Nurse Managers Research Articles

Organizational characteristics of nursing practice environments related to registered nurses’ professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study

BackgroundNurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one’s work and have a sense of control – the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses’ perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction.MethodsA cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction.ResultsPrincipal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse–doctor relationships, organization’s quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization’s quality standards, nurse management and leadership, and collegial nurse–doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization’s quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction.ConclusionNurses’ professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses’ job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

Perspectives on Admissions and Care for Residents With Opioid Use Disorder in Skilled Nursing Facilities

Skilled nursing facilities (SNFs) are being referred more individuals with opioid use disorder (OUD), even when their medical needs are not directly associated with OUD. To characterize factors that influence SNF admission for individuals with OUD and identify strategies for providing medications for OUD (MOUD) in SNFs. In this semistructured qualitative study, interviews were conducted with SNF administrators from 27 SNFs in Rhode Island from November 5, 2021, to April 27, 2022. Data analysis occurred from August 22, 2022, to May 31, 2023. Themes and subthemes on administrator perspectives on admissions and care for people with OUD in SNFs. Audio interviews were transcribed, coded, and analyzed using codebook thematic analysis and guided by community-engaged and participatory research principles. The study included 29 participants representing 27 SNFs in Rhode Island. Participant roles were administrators (17 participants [59%]), directors of nursing (6 participants [21%]), directors of admissions (5 participants [17%]), and unit managers (1 participant [3%]). Participants described active substance use, Medicaid insurance, housing instability, and younger age as potential barriers to SNF admission for individuals with OUD. The lack of formal guidelines for OUD management, staff shortages, facility liability, state regulations, and skills and training deficits among staff were cited among challenges of effectively meeting the needs of residents with OUD. Many participants reported inadequate institutional capacity as a source of negative outcomes for people with OUD yet expressed their concerns by characterizing individuals with OUD as potentially violent, nonadherent, or likely to bring undesirable elements into facilities. Participants also shared strategies they used to better serve residents with OUD, including providing transportation to support group meetings in the community, delivery in advance of resident arrival of predosed methadone, and telemedicine through the state's hotline to prescribe buprenorphine. In this qualitative study of administrator perspectives about admissions and care for individuals with OUD in SNFs, gaps in institutional capacity overlapped with stigmatizing beliefs about OUD; such beliefs perpetuate discrimination of individuals with OUD. Adequate SNF funding and staffing combined with OUD-specific interventions (eg, antistigma training, community partnerships for MOUD and recovery support) could incentivize SNFs to serve individuals with OUD and facilitate OUD care consistent with practice guidelines.

‘Nursing Care Pain Management Program’ for children with cancer: novel views by a qualitative study

Background & objective: Pain management is always a practical challenging issue in pediatric oncology. Nurses should be fortified with essential knowledge, attitude, and skills according to required standard.
 This study aimed to develop a nursing care pain management program in children with cancer.
 Methodology: This qualitative study will be conducted through two phases of interviewing and modified Delphi to develop a pain management nursing care program in children with cancer.
 Results: Three main categories (nursing, pediatrics’ parents, and health care organizations related factors) were achieved in qualitative phase as the base of initial pain management nursing care needs and Delphi technique revealed the contents in 13 pain management items.
 Conclusion: The development of a pain management nursing care program provides professional educational opportunities for optimal pain management in children with cancer.
 Key words: Children; Cancer; Nursing Care; Pain; Pain Management Program; Qualitative Study
 Citation: Naseri N, Irajpour A, Shamsi A. ‘Nursing Care Pain Management Program’ for children with cancer: novel views by a qualitative study. Anaesth. pain intensive care 2024;28(1):10−19; DOI: 10.35975/apic.v28i1.2375
 Received: July 03, 2022; Reviewed: February 10, 2023; Accepted: April 04, 2023

Explaining ethical challenges and practical solutions from a nursing managements' perspective: A phenomenological study.

Ethical practice is a vital aspect of nursing interventions. Complying with the ethical aspects of the intervention procedure in a stressful nursing environment is not easy and nurse managers always face ethical challenges which are in conflict with their personal values and norms. Identifying and solving these challenges improves the efficiency and effectiveness of nursing care activities. Therefore, this research was done to explain the ethical challenges of nurse managers and practical solutions from their perspective. It is a qualitative study that was carried out based on the phenomenological method in 2022. The participants of this study were 20 nurse managers of Arak hospitals who were selected by purposive sampling until data saturation. The data were collected through semi-structured interviews for 30 to 90 minutes. Data collection was carried out with the participant's consent, using a digital recording device and verbatim transcription, and then it was analyzed using Van Manen's six-step hermeneutic phenomenological approach. The results of this study could provide a clear picture of ethical challenges and their practical solutions from the nurse managers' perspective in the form of four themes of managerial ethical challenges which include challenges facing physicians, organizations, employees, managers, and three themes for practical solutions, including organizational solutions, interpersonal solutions, and educational solutions which were manifested. Nurse managers are always faced with ethical challenges in their daily activities. To deal with these challenges, they must be familiar with the rules and principles of professional ethics, practical standards, and laws related to patients' rights. Ethical principles and awareness of the ethical decision-making process are useful and effective in having capable and ethical nurses who provide competent care. To deal with ethical challenges, it is suggested to consider self-care strategies and structural and specialized support in each center, which will ultimately lead to the improvement of service quality and the promotion of ethics in care-treatment environments.

Nurse managers' strategies promoting a Fundamentals of Care-based approach among nurses: A scoping review.

In the last few years, shortcomings in caring for patient needs have promoted a growing interest in the Fundamentals of Care (FoC) to promote the quality of nursing care. However, which strategies nurse managers should implement to facilitate a FoC-based nursing care approach have not been mapped to date; therefore, the intent of this study was to map those strategies related to the nurse manager role that have been documented as being capable of promoting (or hindering), a FoC-based approach among nurses. A scoping review following the Preferred Reporting Items for Systematic Review and Meta-Analysis - Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed, CINAHL, Cochrane Library, Scopus and Web of Science databases and the conference proceedings of the International Learning Collaborative 2022 Annual International Conference were consulted. Studies exploring the relationship between FoC and nurse managers using any methodology, published from 2008 (year of birth of the FoC movement) to September 2022, in Italian or English, were eligible for inclusion. Findings were categorized narratively, according to their similarities and differences. Four qualitative studies, four discussion papers, two reviews and one mixed-method study, published from 2017 to 2021, predominantly in Australia, were included. Several strategies have emerged as promoting a FoC-based care approach by nurse managers. At the macro level, there is a need to disseminate a culture of attention towards patients that should be incorporated in the strategy of the entire system; moreover, synergies and effective leadership styles should be promoted by also providing education both in the undergraduate and continuing education settings. At the micro levels, among others, the required resources should be available, and the quality of the environment promoted. Nurse managers may facilitate a FoC-based approach among nurses through a set of strategies that should be included and considered in their educational pathways.

Work Stress Management Nurse RSUD dr. M.M Dunda Limboto

Job or work-related stress is a response that a person may have when faced with demands and work pressures that are not their knowledge and ability to be able to handle it. The purpose of this study is to find out how the stress management of nurses at RSUD dr. M.M Dunda Limboto. This research method is quantitative research with a descriptive analysis research design. Data collection was carried out using questionnaire sheets with a population of 73 respondents. The number of respondents was taken using purposive sampling techniques. The data was obtained by statistically using frequency distribution. The results of nurses' work stress management with an individual approach with sufficient category 60.3%, organizational approach sufficient category 57.5%, and social approach sufficient category 50.7%. It is suggested that this study is expected to add references to health services on how stress management in nurses.

Abstract WP43: Improving Nurse Retention Through Orientation Restructuring, Planned Professional Development, and Leadership-Employee Support: One Unit’s Journey

Introduction: Increasing RN turnover rates are a noteworthy and nuanced problem for many nurse leaders. It is a particular challenge within specialty units, resulting in the loss of specialty nursing knowledge, assessment, and critical thinking skills relevant to specific patient populations. RN turnover rates increased over a two-year period on a stroke unit in a large teaching hospital that provides specialty care as part of a Comprehensive Stroke Center. Many of the RNs leaving the unit pursued critical care roles, and their knowledge was lost with their attrition. This prompted the nurse leadership to re-examine the orientation process, professional development plan, and leadership-employee support methods that were being utilized. Methods: Using the PDSA model, orientation was reorganized allowing new RNs to be trained solely on the stroke unit for 10-12 weeks then working independently on that unit for 6 months prior to training on the epilepsy monitoring unit, as opposed to training and working on both units from the start of their employment. Professional development plans that included one-on-one resource nurse training with the Assistant Nurse Manager and cross-training to the neuroscience stepdown unit after one year of employment were created for each RN. Each staff member was supported with mentorship check-ins by an assigned Clinical Leader and with bi-monthly check-ins with the Nurse Manager. Quarterly staff meetings were held to promote staff engagement and provide staff members with an opportunity to cascade information on their individual projects, councils, or initiatives to their peers. Results: These changes, including the training of 10 RNs to the stepdown unit, resulted in an 82% decrease in the number of RNs who left their job on the stroke unit in the first year. Conclusion: This process improvement plan demonstrated that thoughtful modifications to the orientation process, a structured professional development plan, and an organized leadership-employee support method can decrease RN turnover. It allowed the preservation of specialty stroke knowledge, thus ensuring that stroke patients continue to receive high-quality, specialized care and that specialty knowledge is transmitted to new staff as they start their careers.

Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses.

Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination-a common response after nurses suffer a patient safety event-may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources. The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes. A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables. There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses. The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences.

Psychometric evaluation of a novel tool for assessing gestational diabetes and hypertension care: knowledge, attitudes, and practices of midwives and nurses.

While standardized assessment of knowledge, attitudes, and practices (KAP) related to gestational diabetes and hypertension is possible with a valid tool, existing research remains limited. This prospective validation study aimed to develop and validate a novel tool to assess the KAP of midwives and obstetric nurses. We included 125 midwives and obstetric nurses who routinely care for patients with gestational diabetes and hypertension. The tool demonstrated good internal consistency (Cronbach's alpha): knowledge (0.729, 95% CI, 0.654-0.776), attitude (0.756, 95% CI, 0.690-0.814), and practices (0.925, 95% CI, 0.905-0.943). Difficulty indices (d) ranged from 0.38 to 0.99 (knowledge), 0.41 to 0.99 (attitudes), and 0.41 to 0.93 (practices), indicating appropriate item difficulty. Discrimination indices (D) confirmed items could differentiate between respondents with low and high knowledge levels (D range: 0.02-0.77 for knowledge, 0.06-0.64 for attitudes, 0.20-0.84 for practices). The robust psychometric properties of this tool support its use in future research on KAP related to diabetes and gestational hypertension management in midwives and nurses. This instrument has the potential to be valuable in various settings, including baseline assessment before educational programs or evaluation of learning outcomes after interventions.

Leadership Behaviors of Frontline Nurse Managers: A Mixed-Methods Research Study Identifying Essential Areas for Social Support.

This study examined how frontline nurse managers (FLNMs) perceive and experience formal and informal social support and how personal factors and social support relate to their transformational leadership (TL) behaviors. Ineffective leadership by FLNMs is associated with costly outcomes. Evidence suggests that leadership development is a function of personal and social factors; however, a better understanding of this process is needed. A convergent mixed-methods design was used. The quantitative strand included a cross-sectional survey in a sample of FLNMs. The qualitative strand used a semistructured interview and a descriptive qualitative approach with a subset of this sample. Formal and informal social support is positively related to the TL behaviors of FLNMs as evidenced by the convergent data. The influence of family members in the work-related decisions of FLNMs has been underreported in the literature and is an area for consideration in supporting retention and desired leadership behaviors. The findings of this study imply a need for organizations to establish systems that endorse the growth of FLNMS, create opportunities for career advancement, and integrate members of the FLNMs' personal support systems into recognition initiatives.

Exploring factors that affect nurse staffing: a descriptive qualitative study from nurse managers’ perspective

BackgroundThe appropriate nurse staffing reflects the situation of nursing management of human resources. Nurse managers have a pivotal role in determining a competent and sufficient number of nurses. It is important to understand the factors influencing nurse staffing to promote appropriate staffing levels. The study aimed to explore the factors affecting nurse staffing from the perspective of nursing managers.MethodsPurposive sampling was adopted to recruit 14 nurse managers from secondary and tertiary hospitals located in the central region of China, and semi-structured interviews via telephone were conducted from April to May 2022. Interview transcripts were analyzed and collated using thematic analysis.ResultsThis research identified four themes and ten subthemes influencing nurse staffing. Extracted themes include: government level (inadequacy of mandatory policies, budgetary constraints), hospital level (hospital characteristics, the control of nurse labor costs, inadequate support on nursing), patient level (patient characteristics, increasing care needs), and nurse level (nurse shortage, skill-mix, individual high-level needs).ConclusionThe findings indicate that it is crucial for decision-makers or policymakers to legislate for safe nurse staffing and establish effective supervision and funding incentives. Tailored interventions are also needed to improve the organizational context, address the nurse workforce and balance the structure of nurse staff.

Should I speak up? How trust in leaders and leader-leader exchanges influence nurses' voice behaviour.

Discussing the nurses' voice behaviour could support the managers in making the right decisions and solve problems. This was a discursive paper. The discursive was based on reviewing the literature. Nurses play a critical role in offering useful constructive advice, which leads to management figuring out and solving problems immediately for the purpose of bettering the working environment. Therefore, we assert that trust in leadership and the leader-leader exchange system also plays a critical role in enforcing voice behaviour. Trust is a crucial aspect of voice behaviour, and integrated trust in leadership and leader-leader exchange as a possible practical suggestion for the fostering of voice behaviour are proposed. Nurse managers must maintain a sense of reciprocal moral obligation in order to nurture value-driven voice behaviour. It is important that open dialogue, active listening and trust in leadership exist. Nurse managers must consider ways to foster mutual trust, and support and enable nurses to use voice behaviour in everyday practice.

Health Self-management Barriers and Facilitators in Long-term Care Facilities: A Qualitative Study

Objectives: Long-term care development has become a global demand. Nurse directors play a crucial role in managing a long-term care facility's quality and costs. Health self-management of nursing service quality managers, however, is relatively unknown. In this study, we aimed to assess determinants of long- term care facilities' (LTCF) quality care, including barriers and facilitators to health self-management as reported by service quality managers and their recommendations for further intervention in healthcare.Methods: An interview outline is developed based on the framework of theoretical domains. Using purposive sampling, we selected 17 managers in LTCFs engaged with the quality of nursing services for semi-structured interviews. We conducted thematic analysis using transcripts of interview recordings, interview notes, reflection diaries, and other materials. Results: Five major barriers were associated with the 10 domains of the theoretical domain framework: (1) negative emotional influence, (2) limited time resources, (3) fetters from professional roles, (4) lack of positive reinforcement, and (5) concerns about physical red flags. Six main facilitators were associated with the 10 domains of the theoretical domain framework: (1) highlight the benefits of good habits, (2) intention to balance life and work, (3) the impact of being considered a benchmark, (4) fragmented exercise management, (5) finding the team – for social support, and (6) wearing sports electronic equipment. Conclusion: A variety of factors impair self-health behaviors of nurse directors in LTCFs, and their mechanisms are complicated.

Application of Nurses' Clinical Authority at Hospital X Jakarta

Clinical nurses ought to exercise their clinical authority in accordance with the provisions outlined in the Clinical Assignment Letter and Details of Clinical Authority, as well as complete the credentialing process. However, this implementation has not been fully utilized or communicated to staff at Hospital. The aim of this research is to identify the mechanism for implementing clinical authority for PK I-III nurses upon receiving SPK in the inpatient room at Hospital X Jakarta. The research design utilizes the qualitative approach of hermeneutic phenomenology, and data collection is carried out through in-depth interviews. A total of 17 participants are involved, including 14 clinical nurses (PK I: 6, PK II: 6, PK III: 2), as well as 3 managerial nurses (2 heads of inpatient units and 1 inpatient coordinator). The thematic data analysis follows the Colaizzi method, and 3 themes emerge from the research findings: the application of clinical authority for PK I-III nurses, the availability of management elements in the application of clinical authority for PK I-III, and the lack of optimal management functions in the application of PK. The application of clinical authority in this research encompasses independent and collaborative actions, and it is essential to strengthen regulations, resocialize, and implement an electronic system to facilitate processes. To ensure that nurses work according to their qualification level, hospitals should reinforce regulations and supervision, provide support and commitment, and resocialize SPO, SPK, and RKK.

First-Line Nurse Managers' Perception Regarding Self Management Knowledge and Skills

First-Line Nurse Managers' Perception Regarding Self Management Knowledge and Skills

Nurse Managers’ Authentic Leadership and their Relationship with Work Engagement among Registered Nurses

Nurse Managers’ Authentic Leadership and their Relationship with Work Engagement among Registered Nurses

Hubungan Ketepatan Triase Dengan Keberharhasilan Penatalaksanaan Tindakan Keperawatan Kegawatdaruratan Ruang IGD Di Rumah Sakit Daerah Tulungagung

Emergency is a critical situation that requires prompt action to save lives. Triage in the Emergency Department (ED) is a crucial step in managing patients with emergency conditions. Emergency nurses must possess triage skills both in the pre-hospital phase and within the hospital setting. The success of patient management in the hospital significantly depends on the accuracy of triage implementation. This research aims to determine the relationship between triage accuracy and the success of emergency nursing care management in the ED of Tulungagung Regional Hospital. The study employs a correlational analytic quantitative approach with a cross-sectional design, involving a sample of 52 nurses from both Type B and Type C Hospitals in Tulungagung. Data are analyzed through univariate and bivariate analyses using the Chi-Square Test. The results indicate that out of the total respondents (52 individuals), 38 (73.1%) successfully conducted accurate triage, and 42 (80.8%) succeeded in emergency care management. The statistical test results yield a p-value of 0.000 (Pvalue> 0.05), concluding that there is a significant relationship between triage accuracy and the success of emergency nursing care management in the ED of Tulungagung Regional Hospital. The precision of triage by nurses directly impacts the effectiveness of emergency care management

WEBSITE-BASED NURSING MANAGEMENT INFORMATION SYSTEM APPLICATION FOR IMPROVING THE CREDENTIAL PROCESS AND DETERMINING NURSE TRAINING NEEDS AT HOSPITAL X JAKARTA

The nursing management information system (SIMKEP) is a software package created to facilitate the nursing management process to improve performance and be able to formulate strategic policies including efficiency from within (organisation, management and HR) and must be able to quickly and make appropriate decisions to improve services to the community so that it can become a responsive, innovative, effective, efficient, profitable organisation that is also responsive to developments in science and technology, including information technology. This study aims to determine whether the creation of a website-based nursing management information system application model can improve the nurse credentialing/re-credentialing process and increase the determination of nurse training needs.The method in this research is a mixed studies review or mixed methods review, which combines literature study methods using secondary data from previous research which are published journals, which are by the criteria set by the research, namely the inclusion criteria and systematic exclusion and searches using online databases accompanied by interviews with participants. This article and journal explain that the application model or design of a website-based nursing management information system can improve the credentialing process and determine nurse training needs. The conclusion in writing this Literature Review is that applying a website-based nursing management information system can improve the credentialing process and determine nurse training needs.

Implementation of Body Worn Camera: Practical and Ethical Considerations

Body-worn cameras are increasingly being used as a violence prevention tool in inpatient mental health wards. However, there remains a limited understanding of this technology from an implementation perspective, such as protocols and best practice guidance if cameras are to be used in these settings. This study explores the perspectives of patients, mental health staff, and senior management to understand the practical and ethical issues related to the implementation of body-worn cameras. Semi-structured interviews (n = 64) with 24 patients, 25 staff from acute wards, six Mental Health Nursing Directors, and 9 community-based patients were conducted. Interviews were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority. Findings from this study show that the implementation of BWC in healthcare settings requires careful consideration. The perspectives of patients and staff demonstrate the complex reality of implementation alongside the consideration of practical and ethical issues around implementation that are essential to ensures that wards recognise the need to assess their capacity to use the cameras in a way that is fair and consistent for all involved. The findings further highlight wider questions around power and autonomy in mental health care.

Nurse Managers' Professional Quality of Life During the COVID-19 Pandemic.

Health systems cannot effectively support nurse managers without understanding psychosocial effects of the COVID-19 pandemic. The objective of this study was to describe the professional quality of life of frontline nursing management during the COVID-19 pandemic. A cross-sectional online survey of 54 nurses in management positions at a large Midwest academic medical center during 2022 was conducted. Participants completed an electronic survey including demographics, Professional Quality of Life Measure Version 5, and items assessing past consideration of and future intent to leave their position, organization, or profession. Most participants had previously considered changing roles (80%) or leaving the organization during the pandemic (76%). Fewer respondents reported that changing role (24%) or organization (20%) was likely during the upcoming 6-12 months. Most participants scored in moderate ranges of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress scales (85%, 89%, and 74%, respectively). Higher Compassion Satisfaction was associated with extreme unlikelihood of leaving for an internal non-management role. Higher Burnout scores were associated with more time working and past consideration or future likelihood of leaving for an external non-nursing position. Secondary Traumatic Stress scores were higher for nurse managers and house operation managers than assistant nurse managers and associated with past consideration of moving to an internal non-management role or external non-nursing position and future likelihood of moving to an external non-nursing position. Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.