Barriers and Facilitators in Nurse Managers’ Change Management: A Mixed-Methods Study

Abstract

Introduction. Healthcare organizations must adapt to ensure quality and sustainability. Nurse

managers play a pivotal role in implementing evidence-based practice (EBP). Few studies explore the topic of behaviors related to change management.

This study examines barriers and facilitators influencing their capacity to lead and sustain

organizational change in EBP.

Methods. An exploratory sequential mixed-methods study was conducted. Two focus groups with nurse managers were explored using deductive–inductive content analysis guided by the Theoretical Domains Framework (TDF). Findings informed a Delphi study, developed in accordance with ACCORD guidance, comprising two rounds with a panel of experts.

Results. Qualitative findings from two focus groups involving 19 nurse managers from different departmental areas informed the Delphi items. Cross two Delphi rounds, 35 items reached and maintained consensus (>85%), IQR ≤ 1. Consistent with the explanatory sequential design, the Delphi results corroborated the qualitative findings. Determinants were subsequently linked to the COM-B model and relevant intervention functions within the Behaviour Change Wheel (BCW).

Discussion. Linking the most relevant TDF domains (Social influences, Environmental context and resources, and Skills) to intervention functions revealed strategic directions to strengthen organizational readiness and implementation capacity, enhance team coordination, optimize resources, and support the sustained adoption of evidence-based practices.