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The Two Types of Nurse Managers and the One to Strive For

Nurses make up the largest segment of the healthcare workforce—and while most nurses approach their careers with patient care in mind, many will unexpectedly transition into leadership roles. Unfortunately, it’s all too common for this “promotion” to arrive without adequate training, development opportunities, or sufficient support/mentorship.

The role of a nurse manager is undoubtedly one of the most challenging positions in healthcare today. With countless demands and new challenges, new nursing managers are rarely prepared for what lies ahead.

My Nurse Manager Journey

As a former nurse manager, I can honestly say that my time in that role taught me some of the biggest lessons I’ve learned so far in my career. I went to nursing school to start a second career after many years of education and experience in client service and business management. After additional education and clinical training, I was ready (or as ready as I could be) to hit the floor and care for patients. Still overwhelmed and learning new skills every day, I was grateful for the years of training preparing me for life as a nurse, and even more appreciative of the guidance and comradery from fellow nurses.

After two years as a critical care nurse in the ICU, I started a new role as a nursing recruitment and retention coordinator, focusing on coordinating efforts between nursing staff, administration, HR, learning and development, system leadership, and nursing schools to hire and retain top nursing talent for the hospital.

Less than a year later, I was approached with a nurse manager opportunity for float pool and central staffing. What seemed like the next logical step in advancing my nursing career led me to learn some of nursing’s toughest lessons.

Throughout my career, I’ve witnessed a distinct difference in nurse management styles—those that are more institutional and high-level focused, and those that are more in-tuned with their frontline staff and day-to-day operations. I set out to blend both styles as a nurse manager.

Institutional Nurse Manager


These nurse managers have a strong understanding of the big picture and focus on organizational goals (mostly likely set by the C-suite) and how they translate into their department. They have a knack for reporting and are skilled at keeping their unit/department within labor budget, while ensuring that supplies and equipment are ordered/maintained sufficiently. These leaders also make sure that staff compliance/education requirements are kept on schedule and use well-defined reporting processes to monitor the quality and satisfaction scorecards.

You may see these leaders spending much of their time on organizational teams and committees. They may also find themselves called upon for multidisciplinary taskforces to help lead health system initiatives above the scope of their specific unit. This type of leader’s visibility and ability to share their message at the highest levels of the organization are of great benefit to their unit.


While the C-suite may recognize that an institutional focused manager is “checking all the boxes,” the nurses being managed by this type of leader might feel less support or appreciation due to the lack of manager visibility. Oftentimes, this organizational/high-level focused manager will focus too heavily on hitting budgets or deadlines via reports, without fully gathering concerns or feedback from the nurses in their unit.

These nurse managers may find that their engagement and satisfaction surveys are less positive, not because of unit performance or gaps, but merely from the disconnect that comes from spending less time with their staff.


Frontline Nurse Manager


This type of “hands on” management approach isn’t afraid to step in and care for patients when the unit is short staffed, which doesn’t go unnoticed by their team. A frontline-focused manager is attuned to what’s concerning their staff and actively works to address those issues as soon as possible.

Nurses under this type of manager appreciate the dedication they see firsthand from this management style. Oftentimes, this manager was promoted from within their team and is considered a subject matter expert for all things in that unit. Managers of this type are often widely valued by staff and patients because they “know what it’s like” and “have been there.”


With such a strong focus on the frontline needs of their unit, other goals or requirements of this style of nurse manager can suffer. These leaders perhaps haven’t built the relationships and connections with other leaders or departments to facilitate big picture change even when they recognize the need for a change.

Similarly, organization/system initiatives may be perceived as a burden as they are sometimes out of line with the challenges of their own unit. In a worst-case scenario, this manager may be underperforming in areas they (and especially their staff) are unaware of.

For example, a frontline-focused manager might concentrate on frustrations from nurses for being short staffed and bring in agency nurses to alleviate tension, only to go over budget for a temporary solution to a bigger problem. By building a strong connection with their hiring and continuing education departments, these leaders might instead fill their needs with longer term and stronger staff.

3 New Lessons to Meet in the Middle

After having experienced both institutional and frontline managers, I developed a strategy for success by implementing aspects of both. With that came lessons that I realized would need to be self-taught—and quickly.

1. Reports tell part of the story, people tell the rest:

Understanding the effects of being under or over budget and how both affect patients, staff, and the organization is invaluable. Nurses are not always prepared for managing budgets, utilization goals, quality metrics, and so on. This is a critical component to a successful nurse manager. You must learn to gather the story from the people and the paper for the full picture.

2. Communication with C-suite leaders and frontline staff:

An effective nurse manager needs buy-in from their staff and their leaders. Your unit’s goals and expectations need to be clearly outlined for all stakeholders in the organization in a clear, concise format.

3. Collaboration is key:

Learning how to partner with other units/departments to help solve your problems is an example of working smarter not harder. From the sharing of staffing resources, supplies, and tools, to driving organizational change for better patient flow and safety—collaboration will only help strengthen your unit and the organization.

How Relias Can Help

As the national leader in holistic healthcare assessments, Relias Assessments empowers nurse managers to leverage assessments to make informed hiring and placement decisions thereby helping them achieve better long-term nurse success, satisfaction, and retention. Assessment data helps nurse managers identify developmental areas, continuously measure competencies, and cultivate future leaders.

Additionally, CE Direct (known for its reputation as the leading provider in continuing education) offers a wealth of knowledge to nurse managers on management and leadership education, including:

  • 100+ courses specific to management and leadership training for nurses, such as Developing Your Leadership Potential and Coaching: An Essential Skill for Nurses.
  • Certification Review courses on nursing’s most popular topics to help nurse managers self-prepare for certification exams, prepare for recertification, and earn CE hours while improving knowledge.
  • Focused CE Series on Nursing Preceptor Specialty Practice to maximize nurses’ knowledge in preceptoring. Topics include boundaries between preceptor and preceptee, critical thinking, time management, evaluation of competency, goal-writing, constructive feedback, patient/family engagement, HCAHPS, NDNQI, and more.

For more information on developing your team’s leaders, download the white paper below.


Transformational Leadership: Preferred Management Style of Magnet®-Recognized Hospitals

Today’s healthcare leaders continuously face the challenge of meeting high expectations and adapting to change. Transformational leadership, the preferred management style of Magnet hospitals, has been shown to transform entire teams to a higher level of practice.

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