The “Great Flattening”—or the elimination of middle management roles as a cost-cutting measure—is on the rise across industries, and thousands of mid-career professionals have either been laid off or risk losing their jobs. Middle managers are essential in any industry, but when it comes to nursing, this is the tier that we cannot risk losing. As healthcare companies nationwide contend with slashed budgets, healthcare leaders must turn their attention to arguably the most undervalued and essential component of healthcare’s ecosystem: the nurse manager.
Imagine being in the eye of the storm on a hospital floor. Every decision you make can impact dozens of lives. The smallest misstep could compromise patient safety, staff morale or operational efficiency. It's a daily reality that nurse managers across the country know well.
Nurse managers are responsible for juggling and controlling a workload much larger than their non-nursing colleagues; financial and HR reporting systems, all while handling everything from staffing crises to birthday celebrations. They’re drowning in information overload, creating a cognitive burden for our nurse leaders.
Nurse manager engagement improvements lag behind the improvements among other healthcare leaders. This trickles down to the nurses on the floor. When nurses don’t feel they have support from leadership, they are 1.53x more likely to leave their organization. The onus isn’t on nursing leadership; it’s on our healthcare system to give nurse managers the resources and time they need to work closely with their teams.
This is more than just about workforce experience, it's about the fundamental stability of our healthcare infrastructure. Nurse managers are the foundation of our system, and if that foundation crumbles, patient safety and care collapse with it.
A call bell to the C-suite
When I was a nurse manager, I felt like a constant barrage of interruptions—like safety audits, hours of administrative meetings and candidate interviews—were keeping me from staying focused on the heart of nursing leadership; mentoring the nurses on my team.
A never-ending to-do list on top of 24/7 accountability for your unit makes the nurse manager role more overloaded than any leadership position in the hospital. Primarily, nurse managers stand at the critical intersection where safety, quality and patient and employee experience converge. When nurse managers are burdened with constant administrative tasks, it keeps them from spending time with their staff to develop positive practice environments where nurse engagement and patient outcomes thrive.
Too often, the C-suite underestimates how clerical overload and constant interruptions prevent nurse managers from focusing on staff development and patient care. Taking steps to reduce the information and administrative load on nurse managers can make a real difference. No solution for a complex problem can exist in isolation, and solving this one requires a partnership between key executives like the chief medical officer, chief nursing officer and chief quality officer. Hospital leaders must be fully aligned in improving the nursing work environment and committed to comprehensive organizational change.
Implementing a continuous listening strategy is paramount. Regular pulse surveys, employee culture assessments and safety evaluations give C-suite leaders real-time insights into the challenges facing nurse managers, while opportunities to share feedback give nurse managers a moment to check with themselves to understand what resources they need to better perform. Constantly shifting from crisis management to administrative demands leaves nurse managers without the time or space to focus on what their teams—and they themselves—need to succeed. By working to understand the experiences of nurse managers and working with them on the ground, hospital leaders can develop targeted, meaningful interventions.
Technology for better human experience
Investing in advanced technological solutions can also remove the onus of administrative tasks from nurse managers’ desks. Managing payroll, scheduling, HR and one of the many other responsibilities nurse managers handle means dealing with countless systems daily. Hospitals can ease the cognitive burden that comes with disparate systems by bringing them into one reporting dashboard, giving nurse managers visibility into every aspect of their role at once.
Technology isn’t meant to replace the human touch, but to enhance it. Deploying predictive analytics lets nurse managers anticipate staffing issues and allow them to work directly with their staff to mediate, and anticipate patient challenges that may require more care with greater accuracy. Training nurse managers on time-saving AI tools can create a critical opportunity to reduce the burden placed on nurses and improve both their engagement and patient care in the process.
Our nurse managers are worth the investment
Supporting nurse managers isn’t just about easing their administrative burden—it’s about investing in their growth as leaders. Empowering nurse managers with targeted leadership development strengthens their ability to navigate complex challenges, mentor their teams and drive exceptional outcomes.
Organizations that put their people first outperform the ones that don’t, and improving nurse manager engagement and development creates a significant financial impact. McKinsey’s Nursing Pulse Survey recently found that US healthcare systems could save between $400 million and $700 million annually and strengthen care by reducing frontline-nurse turnover through improved manager support. Our own research found that engaging and developing 15 nurse leaders can save an estimated $3.5 million in turnover costs, and doing the same for 100 nurse leaders can save an estimated $18.5 million.
No job description can fully capture what it means to be a nurse manager, but in the midst of the challenges and emotional rollercoaster rides, there is profound beauty in this profession. Nurses remain the most trusted profession in the world, a testament to our unwavering commitment to human care. But to maintain that integrity, hospital leaders must transform how we support those who support everyone else.
Jeff Doucette, D.N.P., is chief nursing officer at Press Ganey, and previously held chief nursing officer roles at community-based organizations and academic medical centers.
Editor's note: Press Ganey's business includes nursing leadership development consulting for healthcare organization clients.