Exploring Barriers and Protective Factors in Decision Fatigue Among Clinical Nursing Managers During the Covid-19 Pandemic: A Qualitative Content Analysis Publisher Pubmed



Sheikh S ; Hajibabaee F ; Cheraghi M A ; Nasrabadi A N ; Esmaeili M
Source: Journal of Nursing Management Published:2026

Abstract

Background and Objective: Decision fatigue of nursing managers in stressful hospital environments is considered one of the fundamental challenges of healthcare management. It affects the quality of decisions and organizational outcomes. This study aimed to explore both the barriers that exacerbate decision fatigue and the protective factors and strategies that mitigate it from the perspective of clinical nursing managers during the COVID-19 pandemic. Methodology: This qualitative study was conducted with a conventional content analysis approach. Participants consisted of 11 nursing managers working in the hospitals affiliated with Tehran University of Medical Sciences in Iran, who had been selected purposively and theoretically. Data were collected through semistructured, individual, and face-to-face interviews. MAXQDA software Version 18 was used for data management. Data validity was ensured according to the criteria of Lincoln and Guba (1985). Results: The results revealed three main categories that encompassed both barriers (e.g., responsibility overload, organizational pressures) and protective factors (e.g., humanistic leadership, utilization of support resources), including organizational decision-making and leadership strategies, communication management and organizational interactions, and individual and organizational patterns in decision-making. Each of these categories consisted of two subcategories, including decision-making regulation and guidance, and humanistic management and leadership for the first category, activation of interaction and communication processes, and utilization of support resources for the second category, and finally independence and responsibility in decision-making, and organizational interest and commitment for the third category. Conclusion: Decision fatigue of nursing managers during the COVID-19 pandemic was shaped by a dynamic interplay of barriers and protective strategies. Clarifying these dual influences provides a coherent framework for understanding managerial decision-making under crisis conditions. Strengthening delegation, implementing decision pilots, and building organizational trust are effective strategies for reducing cognitive pressure and improving the quality of decision-making. Medical centers are suggested to reduce decision fatigue by addressing barriers such as organizational pressures and responsibility overload, while simultaneously strengthening protective factors such as supportive leadership, effective communication, and organizational trust. Copyright © 2026 Sarah Sheikh et al. Journal of Nursing Management published by John Wiley & Sons Ltd.