January 2, 2025 Nurse manager turnover is highest in first 4 years as a leader

What the data says

Managers are most likely to leave their role or organization within the first few years, a period when they require the greatest support and encouragement. Nurse manager turnover reaches as high as 12% in their third year as a leader, with years two and four also well above the average of 7.5%. This pattern mirrors a broader trend observed among newly hired Registered Nurses (RNs), who experience higher turnover rates during their initial years. 

What it means 

1. Nurse managers in their first few years as a leader are at their most susceptible to leaving the organization.
   • • As discussed in the Laudio/AONL Fall 2024 report, “Trends and Innovations in Nurse Manager Retention,” nurse managers exiting their roles – regardless of the transition type (e.g., turnover, department change) – increases team turnover by about 2 percentage points in the 12-month period afterwards, creating disruption and additional costs every time a manager leaves. Understanding when manager turnover is most likely to occur gives health systems insight into an especially important window for enhanced manager support to retain these managers and avoid the negative repercussions involved with departures.
       
       
2. While, on average, nurse managers have lower turnover rates than frontline RNs, they are uniquely difficult to replace, especially those relatively new to leadership roles.
   
   1. • Managers with a few years of experience possess leadership, organizational, and departmental knowledge that, when they leave, is often replaced by a new leader that has much less experience in all three areas. When managers leave after four years, they are also replaced by a manager who, on average, will have a higher turnover rate for the next few years.
      • As also detailed in “Trends and Innovations in Nurse Manager Retention,” 57% of incoming nurse managers are promoted from within the same department, underscoring the valuable knowledge they have of the teams and departments that they are leading.
        

What the implications are for healthcare leaders 

1. Enhance investment in nurse managers in their first four years of leadership to successfully make the transition to a sustainable management career.
   • • AONL-led nurse manager interviews that informed the AONL-Laudio report underscored that a healthy work environment is a primary area that managers look for in deciding to continue to stay and lead. Three examples of ways to promote a healthier work environment include:
       1. 1. Establish a “Manager Bill of Rights”
             1. (1)  A "Manager Bill of Rights" establishes clear guidelines to support work-life balance for managers. It includes provisions like designated days off, the option to work from home once every one or two weeks, and fostering a culture of mutual support where managers cover for one another. This ensures that taking time away from the office is free from guilt or competition among peers.
          2. Implement “triple peak days”
             1. (1) This flexible scheduling approach is informed by research on productivity patterns. Managers adjust their work hours to align with personal and professional demands while capitalizing on their most productive periods. For instance, a manager might work until 2:00 p.m., leave to manage personal tasks such as school pick-ups, then resume work in the evening, either from the office or home.
             2. (2) As managers move to a traditionally-structured management schedule, they are often transitioning from a role that has far greater scheduling flexibility. Early tenured managers, in particular, may perceive great benefit from organizational policies that promote increased flexibility and work-life balance.
          3. Pilot a four-day work week
             1. (1) The four-day work week condenses the standard 40-hour schedule into four days, offering a popular alternative that enhances productivity and work-life balance. In healthcare, this arrangement also allows managers to be present during off-shift hours, supporting operations more effectively.
                
                
2. Continue to invest in nurse managers beyond their first four years to grow those who have the most organizational and leadership experience.
   • • Developing and growing leadership development programs is the next primary area managers report looking for as they build their leadership careers. Three examples are ways to do this include:
       1. 1. Host small group dialogues with nurse managers
             1. (1) While dialogues can occur during stay interviews or purposeful rounds, dedicated small group dialogues are recommended.
             2. (2) Executive leaders can schedule focused discussions to address one or two key questions. These dialogues can take place in relaxed, engaging environments, such as over coffee, ice cream, or popcorn, fostering open communication and stronger connections with team members.
          2. Add new competencies to leadership development programs. AONL has established core competencies to serve as a foundation and guide for leadership development. In addition, a recent article highlights four emerging competencies essential for managers to navigate the future effectively:
             1. (1) Understanding informatics: Proficiency in using technology and informatics to enhance healthcare processes and outcomes.
             2. (2) Analyzing data: The ability to analyze, interpret, and leverage data for decision-making and strategic planning.
             3. (3) Committing to ethical practice: Commitment to ethical decision-making and underscoring integrity within the organization.
             4. (4) Leading through crisis: Skills to guide teams and organizations effectively during times of uncertainty and crisis.
          3. Establish a “talent exchange”
             1. (1) A talent exchange program enables organizations to rotate leaders between departments or within a health system. These exchanges can serve multiple purposes, including:
                1. (a) Interim coverage: Providing temporary leadership in a specific area.
                2. (b) Skill development: Offering formal rotations for upskilling, project management, or exposure to new clinical areas.
                3. (c) Leadership opportunities: Allowing frontline caregivers, supervisors, or novice leaders to assume interim leadership roles while their manager participates in a rotation elsewhere.
     • To ensure the program's success, it is essential to establish clear expectations, defined timelines, and regular monitoring to evaluate progress and outcomes. This structured approach enhances leadership development and strengthens organizational agility.