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AIMS Public Health

2026, Volume 13, Issue 3: 798-830. doi: 10.3934/publichealth.2026043
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What shapes job satisfaction for middle nurse managers in hospitals and community care? A qualitative study

  • 1.
    Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
  • 2.
    Department of Nursing, Faculty of Health Sciences, AAB College, Pristina, Kosovo
  • 3.
    Department of Health Professions, Local Health Authority Rome 1, Rome, Italy
  • 4.
    National Center for Clinical Governance and Excellence in Care, Istituto Superiore di Sanità, Rome, Italy
  • 5.
    Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
  • 6.
    Department of Strategic Directorate, Local Health Authority 1 Liguria, Bussana di Sanremo, Italy
  • 7.
    Research Unit in Nursing Science, University Campus Bio-Medico, Rome, Italy
  • Published: 29 July 2026
  • Background 

    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.

    Aim 

    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.

    Methods 

    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.

    Results 

    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.

    Conclusions 

    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.

    Citation: Dhurata Ivziku, Maria Pia Clasadonte, Idriz Sopjani, Gabriella Facchinetti, Marzia Lommi, Pasquale Iozzo, Fabrizio Polverini, Roberta Zanetti, Daniela Tartaglini. What shapes job satisfaction for middle nurse managers in hospitals and community care? A qualitative study[J]. AIMS Public Health, 2026, 13(3): 798-830. doi: 10.3934/publichealth.2026043

    Related Papers:

  • Background 

    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.

    Aim 

    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.

    Methods 

    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.

    Results 

    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.

    Conclusions 

    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.



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    Acknowledgments


    We are thankful to the participants who shared with us their experiences.

    Authors' contribution


    Conceptualization, D.I., M.P.C.; methodology, G.F., D.I; formal analysis, M.P.C., G.F., and D.I.; investigation, M.P.C., M.L., P.I.; data curation I.S., R.Z., F.P.; writing—original draft preparation, M.P.C., G.F., and D.I.; writing—review and editing, D.I., M.P.C., G.F., M.L., P.I., I.S., R.Z., F.P., D.T; visualization, I.S.; project administration, D.I. All authors have read and agreed to the published version of the manuscript.

    Conflict of interest


    The authors declare no conflict of interest.

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