Healthcare organizations face increasing challenges in retaining first-line managers, who play a key role in operational stability and patient care. Studies indicate that approximately half of all first-line managers intend to leave their position within 5 years. This highlights the need for updated knowledge about conditions under which they work. A qualitative descriptive design was used to explore first-line managers' perceptions of what is important for them to remain in the managerial role. Data were collected through 20 individual semi-structured interviews with first-line managers from a medium-sized healthcare organization in Sweden between March and June 2022. The data were analyzed using qualitative content analysis. The results are presented through the overarching theme Empowered through support, responsibility, and meaningful contribution. This theme describes how first-line managers sustain their motivation and commitment by developing confidence in their ability to lead, influence others, and create meaningful change. Their confidence is grounded in support, responsibility, and role clarity. The theme also shows how first-line managers handle challenges, make decisions, and act to improve staff well-being and patient care. Through these actions, they contribute to the development of their units. Trust from their manager, autonomy in decision-making, and support from colleagues enhance first-line managers' sense of purpose and motivation, encouraging them to remain in their role. Moreover, balanced workloads and opportunities to make a meaningful impact strengthen their commitment. By recognizing and addressing these aspects, healthcare organizations can better support long-term engagement of first-line managers, fostering sustainable leadership and stability.

Background

First-line healthcare managers navigate complex organizational demands to ensure a good work environment and quality care. Key factors such as expanded span of control, leadership and management performance, and work-related stress significantly influence their job satisfaction. However, how these factors evolve over time in organizational settings remains unclear.

Objective

To examine expanded span of control, leadership and management performance, work-related stress, and job satisfaction among first-line healthcare managers and assess whether the relationships between these variables remained stable over time.

Methods

A repeated cross-sectional design was used to collect annual data from 2020 to 2023 among first-line managers in a Swedish healthcare organization. The Ottawa Hospital Span of Control tool, the Leadership and Management Inventory, the Health & Safety Executive stress tool, and a single-item job satisfaction measure were used to collect data. Kruskal-Wallis tests and Spearman correlation analysis were performed.

Results

An expanded span of control negatively impacted job satisfaction in certain years. Leadership and management performance showed a positive but inconsistent association with job satisfaction. Factors in work-related stress, particularly high demands and strained relationships, consistently had a negative relationship with job satisfaction, whereas control and support positively contributed to greater job satisfaction.

Conclusions

Work-related stress, driven by high demands and poor relationships, significantly decreases job satisfaction. Leadership and management performance influence satisfaction, but inconsistently. Reducing workload and improving support structures can enhance job satisfaction and managerial effectiveness.

Aim: The aim of this study was to describe first-line managers’ thoughts on and motives for leaving their position.

Introduction: The turnover rate of first-line managers impacts healthcare organizations’ overall performance. Burnout, dissatisfaction, and desired career advancement contribute to the intention to leave. High turnover negatively impacts patient care and has financial consequences. Involving managers in decision-making, providing support, and addressing workload and resource challenges are known to be crucial factors in retaining managers.

Method: Sixteen semistructured interviews were conducted with first-line managers. Qualitative content analysis was used to analyze the data.

Findings: Our study showed that some first-line managers experience difficulties at work, leading them to reach a breaking point and leave. These difficulties stem from a lack of influence, feeling unheard, and having inadequate support. Some first-line managers reach a point where they feel the need to move on, often due to personal reasons or a lack of motivation. Upon deciding to leave, managers commonly have a plan to ensure a smooth transition for their successor, aiming to help both the new manager and the unit’s staff.

Conclusion: First-line managers can perceive their work situation as challenging and frustrating when they lack authority and support. This can lead to them leaving their role for reasons such as retirement, seeking more time for family, or seeking new work challenges. It is important for healthcare management to empower and support first-line managers. Smooth transitions for successors and staff are crucial, regardless of why a manager leaves.

Purpose

The purpose of this study is to examine if and how an expanded span of control, management performance and work-related stress indicators (control, support and relationships) influence the time until first-line managers leave their position.

Design/methodology/approach

A prospective longitudinal cohort design involving 87 first-line managers in a Swedish health-care region. Cox proportional hazards regression was used to analyse expanded span of control, work-related stress indicators and management performance as predictors of turnover.

Findings

The findings indicate that first-line managers who were categorized as having moderate concern and a need for improvement in the work-related stress indicators control and manager support had a significantly higher risk of turnover. In contrast, expanded span of control and the number of employees managed per first-line manager did not significantly influence turnover risk. In addition, the work-related stress indicator relationships was not significantly associated with risk of turnover.

Originality/value

This study expands the understanding of actual turnover among first-line managers in health care by exploring how organizational factors influence the decision to leave. Unlike previous research, which primarily examines turnover intentions, this study takes a longitudinal perspective, capturing real turnover events over time. The findings contribute to future research on organizational conditions, providing a basis for developing strategies to improve retention and working conditions for first-line managers in health care.