Exploring the Career Trajectories of Male Nursing Leaders : A Qualitative Study on Leadership Acquisition

Exploring the Career Trajectories of Male Nursing Leaders : A Qualitative Study on Leadership Acquisition | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring the Career Trajectories of Male Nursing Leaders : A Qualitative Study on Leadership Acquisition Longcha Liu, Wenjun Pan, Zhenjie Dai, Wenyu Li, Danwen Zhuang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8938782/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Nursing has historically been a female-dominated profession; however, the growing presence of male nurses in management and leadership roles has attracted increasing scholarly and institutional attention. This study investigates the career pathways and strategic enablers that facilitate male nurses’ advancement into formal leadership positions, with particular attention to the distinctive opportunities and systemic barriers they encounter within a gendered professional landscape. Methods: The descriptive phenomenological research method was used to conduct semi-structured in-depth interviews with 10 nursing managers, focusing on their real experience of career development, promotion path, organizational and interpersonal support structure. The data were analyzed using the Colaizzi’s seven-step phenomenological method. Results: Four core themes emerged: early systematic career planning, solid clinical expertise, effective mentor support, and strategies to navigate gendered work environments. These were refined into 10 subthemes : clarifying leadership intent early; accumulating leadership-relevant experiences deliberately; building credibility through high-standard practice; clinical expertise enabling leadership behaviors; demonstrating capability during critical incidents; early guidance on career direction and role fit; Skill development through mentorship; managing stereotypes and expectations about male nurses; building collaborative relationships in female-majority teams; and balancing visibility with legitimacy in leadership roles. Conclusion: This study offers practical and theoretical insights for fostering male nurse leadership. Health institutions should institutionalize mentorship, provide early career-planning support, and cultivate inclusive environments to advance diversity and equity in nursing leadership. Male nurse Gender Leadership Strategie Qualitative Study Introduction The nursing profession has long been shaped by a historical tradition of female predominance, a factor that has deeply influenced its professional identity and operational norms. Although male nurses have historically been underrepresented in this female-dominated field, their presence - especially in leadership positions - is increasingly being acknowledged. Empirical evidence demonstrates a growing representation of male leaders in nursing, a development widely recognized as essential for advancing evidence-based practice, strengthening leadership diversity, and addressing systemic gender biases embedded in clinical governance, education, and professional culture[ 1 , 2 ].Moreover, the growing representation of male leaders in nursing underscores the need for a critical reassessment of leadership paradigms - including communication patterns, decision-making frameworks, and relational approaches - within clinical environments. Extensive empirical research confirms that leadership style is a key determinant of interdisciplinary team cohesion, psychological safety, communication efficacy, and ultimately, patient safety and quality of care. For example, transformational leadership - characterized by inspirational motivation, individualized consideration, intellectual stimulation, and idealized influence - has been consistently linked to higher levels of nurse retention, role engagement, and professional satisfaction, all of which are foundational to cultivating an inclusive, resilient, and high-performing practice environment[ 3 ]. Effective leadership education for nursing professionals, regardless of gender, is essential to cultivate the necessary skills and competencies for emerging nurse leaders [ 4 ]. The perspectives of female colleagues regarding male nurses in leadership roles offer valuable insights into the evolving leadership landscape of the profession. Qualitative evidence indicates that female nurses frequently recognize and affirm the competencies, relational strengths, and contributions of their male peers - perceptions associated with enhanced interdisciplinary collaboration, improved team communication, and greater cohesion in clinical settings. As nursing advances toward greater demographic and experiential diversity, the lived experiences and professional narratives of male nurses - particularly those related to leadership entry, advancement, and identity negotiation - will critically inform the future development of evidence-based recruitment strategies, inclusive leadership curricula, and organizational policies aimed at cultivating equitable practice environments. Through correlational analysis and qualitative assessments, it is evident that the career pathways of male nurses can significantly impact the future landscape of nursing leadership. This qualitative study explores the pathways through which male nurses navigate their professional journey towards leadership roles. It highlights the distinctive challenges and opportunities they encounter in an environment largely dominated by female colleagues[ 5 ]. Male nurses may face unique advantages, such as greater access to mentorship opportunities and leadership programs, facilitating their rise to these roles [ 6 ]. However, challenges persist, including societal stereotypes that question their suitability for a caregiving profession that is often associated with traditionally feminine traits such as kindness and empathy[ 7 ]. This duality of male nurses’ experiences underscores the importance of examining their leadership trajectory in depth.This study aims to make a substantial contribution to the field of nursing and advocate for a more inclusive practice that acknowledges the valuable contributions of all nurses, regardless of gender. In conclusion, acknowledging the structural and sociocultural barriers - as well as the agency-driven pathways - that male nurses encounter in attaining leadership roles is essential for advancing equity and inclusivity within the nursing profession. Through qualitative research methods, this study understands the career development trajectory of male nursing managers, which can provide important enlightenment for strengthening the equity of nursing profession, enhancing the diversity of leadership and improving organizational effectiveness. Methods Study design This study employed a descriptive phenomenological approach to explore the career trajectories and leadership development experiences of male nurses in managerial positions across a specific region of China. The primary objective was to identify the enabling factors that facilitate their advancement within a profession historically characterized by female predominance. This study was conducted in full compliance with the ethical principles set forth in the Declaration of Helsinki.Ethical approval was granted by the Ethics Committee for Clinical Research (ECCR) at the First Affiliated Hospital of Wenzhou Medical University (Date: 10 December 2025; No: KY2025-567). Prior to the interviews, all participants received a detailed verbal and written explanation of the study’s aims, procedures, voluntary nature of participation, right to withdraw at any time, audio-recording practices, data handling protocols, and confidentiality safeguards. Written informed consent was obtained from each participant specifically authorizing both participation and audio recording. Participants were explicitly informed that recordings would be used solely for transcription, analysis, and scientific dissemination, and that all identifying information would be anonymized during data processing and reporting. Participants and setting Male nursing managers employed at a Class III, Grade A hospital in China were recruited as study participants through purposive sampling. A total of ten individuals were enrolled. Sampling criteria prioritized information richness, selecting participants with demonstrated capacity to articulate nuanced, reflective insights into their leadership progression, including entry pathways, advancement barriers, and identity negotiation within clinical hierarchies. Inclusion criteria were: (1) registered nurse; (2) self-identified male; (3) minimum two years of continuous service in management positions; (4) willing to engage in in-depth, reflective interviews on leadership . Exclusion criteria were: (1) not currently in a leadership role; (2) unable to complete an interview in the study language. The determination of sample size followed the principle of information saturation. A total of 10 male nurses were interviewed in this study, which were represented by the numbers P1-P10, and the general information of the research subjects is shown in Table 1 . Table 1 Descriptive characteristics of participants (N = 10) Code Gender Age (year) Education Marital status Length of nursing experience (year) Management experience(year) P 1 Male 38 UG Married 15 3 P 2 Male 36 UG Married 13 3 P 3 Male 35 UG Married 12 2 P 4 Male 40 MD Married 15 7 P 5 Male 43 UG Married 20 10 P 6 Male 38 UG Married 16 5 P 7 Male 35 UG Unmarried 13 2 P 8 Male 37 MD Married 15 4 P 9 Male 41 UG Married 19 6 P 10 Male 39 UG Married 16 4 *MD : Master's degree ; UG : Undergraduate Data collection According to the purpose of the study, literature review and group discussion were conducted to draw up the first draft of the interview guide. In order to ensure the scientificity and rationality of the formal interview, two research subjects were selected for pre-interview before the formal interview, and the formal interview guide was determined after modification according to the interview results. The Interview guide contained open-ended questions designed to collect personal and professional information about the participants and explore their career development history. The Interview guide are as follows: Can you walk me through your nursing career from entry into the profession to your current leadership position? What were the main steps and processes through which you moved into management/leadership roles? How did clinical expertise and performance influence your leadership opportunities and credibility? Did you have mentors or sponsors? What did they do that was most helpful, and when did this support matter most? As a man in a female-dominant profession, what gender-related experiences affected your work or promotion, and how did you respond? What strategies did you use to navigate challenges and leverage opportunities, and what would you recommend to institutions or early-career male nurses? Data were collected through semi-structured interviews based on descriptive phenomenological research methods. Before the interview, a relationship of trust was established with the respondents, and the purpose and significance of the study were introduced in detail. The interview was conducted in a quiet demonstration classroom, and the interviewees were encouraged to fully express their true thoughts during the interview. According to the responses of the interviewees, the interview outline sequence was flexibly adjusted to help the interviewees fully express their views and improve the integrity of the data. The interviews were recorded simultaneously, and non-verbal information such as body language, facial expressions and intonation of the respondents were recorded. Each participant was interviewed once, and the interview time was 30–40 minutes. The interview data were transcribed by two researchers within 24 h after the end of the interview, and the transcripts were fed back to the respondents for verification. Data were analyzed using Colaizzi's phenomenological analysis method, which involves identifying important statements, constructing meaning, clustering themes, and co-validating findings with participants. Data analysis The data were analyzed using Colaizzi’s seven-step phenomenological analysis method, a structured and rigorous approach to extracting thematic meaning from narrative data [25]. The process included the following steps: (1) Carefully read all interview materials to form a preliminary understanding of the description of the participants; (2) extract meaningful statements relevant to the research question; (3) summarize, refine and code these meaningful statements; (4) summarize the viewpoints after coding, search for common concepts or characteristics, and form themes, thematic groups and categories; (5) relate the themes to the detailed narratives of the participants; (6) form a statement describing the essential structure of the phenomenon; (7) Feedback the analysis results to the participants to verify the authenticity of the content. Data coding was conducted independently by two investigators, followed by a comparative review to establish inter-coder agreement. Disagreements were adjudicated through consensus discussions involving a third qualitative nursing research specialist. All coding and initial thematic identification took place on the same day as each interview. While the analytical framework was guided by existing theoretical and empirical literature (a deductive orientation), the process remained flexible enough to accommodate newly arising themes. Quality control Ensure that the interview environment is quiet and undisturbed during the interview; Keep neutral on the content of the respondents' answers, avoid using guiding language or actions, so as not to interfere with the respondents' thinking; If there are doubts about the responses of the respondents, flexible communication and requestioning should be conducted to ensure the accuracy and completeness of the information. The interview data were transcribed within 24 hours after the end of the interview, and the recordings were reviewed by two researchers to ensure that the transcribed content was consistent with the recording. The transcribed material needs to be verified with the respondents to ensure the rigor of the findings. The transcript was coded by two researchers separately, and the different opinions during the coding process needed to be discussed by the research group to finally determine the coding scheme and improve the credibility of the research results. All researchers should maintain a neutral attitude during data analysis and avoid mixing their personal opinions into the analysis of research content. Result The findings from the interviews conducted in this study are presented in this section. A total of 10male nurse manager participated in the study. Participants were anonymized and coded sequentially as P1 through P10. The descriptive characteristics of the participants are presented in Table 1 .The mean age of the participants was 38.22 years (min - max: 35–43), The mean nursing experience of the participants was 15.4 years (min - max: 12–20) and the mean manager nursing experience was 4.6 years (min - max: 2–10). As a result of the content analysis of the data obtained from the individual in-depth interviews, four main themes and ten subthemes were identified in Table 2 . Theme 1: Early Systematic Career Planning Subtheme 1.1 Clarifying leadership intent early Many participants recognized the uncertainty of career progression in nursing leadership and responded by explicitly setting managerial goals from the outset of their career. As P3 stated, “From my first year as a staff nurse, I knew I wanted to move into leadership, so I paid close attention to what managers did and planned my steps accordingly.” Similarly, P7 remarked, “I realized early on that waiting for someone to notice me was not enough. Setting my sights on management helped me seek out the right opportunities.” These deliberate intentions enabled participants to navigate ambiguous promotion structures with greater certainty and focus. Subtheme 1.2 Accumulating leadership-relevant experiences deliberately Participants described purposely seeking tasks and projects that would build their credibility for management. For example, P4 explained, “I volunteered for quality improvement committees and offered to coordinate our unit’s scheduling. Those experiences not only built my skills but also made me visible to senior staff.” P10 shared, “Taking initiative in team assignments gave me confidence and allowed others to see my leadership potential.” Through these strategies, participants laid a concrete foundation for future promotion. Theme 2: Solid Clinical Expertise Subtheme 2.1 Building credibility through high-standard practice Clinical competence was regarded as the bedrock for leadership legitimacy. As P5 explained, “Excelling in patient care made my colleagues trust my judgment, which was essential when I started making decisions as a leader.” P9 echoed, “People are more willing to follow your instructions if you have proved yourself clinically.” This consistent demonstration of reliability strengthened participants’ acceptance as managerial candidates. Subtheme 2.2 Clinical expertise enabling leadership behaviors Many participants leveraged their skills to shape group practices and mentor junior staff. P2 described, “By teaching others and consistently following protocols, I demonstrated that I could lead by example rather than just give orders.” P10 recalled, “My hands-on knowledge was critical when addressing team conflicts over clinical procedures—it earned me respect and resolved issues smoothly.” Practical authority rooted in competence eased their path into formal leadership. Subtheme 2.3 Demonstrating capability during critical incidents Participants’ readiness for leadership was often tested during high-pressure events. P6 highlighted, “During an unexpected emergency, I coordinated the response, which management later cited when they promoted me.” Similarly, P5 revealed, “My performance during crisis situations made it clear to everyone that I was ready for more responsibility.” Such “critical incident” experiences provided clear evidence of potential, often accelerating advancement. Theme 3: Effective Mentor Support Subtheme 3.1 Early guidance on career direction and role fit Mentors provided essential orientation to leadership pathways. As P1 described, “My mentor helped me understand what skills and experiences the hospital valued for management roles.”P7 noted, “Without early advice, I might have missed important steps or wasted time in roles that didn’t contribute to my development.” This strategic guidance helped participants make informed and efficient career decisions. Subtheme 3.2 Skill development through Mentorship Mentorship also involved practical skill-building. P4 said, “My mentor challenged me to lead small projects and provided honest feedback, which prepared me for real management challenges.” P9 reflected, “Watching an experienced manager handle difficult staff situations gave me a model to follow and the confidence to do it myself.” These experiences honed both technical and interpersonal leadership competencies. Theme 4: Strategies for Negotiating Gendered Work Environments Subtheme 4.1 Managing stereotypes and expectations about male nurses Participants frequently encountered stereotypical assumptions. P6 observed, “Sometimes, people expected me to take on heavier work or assume I’d be less caring because I’m male. I countered that by consistently demonstrating professionalism and compassion.” P10 added, “I made sure to clarify my role and expectations, so misunderstandings wouldn’t undermine my authority.” Through these strategies, participants maintained their legitimacy. Subtheme 4.2 Building collaborative relationships in female-majority teams Sustaining effective teamwork required relational sensitivity. As P7 reflected, “I worked hard to build trust and show respect for my female colleagues’ expertise.” P2 said, “Listening and integrating into the team culture mattered more than trying to prove myself as a man—collaboration was key.” These tactics helped to minimize friction and fostered inclusive unit environments. Subtheme 4.3 Balancing visibility with legitimacy in leadership roles Being a minority heightened their visibility, which was both an asset and a source of scrutiny. P5 explained, “As one of the few male leaders, I was often noticed, so I made sure my work consistently met high standards.” P4 expressed, “Mentors helped me turn that visibility into an advantage rather than a liability by advising me on how to present myself.” By actively managing their presence and performance, participants converted potential challenges into career leverage. Table 2 Themes and subthemes of participants Theme Subtheme 1. Early Systematic Career Planning 1.1 Clarifying leadership intent early 1.2 Accumulating leadership-relevant experiences deliberately 2.Solid Clinical Expertise 2.1 Building credibility through high-standard practice 2.2 Clinical expertise enabling leadership behaviors 2.3 Demonstrating capability during critical incidents 3.Effective Mentor Support 3.1 Early guidance on career direction and role fit 3.2 Skill development through Mentorship 4.Strategies for Negotiating Gendered Work Environments 4.1 Managing stereotypes and expectations about male nurses 4.2 Building collaborative relationships in female-majority teams 4.3 Balancing visibility with legitimacy in leadership roles Discussion The career experiences of male nurse managers in China reveal a complex landscape influenced by both global trends and local cultural dynamics. In a country where nursing has traditionally been viewed as a female-dominated profession, the emergence of male nurses in managerial roles presents both unique challenges and opportunities. Participants in this study described their pathways to leadership positions, emphasizing that although male nurse managers may experience certain advantages, such as enhanced visibility and perceived authority, they also face unique challenges. These challenges include skepticism from both colleagues and patients regarding their competencies. This intricate interplay of gendered experiences emphasizes the necessity of understanding the specific context in which male nurses operate, as it significantly impacts their career development and leadership potential. By exploring these dynamics, this study contributes to the broader discourse on gender in nursing, underscoring the need for targeted strategies to assist male nurses in overcoming obstacles and advancing in their careers. Early Systematic Career Planning: Intentional Pathways to Leadership The findings of this study underscore the critical role of early systematic career planning in shaping the trajectories of male nurse managers. Participants consistently emphasized that establishing explicit managerial goals at the beginning of their nursing careers was instrumental in navigating the complex promotion pathways characteristic of the nursing profession. This proactive approach enabled nurse managers to articulate their leadership ambitions from the outset, allowing them to actively pursue and capitalize on opportunities that aligned with their professional aspirations. By prioritizing career planning, these individuals were better equipped to navigate the challenges of advancement, ultimately contributing to their success in leadership roles. This highlights the necessity for healthcare organizations to support early career development initiatives that foster goal-setting and strategic planning among male nurse managers.[ 8 , 9 ]. Empirical studies demonstrate that intentional career planning plays a crucial role in professional advancement, particularly in contexts where promotion criteria are often ambiguous. Engaging in activities such as volunteering and leading team projects not only enhances individuals' skill sets but also increases their visibility to senior management[ 10 ]. Research indicates that nursing leaders who actively seek leadership training and mentorship report greater confidence and clarity regarding their career trajectories[ 11 ]. This highlights the critical need for structured career development initiatives within the nursing profession. Therefore, healthcare organizations should prioritize and encourage early career planning initiatives to facilitate the identification of pertinent opportunities for aspiring nurse leaders. Encouraging early career planning empowers aspiring nurse leaders to build a robust foundation for their leadership capabilities, bridging the gap between nursing education and clinical practice. Solid Clinical Expertise: Establishing Credibility in Nursing Management This study underscores the importance of solid clinical expertise as a foundational element for establishing legitimacy in leadership roles among male nurse managers. Participants indicated that their clinical competence was pivotal in earning the trust and respect of their colleagues, which is essential for effective leadership. Existing research suggests that nurses with advanced clinical leadership knowledge perceive themselves as more competent, positively influencing their interactions and relationships within healthcare teams. Many participants emphasized that excelling in patient care not only bolstered their credibility but also facilitated their transition into managerial positions, aligning with findings that demonstrate effective clinical performance enhances both leadership efficacy and stakeholder confidence in nursing roles[ 12 ]. Moreover, acquiring specialty skills and certifications was noted as a significant differentiator, enhancing their reputation and making them more attractive candidates for leadership roles. Professional organizations play a crucial role in developing leadership capabilities through the promotion of specialty certifications, which is particularly pertinent for advancing career trajectories in nursing[ 10 ]. The ability to demonstrate clinical expertise during critical incidents further solidified their readiness for leadership, as these experiences provided tangible evidence of their competencies[ 13 ]. Therefore, nursing education and professional development programs should prioritize the cultivation of clinical skills alongside leadership training to prepare male nurses for future managerial responsibilities[ 14 , 15 ]. Effective Mentor Support: Navigating Career Development through Guidance Mentorship has emerged as a vital component in the leadership development of male nurse managers, providing essential guidance and support throughout their careers. Participants highlighted the significance of having mentors who offered insights into the skills and experiences valued in management roles, which helped them navigate their career paths more effectively. Research indicates that structured mentorship programs significantly enhance the competencies and confidence of nurse managers, making mentorship a critical factor in their professional advancement[ 16 ]. Furthermore, mentorship fosters nurses' leadership self-efficacy, suggesting that such support can directly impact career aspirations and advancement opportunities[ 17 ]. Mentors not only facilitated skill development through feedback and role modeling but also acted as advocates, recommending mentees for advancement opportunities that they might not have accessed otherwise. In the context of a diversity and inclusion framework, mentorship is particularly relevant for male nurses facing challenges in a predominantly female environment, as it equips them with strategies to navigate their roles without reinforcing negative stereotypes[ 18 ]. The advocacy role taken by mentors plays a crucial part in addressing systemic barriers and enhancing the visibility of male nurses in leadership trajectories. Moreover, mentorship programs can significantly improve job satisfaction and retention among nurse managers, indicating that mentorship serves as an essential support mechanism in navigating workplace dynamics. Thus, these insights suggest that health institutions should institutionalize mentorship programs that connect aspiring male nurse leaders with experienced professionals. This structured approach would facilitate their guidance, support, and advocacy, thereby enhancing their chances of success in leadership roles[ 19 ]. Strategies for Negotiating Gendered Work Environments: Balancing Expectations and Professional Identity The study reveals that male nurse managers employ various strategies to navigate the gendered dynamics of their work environments. Participants frequently encountered stereotypes and expectations related to their gender, which they actively managed by demonstrating professionalism and compassion. This aligns with findings by Mrayyan et al., which emphasize that male leaders in nursing need to model professional behavior to address gender stereotypes effectively[ 20 ].Building collaborative relationships within female-majority teams was emphasized as a key strategy for fostering a positive work environment. Such collaboration promotes inclusivity and helps dismantle gender biases, thereby improving team interactions[ 21 ]. By prioritizing teamwork and respecting the expertise of their female colleagues, male nurse managers were able to minimize friction and enhance collaboration. The importance of teamwork in overcoming gender barriers is highlighted by research that states promoting collaborative practices is essential in environments characterized by gender inequality. Additionally, the ability to adapt patient care approaches by addressing gender preferences and ensuring clear communication is recognized as an effective strategy for building trust with patients and their families. This reflects the findings of Li et al., which indicate that effective communication is vital in establishing strong relationships within nursing contexts[ 22 ]. These strategies underscore the necessity of relational sensitivity and adaptability in overcoming gender-related challenges in nursing. To support male nurses in these endeavors, healthcare organizations should promote training programs focused on interpersonal skills and cultural competence. Enhancing communication and leadership skills among male leaders in nursing is crucial for effective management in predominantly female environments. Limitations Despite the valuable insights gained from this study, several limitations must be acknowledged. First, the sample size of ten male nursing managers, while sufficient for qualitative analysis, may not fully represent the diverse experiences of all male nurses in leadership roles across different regions or healthcare settings. The study was conducted in a specific Class III, Grade A hospital in China, which may limit the generalizability of the findings to other contexts or countries with different cultural and institutional frameworks. Additionally, the reliance on self-reported data through semi-structured interviews may introduce biases, as participants might present their experiences in a manner they perceive as favorable. Future research should consider larger, more diverse samples and incorporate longitudinal designs to capture the evolving nature of male nurses' leadership experiences over time. Furthermore, exploring the perspectives of female colleagues regarding male leadership could provide a more comprehensive understanding of the gender dynamics within nursing management. Conclusion This qualitative study provides significant insights into the career development trajectories of male nursing managers within a predominantly female profession. The findings underscore the importance of early systematic career planning, solid clinical expertise, effective mentor support, and strategic navigation of gendered work environments as critical factors influencing their advancement into leadership roles. By articulating the unique challenges and opportunities faced by male nurses, this research contributes to a deeper understanding of the dynamics at play in nursing leadership. The implications of these findings suggest that healthcare institutions should prioritize the institutionalization of mentorship programs, support early career planning initiatives, and foster inclusive environments that promote diversity and equity in nursing leadership. Such measures are essential for enhancing the representation of male leaders in nursing and for cultivating a more equitable professional landscape. Declarations Author contribution Liu, Dai conceptualization; Li, methodology; Dai, Pan, formal analysis; Liu, Pan, Dai, investigation; Liu,Pan, writing-original draft preparation; Liu, Li, writing-review and editing; Zhuang, supervision. All authors have read and approved the final manuscript. Funding There was no funding support for this study. Competing interest The authors declare no competing interests. Data availability The data used in this study are available from the corresponding author upon reasonable request. 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Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study. BMJ Open. 2021;11(2):e041862. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 Apr, 2026 Reviews received at journal 07 Apr, 2026 Reviews received at journal 31 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers invited by journal 24 Feb, 2026 Editor invited by journal 24 Feb, 2026 Editor assigned by journal 23 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 22 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8938782","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596350409,"identity":"099c4e77-eea2-4462-9c52-62df27c63932","order_by":0,"name":"Longcha Liu","email":"","orcid":"","institution":"The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Longcha","middleName":"","lastName":"Liu","suffix":""},{"id":596350411,"identity":"963ce9bd-5b13-4978-a034-9b530403d60e","order_by":1,"name":"Wenjun Pan","email":"","orcid":"","institution":"The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenjun","middleName":"","lastName":"Pan","suffix":""},{"id":596350413,"identity":"88bc6e02-2a2b-41e3-9f85-2c8ed8b41a1c","order_by":2,"name":"Zhenjie Dai","email":"","orcid":"","institution":"The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhenjie","middleName":"","lastName":"Dai","suffix":""},{"id":596350414,"identity":"9e605157-c3f6-4fec-b4c1-351724c2a65e","order_by":3,"name":"Wenyu Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenyu","middleName":"","lastName":"Li","suffix":""},{"id":596350415,"identity":"4e2cc9ef-acd0-4eeb-9828-fa3a38429c29","order_by":4,"name":"Danwen Zhuang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBACxvbmww8SKiSY+YnWwtxzLM3gwRkLdskGYrWwz8gxkHzYUsFvcIBYLbw9BwwMEhskpI2PJ29g+FGxjbAWyfaGhAeJOySMzc48K2DsOXObsBbDngMHDBLPSCSb3cgxYGZsI0KL/Q2gqxLbJOo3zyBWC+OMZAaQFmYDCaK19BxjM0g4I8EsAfTLQaL8wtje//nhj4o6Zv725I0PflQQoQUJJBAfNQgtpOoYBaNgFIyCEQIA+oZBjCldgrEAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Wenzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Danwen","middleName":"","lastName":"Zhuang","suffix":""}],"badges":[],"createdAt":"2026-02-22 11:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8938782/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8938782/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103491800,"identity":"ef8ce25d-c7e8-442d-9faa-2806ecedd2c9","added_by":"auto","created_at":"2026-02-26 10:01:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1300287,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8938782/v1/5e2916f1-b10f-4f4c-b136-561c885692a1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the Career Trajectories of Male Nursing Leaders : A Qualitative Study on Leadership Acquisition","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe nursing profession has long been shaped by a historical tradition of female predominance, a factor that has deeply influenced its professional identity and operational norms. Although male nurses have historically been underrepresented in this female-dominated field, their presence - especially in leadership positions - is increasingly being acknowledged. Empirical evidence demonstrates a growing representation of male leaders in nursing, a development widely recognized as essential for advancing evidence-based practice, strengthening leadership diversity, and addressing systemic gender biases embedded in clinical governance, education, and professional culture[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].Moreover, the growing representation of male leaders in nursing underscores the need for a critical reassessment of leadership paradigms - including communication patterns, decision-making frameworks, and relational approaches - within clinical environments. Extensive empirical research confirms that leadership style is a key determinant of interdisciplinary team cohesion, psychological safety, communication efficacy, and ultimately, patient safety and quality of care. For example, transformational leadership - characterized by inspirational motivation, individualized consideration, intellectual stimulation, and idealized influence - has been consistently linked to higher levels of nurse retention, role engagement, and professional satisfaction, all of which are foundational to cultivating an inclusive, resilient, and high-performing practice environment[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Effective leadership education for nursing professionals, regardless of gender, is essential to cultivate the necessary skills and competencies for emerging nurse leaders [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe perspectives of female colleagues regarding male nurses in leadership roles offer valuable insights into the evolving leadership landscape of the profession. Qualitative evidence indicates that female nurses frequently recognize and affirm the competencies, relational strengths, and contributions of their male peers - perceptions associated with enhanced interdisciplinary collaboration, improved team communication, and greater cohesion in clinical settings. As nursing advances toward greater demographic and experiential diversity, the lived experiences and professional narratives of male nurses - particularly those related to leadership entry, advancement, and identity negotiation - will critically inform the future development of evidence-based recruitment strategies, inclusive leadership curricula, and organizational policies aimed at cultivating equitable practice environments.\u003c/p\u003e \u003cp\u003eThrough correlational analysis and qualitative assessments, it is evident that the career pathways of male nurses can significantly impact the future landscape of nursing leadership. This qualitative study explores the pathways through which male nurses navigate their professional journey towards leadership roles. It highlights the distinctive challenges and opportunities they encounter in an environment largely dominated by female colleagues[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Male nurses may face unique advantages, such as greater access to mentorship opportunities and leadership programs, facilitating their rise to these roles [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, challenges persist, including societal stereotypes that question their suitability for a caregiving profession that is often associated with traditionally feminine traits such as kindness and empathy[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This duality of male nurses\u0026rsquo; experiences underscores the importance of examining their leadership trajectory in depth.This study aims to make a substantial contribution to the field of nursing and advocate for a more inclusive practice that acknowledges the valuable contributions of all nurses, regardless of gender.\u003c/p\u003e \u003cp\u003eIn conclusion, acknowledging the structural and sociocultural barriers - as well as the agency-driven pathways - that male nurses encounter in attaining leadership roles is essential for advancing equity and inclusivity within the nursing profession. Through qualitative research methods, this study understands the career development trajectory of male nursing managers, which can provide important enlightenment for strengthening the equity of nursing profession, enhancing the diversity of leadership and improving organizational effectiveness.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study employed a descriptive phenomenological approach to explore the career trajectories and leadership development experiences of male nurses in managerial positions across a specific region of China. The primary objective was to identify the enabling factors that facilitate their advancement within a profession historically characterized by female predominance.\u003c/p\u003e \u003cp\u003e This study was conducted in full compliance with the ethical principles set forth in the Declaration of Helsinki.Ethical approval was granted by the Ethics Committee for Clinical Research (ECCR) at the First Affiliated Hospital of Wenzhou Medical University (Date: 10 December 2025; No: KY2025-567). Prior to the interviews, all participants received a detailed verbal and written explanation of the study’s aims, procedures, voluntary nature of participation, right to withdraw at any time, audio-recording practices, data handling protocols, and confidentiality safeguards. Written informed consent was obtained from each participant specifically authorizing both participation and audio recording. Participants were explicitly informed that recordings would be used solely for transcription, analysis, and scientific dissemination, and that all identifying information would be anonymized during data processing and reporting.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and setting\u003c/h3\u003e\n\u003cp\u003eMale nursing managers employed at a Class III, Grade A hospital in China were recruited as study participants through purposive sampling. A total of ten individuals were enrolled. Sampling criteria prioritized information richness, selecting participants with demonstrated capacity to articulate nuanced, reflective insights into their leadership progression, including entry pathways, advancement barriers, and identity negotiation within clinical hierarchies.\u003c/p\u003e \u003cp\u003eInclusion criteria were: (1) registered nurse; (2) self-identified male; (3) minimum two years of continuous service in management positions; (4) willing to engage in in-depth, reflective interviews on leadership .\u003c/p\u003e \u003cp\u003eExclusion criteria were: (1) not currently in a leadership role; (2) unable to complete an interview in the study language.\u003c/p\u003e \u003cp\u003eThe determination of sample size followed the principle of information saturation. A total of 10 male nurses were interviewed in this study, which were represented by the numbers P1-P10, and the general information of the research subjects is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive characteristics of participants (N = 10)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eLength of nursing experience\u003c/p\u003e \u003cp\u003e(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003cp\u003eexperience(year)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eP 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*MD : Master's degree ; UG : Undergraduate\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAccording to the purpose of the study, literature review and group discussion were conducted to draw up the first draft of the interview guide. In order to ensure the scientificity and rationality of the formal interview, two research subjects were selected for pre-interview before the formal interview, and the formal interview guide was determined after modification according to the interview results. The Interview guide contained open-ended questions designed to collect personal and professional information about the participants and explore their career development history.\u003c/p\u003e \u003cp\u003eThe Interview guide are as follows:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCan you walk me through your nursing career from entry into the profession to your current leadership position?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat were the main steps and processes through which you moved into management/leadership roles?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow did clinical expertise and performance influence your leadership opportunities and credibility?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDid you have mentors or sponsors? What did they do that was most helpful, and when did this support matter most?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAs a man in a female-dominant profession, what gender-related experiences affected your work or promotion, and how did you respond?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat strategies did you use to navigate challenges and leverage opportunities, and what would you recommend to institutions or early-career male nurses?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eData were collected through semi-structured interviews based on descriptive phenomenological research methods. Before the interview, a relationship of trust was established with the respondents, and the purpose and significance of the study were introduced in detail. The interview was conducted in a quiet demonstration classroom, and the interviewees were encouraged to fully express their true thoughts during the interview. According to the responses of the interviewees, the interview outline sequence was flexibly adjusted to help the interviewees fully express their views and improve the integrity of the data. The interviews were recorded simultaneously, and non-verbal information such as body language, facial expressions and intonation of the respondents were recorded. Each participant was interviewed once, and the interview time was 30–40 minutes.\u003c/p\u003e \u003cp\u003eThe interview data were transcribed by two researchers within 24 h after the end of the interview, and the transcripts were fed back to the respondents for verification. Data were analyzed using Colaizzi's phenomenological analysis method, which involves identifying important statements, constructing meaning, clustering themes, and co-validating findings with participants.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using Colaizzi’s seven-step phenomenological analysis method, a structured and rigorous approach to extracting thematic meaning from narrative data [25]. The process included the following steps:\u003c/p\u003e \u003cp\u003e(1) Carefully read all interview materials to form a preliminary understanding of the description of the participants; (2) extract meaningful statements relevant to the research question; (3) summarize, refine and code these meaningful statements; (4) summarize the viewpoints after coding, search for common concepts or characteristics, and form themes, thematic groups and categories; (5) relate the themes to the detailed narratives of the participants; (6) form a statement describing the essential structure of the phenomenon; (7) Feedback the analysis results to the participants to verify the authenticity of the content.\u003c/p\u003e \u003cp\u003eData coding was conducted independently by two investigators, followed by a comparative review to establish inter-coder agreement. Disagreements were adjudicated through consensus discussions involving a third qualitative nursing research specialist. All coding and initial thematic identification took place on the same day as each interview. While the analytical framework was guided by existing theoretical and empirical literature (a deductive orientation), the process remained flexible enough to accommodate newly arising themes.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuality control\u003c/h3\u003e\n\u003cp\u003eEnsure that the interview environment is quiet and undisturbed during the interview; Keep neutral on the content of the respondents' answers, avoid using guiding language or actions, so as not to interfere with the respondents' thinking; If there are doubts about the responses of the respondents, flexible communication and requestioning should be conducted to ensure the accuracy and completeness of the information. The interview data were transcribed within 24 hours after the end of the interview, and the recordings were reviewed by two researchers to ensure that the transcribed content was consistent with the recording. The transcribed material needs to be verified with the respondents to ensure the rigor of the findings. The transcript was coded by two researchers separately, and the different opinions during the coding process needed to be discussed by the research group to finally determine the coding scheme and improve the credibility of the research results. All researchers should maintain a neutral attitude during data analysis and avoid mixing their personal opinions into the analysis of research content.\u003c/p\u003e "},{"header":"Result","content":"\u003cp\u003eThe findings from the interviews conducted in this study are presented in this section. A total of 10male nurse manager participated in the study. Participants were anonymized and coded sequentially as P1 through P10. The descriptive characteristics of the participants are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.The mean age of the participants was 38.22 years (min - max: 35–43), The mean nursing experience of the participants was 15.4 years (min - max: 12–20) and the mean manager nursing experience was 4.6 years (min - max: 2–10).\u003c/p\u003e\u003cp\u003eAs a result of the content analysis of the data obtained from the individual in-depth interviews, four main themes and ten subthemes were identified in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003ch3\u003eTheme 1: Early Systematic Career Planning\u003c/h3\u003e\u003ch2\u003eSubtheme 1.1 Clarifying leadership intent early\u003c/h2\u003e\u003cp\u003eMany participants recognized the uncertainty of career progression in nursing leadership and responded by explicitly setting managerial goals from the outset of their career. As P3 stated, “From my first year as a staff nurse, I knew I wanted to move into leadership, so I paid close attention to what managers did and planned my steps accordingly.” Similarly, P7 remarked, “I realized early on that waiting for someone to notice me was not enough. Setting my sights on management helped me seek out the right opportunities.” These deliberate intentions enabled participants to navigate ambiguous promotion structures with greater certainty and focus.\u003c/p\u003e\u003ch2\u003eSubtheme 1.2 Accumulating leadership-relevant experiences deliberately\u003c/h2\u003e\u003cp\u003eParticipants described purposely seeking tasks and projects that would build their credibility for management. For example, P4 explained, “I volunteered for quality improvement committees and offered to coordinate our unit’s scheduling. Those experiences not only built my skills but also made me visible to senior staff.” P10 shared, “Taking initiative in team assignments gave me confidence and allowed others to see my leadership potential.” Through these strategies, participants laid a concrete foundation for future promotion.\u003c/p\u003e\u003ch2\u003eTheme 2: Solid Clinical Expertise\u003c/h2\u003e\u003ch2\u003eSubtheme 2.1 Building credibility through high-standard practice\u003c/h2\u003e\u003cp\u003eClinical competence was regarded as the bedrock for leadership legitimacy. As P5 explained, “Excelling in patient care made my colleagues trust my judgment, which was essential when I started making decisions as a leader.” P9 echoed, “People are more willing to follow your instructions if you have proved yourself clinically.” This consistent demonstration of reliability strengthened participants’ acceptance as managerial candidates.\u003c/p\u003e\u003ch2\u003eSubtheme 2.2 Clinical expertise enabling leadership behaviors\u003c/h2\u003e\u003cp\u003eMany participants leveraged their skills to shape group practices and mentor junior staff. P2 described, “By teaching others and consistently following protocols, I demonstrated that I could lead by example rather than just give orders.” P10 recalled, “My hands-on knowledge was critical when addressing team conflicts over clinical procedures—it earned me respect and resolved issues smoothly.” Practical authority rooted in competence eased their path into formal leadership.\u003c/p\u003e\u003ch2\u003eSubtheme 2.3 Demonstrating capability during critical incidents\u003c/h2\u003e\u003cp\u003e Participants’ readiness for leadership was often tested during high-pressure events. P6 highlighted, “During an unexpected emergency, I coordinated the response, which management later cited when they promoted me.” Similarly, P5 revealed, “My performance during crisis situations made it clear to everyone that I was ready for more responsibility.” Such “critical incident” experiences provided clear evidence of potential, often accelerating advancement.\u003c/p\u003e\u003ch2\u003eTheme 3: Effective Mentor Support\u003c/h2\u003e\u003ch2\u003eSubtheme 3.1 Early guidance on career direction and role fit\u003c/h2\u003e\u003cp\u003eMentors provided essential orientation to leadership pathways. As P1 described, “My mentor helped me understand what skills and experiences the hospital valued for management roles.”P7 noted, “Without early advice, I might have missed important steps or wasted time in roles that didn’t contribute to my development.” This strategic guidance helped participants make informed and efficient career decisions.\u003c/p\u003e\u003ch2\u003eSubtheme 3.2 Skill development through Mentorship\u003c/h2\u003e\u003cp\u003eMentorship also involved practical skill-building. P4 said, “My mentor challenged me to lead small projects and provided honest feedback, which prepared me for real management challenges.” P9 reflected, “Watching an experienced manager handle difficult staff situations gave me a model to follow and the confidence to do it myself.” These experiences honed both technical and interpersonal leadership competencies.\u003c/p\u003e\u003ch2\u003eTheme 4: Strategies for Negotiating Gendered Work Environments\u003c/h2\u003e\u003ch2\u003eSubtheme 4.1 Managing stereotypes and expectations about male nurses\u003c/h2\u003e\u003cp\u003eParticipants frequently encountered stereotypical assumptions. P6 observed, “Sometimes, people expected me to take on heavier work or assume I’d be less caring because I’m male. I countered that by consistently demonstrating professionalism and compassion.” P10 added, “I made sure to clarify my role and expectations, so misunderstandings wouldn’t undermine my authority.” Through these strategies, participants maintained their legitimacy.\u003c/p\u003e\u003ch2\u003eSubtheme 4.2 Building collaborative relationships in female-majority teams\u003c/h2\u003e\u003cp\u003eSustaining effective teamwork required relational sensitivity. As P7 reflected, “I worked hard to build trust and show respect for my female colleagues’ expertise.” P2 said, “Listening and integrating into the team culture mattered more than trying to prove myself as a man—collaboration was key.” These tactics helped to minimize friction and fostered inclusive unit environments.\u003c/p\u003e\u003ch2\u003eSubtheme 4.3 Balancing visibility with legitimacy in leadership roles\u003c/h2\u003e\u003cp\u003eBeing a minority heightened their visibility, which was both an asset and a source of scrutiny. P5 explained, “As one of the few male leaders, I was often noticed, so I made sure my work consistently met high standards.” P4 expressed, “Mentors helped me turn that visibility into an advantage rather than a liability by advising me on how to present myself.” By actively managing their presence and performance, participants converted potential challenges into career leverage.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes and subthemes of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e1. Early Systematic Career Planning\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e1.1 Clarifying leadership intent early\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003e1.2 Accumulating leadership-relevant experiences deliberately\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e2.Solid Clinical Expertise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e2.1 Building credibility through high-standard practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e2.2 Clinical expertise enabling leadership behaviors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e2.3 Demonstrating capability during critical incidents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e3.Effective Mentor Support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e3.1 Early guidance on career direction and role fit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e3.2 Skill development through Mentorship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e4.Strategies for Negotiating Gendered Work Environments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e4.1 Managing stereotypes and expectations about male nurses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e4.2 Building collaborative relationships in female-majority teams\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e4.3 Balancing visibility with legitimacy in leadership roles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe career experiences of male nurse managers in China reveal a complex landscape influenced by both global trends and local cultural dynamics. In a country where nursing has traditionally been viewed as a female-dominated profession, the emergence of male nurses in managerial roles presents both unique challenges and opportunities. Participants in this study described their pathways to leadership positions, emphasizing that although male nurse managers may experience certain advantages, such as enhanced visibility and perceived authority, they also face unique challenges. These challenges include skepticism from both colleagues and patients regarding their competencies. This intricate interplay of gendered experiences emphasizes the necessity of understanding the specific context in which male nurses operate, as it significantly impacts their career development and leadership potential. By exploring these dynamics, this study contributes to the broader discourse on gender in nursing, underscoring the need for targeted strategies to assist male nurses in overcoming obstacles and advancing in their careers.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eEarly Systematic Career Planning: Intentional Pathways to Leadership\u003c/h2\u003e \u003cp\u003eThe findings of this study underscore the critical role of early systematic career planning in shaping the trajectories of male nurse managers. Participants consistently emphasized that establishing explicit managerial goals at the beginning of their nursing careers was instrumental in navigating the complex promotion pathways characteristic of the nursing profession. This proactive approach enabled nurse managers to articulate their leadership ambitions from the outset, allowing them to actively pursue and capitalize on opportunities that aligned with their professional aspirations. By prioritizing career planning, these individuals were better equipped to navigate the challenges of advancement, ultimately contributing to their success in leadership roles. This highlights the necessity for healthcare organizations to support early career development initiatives that foster goal-setting and strategic planning among male nurse managers.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Empirical studies demonstrate that intentional career planning plays a crucial role in professional advancement, particularly in contexts where promotion criteria are often ambiguous. Engaging in activities such as volunteering and leading team projects not only enhances individuals' skill sets but also increases their visibility to senior management[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch indicates that nursing leaders who actively seek leadership training and mentorship report greater confidence and clarity regarding their career trajectories[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This highlights the critical need for structured career development initiatives within the nursing profession.\u003c/p\u003e \u003cp\u003eTherefore, healthcare organizations should prioritize and encourage early career planning initiatives to facilitate the identification of pertinent opportunities for aspiring nurse leaders. Encouraging early career planning empowers aspiring nurse leaders to build a robust foundation for their leadership capabilities, bridging the gap between nursing education and clinical practice.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eSolid Clinical Expertise: Establishing Credibility in Nursing Management\u003c/h2\u003e \u003cp\u003eThis study underscores the importance of solid clinical expertise as a foundational element for establishing legitimacy in leadership roles among male nurse managers. Participants indicated that their clinical competence was pivotal in earning the trust and respect of their colleagues, which is essential for effective leadership. Existing research suggests that nurses with advanced clinical leadership knowledge perceive themselves as more competent, positively influencing their interactions and relationships within healthcare teams. Many participants emphasized that excelling in patient care not only bolstered their credibility but also facilitated their transition into managerial positions, aligning with findings that demonstrate effective clinical performance enhances both leadership efficacy and stakeholder confidence in nursing roles[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, acquiring specialty skills and certifications was noted as a significant differentiator, enhancing their reputation and making them more attractive candidates for leadership roles. Professional organizations play a crucial role in developing leadership capabilities through the promotion of specialty certifications, which is particularly pertinent for advancing career trajectories in nursing[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ability to demonstrate clinical expertise during critical incidents further solidified their readiness for leadership, as these experiences provided tangible evidence of their competencies[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, nursing education and professional development programs should prioritize the cultivation of clinical skills alongside leadership training to prepare male nurses for future managerial responsibilities[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eEffective Mentor Support: Navigating Career Development through Guidance\u003c/h2\u003e \u003cp\u003eMentorship has emerged as a vital component in the leadership development of male nurse managers, providing essential guidance and support throughout their careers. Participants highlighted the significance of having mentors who offered insights into the skills and experiences valued in management roles, which helped them navigate their career paths more effectively. Research indicates that structured mentorship programs significantly enhance the competencies and confidence of nurse managers, making mentorship a critical factor in their professional advancement[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, mentorship fosters nurses' leadership self-efficacy, suggesting that such support can directly impact career aspirations and advancement opportunities[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMentors not only facilitated skill development through feedback and role modeling but also acted as advocates, recommending mentees for advancement opportunities that they might not have accessed otherwise. In the context of a diversity and inclusion framework, mentorship is particularly relevant for male nurses facing challenges in a predominantly female environment, as it equips them with strategies to navigate their roles without reinforcing negative stereotypes[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The advocacy role taken by mentors plays a crucial part in addressing systemic barriers and enhancing the visibility of male nurses in leadership trajectories. Moreover, mentorship programs can significantly improve job satisfaction and retention among nurse managers, indicating that mentorship serves as an essential support mechanism in navigating workplace dynamics. Thus, these insights suggest that health institutions should institutionalize mentorship programs that connect aspiring male nurse leaders with experienced professionals. This structured approach would facilitate their guidance, support, and advocacy, thereby enhancing their chances of success in leadership roles[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eStrategies for Negotiating Gendered Work Environments: Balancing Expectations and Professional Identity\u003c/h2\u003e \u003cp\u003eThe study reveals that male nurse managers employ various strategies to navigate the gendered dynamics of their work environments. Participants frequently encountered stereotypes and expectations related to their gender, which they actively managed by demonstrating professionalism and compassion. This aligns with findings by Mrayyan et al., which emphasize that male leaders in nursing need to model professional behavior to address gender stereotypes effectively[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].Building collaborative relationships within female-majority teams was emphasized as a key strategy for fostering a positive work environment. Such collaboration promotes inclusivity and helps dismantle gender biases, thereby improving team interactions[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy prioritizing teamwork and respecting the expertise of their female colleagues, male nurse managers were able to minimize friction and enhance collaboration. The importance of teamwork in overcoming gender barriers is highlighted by research that states promoting collaborative practices is essential in environments characterized by gender inequality. Additionally, the ability to adapt patient care approaches by addressing gender preferences and ensuring clear communication is recognized as an effective strategy for building trust with patients and their families. This reflects the findings of Li et al., which indicate that effective communication is vital in establishing strong relationships within nursing contexts[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese strategies underscore the necessity of relational sensitivity and adaptability in overcoming gender-related challenges in nursing. To support male nurses in these endeavors, healthcare organizations should promote training programs focused on interpersonal skills and cultural competence. Enhancing communication and leadership skills among male leaders in nursing is crucial for effective management in predominantly female environments.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite the valuable insights gained from this study, several limitations must be acknowledged. First, the sample size of ten male nursing managers, while sufficient for qualitative analysis, may not fully represent the diverse experiences of all male nurses in leadership roles across different regions or healthcare settings. The study was conducted in a specific Class III, Grade A hospital in China, which may limit the generalizability of the findings to other contexts or countries with different cultural and institutional frameworks. Additionally, the reliance on self-reported data through semi-structured interviews may introduce biases, as participants might present their experiences in a manner they perceive as favorable. Future research should consider larger, more diverse samples and incorporate longitudinal designs to capture the evolving nature of male nurses' leadership experiences over time. Furthermore, exploring the perspectives of female colleagues regarding male leadership could provide a more comprehensive understanding of the gender dynamics within nursing management.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This qualitative study provides significant insights into the career development trajectories of male nursing managers within a predominantly female profession. The findings underscore the importance of early systematic career planning, solid clinical expertise, effective mentor support, and strategic navigation of gendered work environments as critical factors influencing their advancement into leadership roles. By articulating the unique challenges and opportunities faced by male nurses, this research contributes to a deeper understanding of the dynamics at play in nursing leadership. The implications of these findings suggest that healthcare institutions should prioritize the institutionalization of mentorship programs, support early career planning initiatives, and foster inclusive environments that promote diversity and equity in nursing leadership. Such measures are essential for enhancing the representation of male leaders in nursing and for cultivating a more equitable professional landscape.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiu, Dai conceptualization; Li, methodology; Dai, Pan, formal analysis; Liu, Pan, Dai, investigation; Liu,Pan, writing-original draft preparation; Liu, Li, writing-review and editing; Zhuang, supervision. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding support for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in full compliance with the ethical principles set forth in the Declaration of Helsinki.Ethical approval was granted by the Ethics Committee for Clinical Research (ECCR) at the First Affiliated Hospital of Wenzhou Medical University (Date: 10 December 2025; No: KY2025-567).\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAgeeli MA, Alharbi MF. Healthcare Professional's Attitudes Toward Male Nurses Working in the Context of Pediatric Care. Inquiry. 2024;61:469580241284189.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKane D, Rajacich D, Andary C. Exploring the Contextual Factors Surrounding the Recruitment and Retention of Men in a Baccalaureate Nursing Program. Nurs Forum. 2021;56(1):24\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiwanuka F, et al. Nursing leadership styles and their impact on intensive care unit quality measures: An integrative review. J Nurs Manag. 2021;29(2):133\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage A, Halcomb E, Sim J. The impact of nurse leadership education on clinical practice: An integrative review. J Nurs Manag. 2021;29(6):1385\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang H, Tu J. The working experiences of male nurses in China: Implications for male nurse recruitment and retention. J Nurs Manag. 2020;28(2):441\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmagharbeh WT et al. Exploring Gender Disparities in Emotional Intelligence, Leadership Access, and Career Development Among Jordanian Nurses. J Nurs Manag, 2025. 2025: p. 8824621.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDowning JD, et al. Position Statement on Cancer Nursing Leadership. Cancer Nurs. 2023;46(2):89\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbou Hashish EA, Bajbeir EF. The Effect of Managerial and Leadership Training and Simulation on Senior Nursing Students' Career Planning and Self-Efficacy. SAGE Open Nurs. 2022;8:23779608221127952.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFahie VP, et al. 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Attributes, skills and actions of clinical leadership in nursing as reported by hospital nurses: a cross-sectional study. BMJ Lead, 2023. 7(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmpuriire P, et al. Perspectives of men and women working in vector control in Africa regarding barriers and opportunities for achieving gender inclusivity. Malar J. 2025;24(1):151.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi H, et al. Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study. BMJ Open. 2021;11(2):e041862.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Male nurse, Gender, Leadership, Strategie, Qualitative Study","lastPublishedDoi":"10.21203/rs.3.rs-8938782/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8938782/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eNursing has historically been a female-dominated profession; however, the growing presence of male nurses in management and leadership roles has attracted increasing scholarly and institutional attention. This study investigates the career pathways and strategic enablers that facilitate male nurses’ advancement into formal leadership positions, with particular attention to the distinctive opportunities and systemic barriers they encounter within a gendered professional landscape.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The descriptive phenomenological research method was used to conduct semi-structured in-depth interviews with 10 nursing managers, focusing on their real experience of career development, promotion path, organizational and interpersonal support structure. The data were analyzed using the Colaizzi’s seven-step phenomenological method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eFour core themes emerged: early systematic career planning, solid clinical expertise, effective mentor support, and strategies to navigate gendered work environments. These were refined into 10 subthemes : clarifying leadership intent early; accumulating leadership-relevant experiences deliberately; building credibility through high-standard practice; clinical expertise enabling leadership behaviors; demonstrating capability during critical incidents; early guidance on career direction and role fit; Skill development through mentorship; managing stereotypes and expectations about male nurses; building collaborative relationships in female-majority teams; and balancing visibility with legitimacy in leadership roles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study offers practical and theoretical insights for fostering male nurse leadership. Health institutions should institutionalize mentorship, provide early career-planning support, and cultivate inclusive environments to advance diversity and equity in nursing leadership.\u003c/p\u003e","manuscriptTitle":"Exploring the Career Trajectories of Male Nursing Leaders : A Qualitative Study on Leadership Acquisition","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-26 10:01:07","doi":"10.21203/rs.3.rs-8938782/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-08T07:12:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T23:50:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-31T23:14:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224167170512021229039255000698666412900","date":"2026-03-18T21:26:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324135372994711949006075784577316756369","date":"2026-03-12T12:27:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T07:39:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-24T07:30:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T13:26:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-23T13:26:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-02-22T11:33:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38ef0e57-1cf8-450d-8ceb-e550b1f2ed89","owner":[],"postedDate":"February 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T10:23:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-26 10:01:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8938782","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8938782","identity":"rs-8938782","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}