What shapes job satisfaction for middle nurse managers in hospitals and community care? A qualitative study

Middle nurse managers (MNMs) play a pivotal role in healthcare organizations, acting as a bridge between senior management and frontline staff. Despite their strategic importance, their job satisfaction remains insufficiently explored, particularly within the Italian healthcare context.

To identify the organizational, relational, and professional sources of satisfaction and dissatisfaction characterizing the MNMs' role, seeking to capture the complexity of MNMs' experiences and to foreground their voices and narratives within the Italian healthcare context.

A qualitative descriptive design was adopted. Twenty-five middle nurse managers were recruited using purposive sampling and participated in semi-structured interviews. Data were analyzed through inductive content analysis following Elo and Kyngäs' approach.

Four main categories emerged: (1) "Being an invisible manager"; (2) "Navigating communication across levels"; (3) "Working under pressure while finding meaning"; and (4) "Growing alone". Participants reported limited formal and financial recognition, restricted involvement in decision-making, and challenges in work-life balance. Communication with senior management was often perceived as inadequate, particularly in hospital settings, whereas community-based managers described greater inclusion and appreciation. Despite scarce organizational support, many participants pursued self-directed professional development. Notably, the COVID-19 pandemic was described as a paradoxical period of increased professional fulfillment and team cohesion.

Middle nurse managers' job satisfaction is strongly influenced by recognition, communication, working conditions, and access to professional development. Targeted organizational strategies aimed at enhancing recognition, leadership support, and structured training opportunities are needed to strengthen MNMs' well-being, retention, and contribution to healthcare quality.