Why Nurse Leaders Fail - And How We Can Help Them Succeed

Elizabeth Later, BSN, MHA, RN, CENP, CPPS

There’s a moment most seasoned nurse executives have experienced: a strong bedside nurse, promoted into leadership, full of promise and potential—only to flounder within months.

We watch with a mixture of frustration and heartbreak as they begin to spiral:

• Team morale dips.

• Communication falters.

• KPIs slip out of reach.

• The whispers start: “She’s just not a good fit.”

But here's what we often miss:
Nurse leaders don’t fail because they’re not good enough. They fail because they’re not given the right kind of support.

In my years as a CNO and now as a coach for at-risk nurse leaders, I’ve seen the same patterns emerge again and again. Here are the most common culprits—and none of them point to a lack of character or commitment.

1. We Promote Based on Clinical Skill—Not Leadership Readiness

It happened to me. I was a charge nurse on a unit that needed a manager. The director came to me and said, “You’re a good charge nurse. You’ll be a good manager.” And he handed me the keys to the office and I really never heard from him again. It worked out for me because I had another colleague who was ahead of me on the leadership path and was a good mentor. But it doesn’t always end that well.

The assumption is that a great bedside nurse will naturally become a great leader. But the transition from peer to manager requires an entirely different skill set:

• Setting boundaries with former coworkers - many of whom the new leader considers to be their friends,

• Navigating difficult conversations,

• Managing operational demands without sacrificing work-life balance,

• Understanding key performance indicators and developing business acumen.

2. We Expect Them to Swim Without Teaching Them to Swim

Orientation for a new nurse manager often looks like this: a quick shadow, a handoff folder, and a vague “You’ve got this.”
What they actually need is structured mentorship, time to reflect, and a framework for solving problems with their team—not just for their team.

Without that, even the most eager leader will drift into reactionary, survival-mode leadership.

3. We Ignore the Human Side of Leadership

Nurse leaders carry an invisible weight: they manage team dynamics, patient outcomes, and compliance standards—all while holding the emotional climate of their unit. We confuse 24 hour accountability with 24 hour availability and expect nurse leaders to sacrifice their personal well-being for the good of the unit. How often have nurse leaders been expected to staff their units on a consistent basis because they can’t lift their head up long enough to do interviews, manage onboarding, or execute any recruitment or retention strategies so they don’t have to be in staffing?

Add in personal life stressors, and things can unravel quickly.

What Actually Works: Rebuilding With Reflection and Strength

When I coach struggling nurse leaders, I don’t start with performance plans or checklists. I start with a conversation:

• What’s working?

• When do you feel most connected to your purpose?

• What strengths are you not using right now?

This is the foundation of the evidence-based coaching framework I use:
✨ Appreciative Inquiry to shift the lens from deficit to possibility
✨ Reflective Nursing Practice to deepen self-awareness and learning
✨ Strengths-Based Leadership to bring self awareness and empower the leader to be more of who they are, not more of who they aren ot.

It’s a strategic approach, because when leaders feel seen and supported, are optimistic about what’s working, and are able to use their strengths in intentional ways, they show up differently.

Nurse leaders aren’t failing because they’re weak. They’re failing because we treat leadership like a sink-or-swim proposition.

But we can do better. We can build cultures where reflection is normal, not remedial, and where acknowledging you’re having challenges doesn’t mean you're broken—it means you're ready for growth.

If you have a nurse leader who’s underperforming, under pressure, or at risk of leaving altogether… let’s talk.