How CNOs Can Help Nurse Managers in 2025

It’s a new year, and people all around the world are setting new goals and resolutions for themselves, including CNOs.

In 2025, CNOs and other nurse leaders will have to keep track of many different trends and challenges, including the ones facing a critical part of the workforce: nurse managers.

Nurse managers are vital to the success of a health system. According to the Trends and Innovations Nurse Manager Retention report that was released by the American Organization of Nursing Leadership (AONL) and Laudio in the fall of 2024, nurse manager retention is key to building a sustainable and high-performing healthcare setting.

However, the report says that nurse manager turnover is highest within the first four years of leadership, and according to Robyn Begley, chief executive officer of AONL, and senior vice president and chief nursing officer at the American Hospital Association (AHA), this is due to very high levels of stress and burnout.

“As a former nurse manager earlier in my career,” Begley said, “I can tell you it was the most challenging role that I’ve had in nursing leadership in my entire career.”

Nurse managers are responsible for patient care, their nurses, 24/7 staffing for their units, budgeting, and compliance with regulations. Begley explained that it’s not easy for nurses to move to a nurse manager role, and it should require formal training in leadership, management, and administrative skills.

“They are really the CEOs of their patient care area,” Begley said. “Transitioning from a clinical role to a managerial role requires different competencies.”

Nurse managers work long hours and have to constantly be available in case something goes wrong, and this can have a large impact on their personal lives and wellbeing.

“Hospitals and healthcare settings are very frequently 24/7 operations,” Begley said. “Work-life balance gets a lot of attention, and this really is one of those areas [where] it’s challenging for a nurse manager, and this can strain their wellbeing.”

Organizational culture also has a large impact on nurse managers, and, according to Begley, it can influence a nurse manager’s job satisfaction. CNOs need to make sure that support systems are available.

“Some new managers may feel isolated or perhaps unsupported,” Begley said, “finding it difficult to navigate their new responsibilities and feel confident in their roles, especially in those first few years.”

The nurse manager’s role may also be ambiguous, so Begley recommends clarifying their responsibilities as best as possible to avoid confusion and lack of direction.

“Many times, if a new initiative comes into play, who is left to actually make sure that it gets implemented and outcomes are monitored and measured?” Begley said, “it’s the nurse manager.”

“Frequent changes in management can create a sense of uncertainty and instability among those units that have frequent turnover,” Begley said. “This can lead to decreased morale and job satisfactions, as employees, the nurses, the nursing assistants, and the clerical support on those units may feel that their work environment is unpredictable.”

Improving nurse manager retention

Begley had several tips for CNOs who want to improve their nurse manager retention. As CNOs continue to build an engaging and psychologically safe environment for nurses, they must also think about nurse managers and how they can feel safe speaking up, surfacing concerns, and potentially disagreeing without negative repercussions.

“They understand what it’s like on the front line and they have to feel free to be able to communicate that back to executive nursing leadership,” Begley said. “They have to feel like they can tell it like it is and not sugarcoat some of the messaging that they really do need to communicate to their leadership team.”

Additionally, Begley suggested that CNOs allocate resources and advocate for the funding to provide formal training to their nurses who are aspiring to become managers or leaders.

“It takes continuing leadership development and education because we know there’s always something new to learn and things are changing in healthcare very rapidly,” Begley said.

“Nurse managers told us how important it is to actually see their leadership and to have communication and conversations with them,” Begley said. “Not just fly by rounds where leaders will stroll through a unit, say hi, try to check in with the staff quickly, but really scheduled time for managers to be able to engage in dialogue is what is required.”

Meeting nurse manager expectations

In the report, nurse managers had four priorities that they want CNOs and other nurse leaders to focus on: ensuring a healthy work environment, promoting leadership development, identifying new leaders early, and addressing role complexity.

Begley emphasized the necessity of succession planning for upper management and for executive management, and that there needs to be planning for every level of leadership.

“That involves a formal plan, a succession planning framework, that includes purpose, level, assessment, and nurturing,” Begley said. “We know with the baby boomer retirements that we are creating space in leadership in nursing, as well as in many other professions.”

The career trajectory of many nurses nowadays is also vastly different than what it used to be, Begley explained.

“There are some young up-and-comers who are very willing and able to take on more, to learn and aspire to be leaders,” Begley said, “so these organizations need to do a deep dive and do that assessment and really figure out what their staff nurses desire to do in the future.”

Health systems need to provide exposure to what nurses at different levels do, and provide formal education and leadership development, according to Begley.

“It’s wonderful if nurses decide to stay on the clinical track and become more proficient in a specialty area, or go into a clinical track for advanced education,” Begley said, “but there are also nurses that want to pursue nursing leadership as their specialty, and they also require a career plan.”

In terms of role complexity, Begley said AONL is focusing not only on span of control, but also on what leaders can do to take some of the burden away from the nurse manager.

“Clerical work could be done by an assistant, by someone who is perhaps not a nursing leader or a nurse manager, but can do things like scheduling, managing logistics of their unit, [or] supplies,” Begley said. “It’s so complicated when we look at what [nurse managers] are actually accountable for.”

Begley also emphasized the issue of having four generations in the workforce. One solution is technology and innovation, and having nurse leaders at all levels embracing technology and learning how to use it.

“These are skills that perhaps a decade ago or more, nurses weren’t innately exposed to in their education,” Begley said, “but we know now that technology and innovation is truly the key to the future of transforming healthcare and helping our communities become healthier.”

G Hatfield is the CNO editor for HealthLeaders.