The front-line manager is becoming one of the hardest jobs in healthcare to fill and keep filled.
Health system chief human resources officers recently named nursing and clinic managers among the fast-growing roles they are working hardest to recruit. Medical and health services managers, the category that includes nursing management, ranked as the second-fastest-growing healthcare occupation, according to Bureau of Labor Statistics’ projections through 2035.
The pressure has surfaced repeatedly in conversations with health system executives this year. When Becker’s asked 103 healthcare leaders to name their most pressing workforce challenge for 2026, a shortage of strong middle management emerged as one of 10 defining themes. Leaders said poor management speeds up turnover no matter what the pay is.
“People leave their boss and their team, not their organization,” Peter Banko, president and CEO of Springfield, Mass.-based Baystate Health, said in February.
Fewer nurses may also want the job. At Little Rock-based Arkansas Children’s, only three of more than 60 new-graduate nurses surveyed said they were interested in leadership, Chief People Officer Crystal Kohanke told Becker’s in August. Nurses cited the difficulty of managing people, higher earning potential at the bedside and added responsibility that may not be worth the trade-off.
“We are learning that this is not only a readiness problem,” Ms. Kohanke said. “It is a value-proposition problem.”
At Tucson, Ariz.-based TMC Health, CHRO Alex Horvath said nursing and clinic managers are not just administrators; rather they are leaders who “can support front-line teams, navigate change, develop talent, and keep care moving in a complex environment.”
The demands on the role have grown faster than the support behind it. Vizient and Kaufman Hall reported in February that the nurse manager position “has become increasingly unsustainable,” with 1 in 4 nurse managers overseeing more than 75 direct reports. Managers are expected to address staff burnout, maintain staffing during an ongoing nurse shortage and carry executive priorities into daily workflows, while average nurse manager turnover sits at 7.5%.
With a broad set of responsibilities for one role, systems are rethinking how they prepare and support the people in it so they can do the job well and gain invaluable experience.
Building a structured on-ramp
At Cleveland Clinic, the focus is on the move from bedside to leadership.
“As frontline leadership roles continue to evolve, it’s important that we evolve how we prepare and support our managers,” Kelly Hancock, DNP, executive vice president, chief caregiver officer and chief administrative officer of Cleveland Clinic, told Becker’s.
The system launched a leadership academy in 2025 to provide new nurse managers a structured transition into leadership. The academy’s program combines onboarding, peer mentoring and hands-on development. Dr. Hancock said the aim is to help new leaders build confidence, make better decisions and navigate the challenges of leading a team.
“We want our managers to feel supported from the start and equipped with the tools and resources they need to lead effectively and support their teams,” she said.
Giving teams a voice in the fix
Dallas-based Parkland Health has focused on how managers work with their teams.
“Recognizing that front-line leadership has become increasingly complex, Parkland strengthened manager support by making engagement action planning a more structured and transparent leadership practice,” Felicia Miller, executive vice president and chief talent officer of Parkland Health, told Becker’s.
Leaders are now expected to share survey results with their teams, involve employees in building improvement plans and report progress regularly. Ms. Miller said the change was prompted by survey feedback showing employees wanted more say in decisions and stronger collaboration with management.
Taking tasks off the manager’s plate
Springfield, Ill.-based Hospital Sisters Health System is tackling the same problem from a different direction: cutting the administrative work that pulls managers away from their teams.
Thomas Ahr, senior vice president and CHRO of Hospital Sisters, told Becker’s in July that leader standard work was one of the system’s top workforce priorities for the second half of 2026 and into 2027. The goal is to build systems that take administrative burden off frontline leaders so they can spend their time on the relationship work that drives retention.
“We believe the job of a frontline leader is too complex, too difficult, and too often they’re involved in performing managerial tasks versus leadership duties,” Mr. Ahr said. “We’d rather them engage the team, listening, assisting with care, problem solving, than spending time at a keyboard.”
Charlotte, N.C.-based Advocate Health has taken a similar approach. The system spent 18 months asking nurse managers what they should not be doing and what was consuming their time. It then standardized job descriptions across assistant managers, managers and directors and created a manager relief program so managers don’t have to take over a second unit when a colleague leaves. Since then, the system has seen nurse manager turnover drop, Jane Dus, DNP, RN, senior vice president and chief nursing officer of the system’s Midwest region, told Becker’s.
Mr. Ahr said he treats retention as a result of the whole system rather than of any one manager. He applies high-reliability organization principles, under which outcomes come from systems and individuals are one part of those systems.
“Great leaders can’t overcome bad cultures,” he said. “It doesn’t matter how good you are, if the decisions the organization is making, or the things that the enterprise culture values, leaders can’t overcome that. By the same token, great cultures with poor leaders don’t work out well.”
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