Aim The aim of this study was to investigate how restricted decision‐making autonomy and conflicting demands impact operational managers’ work performance and health. Background Managers at operational level (first‐ and second‐line managers’) in health care organisations are commonly exposed to strain in their work situation with high demands and a challenging work context. Although they play an important role, the knowledge about the causal associations between stressful job demands and their consequences is limited. Methods A prospective design with questionnaire data collected at two points in time, 1 year apart, from a sample of operational managers (N = 162) at five Swedish hospitals was used to conduct a structural equation model analysis with cross‐lagged paths. Results Restricted decision‐making autonomy was negatively associated with both the managers’ health and their managerial work performance over time. Conclusions Health care managers’ work performance and health may be sustained by the top management allowing them a higher degree of autonomy in their decision‐making. Implications for nursing management This study suggests that nursing leaders should create the circumstances for operational managers’ to have higher levels of autonomy in their area of responsibility and the freedom to prioritize their managerial workload.

This study highlights the importance of opportunities for adjustment latitude at work to increase work ability and return to work among female human service workers who have been on long-term sick leave. The results support push and pull theories for individual decision-making on return to work.

Aim. The current article aims to gain insight into (a) what characterises organisational resilience during an unexpected crisis such as COVID-19 and (b) how organisations respond to developments in their environments. Background. In times of societal crises, such as the COVID-19 pandemic, the resilience of the healthcare organisation is tested. Method. This research is based on a case study in a university hospital and a county hospital in Sweden using surveys with both structured and open answers. Results. The result shows ambiguity and “polarised” experiences, emphasising flexibility vs. structure, clear hierarchical information vs. spaces for peer learning through dialogue, and focus on acute care vs. determination to continue with core operations. Conclusion. The article concludes that the pandemic resulted in paradoxes, tensions, and new experiences in organisational processes and interactions. These create opportunities for learning not only during crises but also for improving nursing management in both acute and planned care. Three relations are important in building organisational resilience in crises: resilience capability, resilience capacity, and sustainable resilience practices. Implications for Nursing Management. Organisational resilience under extraordinary circumstances, such as a pandemic, as well as enhancing the previous literature on nursing management that offer a more individually oriented perspective.

Aim:The aim of this study was to identify first-line managers' approaches for maintaining low levels of sick leave among health care employees.Introduction: One challenge in health care is the high level of sick leave among employees. High work demands and conflicting pressures characterize the work situation of both employees and first-line managers, with potential negative effects on work-related health.Method: First-line managers at units with low and/or decreasing sick leave were interviewed. Thematic analysis was used to analyse the data. Results:The managers took a holistic approach in meeting their employees' broader needs, and they were balancing high organisational demands through insubordination. To keep sick leave rate low, they created possibilities for the employees to influence their own working life through a present, visible and trustful leadership. Conclusion:Managers responsible for units with low sick leave seemed to utilize a holistic approach with focus on their employees and prioritized needs of their employees before organisational demands from top management.Implications for nursing management: First-line managers in health care can have impact on sick leave among their employees and create good working conditions, despite pressure from their superiors.