Recently, I was talking with a CHRO about her struggles with nurse retention. We were exploring opportunities to enhance nursing leadership skills across her organization. She told me something that stuck: if she can keep nurses engaged for three years, they will more than likely stay for life.
That insight gets to the heart of what every health system is navigating right now. Like that CHRO, you can name the workforce pressures by heart: open requisitions that linger, never-ending temp staffing expenses, and leaders stretched past any reasonable definition of capacity.
It’s an expensive problem. According to the latest NSI benchmarks, replacing a single RN can cost roughly $60,000. Hospitals losing $5 million or more to turnover aren’t merely facing a staffing problem, but a financial and operating-model problem. The risk is concentrated in nursing, but the leadership investment often isn’t.
Physician leadership investment has matured significantly over the past decade. It’s no longer controversial, but standard practice. Health systems recognize that clinically credible leaders at the executive table drive better strategy, transformation, and alignment. That logic is sound, and the investment is warranted.
But the same logic hasn’t fully caught up to nursing leadership — and health systems are paying for it.
Nursing is the largest employee population in many health systems. Inpatient care doesn’t run without 24/7 nursing coverage. Chief Nursing Executives and senior nursing leaders sit at the center of the workforce crisis: They manage the largest segment of the workforce, absorb the operational weight of turnover and vacancies, and are accountable for patient experience, quality, and safety at scale. They are, in many ways, the connective tissue between executive strategy and frontline reality.
And yet, compared to physician leadership pipelines, investment in nursing leadership development — especially executive coaching — still lags significantly behind.
Why the gap in nursing leadership development persists
Part of this is historical framing. Nursing leadership has long been viewed as operational rather than strategic, which limits investment in higher-order capabilities: enterprise influence, system-level thinking, change leadership. When the default view is that nursing leaders execute strategy rather than shape it, development dollars go elsewhere.
Part of it is a bias toward visible ROI. Credential-based pathways — physician leadership roles, formal titles, structured succession tracks — are easier to point to in a budget conversation than coaching, which builds decision-making under ambiguity, cross-silo collaboration, and adaptive capacity. Those capabilities are harder to quantify and easier to defer.
And part of it is the pressure of the moment itself. When staffing is stretched, organizations default to tactical solutions: recruitment incentives, scheduling optimization, staffing models. Those moves are necessary. But without leadership capability to sustain the change, they don’t hold.
New demands, old investment model
Today’s CNE is simultaneously navigating workforce instability, interdisciplinary tension, financial pressure, and the early waves of AI-driven workflow redesign. This is no longer a role that experience alone can prepare someone for. It requires the ability to operate in ambiguity, influence without authority, and translate executive strategy into sustainable behavioral change at the unit level.
Organizations that invest in nursing leadership coaching build that capacity in a way that training programs and conferences can’t. Coaching works in real time, on real challenges, with a focus on the specific obstacles a leader is facing. In our experience, nurse leaders who engage with a leadership coach over 9 to 12 months build the kind of muscle memory that makes change stick — not just in themselves, but in the teams and systems they lead.
What a stronger investment model looks like
For heads of Talent, OD, and Nursing working to close this gap, here’s where to start.
▷ Treat nursing leadership as enterprise leadership.
CNEs and senior nursing leaders should be developed as system-level strategic partners, not just operational managers. That means building capabilities like enterprise influence, financial acumen, cross-disciplinary alignment, and change leadership intentionally, from director level through the CNE role.
▷ Pair retention work with leader capacity work.
If your strategy is primarily incentives, staffing models, and recruiting, you’re missing the lever that makes those moves hold: leaders who can implement consistently and sustain behavior change over time. The two have to work together.
▷ Invest in long-term executive coaching for senior nursing leaders.
Nine-to-12-month 1:1 coaching engagements — focused on real-time challenges, not theoretical models — build the adaptive capacity that short-term programs can’t. This is where navigating complexity becomes a practiced skill, not just a concept.
▷ Build cohort-based nursing leadership academies.
Cohort models create shared language, cross-functional alignment, and peer accountability across sites and service lines. They move organizations from isolated leadership excellence to collective leadership impact.
▷ Align Nursing, HR/Talent, and Finance on the business case.
Reduced turnover, lower reliance on premium labor, and improved engagement are outcomes of leadership capability. When those conversations happen in different rooms, the investment case for nursing leadership development never gets the traction it deserves.
This investment can’t wait
You cannot hire your way out of this.
Even with increased hiring, most health systems are barely keeping pace with attrition, at significant financial cost. The way out is through leadership, not headcount.
Healthcare has made real progress recognizing the importance of physician leadership. Applying that same level of intentionality to nursing leadership is one of the most consequential and underutilized opportunities available to health systems right now.
Nursing leaders sit at the intersection of every outcome that defines your mission: patient safety, patient satisfaction, physician alignment, financial performance, and employee engagement. Without strong, supported, capable nursing leaders, your workforce won’t stabilize, labor costs will continue to worsen, and strategy will stall.
Developing nurses to lead at that level is one of the most direct investments you can make in the patients and community you serve. It’s also how you honor your mission and protect your ability to deliver on it.
