Who Is Taking Care of the Nurse Managers?

Health systems have spent the last several years asking how to take better care of their nurses. It’s the right question. But it skips a step.

The person who most shapes a nurse’s experience of work isn’t the CEO, the CNO or the HR department. It’s the nurse manager. And in many systems, the nurse manager is the most stretched, least supported leader in the building.

Real support for caregivers starts with the people who lead them.

The span problem nobody budgets for

In April 2025, the American Organization for Nursing Leadership and Laudio released an analysis of more than 5,000 nurse managers responsible for about 75,000 nurses across more than 100 hospitals. The findings are hard to ignore.

On teams with fewer than 45 staff, early-tenure turnover averaged 27%. When a manager had 90 or more direct reports, it reached as high as 40%. The analysis estimated the difference at more than $300,000 in preventable losses per department each year.

The same work found that timing matters as much as volume. When managers checked in with new nurses at the six- or nine-month mark, first-year retention rose by 13 points. When those early check-ins were handed off to someone else, retention fell.

Read together, those numbers say something simple. A manager’s attention is one of the most valuable retention tools a health system has, and many systems are spreading it so thin that it can’t do its job. AONL’s own workforce compendium cites data showing that the share of frontline healthcare managers overseeing multiple departments rose from 12% to 21% in two years.

What it feels like from the middle

Talk to nurse managers and you’ll hear a familiar picture. They’re accountable for staffing, quality, budgets, patient experience and the wellbeing of dozens of people. They spend their days filling gaps, answering escalations and translating system priorities for teams that are already tired. Their own development is usually the first thing to fall off the calendar.

Many of them were outstanding bedside nurses who were promoted because they were good at the work. Very few were given the support they need to lead people through constant change. They absorb pressure from above and below, and they rarely say how heavy it has become, because they see themselves as the ones who are supposed to hold it together. The most conscientious managers are often the most at risk, precisely because they keep saying yes.

When a manager like that burns out or leaves, the cost doesn’t stop with one vacancy. AONL’s compendium notes that manager departures are associated with declines in nurse retention. People don’t just lose a boss. They lose the person who knew them, who remembered which shifts they could work and who noticed when they were struggling before they said a word.

What real support looks like

Treat span of control as a quality metric. If a manager has twice the direct reports anyone can know well, the system has made a decision about retention, whether or not anyone said it out loud. Review spans the same way you review staffing ratios.

Protect the moments that matter most. The check-in with a new nurse at month six can’t be delegated to whoever has a free hour. Build it into the manager’s role and protect the time it takes.

Give managers a peer community, not just a reporting line. The managers I’ve seen sustain themselves usually have a group of peers they can be honest with. Mentoring councils and manager cohorts cost very little and give people a place to put down some of what they carry.

Ask them what they need, and act on one thing quickly. Nurse managers are rarely asked. When they are, they can usually name the single change that would give them back hours each week. Acting on it visibly tells every manager in the system that leadership is paying attention.

I’ve argued that healthcare resilience is a two-way culture: it grows when the culture a system creates honors the culture each person brings. Nurse managers sit exactly where those two cultures meet. They are the system’s face to the front line and the front line’s voice to the system.

The leaders behind the leaders

Every health system says its people are its greatest strength. The nurse manager is where that promise either becomes real or quietly breaks. As I wrote in Every Patient Is an Individual. So Is Every Caregiver., personalization doesn’t stop at the bedside. It applies to the people who make care possible.

So the next time your system asks how it can better support its nurses, ask a second question too. Who is taking care of the people who lead them?

Want to explore these ideas further? Learn more about my work on leadership, identity and conviction at www.theglennllopis.com.