Hey CNOs! Want to Keep Your Nurses? Invest in Middle Management!

Front-line nurses often cite inadequate support from leadership as their top reason for leaving.

Pizza parties, birthday sing-alongs, and other appreciation ceremonies can be welcomed as temporary distractions for stressed-out nurses. But that probably won't do much to prevent them from leaving.

Instead, nurse executives who want to bolster retention should focus on the profession's middle managers, the workhorse administrators who are the face of leadership to frontline nurses. That's according to a new report from McKinsey & Company, which estimates that hospitals could save up to $700 million annually—and improve care—by reducing frontline-nurse turnover through strengthened manager support.  

"Organizations that invest in nurse managers see benefits beyond improving workforce stability, team culture, and quality of care," writes Gretchen Berlin, RN, a senior partner at McKinsey. "Their investments can also deliver a clear financial benefit by reducing turnover for both frontline nurses and nurse managers."

The McKinsey Nursing Pulse Survey, 2025 finds that fewer nurses are considering leaving their jobs, when compared with previous surveys. However, of the 20% of frontline nurses who say in the survey that they are considering leaving their jobs, 41% blame inadequate support from leadership as their top reason for doing so, second only to the 53% of unhappy respondents who say they're simply looking for a better job.   

Savvy middle-managers observe first-hand the stressors direct-care nurses face every day and can offer effective strategies to reduce drudgery and increase job satisfaction.

Along with improved retention, strong middle-management has other benefits, such as influencing team culture, managing productivity, and maintaining care quality.

A 2024 report published by the American Organization for Nursing Leadership linked strong managers with fewer falls among patients, a reduced rate of hospital-acquired infections, along with a 68% increase in frontline-nursing retention.  

M'eh! No Thanks!

Perhaps the biggest obstacle for improving nurse managers is finding people who want the job. Even though 60% of front-line nurses in the survey say effective managers improve their job satisfaction, more than half (54%) of those front-line nurses say they are not interested in leadership jobs because of red tape hassles, high stress, and daunting responsibility.

This disinterest in leadership seems to develop as nurses age (which speaks volumes about the difficulty of the job). Nearly three-fourths (72%) of nurses with less than five years of experience want to pursue a leadership position, but only 53% of mid-tenure nurses with six to 20 years of experience feel the same.

"This drop in interest provides an opportunity for healthcare organizations to evaluate leadership roles in an effort to make leadership an attractive specialty across nursing tenures," Berlin says.

New Roles, More Help

Nurse executives can reduce the burden on mid-level nurse managers by first recognizing their pain points. For example, 48% of nurse managers who told McKinsey they were considering leaving cited "unmanageable workloads."

"To address this, organizations can focus on strategic role design, invest in upskilling, and implement best-in-class tools that enable managers to thrive in their roles," Berlin says.

Oftentimes, unit staff is too big to allow a nurse manager to develop one-on-one interactions with front-line staff, which denies them consistent feedback and professional-development coaching.

To address this, Berlin says  clinical-care organizations can review unit structures and workloads by tapping assistant nurse managers, whose presence in departments has also been shown to decrease RN turnover rates.

"They can also standardize responsibilities for nurse managers across units (for example, administrative expectations such as budgeting and strategic planning, as well as staff onboarding and hiring expectations) to ensure fair distribution of work, provide consistent and clear expectations, and improve accountability and resource allocation," Berlin says.

Hybrid Work Options

More than half (52%) of nurse managers say that not having work–life balance is a big reason for leaving, and 75% say they could continue their work in some capacity remotely. Berlin notes that "while there will always be critical in-person components to the role, organizations could evaluate what level of flexibility may be appropriate (and potentially highly valued by managers in return)."

Invest in upskilling

Successful nurse managers must have a broad range of knowledge, but they are often hampered by training that is limited to daily tasking, such as working with the HR systems, inventory, chart audits and scheduling.  In addition, nurse managers have varying levels of training and experience. And there is often variability in onboarding and training, with nurse managers learning while on the job.

"Organizations can address this by offering standardized training to establish the skills needed for the role, including the technical skills to handle tasks such as balancing a schedule or managing a budget and the interpersonal skills to deal with activities such as conflict resolution, stakeholder management, and coaching," Berlin says. "Such upskilling can help empower nurse leaders to more effectively manage their departments."

"Moreover, organizations can enhance their overall talent development strategy by implementing mentoring programs," Berlin says. "Given that nurses' interest in management roles tends to wane over time, mentorship initiatives can serve as a vital way to sustain engagement and equip nurses with the necessary leadership skills."

"Additionally, fostering frontline nurses' advancement into leadership positions helps to establish a robust succession plan," Berlin says, "which in turn helps to ensure continuity and stability in leadership."

Tap Tech

Nurse managers tell McKinsey that daily administrative tasks were a top source of frustration. That's where technology comes in. AI-enabled automation, for example, can provide a reprieve for some of these tasks and allow managers to focus on high-level, specialized activities.

"Nearly all nurse managers (98%) say that technology that could simplify staffing, support team recognition, manage audits, and streamline onboarding and hiring would make their jobs easier," Berlin says.