Distress, Risk Factors, and Adaptive Strategies of Middle Nurse Managers in Italy

Background/Objectives: The role of middle nurse managers is characterized by high levels of responsibility and complex relationships, which can generate significant stress and put their mental health at risk. A mixed-methods study was carried out to measure distress and work-related factors among Italian middle nurse managers and to explore their experiences in order to identify critical issues and possible actions for improvement. Methods: The study was conducted between October 2019 and January 2020. Results: In the quantitative phase, 65 middle nurse managers completed validated questionnaires on distress, perceived health, working environment, job satisfaction, and emotional workload. Although most participants reported feeling healthy, nearly 30% experienced distress ranging from mild to severe. These findings informed the qualitative phase, in which 10 middle nurse managers were interviewed to further explore the lived experiences. Qualitative analysis identified four main themes: (1) sources of stress at work; (2) the importance of personal and organizational support for middle nurse managers; (3) copingstrategies; (4) actions for change to improve work activities. All themes were further divided into sub-themes. Middle nurse managers report experiencing difficulties in their work, adopting strategies to adapt to everyday challenges, and expressing a need for support to improve the management of their work teams. Conclusions: The findings suggest that, despite generally positive well-being indicators, a substantial subgroup of middle nurse managers experience distress related to organizational constraints. Practical implications include strengthening organizational support, reducing excessive workload, and addressing staffing issues to better sustain middle nurse managers' well-being.