In today’s complex healthcare environment, nurse managers are increasingly viewed as the keystone for achieving organizational outcomes, including delivering high-quality care, preventing harm, managing costs, and enhancing patient and team experiences. Their voices reveal urgent priorities for their Chief Nursing Officers to address to promote their job satisfaction and wellbeing – and avoid them leaving their roles
Nurse managers report mounting frustrations as task-heavy demands prevent them from focusing on the work that truly brings them satisfaction and aligns closely with their organization’s goals. Today, experienced nurse managers are in short supply and manager retention is especially fragile within the first four years of tenure. Across the country, managers voice concerns over the lack of interest in managerial roles from potential successors.
A recent report by Laudio Insights and the American Organization for Nursing Leadership (AONL), Trends and Innovations in Nurse Manager Retention, combined data analysis and one-on-one interviews to capture the top priorities from nurse managers for their Chief Nursing Officers (CNOs) to address.
Four manager priorities for CNOs
1. Ensure a healthy work environment
89% of the nurse managers cited a healthy work environment as their number one priority. Psychological safety, physical safety, and flexibility are crucial in enabling them to thrive.
Psychological safety, which encourages managers to speak openly, take risks, and voice concerns without fear of retaliation, is foundational. It requires consistent, trust-building relationships and a communication culture that values openness and learning from mistakes.
Physical safety is also increasingly critical. The rise in workplace violence has made managers responsible not only for their own well-being but also for protecting their teams and patients. While zero-tolerance policies are now common, many managers feel that effective, actionable strategies to address these risks are lacking. To enhance physical safety, managers need more proactive measures and better support.
Flexibility is the third pillar of a healthy work environment. With a role that demands near-constant availability, many nurse managers struggle to disconnect, which takes a toll on their personal lives.
CNO strategy highlight: Promoting a culture of understanding and allowing managers some latitude to address personal needs. Rather than comparing their roles to other types of managers who don’t need to be available 24/7, CNOs should recognize the unique demands on nurse managers and prioritize work-life balance, including protecting their time at home, as a key component of job satisfaction.
2. Leadership development
In an industry that increasingly demands agility and expertise from its leaders, many of today’s nurse managers, about 60% of whom have fewer than 5 years of experience, find themselves facing rising complexity with little leadership training. Newer managers see leadership development as a top priority – not only through formal training but also through hands-on mentoring and practical guidance.
Executive rounding can be a key component of leadership development when designed effectively. However, according to managers, current executive rounding practices often feel superficial, with “drive-by” or “grip-and-grin” routines that lack substance. Managers are calling for more substantial engagement with CNOs and other executives, seeking meaningful dialogue and mentorship that addresses their specific challenges and growth goals.
Traditional Town Hall meetings, another key lever, reach a broad audience, but many managers prefer smaller, focused discussions where they can ask questions and receive personalized feedback. Additionally, “stay interviews” are increasingly sought as an opportunity for managers to openly share their professional aspirations with leaders who are committed to listening and supporting them. These one-on-one conversations can improve job satisfaction and provide valuable insights into what motivates managers to stay in their roles.
CNO strategy highlight: CNOs can also consider adopting technology that can help facilitate executive engagement across campuses. For example, platforms like Zoom can enable more frequent interactions and AI-based coaching can complement traditional mentoring by offering data-driven insights and personalized guidance. Through consistent, authentic engagement, nurse managers can gain a deeper understanding of effective leadership, helping them to apply these lessons within their own teams and enhance their impact.
3. Identify and cultivate future leaders early
One of the most pressing challenges facing managers is finding team members who aspire to take their leadership roles. Many frontline nurses are hesitant to move into management, viewing the role as demanding, complex, and offering minimal financial incentive. Managers committed to their teams worry about progressing in their own careers if they cannot identify and develop future leaders. CNOs play a key role in shaping the sustainability of leadership roles to attract emerging talent.
CNO strategy highlight: By visibly nurturing a pool of emerging leaders who understand and align with the organization’s mission, vision, and values, CNOs can ease managers’ anxieties about their teams’ futures. This internal leadership pipeline not only allows managers to focus more creatively and confidently on their current responsibilities, but it also empowers them to prepare for career progression, knowing they’ll leave their teams in capable hands. Three ways to do this include:
- Implement a clear succession planning framework.
- Establish Leader Standard Work to set and communicate leadership expectations.
- Provide practical tools to help them organize and prioritize their work, allowing managers to better support their teams and identify potential leaders.
Nurse manager roles have grown increasingly complex. The rise in regulatory and compliance requirements places additional demands on managers, and many find themselves assuming responsibilities once handled by higher-level leadership. The industry’s move toward leaner, flatter organizational structures – driven by rising expenses, labor costs, and stagnating reimbursements – has only intensified this burden.
The complexities of the role are further compounded by the diversity of today’s workforce, which spans five generations. Each generation has unique perspectives, communication preferences, and levels of technological proficiency, yet all seek meaningful work and a sense of connection to their leaders. This generational diversity calls for managers to be adaptable and responsive to different needs, adding yet another layer to an already challenging role.
CNO strategy highlight: Continue to actively reduce spans of control. Partner with other C-Suite leaders to advocate for technologies that alleviate the administrative workload. Clearly define Leader Standard Work that integrates seamlessly into daily workflows. And develop communication strategies that bridge the generational divide, recognizing that each generation may respond differently to various styles, platforms, and messaging tones.
Conclusion
The success of healthcare organizations hinges on the strength and wellbeing of nurse managers. By listening to their concerns and addressing their top priorities – a healthy work environment, leadership development, the cultivation of future leaders, and reduced role complexity – CNOs can support managers in delivering exceptional patient care and creating positive team experiences.
Meeting these priorities requires CNOs to approach their support of nurse managers with empathy and a commitment to sustainable practices. From prioritizing safety and flexibility to advocating for technologies that streamline processes, CNOs can lead their executive team in transforming the nurse manager role from one of burnout and turnover into a career path that is fulfilling, resilient, and essential to the organization’s mission.
For more interview insights and implications for the health system leaders, download Trends and Innovations in Nurse Manager Retention.
Written by Joel Ray, COL, USAF, NC, MSN, RN, NEA-BC
Joel Ray is Chief Clinical Advisor at Laudio, where he brings a CNO perspective to a wide range of cross-functional initiatives and is a key contributor to Laudio Insights. With 42 years in healthcare and over 23 years in executive leadership roles, including Chief Nursing Officer and Chief Operating Officer, Joel brings a wealth of operational leadership experience to Laudio. He understands the needs of executives and frontline leaders. He is passionate and pragmatic about empowering frontline leaders to focus on what matters most: building meaningful connections with their teams to enhance engagement and secure the delivery of high quality, safe care and an excellent patient experience. Previously the Vice President of Patient Care Services and Chief Nursing Officer at UNC Rex Healthcare under his guidance, the hospital obtained its 4th Magnet designation, CMS 5 Star, and Leapfrog A ratings. He served 26 years in the U.S. Air Force Nurse Corps, retiring with the rank of Colonel. He earned a BSN from Arkansas State University and MSN from Arizona State University.