Table 7 Major qualitative themes on administrator decision-making (N = 40)

Commitment to care quality

Sense of duty to patients as foremost priority guiding decisions

“I became a nurse to provide the best care possible for patients - that has to come first.”

Cost-benefit analysis

Weighing monetary, staffing, and time resources against patient benefit

“There are always trade-offs to consider in terms of costs, workload impacts and outcomes.”

Managing competing priorities

Balancing varied bureaucratic, operational, and political pressures

“It feels like a constant juggling act between the different stakeholder agendas.”

Collaborative advocacy

Build alliances with other departments to lobby leadership

“Garnering collective support strengthens our voice in petitioning those controlling the budgets.”

Gradual data-driven change

Incremental evidence-based changes to demonstrate benefit

“We make the case with data and take small steps to bring leadership on board over time.”