3.3.1 Fairness and equity.

Participants described specific leadership behaviours that demonstrated fairness and equity, making them feel more engaged at work. Conversely, participants discussed how unfair and unequal treatment from managers caused them to feel disengaged from their work.

Participants defined equitable treatment behaviours as those that acknowledge their unique contributions, needs, and circumstances in a manner free from bias or favouritism. These behaviours help create an environment where employees feel valued and treated fairly, positively impacting their engagement at work.

Abeer highlighted how her department manager’s approach to allocating tasks based on staff abilities and current workloads boosted her sense of engagement and belonging.: “The head of our department allocated tasks and cases based on individual strengths and workloads, enhancing my engagement and sense of belonging” (Abeer).

Huda also appreciated how their manager handled leave requests, taking everyone’s leave requests into account: “Our head nurse considered our vacation needs, allocating leave fairly, which made us truly appreciate our work” (Huda).

Participants felt that ‘fairness’ from managers motivated them to perform to the best of their abilities, knowing that their efforts and contributions would be appropriately recognised and appreciated: “I enjoyed working with a wonderful head nurse in my current unit. The staff love her, and her approachable demeanour and equal treatment of everyone have made her a respected leader,” adding “She never uses her authority to make others feel inferior. When it comes to performance evaluations, you know she will be fair, which motivates us to work to our full potential.” (Mona).

Participants said working with a nurse manager known for fair treatment fostered a culture of trust and openness. Abeer said, “When this kind of leader gives any comment or suggestion, we accept it with open arms, knowing that this leader is fair and will not put them under pressure” (Abeer).

Some participants identified the negative impacts of perceived unfair behaviour. For example, Nour described having lost leave days due to workload and not being compensated. She observed how this kind of treatment leads to decreased work engagement and increased absenteeism.

We have a lot of compulsory leaves and days off... I can [theoretically]take 23 days off, but they … expired, and [the unit hasn’t] compensated us. Now, they don’t give us money for it; they give us extra time.... However, in [other] units, the head nurse arranges everything for the staff to take their days off. When we tried to talk to our head nurse, we were told there was a staff shortage... So, [there are] a lot of absences; [staff] don’t work with dedication” (Nour).

Julia was not able to take breaks for breastfeeding, which affected her negatively. Despite continuing to fulfil her duties while breastfeeding her baby, the emotional toll this had produced a negatively cascading effect on her productivity at work:

I was struggling to have my right to have a break for breastfeeding; this psychologically affected me at work. I used to work and give the patients everything they needed, but I was internally affected and disappointed... I was affected in terms of productivity. I don’t come to work actively as usual, smiling, and happy that I was coming to work. [While each] patient got all the medications they needed, I [did not do my best] work while I felt upset” (Julia).

3.3.2 Cultural competence.

Participants highlighted the importance of recognising and understanding religious and public holidays in their work practices, expressing disengagement when their managers failed to appreciate the cultural importance of these occasions. For example, Sarah highlighted a particular instance of cultural insensitivity: her manager did not recognise the significance of Eid, a major religious holiday, and expected her to remain at work during the initial days of the celebration, which are traditionally spent with family. This lack of understanding caused her to feel disengaged from her work:

We spend most of our time together, having fun and laughing about non-work-related matters. Unfortunately, some managers don’t understand work-related issues. For instance, they may not realise that during Eid days, they expect you to stay with them for the first four or five days instead of returning to your family. This lack of understanding has led to many arguments……... I see it is just a job; even the idea of quitting crossed my mind. I no longer feel the same excitement and enthusiasm; I used to wake up hours before work and be excited and happy. Now, it’s merely a job; I hope to do it by the end of this period “(Sarah).

Arwaa shared similar concerns about the lack of cultural sensitivity among non-Saudi managers towards national holidays:

“… non-Saudi leaders don’t care about national vacations, the National Day, or the founding day. She doesn’t give these days off, no matter what happens … non-Saudi leaders don’t consider the cultural differences between Saudis and non-Saudis. As for the Saudi leaders, they are appreciative; they would give us our rights as Saudis … our country” (Arwaa).

Arwaa also recounted personal experiences of being unable to meet with family due to work demands:

She used to ask me to work every weekend. I told her that I couldn’t come for a whole month. I can’t meet with my family. I can’t go anywhere else. When I tried to talk to her about this issue, she didn’t understand it. She says we all have families. …There are many absences and sick leaves. I mean, it is normal for someone to put pressure on the staff, but they won’t tolerate it. They won’t be able to bear this anymore” (Arwaa).

Participants discussed how managers’ lack of cultural competence, especially non-Saudi leaders, resulted in biased treatment that negatively impacted team morale. Nour shared her experience with a manager who showed favouritism toward individuals from the same nationality, undermining her sense of inclusion and engagement:

Sometimes, the non-Saudi leader tends to be biased toward her group; she treats them much better than other nationalities. She tends to discriminate between nationalities, like racism. Because they are the same nationality, they get better treatment. For example, if they have requests, she agrees and makes things easier for them, like schedules. But when I, as a Saudi woman, asked for something, she told me, “No, I can’t.” These are the main problems” (Nour).

Participants explained that this cultural insensitivity not only created frustration but also increased absences and sick leave, contributing to burnout among the staff. Nour further highlighted how these practices eroded engagement:

There are many absences and sick leaves. When managers treat people unfairly and don’t understand the importance of fairness across cultures, staff can’t tolerate it. They stop caring about the work. I had completed my first year at work and already felt burned out” (Nour).

Another participant highlighted the need for nurse managers to maintain objectivity and not show favouritism, citing how this bias negatively affected the team’s desire to work: “They should treat all employees equally. They shouldn’t specially treat friends or be biased toward anyone… [otherwise, others] would no longer want to go to work” (Khalid).

3.4.1 Demonstratable communication skills.

Participants emphasised the critical role of effective communication from leaders in fostering a sense of dedication and involvement among nursing staff. They particularly valued being heard, illustrating how active listening by nurse managers can significantly enhance workplace dynamics. Abeer highlighted the responsiveness of her head nurse to concerns, stating, “When a problem arises, the head nurse attentively listens to our issues and seeks solutions. This support enables us to excel in our tasks, deepening our commitment to work” (Abeer).

Huda said she felt more valued and less stressed when her manager discussed relevant issues with staff, holding brief meetings to address problems and provide detailed guidance:

She often discusses every point with her staff. She would hold brief meetings with them to discuss issues and guide them in detail on tasks such as sending emails and receiving cases. There is communication. Despite the high workload in this unit, handling 8-9 cases per shift, the staff feel less stressed than those in other units with lower capacities” (Huda).

Study participants appreciated nurse managers who considered individuals’ personal needs, and this fostered a strong connection between staff members and their work. May articulated this, stating:

“Leaders who listen to our opinions consider what’s best for the team. Our head nurse always consults us, even about scheduling, to accommodate our events and preferences. This approach respects our rights and needs and makes us feel valued and considered” (May).

Participants highlighted the importance of nurse managers who listened and addressed concerns, especially regarding work related stress. They emphasised that these kinds of issues required serious consideration and genuine support from leadership. There was a strong consensus that employee satisfaction correlates to high-quality patient care, emphasising the value of feeling supported and appreciated in their roles. Jolia said:

“[the manager] should listen to the employees; for example, if the employees have some problems, [the manager] should try to solve them, not ignore them; even if the employee is going through … job burnout, [the manager] should take it seriously. The leader should prioritise making employees feel happy and satisfied to help patients properly” (Jolia).

3.4.2 Communicating recognition and appreciation.

Managers who expressed appreciation of staff fostered greater work engagement and commitment in their team:

When a leader appreciates his employees, gives them their rights, and respects them, it makes a great difference…. I come to work with love, feeling happy and enjoying working with her” (Sarah).

Participants expressed how recognising the diverse needs of nursing staff is vital as it influences their energy and enthusiasm for work. Jody’s statement highlighted this:

“It’s different from one staff member to another. While some are motivated by self-development, others appreciate small gestures like coffee or sweets. I seek a balance in my workload and value cooperation when I need a vacation; [then] I can do more work” (Jody).

Mona and Jolia highlighted the significant role of appreciation in managing work pressures and encouraging extra effort. Mona stated, “When leaders appreciate your work, you can work properly and bear all the pressure at work because there is appreciation.”

Jolia echoed this: “If a good leader needed me for extra work, I would do whatever they asked. The appreciation [would] make me willing to take overtime and add new tasks [especially where they create] a comfortable, safe, and good work environment”(Jolia).

Nour and Khalid both felt that genuine appreciation outweighed financial incentives, underscoring the deep impact of recognition on staff engagement: “When you know someone appreciates your work, you will find people working with dedication. They work from their heart, not just for a salary” (Nour). Khalid also supported this: “If manager leaders are appreciative, we will be interested in getting involved in and engaged in our work” (Khalid).

Another participant highlighted how expressions of recognition, such as positive appraisals, salary increments, and incentives, directly contributed to making the physical and emotional stresses of the workplace more bearable:

“We will be more engaged if the manager is appreciated. Good appreciation appraisals, increments, and incentives make physical and emotional stress manageable because we feel recognised and rewarded.” (Abeer).

In contrast, a lack of appreciation can have detrimental effects on staff engagement: “They realise no one appreciates their efforts, so why should [they] work with all [their] heart? They [leadership] won’t appreciate it” (Mona). Nour shared her experience with a head nurse: “In the Paediatrics unit, a head nurse known for harsh orders and a lack of listening skills faced widespread resistance, for example: “Most nurses tended to ignore her orders, resulting in absences and a severe staff shortage” (Nour).

3.5.1 Leadership creating the supportive work environment.

One participant noted that nurses feel supported if, when they are feeling stressed or going through a tough time, and their manager takes an empathetic approach and provides support. This approach fosters a familial atmosphere and encourages staff to stand together during difficult periods:

If a nurse comes to work stressed or faces a hard time, the head nurse asks her what’s wrong and then supports her. She asks other nurses to stand with her, assigning her small tasks with stable cases, not critical ones. This way, we all feel satisfied, more engaged, and dedicated to our work and each other, knowing we could be in this situation one day and the head nurse would stand with us. We are like a family in one unit” (Julia).

Nurse managers who support their teams, especially during periods of conflict, such as disagreements between staff members or other health workers, gain respect and loyalty from their staff. Nurse managers who modelled supportive behaviour encouraged team members to support each other:

Our leader consistently supports us, even in conflicts with other professionals. Her unwavering support has made us deeply loyal; no one wants to leave her unit. We all recognise her value and reciprocate her support, ready to assist whenever she needs us” (Arwaa).

Similarly, a supportive leader positively impacted the team’s ability to manage their workload and challenges, especially in challenging circumstances. Mona described this as follows: “The most motivating factor for me is knowing that my leader is always there to support and guide me, especially in critical situations. [Their] expertise and availability significantly affect how we handle our workload and challenges”(Mona).

Participants felt that having nurse managers who promoted cooperation and mutual support created a better work environment, resulting in lower absenteeism and a stronger sense of community.

The labour ward at our hospital operates like a family, emphasising teamwork and support. Our manager encourages us to assist busy colleagues and be attentive to each other’s needs. This collaborative environment has resulted in low absenteeism; typically, only two people might be absent per shift, and they always communicate their reasons. Our leader’s human and attentive approach, always ready to listen, fosters this strong sense of community” (Samar).

Samar further noted as follows: “Even when we are sometimes busy, she comes in the morning and asks us if we had breakfast. She tells us to leave everything in our hands and eat before starting work” (Samar).

3.5.2 Collaboration and teamwork and their impact on nurses.

Participants said that the way nurse managers treat their teams significantly impacts engagement and motivation. Leaders who ensured their staff’ rights were protected, for example, positively influenced staff attitudes towards work and were respected and valued:

A strong connection exists between a leader’s treatment of their employees and the level of staff work engagement. When a leader shows appreciation, grants employees their rights, and treats them respectfully, it can make a significant difference. For example, when I work in a department with a collaborative leader, I come to work with love; I feel happy and motivated to work with them” (Nour).

Conversely, a work environment where employees feel uncomfortable, unsafe or lack agency results in a deterioration of genuine commitment to their roles:

If the leader has a good relationship with the employee, the employee will have more interest and benefit from team spirit. When the employee has team spirit, they will love their work and dedicate their time to it. This dedication must be physical and mental. However, if the employee is uncomfortable and does not feel safe and was only taught to do the work and go home, whatever they do at work becomes unimportant, so I do not think this person becomes engaged as required” (Huda).

Participants spoke of supportive leaders they have encountered in the past. For instance, a previous head nurse with a kind and collaborative nature fostered respect and motivation, resulting in a positive work environment. On the other hand, head nurses who lacked these qualities had a negative impact on the team. This led to increased absenteeism and diminished work quality, as their inability to inspire and support their team directly affected staff enjoyment of and commitment to their work:

When I first came here, I noticed that the staff admired and respected one of the previous head nurses, and until now, they love and praise him, and they wish he would be with them because he was so kind and collaborative. He was such a good leader. When I observe a head nurse in another unit, I notice how well he collaborates with the staff. [He] motivates them and supports every step they take; it makes me wish for a head nurse like him in my unit. In contrast, I have seen some head nurses in other departments who do not motivate their staff or provide support, leading to increased absences and decreased work quality. The leader’s influence on their team is crucial, as it can make or break their love and dedication for the unit and their job” (Samar).

Khalid believed that the absence of a collaborative spirit, especially between management and staff, breeds dissatisfaction through lack of fulfilment. As a result, the staff feel trapped in their roles and work solely for personal goals such as financial needs or career advancement rather than fostering a shared commitment to the workplace:

As a manager and staff member, we have never had this type of teamwork. Most of our staff are not satisfied. We keep working because every one of us has a goal; some of us work for the sake of money, people work because they want to reach something bigger, while others work to earn a living, so they get stuck in this place” (Khalid).