Ten Questions Nurse Managers Are Asking

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

Nurse Managers have one of the most challenging roles in healthcare today. They are at the frontline of care and usually among the first to witness trends in both the workforce and workplace. I pay close attention to the questions they ask during the leader development session and pre-workshop focus groups that I conduct. Here are ten questions that they are asking and need our help/support/development in answering:

How do I set boundaries in my work when my staff want 24/7 access to me? In polling nurse managers during workshop settings, very few have hard stops on their day. They often work long hours and take texts and calls on weekends. The pace is exhausting, and without clear boundaries around their work and life, nurse managers are susceptible to burnout. Many of these managers are now early-career professionals and have young children at home. Some organizations have 24/7 cultures, which makes it challenging for individual managers to deviate from the expected trend set by other leaders within the organization.
What should I recognize staff for versus what is expected behavior? Many younger staff members grew up in a world where they received high-fives for doing the expected. Nurse managers now struggle with how to best effectively recognize staff in a way that promotes behavior that goes above and beyond.
How can I promote professional behavior when many nurses now view nursing as more of a job than a passion or calling? Nurse managers report that many new graduates have chosen nursing because it offers a level of career stability that other fields don’t, especially in the era of AI. Nursing is now increasingly viewed as a job rather than a chosen profession or passion. When managers discuss professionalism and professional liability, they report that many staff members don’t seem concerned about the potential consequences of losing their licenses, nor are they swayed by arguments about the value of joining professional organizations and obtaining certification.
What methods of communication are other leaders finding most effective today? The spans of control of many nurse managers continue to expand as many nurses now opt not to work full-time. Finding communication methods or channels to reach a generationally diverse staff is challenging. Some union contracts now prohibit the contacting of staff during non-work hours.
How involved should I be in staff conflicts with one another? In a recent McKinsey study, nurse managers cited managing staff conflicts as one of their most frustrating and time-consuming activities. In a world where people block or defriend one another, helping team members socially navigate their conflicts falls to the nurse manager.
Can I require professional engagement? Involving nurses in unit-level decision-making has become increasingly challenging. Managers wonder if they can require engagement of nurses who have advanced on clinical ladders but now opt out of professional involvement.
Why is no one discussing the reality that new graduates don’t want to work in hospitals because of the high acuity and high volume of patients, and tell us from the point of onboarding that they don’t plan to work in acute care for long? The argument from many nurse advocates is that if staffing ratios improve, nurses will return to acute care environments; however, nurse managers disagree, based on their conversations with staff. Even nurse managers in states with mandated ratios, such as California and Oregon, have told me that the mandated RN-to-patient ratios have no impact on new graduates’ intent to remain working in acute care environments. The work in acute care is more complex today – more documentation, higher acuity patients, and families with less civility. Almost three-quarters of RNs are now BSN-prepared, according to the most recent NCSBN data, and this has opened up significant career opportunities for them, including the option to pursue advanced practice roles.
How can I give performance feedback without getting pushback? Nurse managers report that giving feedback today is challenging. Nurses are exhausted, burned out, and feel underappreciated. Younger staff have also received less feedback about their performance in their academic programs and from their parents. They are overly sensitive to feedback about areas where they may need to improve their performance.
How do I balance the work-life needs of my staff versus the staffing needs of my unit? Nurse managers are sensitive to their staff’s needs for work-life balance, but many staff members now expect their leaders to design schedules that accommodate all their personal needs. Nurse leaders struggle with how much accommodation is too much.
How do I promote teamwork in a culture that prioritizes ‘me, me, and more me’? While teamwork is essential in healthcare, it is less of a core value today. Many nurse managers tell me that they feel like these NCAA coaches who watch their players sign for big endorsements and move from one team to another to promote their careers. Promoting teamwork is challenging in a culture that has become highly individualistic.

All of the above questions frequently arise in sessions with nurse managers, and they should be included as part of leader development programs. Nurse managers often feel very alone in their experiences, but the floodgates open when the discussion begins. Frequently, other leaders within the same organization have best practices strategies to address the challenges presented in these questions, or nurse managers can collectively develop strategies that work.

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