“Bureaucratic Blockage” in Healthcare Resource Management: A Qualitative Study of Nurse Managers’ Operational Decisions

BACKGROUND AND OBJECTIVES: Reliable access to materials, pharmaceutical products, and functional equipment is essential for operational readiness and quality management in healthcare. However, nurse managers often make resource-management decisions within fragmented information systems and governance arrangements that limit timely local action. This study examined how information and governance constraints shape nurse managers' operational decisions in healthcare resource management and developed, inductively, from the qualitative findings, the concept of "bureaucratic blockage" to describe a mechanism that may constrain timely local action. METHODS: A qualitative descriptive study was conducted with 16 nurse managers (8 from hospital and 8 from primary care/community settings) in Portugal. Data were collected through semi-structured interviews conducted between January and August 2025. Interviews were audio-recorded, transcribed verbatim in Portuguese, pseudonymized, and analyzed using Bardin's inductive content analysis. ATLAS.ti was used for data management. Reporting was guided by the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Sixty-two resource-related meaning units were identified and organized into 2 thematic domains: management of material and pharmaceutical resources (reported across both settings) and management of equipment (reported by hospital managers only). Material and pharmaceutical decisions were constrained by limited order traceability, weak stock and lifecycle monitoring, restricted access to consumption and cost data, fragmented platforms, material shortages, and repeated ordering work. Equipment-related decisions, reported only by hospital managers, were shaped by unclear failure-response pathways, the absence of fault-management systems, limited autonomy in acquisition decisions, and administrative overload. In participants' accounts, information opacity, nonintegrated systems, and escalation-dependent processes co-occurred across domains, and restricted decision rights were described in hospital equipment management; their accumulation was synthesized inductively as a mechanism termed "bureaucratic blockage." CONCLUSIONS: Resource-management decisions are constrained by system-level factors that limit managerial capacity for timely, locally actionable responses. Quality-management interventions should strengthen resource traceability, system interoperability, and lifecycle monitoring and, in hospital equipment management, fault-management circuits and the alignment between managerial accountability and decision rights. Addressing "bureaucratic blockage" may reduce administrative escalation and support operational readiness; these consequences were inferred from participants' accounts, were not measured, and require empirical testing.