Clinical Nurses’ Involvement in Decision-Making Process at the Nursing Unit-Based Council Level: A Cross-Sectional Study of Shared Professional Governance in the Kingdom of Saudi Arabia

<b>Background:</b> The implementation of shared governance within the nursing practice results in heightened satisfaction among nurses and enhances the quality of care provided. Shared governance fosters collaborative and proactive relationships among nurses and healthcare providers, while also cultivating a sense of confidence among nurses. However, evidence suggests that a lack of awareness, reliance on traditional governance, and inadequate shared governance structures among nurses continue to exist at the unit-based council (UBC) level, including those in the Kingdom of Saudi Arabia (KSA). <b>Purpose:</b> The present study aimed to assess the extent of clinical nurses' perceptions concerning shared governance at the UBC level, and to examine the variations and relationships in their perceptions based on demographic and work-related characteristics. It further explored the demographic and work-related factors that affect the overall perceptions of shared governance among clinical nurses. <b>Methods:</b> This quantitative study utilized a cross-sectional design and was carried out in three governmental hospitals in the KSA. The sample comprised 669 nurses, who were selected using a convenience sampling method. The Index of Professional Nursing Governance (IPNG) tool was utilized for data collection conducted between February 2025 and April 2025. Descriptive statistics alongside the <i>t</i>-test and analysis of variance (ANOVA), Pearson-r correlation coefficient, and multiple linear regression were utilized for data analysis. Significant findings were drawn when <i>p</i> ≤ 0.05. <b>Results:</b> The average perception of shared governance among clinical nurses at the UBC level was 180.42 out of 430, suggesting that decision-making occurs collaboratively between nurses and management. Significant differences in the average level of clinical nurses' perceptions of shared governance were noted in relation to their educational qualifications (<i>F</i> = 5.015, <i>p</i> = 0.001) and nursing units (<i>F</i> = 4.157, <i>p</i> = 0.010). The hospital in which clinical nurses were employed (<i>r</i> = 0.098, <i>p</i> = 0.037) and nursing units (<i>r</i> = 0.087, <i>p</i> = 0.020) exhibited significant correlations with their overall shared professional governance. Furthermore, the hospital where clinical nurses were employed (<i>β</i> = 0.406, <i>p</i> = 0.001, 95% confidence interval [CI] = 0.166, 0.646) and nursing units (<i>β</i> = 0.326, <i>p</i> = 0.038, 95% CI = 0.018, 0.314) served as predictors of their overall professional shared governance. <b>Conclusions:</b> Clinical nurses in this study showed an initial or relatively low level of shared governance at the UBC level. The overall finding highlights a critical need for nursing managers and leaders to enhance the level of professional shared governance among clinical nurses, which may result in improved nurse retention and overall quality of nursing care. It is crucial to consider clinical nurses' educational qualifications and working environment at the UBC level when aiming to enhance their level of professional shared governance.