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Challenges of a First-Line Nurse Manager

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Nursing can be a challenging profession; nursing management can be even more challenging. In addition to the quality of patient care, nurse managers often deal with issues such as staff retention, new graduate mentoring, staff education, patient satisfaction, reimbursement issues, rapid changes in technology and their own professional development and self-care needs.


Annual turnover rates for registered nurses averaged 14 percent in June 2011, according to the American Association of Colleges of Nursing. The nursing budget is often the largest in a health care organization, which makes hiring freezes and layoffs a constant challenge as hospitals look for ways to cut costs. However, there are definite links between staffing ratios, patient safety, employee satisfaction, readmissions and patient mortality, according to a November 2011 article in “HealthLeadersMedia.” In addition to the number of nurses, a nurse manager must consider the mix of experienced nurses to new graduates, who need mentoring and support to become competent practitioners.


High turnover and stressful jobs can affect morale, potentially leading to even more turnover and stress. The actions of a nurse manager can affect her staff, according to “Patient Safety and Quality: An Evidence-based Handbook for Nurses.” Nurse managers who were not physically present on the unit, who did not provide leadership or who failed to address problems created more stress for the nurses they supervised. Nurse managers who used a more participative management style, however, could decrease staff stress and improve group cohesion.

Staff Education

Registered nurses can obtain a license with an associate degree, nursing diploma or bachelor's degree. There is a strong push in the nursing profession, however, to ensure that all RNs obtain a bachelor's degree, according to “HealthLeadersMedia.” The nurse manager may find herself encouraging her nurses to go on for further education and juggling schedules to help accomplish those goals. In addition, staff nurses often know little about some of the larger issues surrounding patient care, such as patient satisfaction, customer service, patient safety and reimbursement issues. Nurse managers frequently must educate staff nurses on all of these issues, as well as clinical issues.

Self-Care and Education

Nurse managers can burn out, just as staff nurses do, according to a February 2012 article on the website. In addition, nurse leaders are often encouraged or expected to go on for advanced degrees such as a master's or doctorate in nursing. A nurse manager might need to add her own educational needs to her already full plate. In one case study reported in the January 2007 “Journal of Clinical Nursing,” the nurse manager had three main goals: a nurse goal, an administrator goal and a leadership goal. Of those, only the nurse goal was self-imposed, suggesting that nurse managers may face demands from multiple sources.


Beth Greenwood is an RN and has been a writer since 2010. She specializes in medical and health topics, as well as career articles about health care professions. Greenwood holds an Associate of Science in nursing from Shasta College.

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