOVA analysis, no statistically significant differences were found between the means of both work ward (F[5,294]= 1.494, p=0.192) and hospital types (F[3,294]=1.181, p= 0.317) and job security.

All factors, including demographic factors and decision-making style, were subjected to multiple linear regression analysis to help identify predictors of job security (Table/Fig 4). As in bivariate analyses, income level (β=0.182, p<0.05) and decision-making style (β=0.436, p <0.05) were found to have significant association with job security. The regression model was found to be significant (F [9, 294]=10.241, p<0.05, R2=0.244).

Discussion

The present study was developed to evaluate the relationship between decision-making and job security among nurses working in Saudi Arabia. The findings show that nurses were intuitive in decision-making and feel secure in their work. Similar to our results, a cross-sectional study by Farčić N et al. reported high levels of clinical decision-making for nurses (20). However, this study included 568 hospital nurses and 129 nursing students, which means the findings apply to both nurses and students, unlike our study, which included only hospital nurses. To ensure the best outcomes, decision-making should be a multifaceted approach to research, education, and practice (1). Expert nurses can also use intuitive decision-making process to better understand difficult medical situations, provide more accurate assessment, and ensure quality care to patients (21). Though job insecurity is a little-discussed topic (2), our findings were similar to those reported by Burke RJ and Singh P (22), who found low levels of job insecurity in their sample. Based on that, more research could improve our understanding of the factors that influence job security in nursing practice.

In bivariate analyses, there was a significant difference found between average income level and job security. A previous study in South Korea found that low income was a risk factor for a higher level of job insecurity (23). Low-income levels have been shown to impact nurse sleep quality, (24) which in turn may lead to feelings of job dissatisfaction and insecurity. Our findings suggested that years of experience would have a relationship with job security, yet no statistically significant relationship was found. To understand these results, we may need to consider potential factors influencing the relationship between years of experience and job insecurity. For example, nurses who live close to the workplace prefer to stay in the same place for years; a common custom in Saudi Arabia. This can also contribute to a sense of security at work. The bivariate analysis also showed that decision-making has a significant and positive relationship with job security. This is backed by previous findings that showed that being involved in decision-making can improve employees’ feelings of control and help them cope with job insecurity (25).

In multivariate analysis, both income level and decision-making style remained significantly associated with job security. This is similar to the findings of Burke RJ and Singh P, (22) but opposite to findings reported by Sokhanvar M et al., (26) who found that monthly income had no significant relationship to job security. Mosadeghrad AM et al., reported moderate levels of job security among hospital nurses and attributed this to multiple issues, including inadequate income and insufficient involvement in decision-making (27). Adequate income and the promotion of decision-making are essential factors for increasing job satisfaction, reducing insecurity, and reducing employee intent to leave the workplace (2),(9). Therefore, interventional initiatives should help nurses feel more secure in their jobs, lower their work burdens, and improve their decision-making and relationship-building skills (28). Additionally, more research examining potential job security influences such as such as organizational structure and/or percentage of registered nurses is recommended.

Study Implications: This study reported nurses to be more intuitive in decision-making and to have a moderate level of job security. Nursing administrations can utilise these findings to create training programs and initiatives that help nurses enhance their decision-making abilities and sense of belonging. Further, they can use highly standard guidelines to improve nurses’ decision-making skills. Income level was found to correlate with job security, and an appropriate income level is vital for nurses to be more satisfied with their jobs. The pay scale for Saudi Arabian nurses should thus be evaluated and adjusted. Finally, decision-making was found to be significantly associated with job security, hence rejecting the null hypothesis. Thus, greater research into the potential challenges of this relationship is recommended.

Limitation(s)

It is important to note that the current study has certain limitations. Despite the use of a multisite methodology, the convenience sampling strategy may have added sampling bias, limiting our results to this particular sample. It is also more difficult to report cause and effect relationships in cross-sectional research than it is with longitudinal studies. Another potential problem was the study’s geographical location, which makes it difficult to use the results outside of this context. Further, the study was conducted at hospitals serving the public sector; therefore, the findings may not apply to private hospitals. Additionally, no comparison was made between Saudi and non-Saudi nurses, which is significant given the potential for differences in decision-making and job security between the two groups. Therefore, in addition to Saudi nurses, future research should consider the degree of non-Saudi nurses' decision-making ability at Saudi hospitals and how this may affect their feeling of job security.

Conclusion

In this study, decision-making was found to have a significant relationship with job security in clinical practice. Both variables were important for motivation and work productivity. Improved patient care outcomes require excellent nurse decision-making skills. Lack of job security may have negative effects on one’s health, well being, and work-related attitudes and actions. Job insecurity is rarely studied in the literature and requires further research. Causes of job insecurity or poor decision-making in Saudi nursing may also be of interest for future studies.

Acknowledgement

The authors are thankful to the Deanship of Scientific Research, College of Nursing Research Center at King Saud University for funding this research.

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DOI and Others

DOI: 10.7860/JCDR/2022/55689.16520

Date of Submission: Feb 14, 2022
Date of Peer Review: Mar 10, 2022
Date of Acceptance: Apr 14, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 19, 2022
• Manual Googling: Apr 13, 2022
• iThenticate Software: May 03, 2022 (11%)

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