Political Influence, Facilitators and Barriers in the Decision-Making Processes of Executive Nurse Leaders During the COVID-19 Pandemic in Spain: An Ethnographic Study

Abstract

Aim: To describe the political influence Executive Nurse Leaders (ENLs) in Spain had on decision-making processes during the COVID-19 pandemic, identifying facilitators and barriers to executive and policy-related decision-making and implementation. Method: A focused ethnographic study, with a direct qualitative analysis of manifest content. Twenty-five semistructured interviews were conducted with ENLs who held senior management positions in one of the executive roles included. The study includes the following executive roles: Chief Nurse Executive in the autonomous government and Chief Executive Officer, Chief Nurse Officer, and Assistant Chief Nurse Officer in healthcare organisations. The study period was from February 2020 until December 2022. Results: Three categories were identified: Category 1: Political influence—a description of the political involvement of ENLs and their influence on political actions, as well as the influence of politics on the work of ENLs; Category 2: Facilitators in the decision-making process—situational, personal and operative characteristics that were mentioned by participants as facilitating decision-making and implementation; Category 3: Barriers in the decision-making process—obstacles that reduced ENL influence in decision-making processes, and the barriers that were found when implementing decisions that were made. Conclusions: The political influence on the work of ENLs is discussed, as well as the influence of ENLs on healthcare policy during the COVID-19 pandemic. Facilitators and barriers during the decision-making process are identified. The study provides new knowledge to help understand the contribution and challenges of ENLs during the context studied. We recommend the implementation of governmental strategies to promote nurse leadership, to eliminate the detected barriers and to combat prejudice and gender bias, recognising the strategic value of nurses during healthcare crises. The findings need to be aligned with policy changes in countries with a similar political context.