Comparing shared governance and psychological empowerment among nurses in Magnet and non-Magnet hospitals

Abstract

Globally, the nursing industry has never been watered down by challenges related to burnout, job satisfaction and high turnover rates. Healthcare organizations progressively employ strategies to improve nurse engagement in the decision making in the organization. One of these strategies is the Magnet recognition Program established by the American Nurses Credentialing Center which recognizes the institutions that exhibits excellence in the nursing practice and leadership. Despite these recognitions, there is scarcity of research that examined the association of Magnet recognition to the psychological empowerment of the staff compared to non-Magnet hospitals. The finding of this study may contribute insights for the hospital administrators and nursing leaders in strengthening nurses’ involvement in decision making within the organization, specifically supporting the Saudi Vision 2030 through healthcare transformation. This descriptive cross-sectional study research design explored perceived level of shared governance and psychological empowerment among nurses from Magnet and non-Magnet hospitals, as well as the differences between variables. A survey was conducted between March 2026-April 2026. at King Abdulaziz University Hospital (KAUH) and King Abdullah bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia. Convenience sampling will be used to recruit participants. Using the Index of Professional Nursing Governance (IPNG) Tool 3.0 and Psychological Empowerment Indicator (PEI), it was revealed that there was significant difference between the perceived level of shared governance among nurses in the Magnet and non-Magnet hospital. However, an absence in significant difference was noted in terms of psychological empowerment. In conclusion, the findings of this study implies that there is a need to foster a shared governance that improves the involvement of nurses in the organization’s decision-making and continue practicing empowerment strategies.

Introduction

The nursing profession is currently experiencing a global workforce challenge manifesting in high burnout rates, decreasing job satisfaction, and poor retention. In response, healthcare institutions are applying to the Magnet Recognition Program, a system established by the American Nurses Credentialing Center (ANCC) that recognizes healthcare organizations that excel in nursing practice, patient care, and professional development [1]. Aligned with the Magnet program’s philosophy are the principles of shared governance and structural empowerment, which describe how the involvement of nurses in decision-making promotes positive stakeholders and patient outcomes.

Shared governance describes a leadership framework in which nurses are given authority, responsibility, and accountability for their patients’ care. This contrasts with the conventional management style in which decision-making power is in the hands of top administrators. In shared governance, decision-making is collaborative, with staff nurses given equal opportunity to contribute to making policy and setting practice standards. While Magnet-recognized hospitals implement this organizational framework, non-Magnet hospitals may also practice a shared governance model without formal national recognition.

The presence of a formal structure of shared governance does not always equate to the empowerment of nurses. As defined by Gretchen Spreitzer, psychological empowerment in the workplace focuses on employees’ creativity and initiative-taking free from micro-management. It also reflects individuals’ personal drive and experiences across meaning, competence, self-determination, and impact [2]. Currently, there is a significant gap in nursing research on whether Magnet recognition translates into higher psychological empowerment among nurses.

This study aimed to fill this gap by examining the perceived level of shared governance and psychological empowerment among nurses from Magnet and non-Magnet hospitals and exploring the differences among the variables. Using a descriptive cross-sectional design, this research sought to determine if the governance structure of hospital is a factor in nurses’ higher level of perceived psychological empowerment. The findings were expected to provide valuable data on how to restructure leadership strategies to produce greater collaboration between levels of management and, subsequently, better healthcare outcomes. In alignment with Saudi Vision 2030, the healthcare sector must decentralize and actively raise standards of care, which begins with empowering nurses to make decisions. The goals of this research align with Vision by prioritizing quality of healthcare services and adherence to international standards.

Statement of the problem

This study aimed to explore the perceived level of shared governance and psychological empowerment among nurses in ANCC Magnet-recognized hospital and non-Magnet-recognized hospital in Saudi Arabia, particularly in seeking alignment with Saudi Vision 2030. Thus, this study sought to answer the following questions:

General research question

• What is the difference between the perceived level of shared governance and psychological empowerment among registered nurses in Magnet-recognized and non-Magnet-recognized hospitals?

Specific research questions

1. What is the level of perceived shared governance among registered nurses working in Magnet and non-Magnet hospitals?

2. What is the level of perceived psychological empowerment among registered nurses working in Magnet and non-Magnet hospitals?

3. Is there a significant difference in the perceived level of shared governance and psychological empowerment among registered nurses working in Magnet and non-Magnet hospitals?

Methodology

Design

This study employed a descriptive cross-sectional design to explore the perceived level of shared governance and psychological empowerment among nurses from Magnet and non-Magnet hospitals as well as the differences between variables of shared governance and psychological empowerment.

Setting and sample

This study was conducted at King Abdulaziz University Hospital (KAUH) and King Abdullah bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia. Both hospitals are under the management of the Ministry of Higher Education, which serves people throughout the Kingdom of Saudi Arabia.

Founded in 1976, KAUH is the first teaching hospital in Saudi Arabia. KAUH has a 104-bed capacity mainly for academic specialty purposes. Over the years, the institution has maintained an exemplary reputation, having been conferred the prestigious DAISY Award for Extraordinary Nurses in recognition of its outstanding contributions to the promotion of better health outcomes and the provision of exceptional care. In January 2026, KAUH was recognized as an ANCC Magnet Hospital, a designation awarded to institutions exhibiting excellence in nursing practice, patient care, and professional development [3].

For over a decade, KAAUH has delivered healthcare services that meet local, regional, and international standards. With a 406-bed capacity, KAAUH is a center of excellence in women’s, pediatric, and adolescent health. It also provides a wide array of integrated specialties, such as surgical, internal and critical care, emergency, and family medicine. KAAUH has been awarded Silver Recognition for Patient Experience from Planetree International, given to hospitals with a commitment to providing empathetic, safe, and respectful care, and the Leadership in Energy and Environmental Design Certificate for Green Building, given to institutions that promote sustainable building practices and environmental responsibility [4]. Although KAAUH is a non-Magnet hospital, these accreditations, certifications, and recognitions attest to the institution’s commitment to excellence.

To recruit participants, convenience sampling was selected for its practical accessibility in the clinical environment [5]. The study included 200 registered nurses, with 100 participants from KAUH and 100 participants from KAAUH, providing a relatively balanced representation of the two hospital settings. The response rate was 100% for KAUH and 100% for KAAUH, respectively. To avoid selection bias, the recruitment was monitored across two hospitals and across different clinical units to minimize overrepresentation of nurses from a single practice area. The researchers did not apply statistical weighting because the purpose was to compare nurses working in Magnet and non-Magnet hospital environments based on the participants who met the predefined eligibility criteria.

Inclusion and exclusion criteria were established to ensure the reliability of the data. Nurses who were registered, with more than one year of clinical experience at the current institution, had completed their institution’s orientation program, and had worked independently on patient care were included. Newly graduated registered nurses with less than one year of experience, part-time or temporary nursing staff, and nurses who had been employed for less than a year, regardless of their clinical experience elsewhere, were excluded.

Instruments

The study employed an English-language questionnaire consisting of three sections: (A) demographic data, (B) the 50-item Index of Professional Nursing Governance (IPNG), and (C) the Psychological Empowerment Instrument (PEI). Section A gathered information on the study population, such as age, gender, nationality, educational degree, years of experience in nursing, position title, and number of years working at the current organization.

Section B—the IPNG tool—consisted of 50 items with six subscales representing the dimensions of shared professional governance: control over personnel, access to information, influence over resources, participation in committee structures, control over practice, and goal setting and conflict resolution. The IPNG tool has been validated and is considered reliable. Participants were asked to indicate the focus of control at their hospital for each item using a 5-point Likert scale in which 1 = “nursing management/administration only,” 2 = “primarily nursing management/administration with some staff nurse input,” 3 = “equally shared by staff nurses and nursing management/administration,” 4 = “primarily staff nurses with some nursing management/administration input,” and 5 = “staff nurses only.” Subtotals and total scores were calculated to determine how the participants perceived the organization’s governance. Perceived type of governance was classified based on score ranges: A total score of 50–100 was classified as traditional governance, in which decisions are made only by management and administration. Scores of 101–200 were classified as shared governance, with 101–149 indicating that decisions are primarily made by management/administration with some staff input, 150 indicating decision-making to be equally shared by staff and management/administration, 151–200 indicating that decisions are made primarily by staff with some management/administration input, and 201–250 representing self-governance in which the decision-making is primarily left to the staff [6].

Section C of the questionnaire comprised the 12-item PEI by Spreitzer. Developed in 1995, the PEI is a self-orientation scale used to assess psychological empowerment in the dimensions of meaning, competence, self-determination, and impact using a 7-point Likert response scale. In this study, the mean of the four subdimension scores was used to create an overall empowerment score [7].

The study determined that the internal consistency reliability of the IPNG subscales was deemed acceptable. The subscales exhibited Cronbach’s alpha coefficients ranging from 0.83 to 0.93, while the overall measure of shared professional governance demonstrated Cronbach’s alpha coefficient of 0.89.

The subscales of psychological empowerment demonstrated acceptable levels of internal consistency reliability. The presence of Cronbach’s alpha coefficients, ranging from 0.95 to 0.97 for the subscales and 0.96 for the overall measure of psychological empowerment, serves as proof for this assertion.

A pilot study was conducted with five nurses who were not part of the study population to assess the questionnaire’s clarity, response options, wording, and format. Although the participants were part-time nurses with less than one year of experience at their current institution, they had more than one year of overall clinical experience, allowing them to assess the questionnaire’s clarity and usability. Five participants were considered sufficient for this preliminary usability assessment, which focused on identifying obvious problems rather than statistical validation. They completed the questionnaire within 10–15 min and confirmed that it was clear and concise. Therefore, no changes were made.

Data collection

The self-administered questionnaire was distributed electronically via Google Forms to nurses at KAUH and KAAUH in Riyadh, Saudi Arabia. The electronic survey package contained a cover letter, an information sheet, and the questionnaire. Data collection took place from March 2026–April 2026. To ensure ethical compliance, the information sheet provided a detailed description of the study and clearly stated that participants were under no obligation and were allowed to withdraw at any point. The estimated time required to complete the questionnaire was 10–15 min, ensuring a minimal disruption to clinical workflow.

Statistical treatment

Appropriate descriptive and inferential statistical treatments were employed to ensure that the research questions were answered accurately and clearly. Developers’ scoring guidelines were followed for each part of the instrument. Weighted mean was adopted to analyze the level of perceived psychological empowerment among nurses. Weighted mean is calculated by multiplying the weight of a particular by the number of items in a dataset and combining all the results [8]. Independent t-tests were used to assess differences in the perception of nurses working at a Magnet institution and those working at a non-Magnet institution. The independent t-test is an inferential statistical test used to determine whether two unrelated groups differ statistically [9].

Results

Table 1 shows the descriptive statistics for each of the six subscales of the IPNG. The scores were compared according to the guidelines set forth by the tool developer. For nurses in the Magnet hospital, the highest mean score was influence over resources (27.30 ± 9.68), which indicates that there is shared governance over resources in this workplace. The lowest mean score was for goal setting and conflict resolution (13.23 ± 5), which falls into the same governance classification as influence over resources. Influence over resources also had the highest mean (29.08 ± 9.73) for the non-Magnet hospital; however, this mean places it as self-governance in which the staff is the dominant group. The lowest mean score in the non-Magnet hospital was also goal setting and conflict resolution (11.52 ± 4.37), which puts it in the shared governance classification, indicating that this domain is dominated primarily by management/administration with some staff input. Both the Magnet hospital and the non-Magnet hospital had an overall mean score (124.39 ± 50.44 and 115.86 ± 47.51, respectively), which classifies them as governed by shared management/administration with some staff input.

Table 1.

Perceived level of shared governance among nurses working in magnet and non-magnet hospitals

Subscales	Ranges	Magnet Hospital		Interpretation	Non-Magnet Hospital		Interpretation
		Mean score	STD		Mean	STD
Control Over Personnel	25–48	22.68	12.405	Primarily management/administration with some staff input	18.22	9.62	Management/administration only
Access to Information	19–36	24.22	8.396	Primarily management/administration with some staff input	23.38	8.87	Primarily management/administration with some staff input
Influence Over Resources	19–36	27.30	9.689	Equally shared by staff and management/administration	29.08	9.73	Staff only
Participation in Committee Structures	17–32	19.00	7.89	Primarily management/administration with some staff input	17.47	7.71	Primarily management/administration with some staff input
Control Over Practice	15–28	17.96	7.06	Primarily management/administration with some staff input	16.19	7.22	Primarily management/administration with some staff input
Goal Setting and Conflict Resolution	10–20	13.23	5.00	Primarily management/administration with some staff input	11.52	4.37	Primarily management/administration with some staff input
Total	101–200	124.39	50.44	Primarily management/administration with some staff input	115.86	47.51	Primarily management/administration with some staff input

Table 2 reveals the level of perceived psychological empowerment within the hospitals studied. As shown in the table, the dimension meaning, which refers to the value of work goals involving a balance between work requirements and beliefs, values, and behaviors, has the highest mean score for both the Magnet and non-Magnet hospitals at 5.07 ± 2.03 and 4.89 ± 1.93, respectively. The lowest dimension for nurses from the Magnet hospital was competence at 4.71 ± 1.98, which refers to the belief in one’s capacity to perform tasks, and for the non-Magnet hospital, the lowest was self-determination, at 4.58 ± 1.75, which refers to the sense of having choice in initiating and regulating actions.

Table 2.

Perceived level of psychological empowerment among nurses working in magnet and non-magnet hospitals

Factors	Items	Magnet Hospital		Non-Magnet Hospital
		Mean	Average Mean (SD)	Mean	Average Mean (SD)
Meaning	PEI 1	5.21	5.07 (2.03)	5.03	4.89 (1.93)
	PEI 2	5.10		5.13
	PEI 3	4.89		4.53
Competence	PEI 4	4.80	4.71 (1.98)	4.58	4.61 (1.78)
	PEI 5	5.01		4.91
	PEI 6	4.32		4.34
Self-determination	PEI 7	4.65	4.81 (1.89)	4.64	4.58 (1.75)
	PEI 8	4.76		4.43
	PEI 9	5.01		4.67
Impact	PEI 10	5.09	5.02 (1.99)	4.88	4.69 (1.89)
	PEI 11	4.75		4.50
	PEI 12	5.23		4.67
	AVERAGE		4.90		4.69

Table 3 shows the difference between the Magnet hospital and non-Magnet hospital in terms of perception of shared governance. Levene’s test results of F = 6.498, p = .012 indicate that the variances of the two groups are not equal. Therefore, the equal-variances-not-assumed result was used because the homogeneity-of-variance assumption was violated. Hence, a standard t-test was used. The results of the independent test were t(198) = 2.226, p = .027, d = 0.019, indicating a significant difference between the level of perceived shared governance among nurses at the Magnet and non-Magnet hospitals.

Table 3.

Difference in perceived levels of shared governance between nurses working in magnet and non-magnet hospitals

	t-test for Equality of Means
	T	df	Sig. (2-tailed)	Mean Difference	Std. Error Difference	95% Confidence Interval of the Difference
						Lower	Upper
Equal variances not assumed	2.226	181.409	.027	.17381	.07808	.01975	.32786

Table 4 shows the differences between the nurses’ perceptions of shared governance at the Magnet hospital and at the non-Magnet hospital. Levene’s test results of F = 4.919, p = .028 indicate that the variances of the two groups can be assumed to not be equal. Therefore, the equal-variances-not-assumed result was used because the homogeneity-of-variance assumption was violated. Hence, a standard t-test was used. The results of the independent test were t (198) = 0.797, p = .42, d = 0.28, indicating no significant difference between the level of perception of psychological empowerment among nurses working at a Magnet and a non-Magnet hospital.

Table 4.

Difference in psychological empowerment between nurses in magnet and non-magnet hospitals

	t-test for Equality of Means
	t	df	Sig. (2-tailed)	Mean Difference	Std. Error Difference	95% Confidence Interval of the Difference
						Lower	Upper
Equal variances not assumed	0.797	193.287	0.426	0.18986	0.23820	− 0.27993	0.65966

Discussion

This study employed a descriptive cross-sectional, descriptive design to explore the perceived level of shared governance and psychological empowerment among nurses from Magnet and non-Magnet hospitals as well as the differences between variables. The findings of the study may provide essential data for leaders seeking strategies for management collaboration and the promotion of better healthcare outcomes.

For both groups, the subscale influence over resources had the highest mean scores. However, for the Magnet hospital, influence over resources is shared equally by staff and management/administration, while for the non-Magnet hospital, resources are fully controlled by staff. This is consistent with a study conducted in England that found that decisions, including resource control, were primarily shared equally by management and the staff. The results of the previous study found a positive relationship between leaders’ support and patient satisfaction linked to staff involvement in decision-making. Supportive management increased staff empowerment, making them more satisfied in their roles and ultimately able to deliver high-quality patient care [10]. Conversely, a study conducted among nurses in Jordan in which the subscale control over resources also had the highest mean found that this dimension continued to be handled by management [11]. Another study underpinned the vital role of management in the governance of resources: While staff are allowed some control over resources, management control is still favored in resource-related decisions [12]. A study in Turkey had similar results, finding that managers are largely in control of resources while nurses play a support role through empowerment and collaboration [13]. In the current study, control over resources was predominantly staff-led in the non-Magnet hospital. This is consistent with the findings of studies from Kenya and India in which employee involvement in decision-making was associated with improved rigor within the organization, such as strategy execution when resources are available [14, 15].

However, several studies have revealed potential tensions in employee/staff-driven governance systems, such as governance gaps and the risk of misalignment. In such cases, resource allocation must be partnered with monitoring, feedback, and performance indicators [14, 16]. The success of staff-led resource control also depends on the organization’s environment. When an organization recognizes coordination and accountability, staff-led control over resources leads to performance improvement; a lack of such recognition leads to inequities in resource distribution [17, 18].

Although, in the current study, there were differences in the two hospitals’ IPNG subscale scores, the total means revealed that most activities in both hospitals are primarily the responsibility of management/administration with some staff input. Several international studies have had similar results. While some found more input coming from nurses and staff, overall IPNG scores remained within the range representing shared governance [11, 12]. Additionally, a Saudi Arabian study reported that although some subscale scores fell under shared governance, the subscale personnel revealed limitations on nurses’ control, with overall IPNG scores ranging from traditional to moderately shared governance depending on the hospital unit under investigation [19]. In the current study, the observation that the two hospitals share the same classification based on total IPNG scores but vary in the subscales indicates management reform targeting a specific domain not classified under shared governance.

In terms of psychological empowerment, the current study found the dimension meaning to have the highest mean in both the Magnet and the non-Magnet hospital. This aligns with the findings of previous studies on Magnet hospitals using the same study instrument in which meaning was also observed as the dimension with the highest means.

This is consistent with the premise that the balance between work requirements and beliefs is most noticeable in Magnet hospitals [20, 21]. In settings with less structural empowerment, such as non-Magnet hospitals, meaning remains a key aspect of perceived empowerment [22, 23]. Ultimately, the Magnet hospital had a higher average overall mean than the non-Magnet hospital.

Several studies, including one in Saudi Arabia, have demonstrated that the environment of Magnet hospitals boosts the psychological empowerment of nurses, which makes these hospitals different from non-Magnet hospitals [21, 23–25]. While more studies provide evidence of psychological empowerment in Magnet hospitals, the results vary by geographical location, institutional context, and measures used. Psychological empowerment can also be elevated in non-Magnet hospitals if strong empowerment practices are adopted [26–29].

This study revealed a significant difference in the perceived level of shared governance between nurses in Magnet and non-Magnet hospitals. Across numerous studies utilizing the IPNG, nurses employed in Magnet hospitals uniformly reported higher perceptions of shared governance than did nurses from non-Magnet hospitals. These results can be seen across different countries and health systems, including the United States, Korea, Jordan, Finland, United Arab Emirates, and Saudi Arabia [12, 28, 29].

Conversely, the present study revealed no significant relationship in the level of perceived psychological empowerment between nurses working at Magnet and non-Magnet hospitals. Several studies support this finding, emphasizing the importance of translating structural conditions into individuals’ psychological experiences. While Magnet status is an important designation, its association with psychological empowerment depends heavily on practices at the unit level by individual nurses as well as other variables such as burnout rate, leadership style, and staffing and resource adequacy [30]. Other studies have postulated that Magnet status is purely dependent on how principles are implemented at the unit level and not on the hospital’s formal designation [31, 32].

Conclusion

This study explored the perceived levels of shared governance and psychological empowerment among nurses working in a Magnet or a non-Magnet hospital. Both hospitals were perceived as having shared governance primarily led by management with some staff input. However, differences were observed in some domains. Specifically, influence over resources garnered the highest means from both hospitals. The Magnet hospital was perceived as having a balanced distribution of roles between staff and management, and the non-Magnet hospital was perceived as having staff-led resource control.

The findings imply that in Magnet hospitals, giving nurses influence over resources promotes empowerment and improves patient satisfaction. At non-Magnet hospitals, staff-led control with the supervision of the management may lead to structural weakness.

In terms of psychological empowerment, the dimension of meaning received the highest mean score from both sets of nurses. This indicates that nurses in both hospitals perceive their work as valuable and aligned with their personal beliefs and professional goals. While the Magnet hospital reported a higher overall level of psychological empowerment, the difference between the two hospitals was not significant. This implies that perceived psychological empowerment is not influenced by a hospital’s governance status or designation but rather by professional practices and empowerment implementation at the unit level.

Additionally, the study revealed a statistical difference in the nurses’ perceptions of shared governance in their respective hospitals, suggesting that Magnet hospitals provide a clear structure that incorporates staff into the organization’s decision-making. However, the absence of significant differences implies that formal organizational recognition and structure alone do not equate to empowerment among nurses.

Overall, the findings of this study highlight the need to cultivate a shared governance that encourages collaboration between management, administration, and staff. Hospitals should increase shared governance in domains in which nurses’ involvement is currently limited and continue empowerment strategies that support nurses’ personal and professional growth. Ultimately, these efforts should improve both stakeholder satisfaction and patient health outcomes.

Limitations of the Study

Several limitations of the study were acknowledged when interpreting the findings. The descriptive cross-sectional design provides an overview of the perception of nurses’ during the study period; therefore, the findings describe the differences between the two settings but not the causal relationship between Magnet status and shared governance or psychological empowerment.

The study was conducted in two hospitals within Riyadh which may limit the extent to which findings can be applied to other healthcare settings in Saudi Arabia.

Abbreviations

IPNG

Index of Professional Nursing Governance

PEI

Psychological Empowerment Instrument

ANCC

American Nurses Credentialing Center

Author contributions

The authors confirm contribution to the manuscript as follows: study conception and design: L.E T. B, J. J. D; data collection: T.B, J.J.D, S.H, A.C, E.M, J.A.C, L.B and S.H.A; analysis and interpretation: L.E, K.E. M.A and S.H.A and L.E, T.B, B.G.L, W.T.D, J.O draft manuscript preparation and editing: L.E and C.S. All authors reviewed the manuscript.

Funding

This study received funding from Princess Nourah bint Abdulrahman University Researchers with supporting project number (PNURSP2026R837), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Data availability

The datasets generated and analyzed during the course of this study are accessible from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The Institutional Review Board at King Khalid University, Abha, Saudi Arabia approved study with Approval Number KKU-100-2026-15. Participants were assured of confidentiality and had the right to withdraw from the study at any time without penalty. All procedures were conducted in accordance with the Declaration of Helsinki. Informed consent to participate was obtained from all participants prior to data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.