Informal Digital Coordination of Nurse Shift Swaps in a Saudi Tertiary Hospital: A Qualitative Descriptive Study

Background/Objectives: Nurses may use digital communication channels alongside formal rostering systems to negotiate shift swaps. How these practices are organized, governed, and experienced in Saudi hospitals remains insufficiently understood. This study explored how nurses in one tertiary hospital coordinated shift swaps through digital communication and navigated reciprocity, professional accountability, and access to scheduling flexibility. Methods: A qualitative descriptive study was conducted in a tertiary hospital in the Riyadh region, Saudi Arabia. Twenty-four registered nurses, recruited by purposive maximum-variation sampling from medical–surgical, intensive care, emergency, and specialty units, completed individual semi-structured interviews incorporating digital journey-mapping prompts. Interviews were audio-recorded, transcribed, de-identified, and analyzed using reflexive thematic analysis, reported with reference to the Reflexive Thematic Analysis Reporting Guidelines. Results: Four interrelated themes were developed: (1) digital pathways of negotiation; (2) reciprocity as social currency; (3) managing risk and responsibility; and (4) collective coping and unequal flexibility. Private and group messaging supported initial negotiation, whereas managerial approval and formal roster documentation established legitimacy and accountability. Reciprocal assistance increased flexibility but could also generate obligation and reproduce inequalities associated with seniority, trust, and social integration. Conclusions: In this hospital, digital shift-swap coordination operated alongside, rather than in place of, formal scheduling governance. Transparent procedures connecting peer communication with managerial approval may support flexibility while protecting fairness, documentation, professional boundaries, and appropriate staffing. These findings describe one purposively recruited sample in a single hospital and require evaluation in multi-center research.