Why great nurses make terrible managers (and what you can do about it!)

Nicole Nash-Arnold, Nurse Manager HQ
Nurse Manager HQ’s Nicole Nash-Arnold discusses how she stumbled but found her strength as a nursing manager.

In nursing and midwifery, the clinical cream rises to the top. Our best nurses and midwives are promoted to management positions.

So if you’re a great nurse or midwife with excellent clinical skills, sooner or later you’ll probably be tapped on the shoulder to become a manager. And you’ll probably discover that great nurses or midwives don’t necessarily make great managers.

I know, because that’s exactly what happened to me.

Early in my career, I fell in love with perioperative nursing. Once I stepped into the inner sanctum of the operating theatre, I never wanted to leave. I become one of those nurses who could handle any case that came through the door. I was skilled, I was confident and I was good with patients.

Naturally, I was noticed and promoted to a nurse management job.

Suddenly I went from being a nurse who could handle a multi-trauma to a nurse manager who couldn’t handle anything. I was 26 when I took up my first management role. Overnight I became responsible for 170 staff. I couldn’t remember to pay my own power bill, yet I was expected to handle a multi-million dollar budget.

I made so many mistakes. I absolutely hated overseeing the data. I hated numbers. And the whole time I was using this tyrannical, ‘my way or the high way’ management persona that wasn’t me at all. I felt like an imposter, totally consumed by a cloud of self-doubt. It was the only time in my career that I considered giving up. I crashed and burned.

I so desperately wanted to go back to being a nurse, which I felt I was actually good at.

I struggled along for a few years until I started having babies, and something had to give at work.

I moved to a role as an After Hours Coordinator at the largest private hospital in the country. That move was one of two things that probably saved my nursing career. I remember making a conscious decision that this job would be different. Things couldn’t get worse, so I felt like I might as well try doing things another way.

With a different kind of pressure in that role, I had more freedom and I started to experiment. That’s when I really found my own authentic leadership style. I discovered that I could be myself and still be a leader. I started using my strengths to open doors and get people to do things for me. I started to remember what it felt like to be good at my job. 

During my 15 years in management, I’ve realised that my story is typical. New managers come to me and say the same things over and over again: “I’m a fraud. I’m not cut out for management. I want to go back to nursing, which I was good at. There’s no education for me and no support.”

Nurse or midwife management requires a very different skill set than nursing or midwifery. Yet we promote our best nurses and midwives and expect them to be the best managers. We throw them in the deep end and expect them to swim! It’s a recipe for disaster.

After getting over that first major speed bump in management, I learned to love it and I was highly motivated to figure out how to make a success of it. That was when the second thing happened that saved me: I accidentally found a Career Coach. 

After finishing up as an After Hours Coordinator, I moved into an Assistant Director of Nursing role and the organization provided support for nurse manager transition through an Executive Coach.  I was confronted: I felt like I was in therapy!  It was totally different from any kind of professional development I’d ever engaged in before.  But when I embraced it, what I realized was this was the first education that I’d ever done that was all about me: I got to define my goals, and I reached them faster as a result.  I was supported to effect change, and the cloud of self-doubt was kept at bay by an objective outsider.  Kay, who was an experienced executive nurse leader, challenged my assumptions, broadened my perspective.  Decision making takes courage, and there are many crossroads. Kay helped provide clarity: two heads are better than one.  Coaching reduced my stress, brought balance and built resilience.  Since then, I’ve tried and tested different techniques for conquering the areas that don’t come naturally to me (to this day, I cheat with an automated spreadsheet to calculate KPIs).

I continue to invest my time and energy in initiatives that provide training and support for nurse managers. By growing better managers, I hope we’ll see an industry revitalised by a generation of passionate people in healthcare—not only great nurses, but inventive thinkers, talented strategists and effective leaders.


This is an edited extract from the e-book Nurse Management Unpacked: 5 systems to save your sanity and make you a star. Find more training and support for nurse managers at Nurse Manager HQ.