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Becoming a Nurse Manager: What You Need to Know

A woman in a white coat stands and smiles while outside in front of a tree.

Did you know there are nursing career options that don’t involve patient care? While virtually all nurses launch their careers in clinical roles, not all of them remain at the bedside until retirement. Instead, some nurses move into managerial and administrative positions as their careers progress.

One such role is nurse manager. Nurse managers may still provide clinical care some of the time but also oversee teams of registered nurses or entire nursing units. Beyond people management, their responsibilities include heading up quality improvement initiatives, participating in policy development, handling staffing issues, setting budgets, approving schedules, and more.

According to the Agency for Healthcare Research and Quality (AHRQ), a branch of the U.S. Department of Health and Human Services, nurse managers “wear two hats.” They are administrative leaders who also deliver clinical care, interfacing with patients and doing rounds when their units are short-staffed. It’s a complex and challenging job. Nurse managers are accountable for everything from patient and staff satisfaction to resource allocation, which means they answer to many stakeholders: patients, their families, physicians, health care administrators, and executives.

This guide explores the questions people interested in this career are most likely to ask. It also looks at how a degree such as the University of Michigan School of Nursing’s Online Master of Science in Nursing (MSN) in Leadership, Analytics, and Innovation can help registered nurses transition into leadership roles such as nurse manager.

What Does a Nurse Manager Do?

Nurse managers work in various medical settings, including hospitals, doctors’ offices, private practices, urgent care clinics, long-term care facilities, surgical centers, and psychiatric facilities.

No matter where they work, nurse managers have a hand in everything that happens in their units, including budgeting and finance, human resources management, and staff education and professional development. They handle scheduling, resource planning, inventory management, records management, operations management, and regulatory compliance. They also oversee case management, discharge planning, patient care standards development, and policy development.

Additionally, some nurse managers manage staff outside of the nursing department. Such staff can include patient aides and assistive personnel, medical technicians, social workers, therapists, office staff, nutritionists, maintenance staff, chaplains, and pharmacists.

However, nurse managers are responsible for more than staffing and operational oversight. AHRQ reports that nurse managers “lead their unit staff in preventing patient harm in their units, empowering nurses to be the first line of defense.” Bedside nurses hold the lives of a handful of patients in their hands. Nurse managers are responsible for the safety and wellbeing of an entire unit’s worth of patients.

Nurse managers must be flexible because the work they do is often responsive. According to one study, “the work of nurse managers, who can be described as middle-managers at health care organizations, is complex and changes on a daily basis.” When a crisis arises, registered nurses (RNs) look to nurse managers for guidance, and nurse managers must advocate for both the patients and the staff under their charge, regularly communicating the needs of both to health care administrators. It’s a lot to take on, which may be why only some RNs aspire to become nurse managers.

How Much Experience Should a Nurse Manager Have?

Nurse managers need to amass years of clinical patient care experience before they can competently manage a unit. Their job requires a deep understanding of how to provide high-quality patient care with whatever resources are available. They also need bedside experience to be confident in representing the needs of RNs in strategic decision-making.

Nurse managers generally have five or more years of experience in clinical roles in hospitals and other health care environments. However, clinical experience alone is not enough to prepare nurses to step into leadership roles. It is common for nurses to assume administrative and managerial positions based on their expertise in clinical roles and to become health care leaders with very little experience related to leadership. In such cases, graduate education can be a significant asset.

Graduate-level leadership training for nurses can have wide-reaching effects. The National Academy of Medicine asserts that “nurses with graduate degrees will be able to replenish the nurse faculty pool; advance nursing science and contribute to the knowledge base on how nurses can provide up-to-date, safe patient care; participate in health care decisions; and provide the leadership needed to establish nurses as full partners in health care redesign.”

Health care needs leaders committed to moving the field forward, but we know nurses have a lot on their plates already. For some nurses, an online MSN program is the best option to further their education. Pursuing an online MSN with a leadership focus from the University of Michigan is one way RNs can develop the skills they need to become nurse managers while still meeting their professional and personal commitments.

University of Michigan School of Nursing faculty members are researchers, nurses, and former CNOs who specialize in areas of nurse leadership like informatics, evidence-based practice, and health analytics. MSN immersions let students explore different roles in nurse leadership, including nurse manager. Plus, U-M’s close connections with leading health care organizations help students build their professional networks and take advantage of a broader range of opportunities. This lets them gain the experience and confidence they need to advance into nurse manager positions.

What Does a Nurse Manager Need to Know?

So, what makes a good nursing leader, and what do they need to know to excel at their job? Nurse leaders must have medical expertise, people skills, and business acumen. The role requires significant nursing experience plus the management skills to oversee operations, personnel management, budgets, and staffing in nursing departments. Plus, nurse managers need skills related to:

Advocacy

Nurse managers are responsible for making sure patients receive top-quality care, staff members have safe working environments, and units have the resources necessary to ensure both.

Analytics

Information is an asset in health care. Nurse managers must analyze current and historical data to predict future events and trends in their units, and then make sound decisions based upon the data.

Change management

Health care is a dynamic field. Leaders such as nurse managers must be flexible when reacting to what the day brings and proactive about guiding change whenever and however possible.

Communication

Nurse managers must communicate clearly with all stakeholders, from distraught caregivers to the hospital board of directors.

Decision-making

Nurse managers must be comfortable using various analytical tools, models, and methods that drive decision analysis under conditions of uncertainty, risk, and sensitivity.

Informatics

Data can positively impact care processes, outcomes, value, costs, and efficiency when leveraged by those who understand the power of information.

Innovation

Effective nurse managers are open to new practices, processes, theories, and products.

Leadership

Nurse managers are leaders. As such, they need the essential managerial skills that form the foundation of effective people and process management.

Negotiation

The needs of patients will sometimes conflict with those of staff, and both may be at odds with organizational goals set by administrators. Nurse managers are skilled at guiding everyone toward compromise.

Quality improvement

Nurse managers are committed to learning, changing, and improving the quality of health care.

The Online MSN in Leadership, Analytics, and Innovation from the University of Michigan can help you learn what you need to know — such as the skills listed above — to become a nurse manager. The online program educates nurses with bachelor’s degrees in nursing looking for the skills and knowledge to make a long-term, sustainable impact on health care.

The Road to Becoming a Nurse Manager

Becoming a nurse manager is challenging. While some RNs have long and successful careers after earning an associate’s degree in nursing and passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam, most nurse managers have a Bachelor of Science in Nursing (BSN) at a minimum and, more often, a master’s degree in nursing. After earning a BSN or MSN, aspiring nurse managers typically spend a few years — usually five or more — working in clinical care roles.

How to become a nurse manager may be straightforward, but ambitious nurses who want to join the ranks of leadership encounter roadblocks. For instance, one study found that while 51% of non-nurse health care workers surveyed felt that nursing leadership skills were “widely recognized” by their organizations, only 24% of nurse respondents felt that way, which can be disheartening given all the hard work they do. Additionally, many health care organizations have no clear advancement pathway for nurses or other clinicians. A quarter of nurses surveyed cited the lack of a clear leadership path as a top barrier to becoming a nurse manager, along with a lack of leadership-focused educational programs.

U-M’s MSN in Leadership, Analytics, and Innovation is notable for its focus on the foundations of leadership in clinical settings, operations leadership in health care, and global health leadership. Because it is delivered online, it removes some of the barriers aspiring nurse managers face. The program is accessible to prospective students no matter where they live and work.

How Much Do Nurse Managers Earn?

The answer varies by source because employment data aggregators use user-reported figures to calculate nationwide annual salary averages. According to Indeed, the typical nurse manager earns about $84,000, while PayScale reports that the average nurse manager’s salary is about $88,000 — or even $120,000 or more with 10+ years of experience working in large health care networks.

Figures like those above are helpful but tell an incomplete story. Looking at nurse manager salaries by the state is potentially more illuminating. ZipRecruiter calculates nurse manager salaries by state and reports that nurse managers in Hawaii and Massachusetts earn the most while nurse managers in Florida and Mississippi earn the least. Before you look for jobs in the top-paying states for nurse managers, consider that those who work in states with lower salaries may have much lower monthly expenses than their peers in other states.

Are There Certifications for Nurse Managers?

There are numerous certifications for nurse leaders and managers, including the Certified Nurse Manager and Leader (CNML) credential granted by the American Organization for Nursing Leadership (AONL), the Certified in Executive Nursing Practice (CENP) credential granted by AONE, the Nurse Executive (NE-BC) credential granted by the American Nurses Credentialing Center (ANCC), the Nurse Executive, Advanced (NEA-BC) credential granted by the ANCC, the Fellow of the American College of Healthcare Executives (FACHE) credential granted by the American College of Healthcare Executives (ACMPE), and the Certified Medical Practice Executive (CMPE) credential granted by the ACMPE. Because U-M’s MSN in Leadership, Analytics, and Innovation teaches AONL and ANCC nurse leader competencies, graduates are eligible to take the related ANCC and AONL certification exams.

There are also graduate certificate programs geared toward aspiring nurse managers and leaders. For example, U-M offers a graduate-level Certificate in Health Informatics that prepares RNs to sit for several informatics certification exams, including the ANCC Informatics Nursing Certification examination. This exam assesses entry-level clinical skills and knowledge of RNs in the informatics specialty. Upon successful completion of the exam, informatics nurses can use the Registered Nurse-Board Certified (RN-BC) credential.

RNs enrolled in the leadership MSN program can also pursue a Certificate in Nursing Education to enhance their skills in professional education and/or academic higher education teaching.

Becoming a Nurse Manager

Nurse management has become exceedingly complex, and nurse managers have more responsibilities than ever. Additionally, this role is evolving, so the skills nurse managers need today may not be the ones they need five or 10 years from now. U-M’s MSN program prepares nurses to lead as the profession evolves.

Nurse managers often have more regular hours than registered nurses and better work-life balance. Administrative emergencies are seldom as dire as medical emergencies. While RNs make a difference one patient at a time, nurse managers can make a difference in the lives of thousands of patients through their influence. Nurse managers can advance into positions such as director of nursing, CNO, or CEO more easily than bedside nurses. And management skills are transferable. Nurse managers can move into other areas of health care administration or project management.

However, while nurse managers are formal leaders, they have less autonomy than CNOs or nursing directors. They answer to everyone from hospital executives to doctors to nursing staff to patients and their families.

What Does a Nurse Manager’s Typical Day Look Like?

A nurse manager’s day may be longer than a staff nurse’s shift and include administrative tasks related to staffing; communication with nurse executives, doctors and specialists, and other employees in the unit; discussions with unit nurses about performance, professional development, or process improvements, and mediating disputes between nurses or other staff members. Their day may also include meetings with patient caregivers to discuss concerns about care or discharge planning, multiple internally facing meetings to discuss staff conditions or patient treatment plans, reviews of previous shift activity to assess what worked and what did not, and quality improvement initiative development and implementation.

Nurse manager Antonio Vazquez Barrero describes his role and his typical day like this: “I often feel like the director of an orchestra, responsible and accountable for the individual sound of every instrument and every nuance. I know that by looking after the individual, collectively, a beautiful sound will emerge.”

Are Nurse Managers in Demand?

The answer is a resounding yes. While the U.S. Bureau of Labor Statistics (BLS) doesn’t track employer demand for nurse managers specifically, it does track employment data for medical and health services managers in general. According to the BLS, the employment of medical and health services managers will grow by 32% over the next 10 years. Employers will create close to 140,000 new jobs in this category due to “the need to replace workers who transfer to different occupations or exit the labor force” and the “increased demand for health care services” caused by an aging but still active population.

Be aware the demand for nurse managers may grow faster in group practices than in hospitals and other inpatient settings. There may also be an uptick in demand for nurse managers with health information technology and informatics skills as health record integration continues and the applications of health care analytics expand.

Should I Become a Nurse Manager?

The answer to this question will depend on what brought you to nursing in the first place. If you entered nursing because you wanted to change health care from within, earning an MSN in Leadership, Analytics, and Innovation and becoming a nurse manager will put you in a position to shape the future of nursing. If this is your mindset, chances are you will be happy with your decision. One study found that 75% of nurse managers are satisfied or very satisfied with their jobs, and 68% were either likely or very likely to recommend nursing management as a career pathway. However, if you love providing bedside care and working directly with patients, you may be happiest pursuing a clinical master’s and becoming a nurse practitioner.

There’s no right or wrong nursing career pathway — just the path that’s the best fit for you. The key to finding the right one is doing plenty of research. Look at U-M’s online MSN FAQ for more information about what the program entails and where it can take you. Read our blog to gain a deeper understanding of the potential career paths available with an MSN degree. Then, take a look at the Master of Science in Nursing program admissions requirements to determine whether this program can help you accomplish your goals.