Nurse managers' awareness and concerns about climate change and leadership in sustainable healthcare practices: a mixed-methods study

Abstract

Aim: To explore nurse managers’ awareness and concerns about climate change, the factors influencing their perceptions, and their leadership roles in sustainable healthcare. Background: Nurse managers play a pivotal role in promoting climate resilience and embedding sustainability into healthcare organizations. Their leadership is essential for mobilizing teams and aligning healthcare systems with sustainability goals, yet evidence on their awareness, concerns, and leadership in this area remains limited. Methods: A mixed-methods convergent parallel design was employed. Quantitative data were collected through surveys of nurse managers, and qualitative data were obtained from focus group discussions. Findings were analyzed using descriptive and interpretive approaches and integrated through the Climate Adaptation Framework. Results: Nurse managers reported high awareness and concern regarding climate change. Awareness was shaped by a younger age, higher education, and prior climate training. Despite strong motivation, participants highlighted limited institutional understanding, weak policy frameworks, and resource constraints. Qualitative insights revealed fragmented planning and a pressing need for interprofessional collaboration. Discussion: Advancing climate action requires shifting from individual efforts to system-level strategies. Nurse managers are positioned to inspire teams and foster innovation, but their effectiveness depends on stronger organizational commitment, adequate resources, and aligned policies. Conclusion: Although nurse managers show readiness to lead, structural barriers such as inadequate policies, funding, and training restrict sustainable action and underutilize their leadership potential. Implications for Nursing: Embedding climate education into curricula, strengthening institutional sustainability initiatives, and fostering cross-sector collaborations are essential for leadership development. Implications for Nursing Policy: Policies should prioritize sustainability leadership training, allocate resources for adaptation, and provide structured frameworks that empower nurse managers as transformative leaders in climate-resilient healthcare systems. © 2025 Elsevier B.V., All rights reserved.