Challenges Faced by New Nurse Managers

By Rose O. Sherman, EdD, RN, FAAN

When you have been in leadership for many years, it can be hard to remember what it is like when you begin in your first nurse manager role. Recently, I had an opportunity to work with many new nurse managers in the leadership development course sponsored by the American Nurses Association. Most were in their first two years in the position and many felt overwhelmed. These roles are very challenging especially in today’s environment. It was surprising to see how many of these managers had little leadership development and most did not have a mentor.

Over time, these leadership roles have become very complex as managers pick up more and more responsibilities incrementally. Staff nurses have little real exposure to what their leaders do on a daily business so when they move into these roles, it can be very shocking. As frontline leaders, they run the equivalent of a small businesses and also serve as chief retention officer for their organizations.

In my discussion with these new managers, I learned that their transition was often very abrupt. One week, they were working three 12 hour shifts as staff nurses and then the next they found themselves working five days a week uncertain about how to even plan their day. Few were given any structure about how to get started, a topic we have covered on this blog about what to do in your first 100 days in a leadership role. We need to do a much better job with onboarding new managers and not leave it to chance. The following are the challenges that they reported to us:

The Challenges

Staffing My Unit

Keeping Staff Engaged in their Work

Understanding the Business of Healthcare

Getting Staff Buy In to Change

Managing Behaviors – Performance Management

Work Boundary Issues in the Nurse Manager Role

Financial Understanding – Reading a Budget and Looking at Variances

Having Difficult Conversations with Staff

Building a Strong Team

My Own Work-Life Balance

Keeping My Staff Patient Focused

Acting Like an Air Traffic Controller

Managing Across Generations

Flexing My Communication Style to Meet Everyone’s Needs

Recruitment and Retention

Role Confusion – How Much Time Should I Be Out on the Unit

Patient Acuity Versus Staffing

Managing Change

Feeling Insecure in my Role/Like an Imposter

Incivility of Patients and Families

Reverse Ageism

Frequent Senior Leadership Turnover – New Leaders and New Expectations

Relating to Former Peers

Working in a Large and Complex Organization

Not Receiving any Training for the Role

Staff Turnover

Bullying on My Unit

Frequent Nurse Manager Turnover = Jaded Staff an No Trust

Managing a Virtual Team

No Educational Support on the Unit

Staffing with High Percent of New Graduates

Leading in a Unionized Environment

Understanding My Budget Responsibilities

Feeling Secure in My Role

Too Much Organizational Change

Staff Disengagement and Burnout

These challenges are a good place to get started in thinking about your onboarding efforts with new managers. We need to be much more intentional about how we transition nurses into these complex roles.