LEADERSHIP NARRATIVES OF HEAD NURSES IN ANDEAN RURAL PRIMARY HEALTH CARE

Objective: To analyze the lived experience of head nurses in primary-level rural Andean health facilities, from life narratives constructed within the context of the Puno Health Network, Peru, and to identify leadership styles, management strategies, and structural determinants of leadership practice. Materials and Methods: A qualitative, descriptive, and narrative research design was employed, epistemologically grounded in Bertaux's life story perspective. The sample was selected through selective and purposive sampling and comprised head nurses or strategy coordinators affiliated with the Puno Health Network. In-depth interviews were conducted between June and December 2022. Data were processed and analyzed with the support of AtlasTi and Python software, enabling the identification and coding of emergent thematic categories related to primary care leadership. Results: The narrative analysis revealed three central dimensions of leadership exercised by head nurses. First, the progressive transformation of the clinical role toward a managerial perspective, marked by initial feelings of insecurity and the absence of formal management training. Second, the performance of leadership under structurally adverse conditions, characterized by scarcity of human and material resources, work overload, and economic constraints. Third, the dynamic coexistence of democratic and authoritarian leadership styles, adopted according to contextual demands. Motivational strategies and practices of progressive evaluation and sanctioning reflect a relational, adaptive, and humanized leadership grounded in trust and horizontal communication. Conclusions: The leadership of head nurses in Andean rural primary care settings is emergent, relational, and substantially adaptive. It combines democratic strategies with authoritarian responsiveness in critical situations such as the COVID-19 pandemic. Although this leadership functions as a driver of organizational innovation, it may also represent a considerable emotional and physical burden when not accompanied by adequate institutional support structures.