Better hospital work environments linked to stronger nurse time management, study finds

Nurses working in Saudi Arabian public hospitals report stronger time management behaviours when they also rate their practice environments more favourably, according to a cross-sectional study published in BMC Nursing. The research, led by Ibrahim Saleh Altuwayjiri and Ahmed Mansour Almansour, surveyed 432 registered nurses recruited through convenience sampling from three public hospitals between February and April 2025, and found a strong statistical association between how nurses perceived their practice environment and how they reported managing competing clinical demands.

Participants completed two instruments: a study-specific modified 28-item configuration of the Practice Environment Scale of the Nursing Work Index (PES-NWI), a widely used measure of organisational characteristics such as staffing, support and nurse participation in hospital affairs, and the 17-item Nursing Time Management Scale (NTMS), which captures behaviours related to prioritisation, coordination and timely delivery of care. The mean PES-NWI score was 3.67 on a five-point scale, with a standard deviation of 0.96, while the mean NTMS score was 3.63 with a standard deviation of 1.07.

Among demographic characteristics, educational level stood out as the only one significantly associated with both outcomes in unadjusted comparisons. For the PES-NWI, the group difference yielded an F statistic of 8.796 with a p-value below 0.001 and an eta-squared effect size of 0.039; for the NTMS, a Welch-corrected F of 11.715 reached significance with an eta-squared of 0.048. Both effect sizes are small in absolute terms, indicating that education accounted for only a modest share of the variation in either measure.

The central result was the correlation between the two scales. PES-NWI and NTMS scores were strongly correlated, with a Pearson coefficient of 0.786 and a 95 percent confidence interval spanning 0.747 to 0.819, well beyond the threshold typically described as a strong association. To test whether this relationship could be explained by differences in the workforce itself, the researchers fitted a multivariable linear regression adjusting for gender, nationality, marital status, age, educational level and years of experience.

Even after these adjustments, the practice environment measure remained strongly associated with reported time management behaviour. The unstandardised coefficient was 0.864, with a heteroskedasticity-consistent HC3 standard error of 0.037, a standardised beta of 0.775 and a 95 percent confidence interval from 0.790 to 0.937. The model’s adjusted R-squared of 0.620 indicates that the measured variables together explained roughly 62 percent of the variance in time management scores, with the practice environment contributing the dominant share.

The authors are careful about what these numbers do and do not mean. Because the modified PES-NWI configuration lacks validated interpretive cut-offs, the scores cannot be mapped onto normative categories of good or poor practice environments. Moreover, both constructs were assessed concurrently using self-report instruments completed by the same nurses, so the association could reflect shared response tendencies rather than a genuine link between organisational conditions and behaviour.

The cross-sectional design imposes a further constraint. The data capture a single point in time, so the findings cannot establish whether favourable practice environments cause better time management, whether nurses who manage time well come to perceive their environments more positively, or whether unmeasured factors shape both. The convenience sampling from three public hospitals also limits how far the results generalise to other settings or to private and primary care facilities in Saudi Arabia, where evidence on this relationship remains limited.

Within those limits, the study offers a quantified picture of a relationship that hospital administrators and nursing leaders often discuss in qualitative terms. If subsequent longitudinal or interventional research confirms that improving organisational characteristics of the practice environment strengthens nurses’ ability to prioritise and coordinate care, the strong adjusted association reported here would provide an early statistical signal worth pursuing. For now, the findings stand as a measured observation: among 432 registered nurses in three Saudi public hospitals, perceived practice environment and reported time management behaviour moved together closely, and that relationship persisted after accounting for who the nurses were.

Subject of Research: The association between nursing practice environments and time management behaviours among registered nurses in Saudi Arabian public hospitals

Article Title: Nursing practice environment and time management behaviours among nurses: a cross-sectional study

Article References: Altuwayjiri, I. S., & Almansour, A. M. (2026). Nursing practice environment and time management behaviours among nurses: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05577-w

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05577-w

Keywords: nursing, practice environment, time management, cross-sectional study, PES-NWI, Saudi Arabia, public hospitals, self-report, linear regression, workforce, BMC Nursing, practice