Navigating reform: Mental health nurses' experiences of policy-driven workforce change in community psychiatry

Recent global mental health reforms have significantly altered the landscape of community psychiatric care. In Saudi Arabia, evolving policy mandates under Vision 2030 have led to expanded roles and responsibilities for mental health nurses. However, the impact of these policy-driven workforce changes on nurses' professional experiences remains underexplored.

This study aimed to explore the lived experiences of mental health nurses adapting to policy-induced workforce transformations within community psychiatric settings.

A qualitative interview study using a reflexive thematic analysis design was employed. In-depth, semi-structured interviews were conducted with 18 registered mental health nurses working in community mental health centers across the Abha region of Saudi Arabia. Participants were purposively sampled to ensure diversity in experience and roles. Data were analysed thematically using Braun and Clarke's six-step approach.

Analysis revealed four interconnected themes: (1) Navigating Role Ambiguity and Expansion, nurses reported blurred boundaries and unclear expectations; (2) Emotional and Ethical Labor Under Strain, participants described moral distress and burnout; (3) Resilience and Adaptive Strategies, nurses developed informal coping mechanisms and peer support networks; and (4) Disconnection Between Policy and Practice, a gap existed between policy ideals and operational realities, contributing to disillusionment and reform fatigue.

Mental health nurses are adapting to policy-driven changes through resilience and collective coping, yet role ambiguity and systemic disconnects pose risks to workforce sustainability. Findings support the need for participatory policy processes, clearer role delineation, and enhanced institutional support to promote nurse well-being and effective reform implementation.