Nurse managers' experience during the COVID‐19 pandemic in China: A qualitative study

Abstract

Aims

The aim of the study was to explore the experiences of female new nurse managers during the COVID‐19 pandemic.

Design

This was a phenomenological study, and qualitative descriptive analysis was used.

Methods

New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face‐to‐face with a semi‐structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven‐step method.

Results

Four main themes and 10 sub‐themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work‐related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles.

Conclusions

New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation‐oriented work environment for new nurse managers.

Patient or Public Contribution

No patient or public contribution.

1. INTRODUCTION

COVID‐19, a novel coronavirus that began in Wuhan, China, in early December 2019, has spread to most countries worldwide (Forsyth et al., 2022). The World Health Organization declared a global pandemic in March 2020 (Jebril, 2020). Due to a severe acute respiratory syndrome coronavirus‐2 infection, millions of people worldwide have been affected by massive death and disability costs (Li et al., 2020; Valdes et al., 2022). As of today (07 November 2022), the number of confirmed cases has topped 9,075,899 in China, with more than 28,000 deaths (WHO Coronavirus (COVID‐19) Dashboard Data Explorer, n.d.). Hospitals across the world have been dealing with substantial and unprecedented challenges caused by the COVID‐19 pandemic (Hodgson & Brennan, 2021).

In this context, nurses around the world have been impacted greatly (Cui et al., 2020; Valdes et al., 2022). In dealing with the coronavirus and providing patients with high‐quality care, nurses must overcome various clinical challenges they have never experienced, which affect their performance (Arcadi et al., 2021).

Numerous publications have documented the experiences of front‐line nurses during the pandemic, especially during the outbreak of the pandemic, and a number of statistically significant themes have emerged (Galehdar et al., 2020; Perraud et al., 2022). But most of the investigations focused on first‐line nurses who provided care for the patients directly, and fewer focused on nurse managers, even within the same context, the experiences of nurses and nurse managers may vary due to the different responsibilities.

Currently, nearly 3 years have passed since the COVID‐19 pandemic began. As the first country that experienced this huge COVID‐19 challenge, China adheres to the dynamic zero‐COVID‐19 strategy in order to prevent COVID‐19 infections. In the present situation, the outbreak of the COVID‐19 pandemic had been small and continued for a long time, a sudden public health emergency had morphed into a state called the post‐pandemic state. Due to the long duration of the pandemic, consumption habits, the economy, culture and education were impacted.

However, few studies examined the experiences of nurse managers during prolonged pandemic control and prevention, especially for new nurse managers. In this study, the specific experiences of new nurse managers during the COVID‐19 post‐pandemic were discussed, filling a gap that had been neglected to date in the research literature. Nursing managers can use this information to improve their experience and plan for future crises similar to this one to draw on their unique expertise.

2. BACKGROUND

In order to conduct this study, the authors searched for articles published prior to and after the COVID‐19 outbreak, providing insight into nurse managers' experiences.

Previous studies showed that: nurse managers played a crucial role in the delivery of high‐quality patient care and the management of associated costs (Trus et al., 2012). but stress, burnout and occupational fatigue were ongoing problems for them (Labrague et al., 2018). Chronic occupational fatigue had been reported by nurse managers due to their level of responsibility, difficulties supporting staff and constant interruptions, among many other ongoing responsibilities (Steege et al., 2017). A lack of adequate role preparation, ambiguity in roles, peer relationship problems, workload and personal issues also contributed to nurse managers' stress (Udod et al., 2017), which caused them to experience low job satisfaction and intentions of leaving the profession.

Following that, we searched for articles related to COVID‐19. It has been found that the aetiology, pathology, transmission, treatment and consequences of COVID‐19 had been well‐published in the current literature (Murugan & Rangasamy, 2022; Nontawong et al., 2022; Qu et al., 2020; Valdes et al., 2022). Managing COVID‐19 and reducing its harm had absorbed substantial medical resources and the energy of hospital managers (Ding & Zhao, 2021). The operation and management stress of major medical and health institutions had intensified due to the substantial consumption of person power and property with limited medical resources (Arcadi et al., 2021).

In terms of the nurses' experience, numerous publications have documented the experiences of front‐line nurses during the pandemic, and a number of statistically significant themes have emerged (Galehdar et al., 2020; Perraud et al., 2022). Qualitative studies have observed that nurses were emotionally and physically exhausted and fearful of spreading infections (Daly et al., 2020; Galehdar et al., 2020). A majority of the qualitative studies found nurses promoting personal and professional growth as a result of their caring during the pandemic (Cui et al., 2020; Vittoradolfo et al., 2022).

During the COVID‐19 pandemic, nurse managers were regarded to play a great role in ensuring the safety and orderly order of nurses and patients, it was the nurse manager's responsibility to make decisions regarding staff and patients as well as to plan nursing care and oversee the front‐line nurses who deliver this care during the period of the pandemic, ensure nurses' safety and the safety of their patients and provide excellent clinical care to patients (Spalletta et al., 2021). It was also stressed that nurses at the forefront of the COVID‐19 pandemic need and deserve strong leaders to ensure their interests are protected (Daly et al., 2020).

It has been reported by Goh et al that nurse managers' experiences in Singapore were focused on caring for their staff and their psycho‐emotional health during the pandemic (Goh et al., 2021). According to Jane H White, nurse managers during the pandemic concentrated on the psychosocial support of front‐line nurses while experiencing stress and exhaustion themselves, the same conclusion as Goh's. In their report, the authors emphasized the need to give more attention to nurse managers' psychosocial needs, allay their exhaustion and provide them with readily accessible support and resources.

In contrast, there were few reports discussing the role of new nurse managers during the pandemic. There was evidence that new nurse managers with a lack of managerial experience may experience greater levels of stress during the transition from being a general nurse to being a nurse manager (Kelly et al., 2019). The COVID‐19 pandemic may be a barrier for inexperienced new nurse managers with different backgrounds as work grows, and the role had become more challenging and variable as a result, but few studies have been conducted on the experiences of new nurse managers in new settings. The experiences of new nurse managers during the post‐pandemic in China have not been investigated qualitatively. This study, the purpose is to investigate the experiences of new nurse managers during the post‐COVID‐19 pandemic. It provides insight into the experiences of new nurse managers during the COVID‐19 pandemic.

3. METHODS

3.1. Design

3.1.1. Philosophical approach

Phenomenological psychology is the study of first‐person experiences from an individual's perspective. There is a conventional distinction in phenomenological psychology between descriptive and interpretive approaches (Elliott & Timulak, 2015). In the descriptive tradition, the essence or ‘essential structure’ of a phenomenon is described, relying heavily on Husserl's original philosophical position (Lévinas, 1995). In this study, qualitative descriptive analysis was used, in order to identify what was essential to the experience of new nurse managers during the post‐COVID‐19 pandemic. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports (‘General Guidelines for Qualitative Research’, 2007).

This study was approved by the Medical Ethics Committee of Huzhou Maternal and Child Health Care Hospital (No: 2020006; Date: 2020‐05‐25).

3.1.2. Personal statement

One master's degree and five bachelor's degrees were on the research team. The researchers were not personally acquainted with the participants or had ever dealt with COVID‐19 patients. All of the authors were female with over 15 years of relevant professional experience, specializing in women's care and also had extensive experience as administrative assistants; they were trained in qualitative research methods. The authors understand how sensitive it is to interview nurse managers regarding such emotional experiences.

3.2. Setting and participants

In order to determine essential themes and provide an exhaustive description of the phenomenon, we carefully considered the interview outline. First, by consulting the relevant literature (Rathnayake et al., 2021) and keeping the research purpose in mind, the researchers prepared preliminary interview outlines; then, consulting experts and two interviewees were involved in the development of the final interview outline. The semi‐structured interview guide included five open‐ended questions about the experiences of new nurse managers: (1) What is your opinion of being a nurse manager?/Can you tell me about your work experiences as a nurse manager? (2) In the past few months, how has your family life been?/being a nurse manager, has your life changed, if yes, what has changed? (3) What do you think about this change?/What are your thoughts on the current situation? (4) Could you tell me what barriers and challenges you experience? How do you handle it?/What is your approach to it? (5) Do you have anything else you would like to share with us beyond these questions? Following initial responses to questions, probe‐type questions allowed managers to describe their experiences in greater detail (Smith, 2007).

This study utilized a purposive approach to obtain samples. We distributed flyers to three major medical institutions in Huzhou city in the local east of China, the top three hospitals in the region. In the recruitment flyer, it was stated that nurse managers with less than 3 years of management experience and who had worked during the COVID‐19 pandemic and that their participation was voluntary. Participants were excluded if they had a history of mental illness or used mood‐altering oral drugs. Their participation was described on the flyer as a face‐to‐face interview focusing on their experiences as nurse managers during the COVID‐19 pandemic. When potential participants expressed an interest in the study, the researcher contacted them by phone and arranged an interview date and time.

3.3. Data collection

During November and December of 2021, data were collected, and interviews were conducted. A semi‐structured interview was used to collect data. Face‐to‐face interviews were conducted, which was superior to audio telephone interviews (Webber‐Ritchey et al., 2021). Researchers conducted their interviews in a quiet room prepared specifically for participants without anyone else present. Interviews were conducted and recorded during the interview by the first author and another researcher with more than 15 years of hospital management experience the interview process was audio‐recorded simultaneously. A detailed explanation of the purpose, content, and methods of the study, as well as the commitment to confidentiality, the voluntary nature of the study, and the required informed consent, were given prior to the interview. A verbal survey was conducted to collect demographic information. It took approximately 10–15 min for the demographic data and the informed consent to be collected. By providing appropriate recognition and encouragement, the researchers interacted actively with the interviewees during the interview and share their experiences about management. Also, the interview content was adjusted based on the interview circumstances, enabling the interviewees to express their thoughts and feelings in depth, ask inquiries, repeat questions and seek guidance as needed. To avoid misunderstandings, in‐depth communication skills were used. Interviewees' nonverbal behaviour was observed and recorded in real time to maintain the integrity of the interview. It took about an hour for each participant to be interviewed, and each participant was interviewed only once. Transcripts returned to participants for correction at the end of the interview. Through face‐to‐face interviews, the researchers established rapport with every participant. The sample became saturated after the 16th interview, and two more interviews were conducted to ensure that no further data could be collected. No participant dropped out during the interview.

3.4. Data analysis

Researchers were interested in learning about the experience of new nurse managers. For this study, we opted to use Colaizzi's method (Valle & King, 1978). As a reliable phenomenological methodology, Colaizzi's data analysis method is rigorous and robust for understanding people's experiences (Colaizzi, 1971). Research in health and healthcare has widely used this method because of its ability to identify ‘essential themes’ and to illustrate the fundamental structure of experiences in a concise manner (Bazeley, 2020). This study followed the following process: (1) read the interview repeatedly; (2) extract important statements; (3) construct/code recurring perspectives; (4) encoded views are combined to form the theme prototype; (5) define and describe the theme prototype; (6) compare similar theme prototypes, extract similar views and form the theme. The audio recordings were converted into text within 24 h, and a second researcher checked the transcribed interviews for accuracy and completeness. Stages 5 and 6 were completed by the first author, with frequent team meetings to discuss, review and complete these stages of data analysis. Stage 7 (‘Seeking verification of the fundamental structure’) was not completed as controversial, according to Giorgi (2006), who argued that giving participants the chance to discuss the fundamental description is misguided, because participants' views will inevitably differ from those of systematic analysis, and as a result, this step was avoided.

3.5. Ethical considerations

We obtained approval for this research from the ethics committee for the use of human subjects at the hospital where the research was conducted. Before the interview begin, the consent form was signed which contained all of the required assurances about confidentiality and anonymity and ensured that no employment reprisals would be imposed. Participant incentives were also not provided in the consent form. During the interview session, we anticipated any anxieties they might be experiencing as they processed potential emotional traumas as far as possible, a handling plan for special cases was formulated for ensuring the safety of interviewees. The real name of each interviewee was hidden during the data analysis. We obtained verbal recorded consent from each participant. The participants were informed that they could withdraw from the study at any time. All transcripts were stored on password‐protected computers accessible only to researchers.

3.6. Methodological rigour

Credibility refers to the accuracy of the findings, which was ensured by recording the interviews. Authenticity refers to the portrayal of the findings as that of the participants. During the interview process, the researchers kept the authenticity and accuracy of the records and made the live recording. Due to the researcher's lack of direct experience with COVID‐19 patients and experience in nurse management, the potential for gaining insights from participants' experiences was limited. Furthermore, the researchers were always alert to their bias. Following rather than leading the direction of interviews by asking for clarification when necessary. Moreover, the researcher frequently stopped to review prejudice especially related to alternative hypotheses. These ensured the biases of researchers were attended to ensure the integrity and mitigate threats of researcher bias.

4. RESULTS

4.1. Description of participants

A total of 18 new nurse managers participated in the study, all of whom were female and married, 8 of them had two kids, 9 had one kid, and 1 had not given birth yet but was eager to do so. The mean age was 37.39 ± 1.29 years old. 10 of them had a diploma in nursing, 5 of them had a bachelor's degree, and 3 of them had a master's degree. Five senior professional titles and 13 medium professional titles. Nursing experience ranged from 13 to 20 years, and nurse management experience ranged from 2 to 3 years. They worked in a variety of units, which were as follows: Gynaecology/Obstetrics/Neonatal/Intensive Care/Reproductive/Neurology/Sterilization Center/Breast/Digestive Surgery/Paediatrics/Orthopaedics/Fever Center.

4.2. Themes

Listed in Table 1 are the four major themes and their respective sub‐themes, along with examples of supporting verbatim phrases, demonstrating reduction. The sub‐themes within the overarching theme are described with examples from participants' transcripts. In order to maintain as much anonymity as possible, the verbatim phrases in this article do not include participants' age or unit assignments

TABLE 1.

Themes and sub‐themes.

Themes	Sub‐themes	Examples of CODED phrases	Participants
A shift in stress	Management is stressful	“the heart rumbled”; “breathing hard”	(Gynaecology, female) (Gynaecology, female)
	Stress persists without relaxation	“physical and mental exhaustion”; “cannot relax”; “daily delay”	(Neonatal, female) (Intensive care, female) (Gynaecology, female)
Work‐related physical and psychological discomfort	Emotions	“unhappy”; “uneasy, upset, uncomfortable, silence”	(Intensive care, female) (Sterilization centre, female)
	Impaired health	“heaviness body”; “ruined my neck”; “finally sick”	(Neonatal, female) (Orthopaedics, female) (Reproductive, female)
Reflection on the cause	Role conflict	“… not possible to spend enough time with family (eyes red)”; “daughter's grades were down”; “did not fulfil my promise(guilty)”; “complains overtime work”; “kept silent…considered hypocritical”	(Gynaecology, female) (Obstetrics, female) (Digestive surgery, female) (Sterilization centre, female) (Gynaecology, female) (Breast, female) (Fever centre, female) (Reproductive, female) (Sterilization centre, female) (Gynaecology, female)
	No care‐related work	“squeezing out time should spent…”; “… occupied with…, which overwhelmed “; “… became a security guard”; “professional being wasted”	(Neonatal, female) (Sterilization centre, female) (Gynaecology, female) (Neurology, female)
	Management be questioned	“sceptical abilities”; “work did not meet requirements…stressful”; “hard to coordinate”; “difficult to satisfy everyone”; “… low productivity… means overtime (wry smile)”; “…management should be easier than clinical nursing”	(Paediatrics, female) (Gynaecology, female) (Gynaecology, female) (Paediatrics, female)
	Workplace bullying	“do less work…give you their work”; “…if I am a senior nurse manager”; “…could not say no”; “important to maintain good relationships”	(Neurology, female) (Neonatal, female) (Neonatal, female) (Reproductive, female)
Coping and Struggles	Taking efforts to control their own lives	“pressure motivates me, …to handle it”; “…achieve unexpected results”; “management became smooth, …thanks to…”; “…makes me feel accomplished”; “…forget work”; “giving some blank…can relieve”; “…friendships make us relaxed”; “exchanging experiences makes work easier”; “reporting release stress”; “… gain a better understanding”	(Gynaecology, female) (Gynaecology, female) (Intensive care, female) (Reproductive, female) (Gynaecology, female) (Neurology, female) (Breast, female) (Intensive care, female) (Obstetrics, female) (Sterilization centre, female)
	Withdrawal behaviour	“resign at the end”; “give priority to children”; “I resigned(laugh)”	(Gynaecology, female) (Reproductive, female) (Neonatal, female)

4.2.1. Theme 1 A shift in stress

Management is stressful

In this study, the interviewees were between 35 and 40 years old. They experienced stress in all areas of their work, despite their high energy, active thinking abilities and brave innovation. According to all interviewees, management was extremely stressful. Local COVID‐19‐positive cases, even if there are only a few, often lead to intense pressure. they said:

(Gynaecology, female): "the heart rumbled when a positive case was reported around, meaning the prevention and control efforts would be more intense"; (Gynaecology, female): "I find myself breathing hard".

Stress persists without relaxation

While hospitals had been under tremendous management pressure regarding COVID‐19, the Chinese government continued to promote the work planned in the annual plan, including the Hospital Grade Review. Hospital grade reviews were directly related to hospital appraisals and future development. A hospital's primary goal over the course of a year was to ensure that the review is successful. Infection prevention for COVID‐19 was undertaken simultaneously with hospital review preparation, making the management of nurse managers in hospitals more challenging. Against this backdrop, three interviewees said the workload was more than ever and their work pressure persistent without relaxation, exhausts them:

(Neonatal, female): "Physical and mental exhaustion are the typical experiences"; (Intensive care, female):"I cannot relax due to the high frequency of prevention and control responsibility supervision from authorities"; (Gynaecology, female): “Daily delay is certainly not the same as occasional delays".

4.2.2. Theme 2 Work‐related physical and psychological discomfort

Emotions

In the workplace, it was challenging to ensure that all nurses and patients took good pandemic prevention and control measures, and the standards of evaluation in grade hospitals are higher than those of management. Puzzles like these make workers emotionally depressed. they were experiencing irritability, mental tension, anxiety and depression. The following feelings were expressed by two nurse managers:

(Intensive care, female): "Generally unhappy"; (Sterilization center, female): "Not finishing on time makes me uneasy, upset, uncomfortable, and I lack confidence and silence."

Impaired health

In addition to being overburdened with trivial work, the interviewees felt fatigued and suffered health problems over a lengthy period of time as a result of the stress. According to three nurse managers:

(Neonatal, female): “Heaviness in the body”; (Orthopaedics, female): “Decades of desk work ruined my neck”; (Reproductive, female): “My brain is constantly thinking, preventing me from resting, and finally I get sick”.

4.2.3. Theme 3 Reflection on the cause

This theme examined the causes of post‐traumatic stress disorder. Participants provided the following analyses.

Role conflict

Role conflict was a concern raised by all interviewees. Since work consumes a great deal of personal time, interviewees reported that balancing work with family was difficult, and role conflicts led to psychological stress. Because of the overload of management, the mothers' roles conflicted, and nursing managers were not able to provide adequate care to their elderly and children. When faced with a role conflict, most interviewees chose to put work first, but this decision was followed by guilt and anxiety. The following annoyances were expressed by interviewees:

(Gynaecology, female): "… It's not possible for me to spend enough time with my family every day. My 10‐year‐old daughter has to take care of my two‐year‐old brother sometimes, which annoys me (eyes red). "(Obstetrics, female): "My daughter's grades were down because she lacked enough supervision from me. "(Digestive surgery, female): "I didn't fulfill my promise to be a teaching assistant at my son's school, since I was swamped with work (guilty)…"(guilty)…"

The interviewees were being questioned and lack of incomprehension as they were unable to fulfil their roles of mother, wife and daughter, and they suffered negative feedback which made them feel inadequate. In this regard, interviewees said:

(Sterilization center, female): "My husband complained about my overtime work"; (Fever center, female): "I just kept silent or I would be considered hypocritical"; (Reproductive, female): "I couldn't get much constructive advice from my families and friends because they couldn't understand hospital management's connotation".

No care‐related work

During the interview, participants believed that depression was caused in part by the absence of work related to their profession. Because hospitals were assigned many tasks by the government to assist in the management of the city, they were usually required to send volunteers, and most of these tasks were performed by nurses. They were required to act as assistants to the traffic police on the road to ensure that pedestrians obey the traffic rules. To make sure hospital household garbage was correctly classified, their work indicators include advising patients to classify garbage, and so on. Furthermore, due to the need for a large number of people to prevent and control pandemics, nurses were asked to stand at the hospital gate and check people's health codes to ensure high‐risk patients entered the appropriate areas of the hospital due to changes in hospital access patterns as a result of COVID‐19, Additionally, they were instructed to promote medical security apps and teach patients how to communicate with the hospital using new apps. In this regard, four participants commented:

(Neonatal, female): "I often deal with hospital policy promotion and inspection, like garbage sorting and health code checks. It took up a lot of my time, squeezing out time I should've spent on my patients and management"; (Sterilization center, female): "… occupied with garbage sorting, promotion, and assessment, which overwhelmed me". (Gynaecology, female):"… a nurse manager became a security guard"; (Neurology, female): "professional quality is being wasted".

Management be questioned

New nurse managers lack experience with difficult work, and they do not possess the skills needed to manage affairs with professional skills. Instead, they should utilize all available resources to coordinate and resolve various problems in their areas. As a result of questioning or rejection of their work ethic by their superiors, colleagues or themselves, they also developed stress. In this regard, four of the participants stated:

(Paediatrics, female): "I'm skeptical of my abilities, perhaps I'm not suited to management"; (Gynaecology, female): "My work didn't meet my superiors' requirements, so I had to rework often, which is very stressful for me”; (Gynaecology, female): "… said low productivity always means overtime (wry smile)"; (Breast, female): "…said management should be easier than clinical nursing".

Nurse managers were also challenged by the ability to recognize and respond to the psychological changes of nurses. In this regard, two of the participants said:

(Gynaecology, female): "It's important to listen to the feelings of each nurse; otherwise, it's hard to coordinate"; (Paediatrics, female): "I did my best to treat everyone fairly, but it is very difficult to satisfy everyone”.

Workplace bullying

The issue of workplace bullying was not limited to nurses but also affects nurse managers. In this study, interviewees described bullying from colleagues, they did not react because they did not know how to handle the situation; some had concerns and tolerated it. several participants shared their experiences of bullying with us:

(Neurology, female): "they(senior nurse managers) do less work, or even give you their work"; (Neonatal, female): "This incident happened in my area, I believe I will receive a different treatment if I am a senior nurse manager"; (Neonatal, female):" …but I couldn't say no(be assigned more work by a senior”;(Reproductive, female): "as new ones, it may be more important to maintain good relationships".

4.2.4. Theme 4 coping and struggles

Taking efforts to control their own lives

As a result of the new position, they encountered greater difficulties, however, they were aware of these problems and actively solved them. In order to cope with these changes, they try to improve the experience through individual self‐accommodation. and then achieved a new balance while completing their work. Participants shared their thoughts on intense work as follows:

(Gynaecology, female): "Pressure motivates me, I want to handle it". (Gynaecology, female): "Change mentality and take a different perspective to achieve unexpected results". (Intensive care, female): "I have to say my management became smooth, especially for nosocomial infections, thanks to grade hospital reviews and COVID‐19 prevention and control."

Performing activities that were of interest to them was recognized to be a source of power among interviewees. Their experiences were improved when they obtained satisfaction from other activities. In this regard, participants said:

(Reproductive, female): "Cooking for my family and sharing it on Wechat makes me feel accomplished"; (Gynaecology, female): "I forget about my work when I'm selling in WeChat and getting customer trust". An interviewee said she needed some blank time and space: (Neurology, female): "Giving myself some blank time and space can relieve my nerves."

By sharing their experiences with each other, the new nurse managers were able to reduce their stress because they established good peer relationships and established mutual trust. It was also possible to increase support by reporting to department directors or superior managers actively. In this regard, participants state:

(Breast, female): "Same situation facilitates friendships which make us relaxed"; (Intensive care, female): "Exchanging experiences makes work easier". (Obstetrics, female): "reporting release stress". (Sterilization center, female): "by being honest about the problems, I can gain a better understanding of them".

Withdrawal behaviour

Some interviewees expressed a desire to escape and withdraw in order to return to their original roles and status in life. It was primarily due to role conflicts that this withdrawal occurred. In view of the Chinese Confucian culture's values and the nature of mothers, they calculated the consequences of withdrawing repeatedly and held that family stability and harmony were more important than work. In order to maintain a good relationship with their families and to improve their role as mothers, they planned to resign. According to three interviewees:

(Gynaecology, female): "I may resign at the end of my term"; (Reproductive, female): "I should give priority to my children"; (Neonatal, female): "I resigned, but was rejected (laugh)".

5. DISCUSSION

This is a post‐pandemic era study, and since this is the first published study on the experience of post‐pandemic nurse managers during the COVID‐19 pandemic in China, there can be no comparison between this study and other studies.

This study found that new nurse managers in China face a number of challenges that are stressful for them. Extensive interviews with interviewees revealed their experiences from realistic perspectives, including self‐evaluation of workability, workload and family. In terms of stress management, new nurse managers release stress primarily by empathizing with peers and seeking other aspects of satisfaction, which differs from nurses in other countries who seek inner peace through religious activities (Achour et al., 2019). Differences in economies, cultures and religious beliefs may be responsible for this difference.

Furthermore, this study clarified the reasons for female new nurse managers' high stress, which included work overload, a lack of support, and so on. It is consistent with findings from previous studies (Udod et al., 2017). As reported by other studies (Shi et al., 2022), new nurse managers have experienced excessive workloads and inadequate support, which was also the major cause of their loss. Nevertheless, the female new nurse managers were likely more exhausted due to coping with the pandemic prevention and control work of COVID‐19 for such a long time in this study. There were two different ways in which the interviewees coped with stress: by coping or by withdrawing from the situation. Even so, a majority of the interviewees demonstrated maturity, stability and the ability to solve problems in their roles. This study has also revealed new themes on female new nurse managers, including role conflict, workplace bullying and no care‐related work.

There was a frequent mention of ‘role conflict’ by interviewees in this study. Various degrees of transition and adaptation lead to varying degrees of change in the family and social roles of new nurse managers, some of whom are unable to maintain their original family roles. With the implementation of China's new birth policy, an increasing number of women are having more than one child. Taking care of the family is a greater responsibility for women in Chinese culture, although they perform the same occupations as men. Some interviewees experience significant conflicts between their roles and stress as a consequence of their positions, leading to them shuffling back and escaping and choosing to devote their time and effort to their families. As mothers, this behaviour is in keeping with their nature and reflects their sense of family responsibility as well as their own need to preserve themselves. However, managers should pay more attention and consider the needs of new nurse managers who retreat due to role conflicts.

The interviewees in this study also cited ‘workplace bullying’ as a contributing factor to their poor work experiences, which differed from previous studies. It was also challenging for new nurse managers to deal with workplace bullying. As a result of workplace bullying, new nursing managers experience poor experiences, but it is difficult to say outright, though one hypothesis is that most of them do not know how to respond to it and instead tolerate it, which is not conducive to team cooperation and development. It has been shown that reducing workplace bullying reduces organizational costs as well as improves employee experience (Olender, 2017; Skarbek et al., 2015). Therefore, it is important to identify and prevent workplace bullying. Nurse directors play an important role in preventing and eliminating bullying among new nurse managers, as stated by Duffy and Yamada (2018); Gillen et al. (2012). Despite this finding, there have been few studies conducted in China concerning workplace bullying among nurse managers. In China, nurse managers have not been taken seriously and there is a lack of research on the issue. In order to properly identify and deal with bullying, not only new nurse managers but also their leaders require training and support.

Furthermore, the new nurse managers frequently mentioned ‘non‐nursing related work’. In accordance with the dynamic zero‐COVID‐19 strategy in China, the pathways to the hospital and patient and caregiver requirements have been adjusted at all hospitals, which requires an increase in person power. As a result of a shortage of human resources in hospitals, medical professionals including nurses often take on non‐professional roles, such as checking eligibility. Furthermore, the promotion of the smart hospital project has led to much no care‐related work, which has decreased nursing self‐efficacy as nurses and nurse managers. Meanwhile, the new nurse manager had to deal with high‐intensity work aggravated by no care‐related work, which caused increased physical and mental strain. To reduce the amount of no‐nursing work and allow nurse managers to return to their management duties, hospitals should coordinate human resources or invest more in building hospital convenience facilities and supervision facilities.

As a result of this study, it was found that new nurse managers actively adapt to the demands and challenges of the role at the expense of their family roles and functions, leading to anxiety and depression in this group and requiring them to reevaluate their reappraisal of the role. As Lin Y points out, long‐term anxiety may cause a change in self‐cognition, and distorted cognitive concepts will further aggravate negative emotions such as anxiety and depression (Lin et al., 2015). Negative emotions such as these have a detrimental effect on the health of new nurse managers, impede their career development, and negatively affect the stability of nursing management teams. The assistance of new nurse managers is therefore necessary. Nurse managers require a robust support system. It is the responsibility of senior nursing managers to provide new hires with training in management so they may succeed in overcoming challenges they have not faced before, improving their emotions, cognitions, management abilities and appropriate responses to assist them in adapting quickly.

5.1. Advantages and limitations

In this study, phenomenology is applied. Detailed analysis of the work experience of new nurse managers over a long period under the policy of tight pandemic prevention and control and the strategy of dynamic zero clearance has been conducted through in‐depth interviews. Among interviewees, there were differences in their ages, working years, education levels and personality characteristics. Despite the fact that the samples were drawn from the same geographical location, the experience of nurse managers may differ in different hospitals with different management, and the results may not fully reflect the work experience of the new nurse managers in China.

6. IMPLICATIONS FOR NURSING MANAGEMENT

According to this investigation, China's nurse managers have a wide range of content, and new female nurse managers have poor experience. As long working hours and persistent stress had a statistically significant physical and emotional toll on new nurse managers, it was necessary to provide them with readily accessible support, address their psychological needs and deal with exhaustion.

Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles and improve their management skills. Training programmes for stress management are available, such as stretch‐release and cognitive relaxation exercises (Payne & Donaghy, 2010). Authentic Connections (AC) interventions can be provided to them, according to Sherry S (Chesak et al., 2020), the AC intervention shows promise as a feasible intervention to reduce stress among nurse leader mothers by positively influencing depression, self‐compassion and perceived stress. Additionally, Nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation‐oriented work environment for new nurse managers. Furthermore, it is necessary to humanize the management of new nurse managers in order to secure the stability of the nursing management team.

7. CONCLUSION

New nurse managers experience great stress and exhaustion in their roles during the COVID‐19 pandemic. When stress is more statistically significant, fatigue is more prominent (Zhang et al., 2018). Considering the importance of new nurse managers' experiences, senior managers need to support them with psychological interventions based on their personal characteristics and responsibilities, train them in management and psychological and professional knowledge, strengthen teamwork and increase the adaptability of nurse managers.

AUTHOR CONTRIBUTIONS

Each named author has substantially contributed to conducting the underlying research and developing or reviewing this manuscript. Additionally, to the best of our knowledge, the named authors have no conflict of interest, financial or otherwise.

FUNDING INFORMATION

This research was supported by the Zhejiang Province Public Welfare Technology Application Research Project under Grant No. LGF20H040001.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no conflicts of interest.

Chen, Y. , Jiang, H. , Shen, Y. , Gu, H. , & Zhou, P. (2023). Nurse managers' experience during the COVID‐19 pandemic in China: A qualitative study. Nursing Open, 10, 7255–7265. 10.1002/nop2.1978

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.