Between policy and practice: nurse managers’ relational influence on nurses’ adaptation, job embeddedness, and psychological capital during healthcare transformation

Healthcare transformation places nurse managers between executive policy and frontline practice. Although leadership is associated with retention and well-being, less is known about how nurses construct the credibility and meaning of managers’ day-to-day practices across adaptation, job embeddedness, and psychological capital during active reform. This study explored that process in northern Saudi Arabia. Using Interpretive Description, purposively interviewed 19 registered nurses, sampled for maximum variation, from four governmental hospitals (June–December 2025). Interviews were conducted in Arabic ( n = 9) or English ( n = 10), in person ( n = 14) or online ( n = 5), and analysed inductively. Language and mode were examined as contextual dimensions during constant comparison. Transformational leadership, sensemaking, job embeddedness, and psychological capital were sensitising resources, not coding frameworks. Information power, peer debriefing, member checking, disconfirming-case analysis, reflexive memoing, and a dated audit trail supported rigour. Reporting followed COREQ. Five themes (16 subthemes) formed an integrated relational–interpretive model: Reading the Room; Between Policy and Practice; Threads of Belonging; Psychological Resources Under Pressure; and The Systemic Frame. Nurses interpreted visible, consistent presence as a credibility signal and described policy translation and pacing as making reform more or less workable. Recognition, delegation, and containment of reform-related stress were connected with belonging and psychological resources; absence, failed translation, and punitive responses were connected with weaker trust, fit, optimism, and voice. Disconfirming accounts showed that some apparent managerial failures reflected constrained authority, peer workarounds could sustain adaptation when formal support failed, and supportive management could not offset insecure employment conditions. Meanings varied with hierarchy, workforce diversity, managerial authority, and institutional trust. Managerial influence was experienced not as leadership behaviour alone but as a credibility-building process whose meaning accumulated across interactions and was bounded by systemic conditions. Organisations should combine relational leadership development with authority to pace implementation, protected escalation pathways, and employment conditions that support retention. The model is interpretive, not causal. Not applicable.