Improving the Work-Lives of Nurse Managers

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Last week, I gave the AONL Research Foundation Keynote at the AONL meeting in New Orleans. My topic was the Evolving Role of Nurse Managers in the New World of Work. To prepare for this presentation, we sought input from nurse managers through five focus groups conducted in February and March 2024. I promised the 141 managers who participated in this research that I would share their feedback in this blog, as many could not attend the conference. In last Thursday’s blog, I wrote about the impact of staffing shortages on the nurse manager role. Today, I will focus on their six recommended strategies to improve their work lives.

Their recommendations included the following:

1. Provide more effective onboarding for nurse managers – managers in our focus groups noted considerable time and resources spent on transitioning new nurses into practice. At the same time, they had little development as they transitioned into their roles. Being a manager today is complex and involves new challenges. Moving from a staff nurse to a manager role is like returning to a novice on Benner’s novice to expert competency development scale. Many managers noted that the transition had been stressful and that they had made leadership mistakes because they lacked skills. It was surprising to hear how many had received no onboarding in the first six months of their role.
2. Offer nurse managers the option of either a 4-day workweek or remote work –nurse managers discussed the need for more flexibility in their scheduling. Some members of these focus groups worked in organizations that had already implemented options of working four days and remote work and noted how it had improved their work lives. Interestingly, this same recommendation was made in AONL focus groups to highlight best practices in nurse manager retention. Some managers had lobbied for this at an individual hospital level with varying degrees of success.
3. Reduce nurse manager span of control and role scope – many nurse managers reported that their span of control had increased in this post-Covid environment. In our sample of 141 managers, 41% directly supervised more than 76 staff, and 22% supervised more than 100. These spans of control are challenging in the current environment, where a significant percentage of nurses have less than three years of experience. The span of control in the role was not the only issue managers discussed. They are also seeing an increase in the role scope of their nurses and themselves. Support services such as environmental services, lab, PT, dietary, and respiratory are often short-staffed and look to nursing to pick up some of their role responsibilities. Other services, such as EHR support and HR, went remote during COVID-19 and have not returned onsite to support nursing. One manager described HR as “missing in action” in her health system, and others agreed that increasing leaders had to access HR databases and could not rely on HR support for help with complex performance issues. They questioned what the concept of “support services” even means because those in the role don’t necessarily see that as part of their job.
4. Eliminate the burden of 24/7 responsibility – nurse managers talked about the burden of constantly being told that their roles were 24/7. They noted that such a practice leads to no downtime and unrealistic expectations. One nurse manager shared, “Recognize that work-life values have changed. Those in senior leadership like to stick with older generational values that glorify sacrificing themselves for the organization. This won’t work to recruit younger leaders. We need to have healthy workloads and boundaries.”
5. Allow more autonomy for unit-based decisions – nurse managers talked about how few unit-based decisions they had input into. Those with experience noted that hospital mega-mergers into health systems take more and more control from the point of care as systems make decisions without consideration of geographical context. They are not surprised by the drop in engagement in professional governance efforts as they too often have limited or no input into decision-making.
6. Pay us commensurate with the responsibilities – the issue today with nurse manager versus staff nurse pay compression has always been a challenge but even more so today as nurse managers work more hours. Signing off on payroll and seeing staff nurses who make twice what you make is very discouraging some noted.

Nurse managers are concerned about succession planning for nurse leader roles. Many noted that their nurses look at their role expectations and number of hours worked and tell managers they won’t pursue these roles. Recruitment and retention in the role are especially problematic today.

Nothing shared above is new, yet very few changes have been made to improve nurse managers’ work-life quality. The poet Maya Angelou wrote, “Do the best you can until you know better. When you know better, do better.” We do know better, and the time to act is now. In upcoming blogs, I will share more data from our research.

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