How to Support First-Line Healthcare Managers in Promoting Both Their Own and Employees’ Sleep and Recovery: A Qualitative Interview Study

Introduction: Nursing staff often face a challenging work situation characterized by high workload and demanding working hours. A previous study showed that a sleep and recovery intervention for new nurses, focusing on individual strategies, decreased burnout and fatigue symptoms and had a preventive effect on somatic symptoms. However, a process evaluation highlighted workplace- related factors as barriers for individual sleep and recovery, such as overtime work, demanding shifts and schedule changes at short notice. In line with previous research, this highlights the importance of management involvement and leadership for employee sleep, recovery and health. At the same time, first-line healthcare managers often also struggle with heavy workloads, which may hinder health-promoting leadership. The aims of this study were 1) to explore first-line healthcare managers’ strategies for their own sleep and recovery, and work-related factors affecting sleep and recovery opportunities, and 2) to explore if and how first-line healthcare managers work to support employees’ sleep and recovery, and factors affecting such work.

Methods: Semi-structured interviews were conducted with 15 first-line healthcare managers (13 women) working in different medical specialties at two Swedish hospitals. The managers had between 9 months to 10 years (M=5y, SD=4y) of work experience. Thematic analysis was used.

Results: Managers had to actively engage in strategies for their own recovery, e.g., through setting limits for work hours and tasks, and optimising recovery during breaks. To promote employees’ recovery, managers aimed to be present and accessible to pick up signs of employee ill-health and to be an immediate support. They were also promoting open communication about recovery; facilitating detachment by creating opportunities for reflection during work; considering the impact of scheduling; trying to create a manageable workload; and making schedules for meal breaks. Only a few actively supported shorter microbreaks. Factors related to the organization (e.g., staffing), the individual manager (e.g., stress management strategies) and the employees (e.g., communication) affected the possibilities for managers’ and employees’ recovery.

Conclusion: A systems approach for promoting sleep and recovery among first-line managers and nursing staff in healthcare is likely needed. In addition to address organisational conditions, first-line managers may need individual support in promoting both their own recovery and employee recovery. For example, support in how to handle the potential conflict between being a present and accessible manager versus their own recovery needs, and support in the creation of workplace-related conditions for employee recovery, e.g., opportunities for micro-breaks. A behavior analytic approach could be used to address own behaviors and employee behaviors interfering with recovery, and to support recovery behaviors. Based on the results from this study, a recovery and leadership program for first-line healthcare managers has been developed. At the conference, the content of the program and preliminary results from a process evaluation will be presented. Support: The study was funded by AfaFörsäkring (230022), Sweden.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
08 October 2025