What Is the Meaning of Patient-Centered Decision-Making for a Middle Nurse Manager?—A Qualitative Study

<b>Background</b>: Patient-centered care (PCC) is a cornerstone of quality, yet its translation into managerial decision-making remains underexplored. Middle nurse managers (MNMs) play a pivotal role in enabling patient-centeredness, but their perspectives on PCC decisions are rarely investigated. <b>Aim</b>: This study explored MNMs' perceptions of what constitutes a patient-centered decision in hospital settings and identified the essential dimensions underpinning such decisions. <b>Methods</b>: A qualitative descriptive design was adopted using semi-structured interviews. Thirty-eight MNMs from three hospitals in central Italy were included. Data were analyzed using Elo and Kyngäs' content analysis approach. <b>Results</b>: Two overarching themes emerged as central to patient-centered managerial decision-making (PCMDM): "Meaning and definition of PCMDM," and "Influencing dimensions of PCMDM". MNMs described PCMDM as an evolving and adaptable process shaped by patient needs and organizational constraints and unfolding across distinct phases. Key influencing dimensions included the manager's role, organizational environment, human resource management and knowledge of the patient. <b>Conclusions</b>: PCMDM is a continuous, ethical, and reflective process mediated by MNMs, who reconcile institutional priorities, team dynamics, and patient needs to create conditions for high-quality PCC. Implications for Practice: Strengthening PCMDM requires coordinated action aimed at equipping nurse managers with advanced leadership capabilities, building organizational structures that sustain patient-centered decisions, and empowering patients to actively co-shape the care process.