Functions and Activities Missed by Nurse Managers, Their Antecedents and Consequences: Findings From a Qualitative Study.

objectiveTo understand the phenomenon of Missed Nursing Management functions and activities in the daily practice of nurse managers (NMs) and to identify its antecedents and consequences.

designA descriptive qualitative study conducted according to the COnsolidated criteria for REporting Qualitative research guidelines.

methodsA purposive sample of 22 Italian nurses from different roles-NMs, their clinical nurses, nurse executives, representatives of NM associations, and nurse educators-were identified and individually interviewed face-to-face in 2023. The data were thematically categorized using both inductive and deductive approaches.

findingsFour Missed Nursing Management functions have emerged: (1) "Missing systemic planning and monitoring", (2) "Missing effective presence in the clinical environment", (3) "Missing coordination and continuous alignment with expected goals" and (4) "Missing to promote the development of the department, staff and the profession". Several antecedents were identified at the (1) macrolevel: "Systemic challenges such as the shortage of nurses and postpandemic recovery", "Strategic systemic uncertainties", "Inadequate role recognition"; (2) exolevel: "Lacks in tailored training and professional development opportunities", "Lack of independence in decision making"; (3) mesolevel: "Lack of structural and organizational support", "Lack of coordination"; (4) microlevel: "Ambiguities in role expectations", "Bureaucratic burden", "Lack of team cohesion and a feeling of loneliness", "Disjointed information" and (5) NM level: "Chronic time scarcity", "Lack of experience", "Attitudes", "Sense of disengagement". Missed Nursing Management consequences were reported at NM, staff, unit and patient/family levels.

conclusionsEssential nursing management functions, such as planning, supervision, visibility, coordination and professional development, are missed or postponed by NMs, as activities like resource management remain prioritised for daily unit functioning. Antecedents influence the phenomenon across multiple levels, indicating the need for system-wide interventions, while consequences primarily affect the microsystem, including NMs, teams, organisational performance and potentially care quality. IMPLICATION FOR NURSING MANAGEMENT: These results inform management by highlighting the need to protect NMs' time for core managerial functions, strengthen their visible presence in clinical settings, and reduce bureaucratic burden. From an organisational and policy perspective, the study supports investment in role clarification and decision-making autonomy, as well as workforce policies that address structural staffing shortages and strengthen coordination across system levels. Moreover, it is essential to develop strategies that enhance leadership competencies and support NMs to fully perform their leadership role, creating an environment that enables them to fulfil their strategic and support responsibilities.