Nurse Manager's strategies to mitigate staff Burnout in acute care settings: A Qualitative Study

Background: Nursing is a demanding and sensitive profession that generally causes fatigue and exhaustion among staff, especially in intensive care settings. While nurse managers are responsible for translating organizational policy into unit culture and ensuring staff well-being, there is a significant gap in qualitative research exploring their specific lived experiences and the practical challenges they face in mitigating burnout. ​Purpose: The paper aimed to investigate the lived experiences of nurse managers regarding staff burnout in acute care settings, identifying the techniques they employ and the factors influencing their effectiveness. ​Methods: A descriptive phenomenological design grounded in the interpretivist/constructivist paradigm, this study conducted in-depth, semi-structured interviews with a purposeful sample of 10 nurse managers and directors from acute care units (ICU, CCU, Emergency Department) in West Bank hospitals. Data were analyzed using Braun and Clarke’s six-phase thematic analysis. The Job Demands-Resources (JD-R) model served as the conceptual framework. ​Results: Five major themes emerged: ​1. The Dilemma of the Middle Leader: Managers experience a "double bind," struggling to balance rigid organizational job demands with the fundamental resources required by their teams. ​2. The Requirement of Informal, Simple Managerial Strategies: In the absence of organizational solutions, managers rely on self management such as proactive listening, ten minutes breaks, and staff empowerment. ​3-Structural Policy Barriers to Wellness: Rigid staffing metrics and a deficit in organizational satisfaction strategies were identified as main obstacles that hinder the mitigation of chronic stress. ​4-Servant Leadership as a Complete Resource: Managers utilize authentic leadership styles, including active advocacy and clinical collaboration, to provide psychological safety and trust. ​5-Political Constraints and Roadblocks: Unique external factors, specifically checkpoints and travel restrictions in Palestinian cities, necessitate specialized scheduling to reduce the physical and mental burden on staff. ​Conclusion: The findings indicate that nurse managers are essential, though often unsupported, promoters of staff wellness. Effectiveness in mitigating burnout requires a shift from individual resilience to organizational accountability, including the implementation of safe staffing ratios based on acuity and formal motivational reward systems.