The purpose of this study is to deeply and comprehensively understand the experiences related to the role of the executive director of nursing department in small and medium sized hospital. And to understand the nature of the role experience. A total of 49 concepts, 13 sub-categories, and 5 categories were extracted from the study. In the first category, 'Heavy pressure of work load', the participants stated that the job and position of the small and medium hospitals are unstructured and the responsibility of the executive director is wide because the role sharing is not done well. In the second category 'Difficulty in role performance', the participants said that there were many difficulties in the shortage of the new and career nurses and in the supply and demand of the nurses and lack of self-esteem as the executive director. In the third category, 'Difficulty in acting as a mid-level manager of hospital', said that there were unequal evaluations, difficulties in coordinating between other departments, and hospital tasks other than nursing. In the fourth category 'Efforts to solve problems,' participants were constantly engaged in conversations and meetings to coordinate with nurses, managers, and other departments. And suggested to the institution or society. In the fifth category, "Belief and values," participants said they wanted to be a personal manager who creates a family-like environment, a department manager who communicates, a department manager who encourages quality academic work for nursing.