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The impact of high-performing nurse managers across clinical settings

Coauthored by Angela Pascale, Research Analyst, Press Ganey.

For those of us in healthcare, we’re all well aware of the challenges we’ve faced over the past few years. Our workforce, in particular, has suffered. Across role, level, and tenure, both clinical and nonclinical staff have seen dwindling engagement, and burnout has soared—which has driven record healthcare employee turnover nationwide.

Where I’d like to focus today is the crisis among the nursing workforce—specifically, our nurse managers. Over the past few years, high nurse turnover has expedited the careers of many nurse managers. While there’s no doubt that we must applaud the individuals who have stepped into new roles—and have big shoes to fill—we also must face a harsh reality: that these newly minted nurse managers often don’t have the skill, experience, and expertise to do the job. And it’s our job to give them the support they need to become effective nurse managers and excel in their roles.

Expanding our initial analysis: Nurse manager impact in all clinical settings

The sizable impact of high-performing nurse managers was illustrated in recent findings from a sample of 1,099 adult acute care units using Press Ganey’s National Database of Nursing Quality Indicators (NDNQI). This analysis found that nurses who perceive their managers as highly engaged and competent deliver higher-quality care, miss fewer nursing care events, and are more likely to stay in their current positions.

We then extended our analysis to include all clinical settings (adult acute care, pediatric acute care, emergency care, and ambulatory care). We wanted to see if the compelling findings from our initial analysis remained consistent.

For this analysis, units across clinical settings were stratified according to unit performance on the nurse manager ability, leadership, and support subscale of the Practice Environment Scale (PES). The top 10–25% and lowest 10–25% of nursing units (depending on clinical setting) were retained for comparative analysis, with the following samples used: 116 adult acute care units per NM (Nurse Manager) category (n = 232 total units), 89 ambulatory care units per NM category (n = 178 total units), 50 emergency care units per NM category (n = 100 total units), and 42 pediatric acute care units per NM category (n = 84 total units).

  • Nurse manager ability and leadership support: Top-performing nurse managers scored 0.88–1.37 points higher on the nurse manager ability, leadership, and support subscale compared to bottom-performing nurse managers across acuity settings.
  • Intent to stay: Units with top-performing nurse managers had 21–32% more nurses reporting an intent to stay compared to units with bottom-performing managers.
  • Nurse-reported Quality of Care (QoC): Units with top-performing nurse managers reported a 0.39–0.68 increase in nurse-reported quality of care compared to units with bottom-performing managers.
  • Reduced missed nursing care activities: Units with top-performing nurse managers reported 0.72–2.05 fewer missed nursing care activities per nurse, per shift, compared to units with bottom-performing managers.

Performance of top vs. bottom nurse managers

Across clinical settings, top-performing nurse managers drive nurse engagement and satisfaction

The extension of our initial analysis illustrates the value of promoting nurse leadership development in producing positive, healthy work environments across clinical settings.

Press Ganey's expert team of nursing consultants have decades of experience—both on the front lines as well as behind the scenes, supporting the nursing workforce across all care settings. We designed our world-class Nurse Leadership Development program to help nurse managers adapt to and overcome the unique challenges they face every day. Our curriculum is rooted in national professional standards and competencies from the American Organization of Nursing Leaders (AONL) and the American Nurses Credentialing Center (ANCC). Completing our program reinforces the skills needed to grow—and succeed—in nurse leadership roles, including tactical skills for deepening relationships, fostering a culture of accountability, and driving retention.

To learn more about this program and our nurse-specific solutions, schedule a quick call with a strategic consultant. We can dig into your unique challenges and needs, and develop an action plan for improvement. 

About the author

Dr. Nora Warshawsky oversees all aspects of nursing research and evidence-based practice for Press Ganey’s global hospital and healthcare clients. She works with clients to better understand the insight Press Ganey can provide into some of the most challenging issues that nurse leaders face today, including workforce and retention, safety, reliability and quality of care, to help provide the best support to their nursing staff.

Profile Photo of Nora Warshawsky, Ph.D., R.N., NEA-BC, CNE, FAAN