Workplace Barriers to Nursing Autonomy in Saudi Hospitals: Implications for Management and Policy Under Vision 2030

This study explored how nurses perceive and navigate professional autonomy in Saudi hospital settings, with particular attention to the organisational and cultural barriers that shape autonomous practice.

Vision 2030 provides the strategic framework for transforming healthcare systems in Saudi Arabia, placing nursing autonomy at the centre of efforts to deliver safe, patient-centred care. Nursing autonomy influences clinical decision-making, job satisfaction and workforce retention.

A qualitative descriptive design was employed across two referral hospitals in northern Saudi Arabia. Purposive sampling was used to recruit staff nurses and nurse managers with direct experience of clinical autonomy in practice. Twenty-four semistructured interviews were conducted in Arabic with staff nurses (n = 16) and nurse managers (n = 8). Data were analysed using Braun and Clarke's reflexive thematic analysis.

Three themes were constructed through analysis: (1) structured dependency, reflecting how hierarchical systems restrict independent decision-making; (2) navigating interprofessional dynamics, addressing collaborative practice and role negotiation and (3) communication and professional identity, capturing how nurses' sense of agency is shaped by confidence, visibility and perceived professional status.

The findings indicate that nursing autonomy is variably supported and is shaped by the interplay of hierarchical structures, interprofessional dynamics and communication-based professional identity work.

A substantive misalignment exists between the strategic aims of Vision 2030 and nurses' day-to-day experiences of hierarchical control and structured dependency. Addressing this gap requires targeted interventions, including leadership development and sustained institutional commitment to shared governance models.