"Trust, Responsibility, and Making a Difference": Qualitative Insights into Why First-Line Managers in Healthcare Remain in Their Role.

Healthcare organizations face increasing challenges in retaining first-line managers, who play a key role in operational stability and patient care. Studies indicate that approximately half of all first-line managers intend to leave their position within 5 years. This highlights the need for updated knowledge about conditions under which they work. A qualitative descriptive design was used to explore first-line managers' perceptions of what is important for them to remain in the managerial role. Data were collected through 20 individual semi-structured interviews with first-line managers from a medium-sized healthcare organization in Sweden between March and June 2022. The data were analyzed using qualitative content analysis. The results are presented through the overarching theme . This theme describes how first-line managers sustain their motivation and commitment by developing confidence in their ability to lead, influence others, and create meaningful change. Their confidence is grounded in support, responsibility, and role clarity. The theme also shows how first-line managers handle challenges, make decisions, and act to improve staff well-being and patient care. Through these actions, they contribute to the development of their units. Trust from their manager, autonomy in decision-making, and support from colleagues enhance first-line managers' sense of purpose and motivation, encouraging them to remain in their role. Moreover, balanced workloads and opportunities to make a meaningful impact strengthen their commitment. By recognizing and addressing these aspects, healthcare organizations can better support long-term engagement of first-line managers, fostering sustainable leadership and stability.