Clinical Learning Environment, Decision Making Competencies and Work Engagement Among Operating Room Nurses in a Selected Private Hospital: A Cross-Sectional Study

Abstract

The operating room (OR) represents a dynamic and high-stakes clinical setting where learning opportunities, decision-making competencies, and work engagement collectively shape patient safety and surgical outcomes. Exploring the interrelationship of these factors is essential in identifying strategies that optimize nurse performance and strengthen workforce retention. This study investigated the associations between the clinical learning environment (CLE), decision-making competencies, and work engagement among operating room nurses in a private tertiary hospital in Laguna, Philippines. Utilizing a descriptive-correlational design, the study employed total enumeration sampling of 18 registered nurses assigned to perioperative care. Data were gathered through a structured, self-administered questionnaire encompassing four sections: demographic profile, Clinical Learning Environment Tool (CLET), Decision-Making Competence and Style Scale, and the Work Engagement Scale. Statistical analyses included descriptive measures, Pearson’s correlation, and significance testing at the 0.05 alpha level.
Findings revealed that respondents were predominantly female (61%), within the 21–30 age group (44%), largely bachelor’s degree holders (94%), and with 2–3 years of OR experience (33%). Perceptions of the CLE were favorable, with the highest evaluations in skills development (M = 3.87) and feedback mechanisms (M = 3.73). Decision-making competence was also rated positively (M = 3.75), particularly in structured approaches and probability-based judgments, though a notable deficiency emerged in training related to decision science (M = 1.72). Work engagement levels were strong, with dedication receiving the highest score (M = 4.00). Correlational analysis indicated no significant association between the CLE and work engagement (p > 0.05). However, a weak but significant negative correlation was observed between pedagogical atmosphere and decision-making competence (r = –0.47, p = 0.0492), suggesting that highly prescriptive supervisory climates may inadvertently hinder independent judgment.
The results suggest that OR nurses in this setting perceive themselves as engaged and competent within a supportive learning environment, yet critical gaps persist in pedagogical reinforcement and formal decision-making training. To address these, the study recommends the adoption of a Comprehensive Clinical Leadership and Reflective Practice Program (CCLRPP) aimed at strengthening mentorship quality, feedback processes, and evidence-based decision-making practices.