Greater investment and support for nurse managers could help healthcare provider organizations stem turnover within their nursing teams and, collectively, save hundreds of millions of dollars, according to recent reports.
One of these, published Tuesday by McKinsey, found that about a fifth of surveyed frontline nurses expected to leave their roles within half a year, with many of those saying they didn’t feel valued by leadership (41%) or their organization (40%).
Addressing these concerns with approaches recommended in the report to train managers or improve their relationships with teams would be well worth the investment, wrote the McKinsey partners who authored the report. Preventing just 20% to 30% of those potential departures would save the nationwide health system about $400 million to $700 million per year in nurse turnover costs, they estimated.
The McKinsey report goes on to outline shrinking interest in nursing leadership roles among frontline care respondents who were later in their careers, the uneven workloads and requirements reported by different nurse managers and recommended investment areas for organizations looking to develop managers and limit turnover.
“This can be part of your broader retention strategy, we clearly see the benefit,” Mhoire Murphy, a partner in McKinsey’s Boston office and one of the survey report’s authors, explained to Fierce Healthcare.
“Really unpacking and spending time with your manager cohort on how are they spending their time, what are those detractors, what are … some of the areas that they’re really excited about, is your job profile and their day-to-day matched up with that, and are there some things you could be doing to better support them in their day-to-day—I think there are a lot of levers you could pull there," Murphy said.
Those findings are largely in line with another survey report released last week by the American Organization for Nursing Leadership (AONL) and Laudio, a workflow platform for frontline managers and leaders.
Echoing past editions, the pair’s latest report outlined higher turnover among teams where nurse managers had more direct reports and were less capable of face-to-face support. It also pointed to reduced departures among first-year nurses when their managers conducted regular check-ins.
“The first year of a nurse’s career is a critical time—it’s when they determine if the fit is right, if they're getting the support they need to succeed, and ultimately whether the job is sustainable for them,” Claire Zangerle, CEO of AONL. “Leveraging that first year is essential. As nurse leaders and hospital executives, we can’t miss the moment to engage these valuable members of the care team.”
Reducing 'frustrating' administrative burdens, supporting high-reward people management
McKinsey’s findings are informed by its Winter 2025 Nursing Pulse Survey, a poll of 1,301 U.S. nurses fielded between Jan. 10 to Feb.17. Of those respondents, 768 were frontline nurses and 533 were nurse leaders, including 391 nurse managers.
First, some encouraging news for healthcare employers—the percentage of frontline respondents expecting to leave their roles in the next six months had fallen from the 30% of last year’s survey to 20%. Only 11% of nurse managers said they planned to leave during the same timeframe. However, looking at the reasons for those planned departures showed frontline nurses’ feelings of not being valued as major decision drivers—even as 60% of frontline nurses said their managers improved their job satisfaction.
The second concerning trend for Murphy and colleagues was apparent disinterest in nurse leadership roles among frontline workers. Specifically, 54% said they were uninterested in joining leadership, according to the report. The disinterest seems to develop with time, as 72% of nurses with less than five years of experience said they wanted to pursue a leadership position, but just 53% of those with six to 20 years of experience felt the same.
Polled nurses pointed to “administrative burdens, high stress and significant responsibility as key deterrents” to pursuing a leadership role, according to the report. Though these managers generally report high job satisfaction, 48% said that unmanageable workloads contribute to their desire to leave and described wide variability in responsibilities—such as average direct reports of 30 but as high as 250, or average hours worked per week of 46 but highs up to 90.
Addressing these burdens, standardizing responsibilities and offloading “frustrating” administrative tasks could help maintain existing nurse managers and make such development paths more appealing to frontline nurses, Murphy and colleagues said. To drive satisfaction and help retain more frontline staff, organizations should also support nurse leaders’ people management responsibilities—which take up more of their daily time than other areas but across the board were named as managers’ most satisfying tasks.
Murphy broke the report’s recommendations into three major camps. The first is to review the role of the nursing manager and its responsibilities to make sure “it’s as standard, as consistent as possible” across units, she said. Doing so ensures work is distributed fairly with clear expectations, and can help identify areas in which greater support may be appropriate—such as the hiring of a support role, like an assistant nurse manager, or by permitting remote work arrangements that improve work-life balance.
Another step, which Murphy noted has become more prevalent among systems McKinsey has worked with, would be to invest more heavily into training and upskilling, either through “internal leadership academics” or outside partnerships. Alongside helping managers develop the hard and soft skills needed to better support their frontline nurses, outlining those training pathways can help retain and motivate the early-career nurses who more often said they were interested in leadership roles.
“Are [organizations] making those nurses earlier in their journey understand what the path to manager looks like, and what to really think about that role? Are they having the right sort of awareness points, mentorship programs, … to build upon that captive audience?” Murphy asked. “There’s a lot of early professional development that could help orient someone, or make them aware or start to see some of those [leadership] skills in action.”
Finally, McKinsey called out the growing market of technology platforms designed to streamline or, in the case of automation, offload administrative tasks cited as frustration points by nurse managers. The report called out organizations like Nebraska Medicine and Mercy that have had success with tech-driven employee milestone tracking and staffing, respectively.
Of note, the authors specified in the report that “healthcare stands apart” from the expectations of generative AI and similar tools replacing a human workforce.
“Indeed, we expect the demand for healthcare workers to increase as the population ages,” they wrote. “What’s more, nurse managers shoulder significant responsibilities both in people management and on the front lines of patient care with their teams, making them indispensable to their units and organizations.”
Nurse managers can support early-career nurses
Several of the McKinsey survey’s findings also surfaced in the Laudio and AONL report, published last week. That review leaned on data collected from Laudio platform users—more than 5,000 nurse managers across more than 100 hospitals.
Similar to prior reports from the pair, it found that limiting the manager's span of control could help cut down turnover among early tenure nurses. Specifically, while nurse managers with 90 or more direct reports saw an average turnover rate of 40% among fresh nurses, those with fewer than 45 staff had an average 27% turnover.
“Using national average costs of turnover, this corresponds to over $300,000 in additional annual costs,” according to the report. “In other words, for teams with high spans of control and a high percentage of early-tenure RNs, a business case can be made to split the team into two units with separate managers. The cost of the additional nurse manager would be more than covered by the estimated $300,000 in savings.”
The report’s other major takeaway: clear phases within a nurse’s early career where nurse managers can provide guidance, if given the opportunity.
Here, the report’s authors found initial check-in connections between nurse managers and new nurses at the 30-day or 45-day mark aligned with a 6% rise in retention, six-month and nine-month check-ins providing a 10% increase, and 12-month check-ins a 3% increase. That said, the check-ins only brought benefits when conducted by a manager, as assistant managers were sometimes associated with retention reductions.
“New hire check-ins should be a priority, yet managers face increasing administrative and operational workloads, limiting their capacity to conduct them,” according to the report. “Executives must adjust workloads to ensure managers can consistently provide this critical support.”