From Individual to Group: Organizational and Relational Strategies for Nurse Leader Well-Being

This study identifies psychosocial risk and resource factors influencing nurse leaders' well-being at the relational and group levels to guide organizational strategies for improvement.

Nurse leaders face significant emotional and organizational demands that strain their well-being. Research on interventions to support nurse leaders' well-being has largely focused on individual strategies, with less attention to relational and organizational factors. This study addresses that gap by examining how leadership groups and relational dynamics influence nurse leaders' well-being. Understanding these influences is crucial for improving nurse leaders' well-being and reducing stress.

The study employs a qualitative, exploratory design with 22 semistructured interviews with 18 nurse leaders and four other health managers working together in interprofessional leadership groups from a Danish healthcare region. The interview guide and analysis were informed by prior research on nurse leader well-being and by the job demands-resources and conservation of resources frameworks. Using thematic analysis, we identified key patterns of relational risks, resources, and strategies, guided by these frameworks.

Participants described risks and resources across four relational and organizational levels: the immediate leader, the peer leadership group, the broader leadership network, and the work system surrounding the leadership group and leader. We identified key risk and resource factors on each level. Risks included weak supervisory support, low peer trust, isolation, and being alone with heavy workloads. Resources encompassed supportive supervisors, peer safety within leadership groups, access to mentoring and reflection across units, and manageable workloads. Suggested relational and organizational strategies focused on fostering peer safety, implementing coleadership or buddy systems, protecting leadership time, ensuring influence in decision-making, and creating cross-unit forums for support and peer supervision.

The findings identify four relational and organizational levels, and the implications address them. Organizations should establish (1) clear priorities, transparent involvement in decisions, and visible backing from immediate leaders; (2) leadership groups as peer-reflection forums for systematically addressing leadership dilemmas; (3) cross-unit mentoring, buddy arrangements, or other confidential professional support; and (4) a regular review of structural factors such as spans of control, administrative workload, protected leadership time, and expectations of after-hours availability.

The findings identify supportive leader groups, trusting supervisory relationships, and well-structured work systems as resources for nurse leaders' well-being. This study introduces nurse leader well-being as an organizational capability that emerges from relational structures and organizational strategies.