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

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.

clinical learning environment, decision-making competencies, work engagement, operating room nurses, correlational study

1. Aiken, L. H., Sloane, D. M., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., Maier, C. B., Moreno-Casbas, M. T., Ball, J. E., Ausserhofer, D., & Sermeus, W. (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 26(7), 559–568. https://doi.org/10.1136/bmjqs-2016-005567 [Google Scholar] [Crossref]

2. Alibudbud, R. C. (2023). Burnout among Filipino nurses: Causes, consequences, and countermeasures. Philippine Journal of Nursing, 93(1), 45–52. https://doi.org/10.3860/pjn.v93i1.103 [Google Scholar] [Crossref]

3. Appinio. (2023). Correlation research: Definition, methods, and examples. Appinio Research Guide. https://www.appinio.com/en/blog/correlation-research [Google Scholar] [Crossref]

4. Bhandari, P. (2021). Correlational research design: Methods and examples. Scribbr. https://www.scribbr.com/methodology/correlational-research/ [Google Scholar] [Crossref]

5. Biabani, M., & Izadpanah, S. (2019). Kolb’s experiential learning theory as a conceptual framework for teaching and learning in nursing education. Journal of Nursing Education and Practice, 9(6), 1–8. https://doi.org/10.5430/jnep.v9n6p1 [Google Scholar] [Crossref]

6. Bujar, M., Donelan, R., O’Kelly, J., & McAuslane, N. (2017). Assessing the quality of decision making in the development and regulation of medicines: Development, reliability, and validity of a new instrument. Frontiers in Pharmacology, 8, 929. https://doi.org/10.3389/fphar.2017.00929 [Google Scholar] [Crossref]

7. Burgess, A., van Diggele, C., & Mellis, C. (2020). Mentorship in the health professions: A review. Clinical Teacher, 17(4), 356–361. https://doi.org/10.1111/tct.13036 [Google Scholar] [Crossref]

8. Crossman, A. (2020). Understanding purposive sampling. ThoughtCo. https://www.thoughtco.com/purposive-sampling-3026727 [Google Scholar] [Crossref]

9. Falguera, C. C., Santos, R. A., & Delos Reyes, M. E. (2025). Pedagogical atmosphere in clinical settings: Implications for nursing education. Nurse Education Today, 126, 105768. https://doi.org/10.1016/j.nedt.2024.105768 [Google Scholar] [Crossref]

10. Falguera, C. C., Santos, R. A., & Delos Reyes, M. E. (2025). Pedagogical atmosphere in clinical settings: Implications for nursing education. Nurse Education Today, 126, 105768. https://doi.org/10.1016/j.nedt.2024.105768 [Google Scholar] [Crossref]

11. Johansson, U. B., Kaila, P., Ahlner-Elmqvist, M., Leksell, J., Isoaho, H., & Saarikoski, M. (2010). Clinical learning environment, supervision and nurse teacher scale: Psychometric evaluation of the Swedish version. Journal of Advanced Nursing, 66(9), 2085–2093. https://doi.org/10.1111/j.1365-2648.2010.05370.x [Google Scholar] [Crossref]

12. Johansson, U. B., Kaila, P., Ahlner-Elmqvist, M., Leksell, J., Isoaho, H., & Saarikoski, M. (2010). Clinical learning environment, supervision and nurse teacher scale: Psychometric evaluation of the Swedish version. Journal of Advanced Nursing, 66(9), 2085–2093. https://doi.org/10.1111/j.1365-2648.2010.05370.x [Google Scholar] [Crossref]

13. Karimi Mirzanezam, S., Hashemi, S., & Akbari, M. (2024). The influence of the clinical learning environment on nursing students’ engagement: A cross-sectional study. BMC Nursing, 23, 112. https://doi.org/10.1186/s12912-024-01587-5 [Google Scholar] [Crossref]

14. Karimi Mirzanezam, S., Hashemi, S., & Akbari, M. (2024). The influence of the clinical learning environment on nursing students’ engagement: A cross-sectional study. BMC Nursing, 23, 112. https://doi.org/10.1186/s12912-024-01587-5 [Google Scholar] [Crossref]

15. Kim, Y. S., Kim, E., & Park, J. (2023). Nurse managers’ leadership and its influence on nurses’ work engagement: A cross-sectional study. Journal of Nursing Management, 31(2), 270–278. https://doi.org/10.1111/jonm.13693 [Google Scholar] [Crossref]

16. Lyu, H., Xu, T., & Zhao, W. (2022). Trends and characteristics of male nurses in the United States, 1970–2019. Journal of Nursing Scholarship, 54(5), 531–539. https://doi.org/10.1111/jnu.12792 [Google Scholar] [Crossref]

17. Mohamed, N., & Elrais, A. (2017). Factors influencing decision-making competencies of nurse managers. Journal of Nursing Management, 25(3), 201–210. https://doi.org/10.1111/jonm.12455 [Google Scholar] [Crossref]

18. National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. National Academies Press. https://doi.org/10.17226/25982 [Google Scholar] [Crossref]

19. Tadayon, M., & Bijandi, M. (2012). The role of social cognitive theory in promoting nurses’ self-efficacy and professional development. Iranian Journal of Nursing and Midwifery Research, 17(3), 191–197. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583113 [Google Scholar] [Crossref]

20. Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. https://doi.org/10.5116/ijme.4dfb.8dfd [Google Scholar] [Crossref]

21. Torabinia, M., Khezri, A., & Zare, M. (2017). Validity and reliability of the Persian version of the Utrecht Work Engagement Scale among nurses. Journal of Nursing Management, 25(6), 499–507. https://doi.org/10.1111/jonm.12491 [Google Scholar] [Crossref]

22. Uddin, M. (2023). Workplace social support and work engagement among nurses: The mediating role of affective commitment. Nursing Open, 10(1), 34–43. https://doi.org/10.1002/nop2.1299 [Google Scholar] [Crossref]

23. World Health Organization. (2020). State of the world’s nursing 2020: Investing in education, jobs and leadership. World Health Organization. https://apps.who.int/iris/handle/10665/331677 [Google Scholar] [Crossref]

24. World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 [Google Scholar] [Crossref]

25. Zapata, J. E., Santos, C. A., & Abad, R. M. (2023). Work values and professional identity among Millennial and Gen Z nurses in the Philippines. Journal of Nursing Management, 31(4), 854–862. https://doi.org/10.1111/jonm.13899 [Google Scholar] [Crossref]

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