Open Journal of Leadership
2013. Vol.2, No.3, 63-67
Published Online September 2013 in SciRes (
Copyright © 2013 SciRes. 63
How Staff RNs Perceive Nurse Manager Roles
Rebecca A. Feather1, Patricia R. Ebright2
1School of Nursing, Indiana University, B l oomington, USA
2School of Nursing, Indiana Univer sity, Indianapolis, USA
Email: reafeath@indiana. edu ,
Received June 11th, 2013; revised July 22nd, 2013; accepted July 29th, 2013
Copyright © 2013 Rebecca A. Feather, Patricia R. Ebright. This is an open access article distributed under the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cite d.
Purpose: Nurse managers’ behaviors and job satisfaction are commonly addressed in the literature; how-
ever, registered nurse perceptions of nurse manager behaviors provide a unique perspective that may in-
form future strategies designed to enhance RN job satisfaction. The purpose of this study was to assess
the perceptions of registered nurses that were explored through focus groups to learn the behaviors of
nurse managers that most influence registered nurse’s job satisfaction. Methods: Five focus groups were
conducted through semi-structured interviews of a total of 28 RNs to provide data that were coded
through qualitative content analysis for themes. Findings: The findings provide nurse managers with data
related to the perceptions of RNs and the behaviors of managers that influence job satisfaction. In relation
to the focus group’s discussions, a disconnection was identified between the perceptions of the RNs re-
garding their actual work issues and the nurse manager’s role on the hospital unit. There were five themes
that emerged in the category of RNs perceived disconnect between work issues and the manager’s role.
The daily role, manager meeting time, visibility of nurse managers, no longer a nurse, and RN preferences
for the nurse manager role. Conclusion: Findings support past research in relation to the perceptions of
RNs wanting to be respected, included in communication, and the need to feel cared for by nurse manag-
ers to have higher levels of job satisfaction. This study provided findings important to staff nurses, nurse
managers and administration. There is a need for administrator support for nurse manager’s ability to
spend more time on the unit with RNs to attend to direct care provider relationships and team building
through communication with staff is a recommended approach for decreasing the disconnect between
RNs and nurse managers.
Keywords: Job Satisfaction; Managers’ Behavior; Disconnect
The American Nursing Association (ANA) has recognized
that supply solutions for the nursing workforce must focus on
both recruitment and retention of registered nurses (ANA,
2008). Because current research shows that job satisfaction may
influence the retention of registered nurse (RN) staff in light of
the predicted shortage over the next 10 to 15 years, it is impor-
tant to focus on the determinants of RN job satisfaction. A
study by Gormley (2011) indicated anticipated turnover by RNs
was correlated to the work environment and perceptions of
nursing management. This article reports on findings of a study
to identify RN perceptions of nurse manager behaviors that
have been shown to influence RN job satisfaction. Focus group
interview responses from RNs demonstrated a disconnection
between what RNs saw the manager doing and their own work.
According to a study by Aiken, Clarke, Sloane, et al. (2001),
more than 40 percent of hospital nurses reported lack of satis-
faction with their jobs. Nursing and human resource studies
have identified the relationship between the nurse manager and
the nursing staff as invaluable to nurse job satisfaction. Re-
searchers have reported that nurse managers provide a vital role
in influencing the type of work environment that nurses work in
daily and, therefore, have an effect on the retention of RNs
(Shirey, Ebright, & McDaniel, 2008).
Staff nurses stated in a study by Aiken et al. (2001) that
managers influenced their job satisfaction through behaviors of
providing recognition and appreciation, meeting personal needs,
helping or guiding them, using leadership skills effectively,
meeting unit needs, and supporting the team. Likewise, Herrin
and Spears (2007) found a supportive environment to be one of
the most important factors associated with job satisfaction for
nurses, and nurse managers are important in structuring the type
of environment critical to the satisfaction and retention of staff
nurses (Force, 2005; Kramer et al., 2007). In additional studies,
and consistent with previous evidence about the importance of
nurse manager behaviors, staff nurses reported in exit inter-
views that nurse manager behaviors most influenced their deci-
sion to leave their positions (Kramer et al., 2007; Shobbrook &
Fenton, 2002).
The role of the nurse in charge of the patient care unit has
changed over the past several decades from being the “head
nurse” in the 1980’s, who was the expert clinician, to becoming
a manager of one or several units in the 1990’s. This role in-
volved budgeting, managing or directing patient placement and
personnel management (Kramer, Schmalenberg, & Maguire,
2008). Currently, the role has expanded even more to include
more leadership behaviors such as counseling staff, orienting
physicians, and facilitating teamwork on the units. Has the in-
crease in responsibilities of the nurse manager led to a decrease
in RN job satisfaction? Has the relationship between the two
positions diminished due to the inability of the nurse manager
to fulfill the perceived expectations of their nursing staff?
Design. We conducted a qualitative descriptive study using
focus groups to explore RN perceptions of the behaviors of
their nurse managers that influenced their job satisfaction. The
data reported in this paper relate to our finding that the RNs
seem to have a disconnection between their perceptions of their
managers’ daily activities and the influence on the RNs’ work
and health care environment.
Sample. A purposive sample of 28 RNs was recruited from
the target population of available RN staff nurses currently em-
ployed by two nationally accredited, community-based hospi-
tals in the Midwest, both with a minimum of 50 licensed beds.
A staff nurse was defined as an RN on a hospital unit re-
sponsible for the care of a certain number of patients admitted
to that unit. Staff nurse inclusion criteria included a minimum
of six months of experience in patient care and having a nurse
manager who had been employed for a minimum of six months.
The definition of a Nurse Manager was an RN who had
24-hour accountability for the operations of one or more hospi-
tal or clinic units, regardless of the title given to that position.
This position involved management of charge and staff nurses
on all shifts and accountability for those positions. To be eligi-
ble for their staff to participate in this study, the nurse manager
must have had one or more years of experience as a nurse
manager. The required-year experience is important in order to
establish that the nurse manager is not in the orientation or
initial/transitional stage of learning the role of management.
Lack of experience in this position could pose an external threat
to the study. Other demographics about the nurse manager were
not included to protect the confidentiality of the RN partici-
Both organizations had a charge nurse (CN) role in place on
the units who may or may not have taken patients in addition to
their CN responsibilities. The CN was not included in the defi-
nition of being in the role of a nurse manager for the purposes
of this study.
Recruitment goals for the sample were met by including staff
nurse participants from each of the two organizations in focus
groups of five to eight participants, with a minimum of two
focus groups per organization. Each focus group represented
multiple units and shifts, including at least 5 and no more than
8 participants in the order in which they volunteered. The nurs-
es had varying levels of experience, increasing the likelihood of
diverse participants for the identification of common themes re-
lated to the influence of nurse manager behaviors on job satis-
Procedures. After obtaining approval from the institutional
review board (IRB) from the university and both hospital IRBs,
focus groups were established through a recruitment process
including email and fliers posted on the nursing units. Focus
groups were conducted after regular business hours and at a
location away from the clinical unit and nurse manager offices
to protect the privacy of the participants. At the beginning of
each focus group, participants were asked to complete a one-
time demographic questionnaire. After that, the investigator
asked participants to respond in their focus group to probing
questions regarding nurse manager behaviors that positively or
negatively affected the participants’ job satisfaction (Figure 1).
The focus group process allows for sharing and comparing ex-
periences in relation to the topic that would be less accessible
without the group interaction (Morgan, 1998). Th e probing ques-
tions were used to explore issues and generate in-depth re-
sponses from the RNs.
All focus group discussions were confidential and audio-re-
corded for transcription purposes. The evolving pattern of dis-
cussion helped to guide probing questions to supplement re-
sponses in subsequent groups. The investigator created a tran-
script from each audio recording, which became the raw data
that were subject to analysis (Sandelowski, 1995).
Data Analysis. Transcripts were proofed for accuracy by
comparing the audio tapes to the written transcripts. Data were
analyzed for each focus group separately. The research team in-
cluded two qualitative analysis experts, both with knowledge of
nursing leadership and management, and one instrument deve-
lopment expert knowledgeable in the aspects of comparison of
the data with past and current research results. The research
team conducted content analysis of the data and then summariz-
ed the information (Sandelowski, 1995).
Content analysis of audio transcripts and repeated iterative
discussion among members of the research team resulted in two
conceptual categories: manager behaviors supportive of RNs
and, the focus of this article, RNs’ perceived disconnect be-
tween work issues and the manager’s role.
RNs Perceived Disconnect between Work Issues and the
Managers Role.
Each of the RNs in the five focus groups were asked to dis-
cuss his/her typical day at work and the problems that often
occurred on a daily basis. However, initially, very little of the
discussions included the nurse manager’s role in everyday life
on the unit. As the RNs began to describe their daily routine
and the problems or issues that often occurred on their unit or
with patient care, they did not talk much about their manager
being present or having an impact on how the unit functioned
on a typical day. There seemed to be a disconnection between
the perceptions of the RNs regarding their actual work issues
and the nurse manager’s role on the hospital unit. The follow-
ing themes (Figure 2) emerged in the category of RNs percei-
ved disconnect between work issues and the manager’s role.
Each theme represents a discussion that occurred during a mini-
mum of 3 focus groups (or in over 50 percent of the groups).
The daily role. A disconnect was frequently apparent when
RNs explicitly stated that the nurse manager did not play a role
1) Tell me about a really memorable day for you at work, good or bad.
2) What do you think makes a day go well and go poorly for you?
3) What part do you think your manager plays in how your day goes at
4) What might your manager do to worsen your day at work?
5) What might your manager do to improve yo ur day at work?
Figure 1.
Focus group interview questions.
Copyright © 2013 SciRes.
1) The daily role
2) Manager meeting time
3) Visibility of nurse managers
4) No lo nger a nu rse
5) RN preferences for the nurse manager role
Figure 2.
Themes surrounding the RN disconnect with the nurse manager role.
in their day-to-day job in providing patient care.
One RN stated: “The only time that she’s really involved in
what we’re doing is when we’re full and there are patients that
need to be placed and she wants us to constantly call the doc-
tors and get them transferred. That is hard to do when you have
critical patients that still need our attention.”
A second RN did not relate the manager to the daily needs of
the unit: “Our manager is fantastic, the one we have right now,
but as far as my day to day, it does, she doesn’t really have an
effect on my day.”
Manager meeting time. The discussion often targeted the
amount of time the nurse managers spent in meetings and how
this part of their role kept them from being active participants
on the unit to solve problems with patient care or simply to
show the staff they were there to support them.
As one RN said: “They’re going to come and they’re going
to come flying to the unit if there’s something wrong and they’re
going to be there for you, which is great, but these meetings I
think preclude them being able to help on a daily basis in a way
that they might be able to help even more, which would be nice.
And I also think by virtue of having all these meetings that it
pulls them away from the day-to-day activity of what really
happens on a unit sometimes, so that when you’re making pol-
icy, but you’re not there as much, it’s harder for you to really
see how what you’re doing is going to impact that person and
that’s what scares me about the number of meetings that they
have to attend.”
Others also shared concerns that meetings hindered manag-
ers’ effectiveness because “that’s basically all they do is just
meetings from the time they get here until the time they go
home mostly” and “if you’re in different meetings all the time,
how can you be effective? I don’t know.” One nurse described
her manager as attending “meetings about meetings, exactly”
and believed that “they kind of need to be on the floor.”
Visibility of nurse managers. Other discussions by nurses
who worked nights or weekends also involved a disconnection
between the manager’s role and the functioning of the unit. A
nurse who worked mainly weekends commented that “I never
see her on the weekends. When I’m there during the week or
before I went weekend option, you would see her Monday
through Friday—every morning that she wasn’t already in
One RN described her perception of the role of the nurse ma-
nager in comparison to the charge nurse: “I think the charge
nurse actually plays a bigger role than your manager. Our ma-
nager is there, but if something goes down you’re going to go
to your charge nurse first, so they are more important. That’s
just me, not in the step-by-step involvement. With my manager,
only if something major goes wrong do you ever see them.”
No longer a nurse. Finally, one particular perception by the
nurses during the focus group discussions highlighted a dis-
connect between the manager and the actual work of nursing at
the bedside. The nurses often shared opinions in relation to the
manager no longer knowing how to be a nurse, such as this
comment: “She’s there. She makes an appearance and she’s
nice. I’ve just heard other people, when it’s been really busy
like, she’ll say she’ll get them some help and then the help she
gives is saying,” You’re doing a great job,” but doesn’t jump in
and put on a pair of gloves or do anything like that.”
Another nurse shared feelings about how the manager loses
the connection with the clinical aspect of the job when taking
on the manager role: “They have more administrative things
than really nursing things. Likely, they’re not held together.
The connection is broken, when they step up. I see it being dif-
ferent when you are a clinical nurse and you go one step up.
Most of them when they are managers, they are managers, not
clinic al managers. ”
The RNs believed the managers were not able to relate to the
many problems the nursing staff had on a day-to-day basis,
including the physical stress and strain of being directly in-
volved in patient care. One RN commented: “I’d just like some
feedback because I feel like my boss has no idea what kind of a
job I do because there’s a big gap between what she does and
what happens on the floor.”
Another described a level of frustration when staff perceived
the nurse manager as being disconnected from the demands of
the job of an RN: “I do wish the managers… could put their
self in our shoes sometimes. Because, you know, we do have
limits, not only physically but emotionally too. I mean, some-
times at the end of the day when I know when we go home
we’re just wiped out. We’re usually there till 6, sometimes later.
We stay until the patients are done and it can be a long day. It’s
mentally exhausting as well as physically.”
RN preferences for the nurse manager role. Often the dis-
cussion led to RNs sharing their expectations of the nurse ma-
nager. For example: “Just actually physically being in front of
somebody, you know. Listening to report, just so you kind of
get a feel for, you know, what the staff’s day is going to be.
That would be nice. Showing up on the off shifts and just being
in that full-time slot and you know, you could set your watch
by when she’s going to get there and when she’s going to go
home. Answering their cell phone when staff calls because they
need something, and you know, I think we are expected to only
call when it’s something that’s really out of the ordinary.”
Yet another nurse described how it affected the staff when
the manager did provide assistance during a time when they
were short staffed: “Even if, you know, you’re short staffed, I
mean, you can have a good day when you’re short staffed, it
just depends on the support that you do get from the people that
are there and if your manager can come out and support you
while you’re having that bad day. It just kind of alleviates that.”
Managers as leaders have two broad and independent func-
tions, according to Hersey and Blanchard (1977). One dimen-
sion is production or task oriented, and the other is employee
oriented with a focus on relationships, building teamwork, and
employee identification with the organization. Findings from
this study show that the staff nurse participants generally
viewed their managers as being task oriented in relation to at-
tending meetings and scheduling staff, for example, but did not
perceive their managers to be employee oriented with a focus
on relationships, building teamwork, or employee identification
with the organization. In this study, the nurses did not usually
see a connection between the daily tasks of the manager and the
Copyright © 2013 SciRes. 65
manager’s role in solving work issues when they occurred dur-
ing a shift. And yet the nurses seemed to want more connec-
tion and communication with the manager. These findings are
consistent with a study by Sellgren et al. (2006), who found
that, when both subordinates and managers were provided the
same survey on leadership behaviors, thesubordinates preferr-
ed different leadership behaviors from those that managers
thought were appropriate. In another study by Gormley (2011)
significant differences were indicated between nurses and the
nurse manager’s perceptions of the work environment. Man-
agers rated the environment higher than the staff on all sub-
scales. Both of these studies also revealed a disconnection be-
tween the perceptions of the nurses and the beliefs of the nurse
A study by Schmalenberg and Kramer (2009) found that if
the nurse manager is involved in roles or behaviors that are not
perceived by the nurses as part of their job, then the nurse
manager is seen as being non-supportive. In a study by Shirey,
Ebright and McDaniel (2008) where nurse managers were in-
terviewed about their roles on the unit, they stated the need to
spend an adequate amount of time on the unit in order to be
aware of and prevent issues from growing into bigger problems.
However, unrealistic expectations of their roles by administra-
tion (being in meetings, putting out fires, taking on additional
responsibilities) may keep them from being present on the unit
as much as they would like to be (Shirey, Ebright, & McDaniel,
Given the findings of this study, and potential for similar si-
tuations in other complex healthcare settings reflected in re-
cent literature on the nurse manager role, stress and work (Shi-
rey, Ebright, & McDaniel, 2013), staff nurse perceptions of the
manager role have important implications for nursing education
and service settings. First, staff nurses may not understand the
role of the nurse manager and therefore may have unrealistic
expectations of their nurse manager. Second, how do we enable
nursing management to carry out both the task and leadership
functions described by Hersey and Blanchard (1977) that may
assist them in fulfilling the perceived expectations of the RN
staff? Because supportive roles and behaviors of nurse manag-
ers may vary, or be non-existent, among hospitals and patient
care units, an extrinsic list of supportive behaviors must be built
and validated for comprehensiveness and to diminish the lack
of understanding of the nurse manager role by staff nurses
(Schmalenberg & Kramer, 2009).
In a study by Shirey, Ebright and McDaniel (2008) managers
expressed that younger nurses often did not find the role of the
nurse manager to be desirable, and that they often asked man-
agers “what do you do” and “is it worth it” (p. 128). Managers
expressed in the same study that a lack of clarity of their roles
creates ambiguity with their position as different people expect
different things from the nurse manager (Shirey, Ebright, &
McDaniel, 2008), thus possibly leading to the disconnect that
occurs between RN perceptions of the role and the actual role
expectations of the nurse manager by hospital administration.
The participants in our study indeed did not seem to have an
understanding of the roles of management, indicating a need for
a dialogue between the nurse manager and the nursing staff to
occur so that perceptions and expectations of RNs can be clari-
fied to improve the effective performance of the nurse ma-
nager (Schmalenberg & Kramer, 2009; Utriainen & Kyngas,
Very few of the RNs mentioned the manager as their go to
person to assist them in solving problems related to staffing,
patient care, or negative physician relationships. Findings re-
flected staff perceptions of managers as out of sight, out of
mind and not being there to provide support for patient care or
to meet the individual needs of the staff.
The most important implication from these study findings is
related to the ability and capacity for nurses in the nurse man-
ager role to carry out functions that capture both leadership di-
mensions (task and relationships) described by Hersey and
Blanchard (1977). The manager who is office bound and has
rigid rules with authoritative styles of communication under-
mines the morale of the staff by increasing feelings of power-
lessness, emotional exhaustion and decreased levels of job sat-
isfaction (Stuenkel, Nguyen, & Cohen, 2007). Are nurse man-
agers working in our current healthcare settings, with their con-
stant change and complexity, realistically able to attend to the
dimension of the role that includes being employee oriented
with a focus on relationships, building teamwork, and employee
identification with the organization?
There is a need for nurse managers to discuss the roles and
expectations or perceptions of the RNs with administration as
they also affect the support a nurse manager can provide to the
nursing staff (Schmalenberg & Kramer, 2009). Nurse managers
describe their jobs being stressful due to the perceived demands
of their roles by staff and administration, and not having the
time or resources to meet those demands (Shirey, Ebright, &
McDaniel, 2008). Organizations that require participation by
nurse managers in meetings and other time spent away from the
direct care areas decrease availability of the manager. Lack of
presence on the unit affects the ability of the nurse manager to
build relationships, assess teamwork and resulting patient care
outcomes, and also engage staff in problem solving about care
issues, organizational decisions, and new initiatives that affect
them. Management must be allowed to delegate tasks to others
so that leadership behaviors as perceived by RNs as important
to them can be maintained by the nurse manager (Schmalen-
berg & Kramer, 2009).
The purpose of this study was to identify RN perceptions of
their nurse manager behaviors that influenced the RNs’ job
satisfaction. In addition to learning about the RNs expectations
of their nurse manager, the study also revealed a disconnection
between what the RNs perceived the managers doing in their
role and how it related to their daily work. This disconnect may
demonstrate a lack of understanding of the manager’s role by
staff RNs, as well as reflect the difficulty for managers in ful-
filling both dimensions of the leadership role (task and relation-
ships with staff) due to the complexity and demands required in
healthcare environments. Because the nurses believed increased
visibility should be an expectation of the nurse manager, the
level of job satisfaction for the RNs may decrease, especially
during busy times if the nurse manager is not there to assist
with issues and problem solving on the unit. This study pro-
vided findings important to staff nurses, nurse managers and
administration. There is a need for administrator support for
nurse manager’s ability to spend more time on the unit with
RNs to attend to direct care provider relationships and team
building through communication with staff is a recommended
approach for decreasing the disconnection between RNs and
nurse managers.
Copyright © 2013 SciRes.
Copyright © 2013 SciRes. 67
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