Understanding the current role of nurse managers in the Saudi context and challenges and enablers experienced in this role : a mixed-methods study

Background: Nurse managers (NMs) are pivotal in the healthcare sector, directly influencing operational and clinical outcomes through their extensive responsibilities, which have grown in recent years to include leadership and management, fiscal and human resource management, and the implementation of healthcare policies. These roles significantly affect profitability, staff turnover, and the overall organisational environment, as well as the quality of patient care. However, NMs face numerous challenges such as high workloads, insufficient support from senior management, and stressful job demands, which can lead to physical and psychological effects, job dissatisfaction, and turnover. Despite these challenges, some NMs find support in organisational cultures, access to resources, and meaningful work, which facilitate their roles. While extensive research exists on the experiences of NMs, there is a significant gap concerning these perspectives in the context of Saudi Arabia, particularly regarding the unique challenges and enablers within this cultural and healthcare setting. This study aims to address this gap by exploring the detailed roles, responsibilities, challenges, and enablers experienced by NMs in the Saudi healthcare system. Methodology: An explanatory sequential mixed methods design was utilized in this study, beginning with a descriptive correlational quantitative study, followed by a hermeneutic phenomenology study. Methods: In the first phase, data were collected from 141 NMs using a cross-sectional survey. The collected data were analysed using SPSS, with descriptive statistics including mean, standard deviation, percentages, and frequencies employed. Non-parametric tests were performed to compare score differences among the independent variables and assess the relationships between the independent and dependent variables. In the second phase, semi-structured interviews were conducted with 12 NMs using Microsoft Teams. The analysis of the interviews was guided by Van Manen’s 1997 framework. Integration: The integration of quantitative and qualitative data was facilitated through the Pillar Integration Process (PIP) (Johnson, Grove, & Clarke, 2019). Findings: The criteria used for selecting NMs within the Saudi healthcare system included qualifications, experience, and nepotism. Key components of the NMs’ roles, encompassed acting as moderators, unit management, and clinical nursing. The findings also revealed unveiled challenges faced by NMs in the Saudi context, including transitioning from a clinical to a management position, work environment issues, and the broader healthcare transformation under Saudi Vision 2030. The study found that NMs employed coping mechanisms, which predominantly involved seeking social support rather than relying on organisational support. Finally, it highlighted opportunities within the role that enhanced NMs' effectiveness and satisfaction in their positions, including networking, organisational factors, and the Saudi Vision 2030. Conclusion and recommendations: To enhance the recruitment processes within the Saudi healthcare system, selection criteria should be based on transparent and merit-based principles such as experience and qualification. In addition, clear job descriptions should be established, and comprehensive training provided before any transitions to new roles. Moreover, a robust supportive leadership structure is essential to assist nurse managers in effectively handling operational challenges. Strategic planning and support are crucial to successfully navigate the ongoing transformations in healthcare. It is also vital to enhance the nursing sector by fostering positive job experiences, promoting professional growth opportunities, and cultivating an inclusive workplace culture. Further, establishing professional networks within healthcare organisations will further promote professional development and knowledge sharing.