Middle-Level Nurse Managers: Psychological Trauma, Work-Related Challenges, Substance Use And Intention To Leave

This mixed-methods study examined psychological trauma, occupational stressors, perceived organizational support, and resilience among middle-level nurse managers (MLNMs), with a focus on how these factors influence substance use and turnover intention. Guided by Foli’s (2022) Middle-Range Theory of Nurses’ Psychological Trauma, the study included quantitative data from 234 MLNMs across the U.S. and qualitative data from four open-ended questions to enrich interpretation.

Structural equation modeling indicated that workplace stressors and perceived organizational support were significant predictors of turnover intention. However, resilience and secondary trauma were not significantly associated with either outcome. Content analysis of open-ended responses revealed themes related to heavy workload, role conflict, limited organizational support, and a lack of mental health resources, offering deeper insight into nurse managers’ lived experiences. These findings highlight the unique stressors MLNMs face in healthcare settings and emphasize the importance of strengthening organizational support to reduce turnover risk. The results inform future interventions aimed at sustaining the nurse manager workforce and supporting mental health in nursing leadership roles.