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

aimTo explore nurse managers' perceptions at first-line, middle and executive levels regarding their transition to first-line management in two divisions of a highly specialised university hospital in Spain.

designA qualitative descriptive study.

methodA purposive sampling technique was employed to conduct four focus groups and two semi-structured interviews with 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 analysed thematically.

resultsThree themes emerged: 'Bridging the Readiness Gap: Training, Role Clarity, and Institutional Alignment', revealing the lack of structured transition plans, role ambiguity and gaps in managerial skills, such as human resources, financial management and leadership; 'Fighting Loneliness: A Common Challenge in Care Management', highlighting the isolation of first-line nurse managers due to the absence of structured mentorship and peer support; 'Clinical Expertise as a Cornerstone: The Role of Prior Experience 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.

conclusionsFindings 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 mentoring and training tailored to first-line nurse managers can improve team dynamics, support professional integration and strengthen organisational cohesion. IMPACT: Tailored educational interventions are essential in supporting nurse managers' transitions. Structured mentorship and targeted 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.