Career plateau among nurse managers in China: a mixed-methods study with a quantitative-dominant triangulation design of social media discourse and a multi-province convenience survey

Abstract Background Nurse managers occupy a structurally constrained position between hospital administration and bedside nursing, yet career plateau — the perceived cessation of further hierarchical, content and centralisation mobility — has been studied almost exclusively among staff nurses. This study examined the level, protective resources and structural patterning of career plateau among nurse managers in China, and how hospital level operates through those resources. Methods We used a mixed-methods design with a quantitative-dominant triangulation (QUAN + qual) framed by career-plateau theory and role theory. The quantitative strand was a cross-sectional online survey of 624 incumbent nurse managers across mainland China (87.8% tertiary grade A hospitals) measuring career plateau, perceived organisational support, career planning, workplace resilience and healthcare resilience. Hypotheses were tested with latent-variable structural equation modelling and 5,000 bootstrap resamples, with observed-score regression, quantile regression and a random-forest model as sensitivity analyses. The qualitative strand analysed 1,502 coded units from 1,921 public Chinese social-media posts retrieved with an 18-phrase search across six platforms. Rather than nurse managers' own speech, the corpus is a public discourse field in which the position is constructed by three speaking positions — head nurses (8.6% of units), the clinical nurses they manage (46.5%) and the nursing managers above them (44.9%). Results Career plateau was moderate-to-low (2.63 ± 0.61 on a 1–6 scale) and lower in tertiary than hospitals of other levels (2.61 vs 2.81; p = 0.003; Cliff's δ = −0.21). In the latent structural model (CFI = 0.986, TLI = 0.981, RMSEA = 0.054; R² = 0.74), career planning (β = −0.438, p < 0.001) and perceived organisational support (β = −0.421, p < 0.001) were the dominant protective factors; workplace resilience contributed less (β = −0.117, p = 0.002) and healthcare resilience was not significant. Mediation was indirect-only through career planning (− 0.078, 95% CI − 0.139 to − 0.020); the direct effect of hospital level was not significant. Quantile regression did not establish a distributional gradient: although the point estimates were largest at the upper end of the plateau distribution, a joint Wald test of slope equality across quantiles did not reject homogeneity, so the protective associations are best described as holding across the whole outcome distribution rather than being confined to one end of it. In the discourse field, superior–subordinate relations (27.0% of units) and promotion and career development (24.4%) were the largest themes; sentiment towards the position was more often negative (32.3%) than positive (7.2%), and negativity was markedly more common among clinical nurses (52.7% of their units) than among head nurses themselves (31.8%). Conclusions Career plateau among Chinese nurse managers is moderate-to-low but structurally patterned. The advantage of tertiary grade A hospitals is conveyed through more active career planning rather than through organisational support or hospital level itself, and the protective resources of career planning and organisational support operate across the whole range of plateau rather than only among the most affected managers. The discourse field adds a structural observation the survey cannot make: the nurse-manager position is publicly defined mainly by those above and below it, with criticism arriving from below. Institutionalised career-planning pathways, with hospitals below tertiary grade A given priority, are therefore the most promising intervention target.