October 2, 2024 The relative number of new healthcare managers is growing 7% per year

What the data says
The analysis shows that the relative mix of newer clinical managers at health systems is increasing by 7% every year. More tenured managers are leaving the manager role or retiring faster than has been historically typical. They are being replaced by new managers, which is increasing the relative number of newer managers.

The relative number of experienced clinical managers in all tenure cohorts is declining, with the greatest decline amongst those with 6-10 years of experience (as shown by the greatest relative reduction between July 2022 and July 2024). This could be because those who were new to the manager role over the last 6-10 years have had their only experience as a manager during the accumulating stresses of the pandemic and increased scopes of responsibility that have made the role less sustainable for them; those who had more experience prior to the past few years have been better able to persist in the role.

A similar pattern in the increase in new managers exists for support services managers (not shown).

What it means

There are two major themes associated with a swift increase in the relative number of less experienced managers.

1. The growth in the relative number of new managers is occurring at a time when spans of control and breadth of responsibility of managers is also increasing, creating compounding stress on leaders.
   • The growth of managers’ spans of control is documented in a prior article (“Under stress: 33% annual rise in healthcare managers with 2+ cost centers”).
     1. Learning to lead a clinical or support services team is a major change for most new managers, moving from caring for a few patients or supporting a few processes to having global accountability for an entire unit or department.
     2. Managers have ownership of maintaining high reliability of multiple outcomes; of leading a large team and all of the complexities of building culture; of scheduling to make use of the teams’ skill mix; of transitioning new RNs into practice; of creating and balancing large budgets; and of managing incremental overtime and premium labor, to name a few items.
   • In addition, as shown in a prior article (“Experienced managers have more meaningful interactions with their teams”), managers in their first five years in the role have significantly fewer meaningful interactions with their direct reports than more experienced managers, reflecting that it usually takes a few years of experience to reach a steady state of standard leadership practice.
   • As one manager shared with us recently, “As a new leader I was shocked at how much I was responsible for… this was really an overwhelming realization.”
     
     
2. As a group, the leadership team will be less balanced with fewer opportunities for newer managers to learn from more tenured ones.
   • New manager candidate pipeline will be drained causing an increase in absent leadership positions, drive combining work centers resulting in larger span of controls and associated risks (see article on span of controls).
   • As one Director of Clinical Education shared, “More and more I see manager positions being filled by assistant nurse managers that do not have a desire for the role and who have not been mentored to be prepared for the elevated responsibility. They take the role, not due to a passion for leading people, but out of necessity for the unit; they eventually inevitably leave after 2 years in the role.”

What the implications are for healthcare leaders 

1. Executives need to invest more in support for managers, ideally by increasing both training and tools – especially for early tenure managers as they are learning to lead.
   • As a cohort, these leaders will need more support and investment than managers have historically required.
   • New leaders have the chance to learn the highest impact and most complex parts of their management role faster if they are not inundated with administrative tasks. Executives and service line leaders can look for new ways of removing administrative tasks from managers’ responsibilities.
     1. For example, health systems can reduce the number of self-service tools that sometimes create more administrative work for managers; they can also look to invest in platforms that automate common processes. While self-service tools (e.g., expense reimbursement systems that allow/require individual employees to enter all expense details) remove the burden from central resources, the hidden cost is that even seasoned managers are overwhelmed and new managers are inundated with administrative work.
   • The training and tools deployed for managers should have a particular emphasis on increasing the level of meaningful interactions with team members.
     1. A range of training and tools can support managers learning their role. Many new managers are focused on tactical processes of the manager role (e.g., submitting payroll and ordering supplies). Managers who are new to the role often share that learning to do these tactical steps more effectively is their primary goal; more experienced leaders appreciate that meaningful time spent with their team members is the higher-impact goal.
   • Executives can also consider conducting purposeful stay interviews with their managers, starting with those in this early tenure group, followed by those with 6-10 years’ manager experience. These discussions could include ways to build and maintain work-life balance, ways to align work to their professional goals, ways to keep managers from having to cover for staff in the unit, and ways to use tools or technologies to alleviate their administrative burden.
     
     
2. As a group, the leadership team will be less balanced with fewer opportunities for newer managers to learn from more tenured ones, requiring new approaches to creating effective support networks.
   • New managers look to both their peers and more experienced leaders to learn from in their first few years.
   • Health systems could consider creating a formal “early tenure manager” group, similar to other employee resource groups, where they meet once a month for support and can ask questions of each other. This can be supported either in a made-for-purpose chat group or in the Nurse Manager Council; in either case, managers need time to discuss their challenges and questions, with guidance provided by directors and experienced managers.
   • Executives can also consider building formal mentorship programs to connect new managers to more senior managers, giving junior managers the opportunity to “phone a friend” for guidance and advice.The “tone from the top” can be used to remind other leaders of the value and intent of the solutions, such as mentorship, that are put in place and connect them to broader organizational strategies, especially people strategies.