From Crisis Response to Recovery: A Two-Wave Qualitative Study of Nursing Leadership Trajectories in Italy...

Nursing leadership was pivotal during the acute COVID-19 response, yet less is known about how crisis-era leadership practices persisted, changed, or were replaced by new responsibilities during recovery. This study explored nursing leadership trajectories in Italy from the first pandemic wave to 5 years later.

Two-wave qualitative study with a longitudinal follow-up subsample and a supplementary 2025 refreshment sample, conducted within a descriptive-interpretive orientation.

Semi-structured interviews were conducted with nurse managers and staff nurses in Italian public healthcare settings at two time points: Phase 1 (August-December 2020; n = 22) and Phase 2 (June-September 2025; n = 22). Nine participants were re-interviewed and 13 were newly recruited in 2025, yielding 44 interviews with 35 unique participants. Interviews were transcribed in Italian and analyzed using team-based thematic analysis with a hybrid deductive-inductive strategy. Deductive sensitizing domains were derived from the 2020 dataset and nursing leadership literature, while inductive analysis identified issues newly prominent in 2025. For returning participants, within-case summaries supported longitudinal comparison. Reporting followed COREQ and SRQR guidance.

Findings are reported as patterns of continuity, change, and newly prominent phenomena rather than as uniform within-person change across the full sample. Six themes described leadership trajectories: (1) sustaining emotional support and compassionate leadership; (2) adaptive leadership and system learning; (3) leading digital adoption and technology-enabled care; (4) ethical challenges and moral resilience; (5) coordinating post-COVID pathways across settings; and (6) workforce stewardship, shortages, and retention efforts. Across waves, participants described leadership as shifting from immediate crisis reassurance and improvisation toward institutionalized preparedness, digital change work, cross-sector coordination, and workforce advocacy.

Within this sample, nursing leadership was described as moving from acute crisis containment toward a broader portfolio of organizational, ethical, digital, and workforce-oriented responsibilities in the post-pandemic period.

Health organizations should proactively support nurse leaders' capacity for compassionate leadership and moral resilience, invest in digital competencies, and strengthen retention and preparedness strategies to sustain the nursing workforce beyond crisis periods.