Navigating crisis: A qualitative study of nurse middle managers' role in building resilience during times of crisis

Background: Global crises, such as pandemics and armed conflicts, highlight the need for resilient healthcare systems. Nurse middle managers play a critical meso-level role in bridging frontline staff and senior leadership, yet their crisis experiences remain underexplored. Aims: (1) To identify coping strategies used by nurse middle managers and their impact on bedside nurses' resilience during crises; (2) to explore how prior crises, such as COVID-19, shaped their approaches, and (3) to examine contextual factors influencing their ability to anticipate, cope, and adapt. Methods: A descriptive qualitative design was employed, involving semi-structured interviews with 17 nurse middle managers from diverse healthcare sectors. Data were analyzed using Duchek's Organizational Resilience Model, focusing on anticipation, coping, and adaptation. Results: Nurse middle managers play a crucial role in organizational resilience by acting as intermediaries between frontline staff and senior leadership. Their prior experiences with crises, such as COVID-19, strengthened their ability to manage uncertainty, problem-solve, and support their teams. Key resilience-enhancing strategies included fostering team cohesion, adapting workflows in real time, and advocating for staff well-being. However, systemic challenges, such as resource shortages and gaps in structured emergency preparedness, hindered their effectiveness. Conclusions: This study underscores the pivotal role of nurse middle managers in fostering organizational resilience during healthcare crises. Their leadership, adaptability, and capacity to support teams through uncertainty were instrumental in maintaining care continuity. However, systemic challenges—including limited preparedness frameworks, ethical ambiguities, and resource constraints—hindered their effectiveness. These findings highlight the urgent need for structured crisis leadership training, investment in mental health support, and inclusive preparedness planning. Strengthening these areas can enhance organizational readiness, reduce burnout, and reinforce the resilience of both the workforce and the healthcare system at large.