Nurse Manager Retention ‘Particularly Critical’ in First 4 Years

• Nurse manager turnover is highest in the first four years, according to a new report from the American Organization for Nursing Leadership.
• Workplace violence and staffing shortages have been cited as reasons for leaving a managerial position.
• However, nurse leaders identified four key areas that could aid in retention: ensuring a healthy work environment; promoting leadership development; identifying and developing leaders early; and addressing the complexity of the manager role.

Turnover among nurse managers is highest in the first four years, according to a new industry report.

The American Organization for Nursing Leadership (AONL), partnering with Laudio, interviewed nurses for its fall 2024 report, “Trends and Innovations in Nurse Manager Retention.” AONL found that a focus on retention is “particularly critical” for those in the beginning of their leadership careers.

Robyn Begley, CEO of AONL and chief nursing officer, SVP of workforce at the American Hospital Association, said in a news release that nurse managers are “vital” to maintain stability among frontline teams and to ensure “optimal patient care.”

“This report underscores the importance of prioritizing nurse manager well-being and engagement in health systems’ workforce strategies,” Begley stated. “It also provides practical guidance to implement meaningful changes to support these crucial leaders.”

Nurse leaders identified several ways in which organizations can support and retain its leadership: 

1. Ensure a healthy work environment 
2. Promote leadership development 
3. Identify and develop future leaders early 
4. Address manager role complexity 

What Causes Nurse Manager Turnover?

When a nurse manager leaves a role, regardless of the reason, there’s a short-term negative impact, according to the AONL report, which found that annual RN turnover increases between 2% and 4% in the year after a departure.

One nurse told AONL that they had been asked to complete tasks not typically associated with managers, like credentialing nurse practitioners.

Several personal and organizational factors, including violence in the workplace and staffing shortages, have led to high turnover, according to a 2023-24 AONL Workforce Committee report.

“I need to be listened to and not dismissed with ‘toxic positivity,’” one nurse told AONL in its fall report. “Conversations don’t get to real answers often enough when I have a challenge. There’s not enough root cause discussion.” 

Addressing the Problem

In June, NPR reported that New Jersey’s AtlantiCare Regional Medical Center implemented a four-day workweek for nurse managers in response to “alarming rates of turnover since the pandemic.” At the time of the reporting, no nurse managers had quit.

“I think it has actually made us stronger,” Nurse Manager Danielle DiLella told the radio outlet, “because when you’re covering that other person’s team, you have to build rapport with that team. You have to develop trust with that team,” she says. “So it kind of gives you a more global perspective of what’s happening in the hospital.”

A 2021 study from BMC Health Services Research, which examined the relationship among nurse manager work responsibilities, nurse job satisfaction, patient satisfaction, and medication errors, echoed the sentiments expressed in AONL’s report.

“Nurse managers should adopt a leadership style that emphasizes safe and patient-centered care,” the authors stated. “The results also suggest that the administration of today’s health care organizations should actively evaluate nurse managers’ share of work activities to ensure that their daily work is in line with the organizational goals.”

The Cleveland Clinic offers a residency for assistant nurse managers, providing leadership skills and opening “a robust pipeline for future nurse managers,” according to a Consult QD report.

“After a few months in the residency, I felt more confident,” Kendra Kulwicki, BSN, RN-BC, told Consult QD. “The program reaches you where you are and elevates your thinking. Coming from an outside organization, I was impressed that Cleveland Clinic cared that I was comfortable in my job and that I could do it well.” 

The Bottom Line

A new report from the American Organization for Nursing Leadership found that most new nurse managers leave their position within the first four years. To combat this, nurse managers who spoke to AONL for its report offered four focus areas that could help retain new managers: ensure a healthy work environment; promote leadership development; identify and develop future leaders early; and address manager role complexity. Some facilities, like the Cleveland Clinic and New Jersey’s AtlantiCare Regional Medical Center, started programs or made institutional changes to do just that even before the report was released. 

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