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. 2025 Mar;81(3):1463-1475.
doi: 10.1111/jan.16329. Epub 2024 Jul 14.

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors

Alison H James  1 , Rebecca Dimond  1 , Aled Jones  2 , Dianne Watkins  1 , Daniel Kelly  1
Affiliations

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors

Alison H James et al. J Adv Nurs. 2025 Mar.

Abstract

Aim: To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies.

Design: A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales.

Methods: Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis.

Results: Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders.

Conclusion: Future strategies for nursing leadership during public health, national and global emergencies are recommended.

Impact: This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership.

Reporting method: The study adhered to the Consolidated Criteria for Reporting Qualitative Research.

Patient or public contribution: No patient or public contribution.

Keywords: COVID19; director of nursing; executive nurse director; leadership; pandemic; qualitative research.

PubMed Disclaimer

Conflict of interest statement

No conflict of interest.

Figures

FIGURE 1
FIGURE 1
Overview of thematic analysis (Braun & Clarke, 2021).
See this image and copyright information in PMC

References

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    1. Data Protection Act (2018). Available at https://www.legislation.gov.uk/ukpga//2018 (Accessed 11.7.24).