The Journey to First‐Line Nursing Management: A Qualitative Study in a Spanish University Hospital

  1. Esquisábel‐Soteras, Beatriz 12
  2. Robert, Glenn 5
  3. Acilu‐Fernández, Aitor 4
  4. González‐García, Alberto 3
  5. Neddermann‐Carrillo, Sofía 12
  6. Vázquez‐Calatayud, Mónica 26
  7. Pardavila‐Belio, Miren Idoia 23
  1. 1 School of Nursing, Department of Community, Maternity and Pediatric Nursing. Campus Universitario University of Navarra Pamplona Spain
  2. 2 Navarra's Health Research Institute (IdiSNA) Pamplona Spain
  3. 3 Department of Nursing and Physiotherapy University of León León Spain
  4. 4 School of Architecture, Academic Department: (ETSA) Theory, Projects and Urbanism University of Navarra Pamplona Spain
  5. 5 Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London London UK
  6. 6 Area of Nursing Professional Development and Research Clínica Universidad de Navarra Pamplona Spain
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Journal:
Journal of Advanced Nursing

ISSN: 0309-2402,  1365-2648

Year of publication: 2025

Type: Article

DOI: 10.1111/JAN.16973 GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Journal of Advanced Nursing

Abstract

Aim: To explore nurse managers' perceptions at first-line, middle and executive levels regarding their transition to first-linemanagement in two divisions of a highly specialised university hospital in Spain.Design: A qualitative descriptive study.Method: A purposive sampling technique was employed to conduct four focus groups and two semi-structured interviewswith 31 nurse managers across three hierarchical levels in two divisions of a highly specialised university hospital in Spain.Participants included two Chief Nursing Officers, four Nursing Directors and 25 first-line nurse managers. Data were analysedthematically.Results: Three themes emerged: ‘Bridging the Readiness Gap: Training, Role Clarity, and Institutional Alignment’, revealing thelack of structured transition plans, role ambiguity and gaps in managerial skills, such as human resources, financial managementand leadership; ‘Fighting Loneliness: A Common Challenge in Care Management’, highlighting the isolation of first-line nursemanagers due to the absence of structured mentorship and peer support; ‘Clinical Expertise as a Cornerstone: The Role of PriorExperience in Nurse Management’, examining how clinical expertise facilitates leadership transitions but also presents challenges,particularly for managers promoted within their teams, where authority negotiation and role redefinition become critical.Conclusions: Findings underscore the need for structured training and mentorship to address role ambiguity, enhance managerial competencies and support nurse managers' transitions through targeted education.Implications for Profession and Patient Care: Structured transition programmes focusing on role clarity, training and institutional alignment can ease transitions, boost leadership confidence and enhance peer collaboration. Providing mentoringand training tailored to first-line nurse managers can improve team dynamics, support professional integration and strengthenorganisational cohesion.Impact: Tailored educational interventions are essential in supporting nurse managers' transitions. Structured mentorship andtargeted training enhance leadership readiness, adaptability and institutional alignment, strengthening healthcare leadership,efficiency and patient care quality.Patient and Public Contribution: No patient or public contribution.

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