Ten Things Nurse Managers Wish Their CNOs Knew But Some Don’t

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

It always surprises me when I go on-site to do nurse manager workshops and the CNO isn’t present for any of the discussions. Some CNOs are quite the opposite and stay all day. There is never any awkwardness because I have found that nurse managers are diplomatic and rarely look for people to blame; they just want to be heard. The following are ten things nurse managers often share with me, and some, but not all, CNOs know.

1. “My job has become too big for one person.” The nurse manager role has expanded to include staffing, quality, patient experience, financial performance, employee engagement, regulatory compliance, and constant problem-solving. Something has to give, and telling a manager to do more with less can feel insulting.

2. “Having enough nurses is not the same as having enough experience.” A unit may meet its staffing targets but still be clinically vulnerable when most nurses have fewer than two years of experience. Novice density changes the support and supervision a unit needs. As our novice density increases, so too does leader intensity.

3. “My experienced nurses are carrying an invisible workload.” Experienced nurses coach novices, catch errors, anticipate problems, and rescue struggling colleagues while managing their own patients. This work rarely appears in staffing calculations. They need the bonuses, not new graduates.

4. “I spend much of my day putting out fires instead of leading.” Constant interruptions, staffing problems, and operational demands leave little time for coaching, developing staff, improving practice, or thinking strategically.

5. “Every new initiative adds work, but almost nothing gets taken away.” Nurse managers are expected to implement new programs, technologies, reporting requirements, and organizational priorities without eliminating older responsibilities. Nothing is ever taken off our plates – things are just added.

6. “I need more than encouragement to build a healthy work environment.” Psychological safety, accountability, teamwork, and retention require time, leadership development, consistent organizational support, and the authority to address difficult behaviors.

7. “My charge nurses are often novices at leadership themselves.” Nurses with 18 months or two years of experience may be placed in charge roles before they have developed the clinical judgment, conflict management, delegation, and team leadership skills those roles require.

8. “I am held accountable for outcomes and metrics I cannot fully control.” Nurse managers are responsible for turnover, overtime, staffing, patient experience, and quality outcomes, yet they may have limited influence over budgets, hiring, staffing resources, support from other departments, or organizational policies.

9. “I don’t always feel safe telling senior leadership how bad things really are.” Managers may worry that raising concerns will make them appear negative, ineffective, or unable to handle their responsibilities. As a result, executives often get an incomplete picture of frontline conditions. One manager shared: ” My CNO only wants happy news.”

10. “I love nursing leadership, but I don’t know how long I can keep doing this.” Even highly committed managers can become exhausted when their workload is unsustainable, and their efforts seem insufficient. Losing these leaders also means losing valuable organizational knowledge and relationships.

The question for CNOs is not simply whether nurse managers are resilient enough. It is whether the organization has designed a nurse manager role that is realistically achievable. If your nurse managers could speak with complete candor and without fear of consequences, what would they tell you?