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Move up to the role of nurse manager

nurse manager command

NURSE MANAGERS at all levels work together to address emerging trends, adopt innovative ideas, and work toward the shared goals of quality, efficiency, and excellence in practice. They guide and lead frontline nurses while contributing to an organization’s success.

Some of the most rewarding experiences happen on the front lines. The nurse manager is responsible for nursing practice and quality of care among frontline nurses or nurses in a single unit or department—as well as overseeing all personnel and budget matters and creating an environment that supports professional practice and employee engagement. Traditionally, head nurse was the title assigned to the frontline manager role. Today, nurse manager or director is more common.

Nurse managers straddle the worlds of staff and middle-upper management, ensuring a two-way flow of communication. They translate and promote organizational goals to frontline staff and remove barriers that could hinder their performance. Managers must keep pace with current advances in care and technology as well as regulatory and legal requirements.

Command central

Most nurse managers play the role of command central—providing support, recognition, just-in-time information, a calm hand and cool head in emergencies, and advocacy for patients, families, and staff. They also have an opportunity to encourage personal development and professional growth among staff. Above all, managers see the impact of the care their nurses provide and its effect on patients and families. Managers set the stage and expectations for excellence
in caring, optimizing quality, and a “just culture”—one that doesn’t hold practitioners accountable for system failures but that doesn’t tolerate reckless behavior. Nurse managers instill hope and determination for teams to do their best work.

The larger the organization, the greater the need to ensure a unified approach to staying focused on achieving goals and objectives. Directors or administrators responsible for more than one department take a systematic approach with managers, providing clear expectations and direction so staff know their roles and accountabilities.

Beyond nursing

Nurse managers may be responsible for personnel in other disciplines, not just nursing. In many settings, teams consist of nurses, assistive personnel, social workers, therapists, technicians, teachers, fiscal and front-office staff, chaplains, pharmacists, and others who contribute to patient care. Nurse managers also interact with ancillary staff who care for the environment, provide nutritional services, maintain physical facilities, and support the nursing staff in care delivery. Nurse managers have the skill and breadth of experience to manage
complex operations as well as diverse personnel.


Together with frontline managers and clinical leaders, nurse management teams help set the organization’s direction and goals. These teams strive for consistent practices and accountability across an organization. Together, the team sets goals to support the overall direction of the organization, encourage and monitor performance at the unit or department level, and evaluate results that build across the organization.

Nurse managers may choose to advance to a nurse executive role. The executive is responsible for practice, fiscal matters, strategic planning, advocacy for human resource issues, promoting professional achievement, and assuring an environment that supports clinical excellence. Serving as liaisons, nurse executives partner with multidisciplinary colleagues, set the vision, and serve in a leadership capacity for the organization as a whole. They also act as external ambassadors and establish collaborative relationships with the public, lawmakers, academic partners, and other nursing groups.

Look for stepping stones

If you’re interested in becoming a nurse manager, look for ways to add supervisory responsibilities to your role; these can be stepping stones to a management position. Specific education in management helps prepare you to handle the legal, fiscal, planning, direction, and control functions. For nurse executives, graduate education is a must in the view of the Joint Commission. For a top nursing position in an accredited organization, you’ll need a master’s degree. (See How much do nurse managers make? by clicking on the PDF icon above.)

As a nurse manager, you’ll serve in a highly rewarding multidimensional role, reaching patients, families, staff, and professional colleagues. But you may have to make sacrifices; managing people can be stressful and challenging. Dealing with staff recruitment and retention, resource competition, and relationships always creates dynamic tension. But with greater attention now focused on transforming nursing care and the profession for the future, this is an exciting time to consider a career in management.

Selected references

Cathcart EB, Greenspan M, Quin M. The making of a nurse manager: the role of experiential learning in leadership development. J Nurs Manag. 2010;18:440-447.

Espinoza D, Lopez-Saldana A, Stonestreet J. The pivotal role of the nurse manager in healthy workplaces: implications for training and development. Crit Care Nurs Q. 2009;32(4):327-334.

Hader R. The compensation tumble. Nurs Manage. 2010;41(8):26-31.

Kirby KK. Are your nurse managers ready for health care reform? Consider the 8 ‘Es.’ Nurs Econ. 2010;28(3):208-211.

Kleinman CS. Leadership roles, competencies, and education: how prepared are our nurse managers? J Nurs Adm. 2003;33(9):451-455.

Perrotto A, Grossman MB. Ten ways to the top. Nurs Manage. 2010;41(4):28-32.

Pamela F. Cipriano is Editor-in-Chief of American Nurse Today and Nurse Scholar-in-Residence at the Institute of Medicine in Washington, D.C.

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