If you want to understand why a nurse, tech, or frontline clinician stays, struggles, or walks out the door, don’t look at the org chart. Look at their direct supervisor.
And in healthcare right now, that relationship matters more than ever. Gallup’s research shows that roughly 70 percent of the variance in team engagement traces back to the manager.
Persistent staffing shortages and burnout mean we can’t afford to lose people an organization has already invested in or have them disengaged. Rapid change from AI, evolving care models, and shifting regulatory pressure means staff need a supervisor who can translate what’s happening at the organizational level into something clear and manageable at the bedside or in the department. And as trust in institutions erodes broadly, the immediate supervisor is the primary lens through which most employees judge whether their organization actually has their back…or not.
Part of the challenge is that clinicians and charge nurses are promoted into leadership roles with little to no training in leading people. Clinical competency and leadership competency are very different skill sets. The gap shows up in turnover, disengagement, and burnout.
Of course, supervisors don’t damage trust on purpose. They’re stretched thin, pulled between patient care demands and people management, operating on autopilot during a chaotic shift. They unintentionally do things that harm relationships, like:
- Saying “I’ll look into that” and never closing the loop
- Saving all feedback for the annual review instead of addressing it in the moment
- Giving the best assignments or shifts to whoever is easiest to talk to
- Canceling one-on-ones when the unit gets short-staffed
- Handing down new protocols or directives without explaining the why
The good news is that rebuilding trust and shoring up relationships with employees doesn’t require a dramatic overhaul. It requires consistency. Make sure you regularly do these things:
- Follow through on small commitments and say when you have
- Give feedback close to the moment, not just at reviews
- Ask specific questions about workload and barriers and visibly act on the answers
- Give credit publicly and address problems privately
- Explain the reasoning behind clinical or operational changes, even unpopular ones
- Be transparent about what you don’t know yet rather than offering false reassurance during uncertainty
- Make it safe to disagree, without punishing pushback
Another critical point: trust builds fastest when a supervisor is actively invested in an employee’s growth. I don’t mean through an annual review or an HR-owned training calendar, but as an ongoing part of the working relationship. That’s one of the core tenets of Precision Leader DevelopmentTM (PLD): development works best when it’s owned by the direct supervisor. According to the Global Leadership Forecast 2023, leaders who get quality coaching from their direct manager are 4.3 times more likely to have a clear development path and 1.5 times less likely to feel they need to leave the organization to advance.
But supervisors can’t invest in their team’s development if no one’s invested in them first. That’s the gap PLD closes: precise, tailored skills based on where each supervisor actually needs to grow, built to run alongside patient care instead of stalling in a classroom or an LMS.
Organizations spend enormous energy trying to fix engagement and retention from the top down. But the fix usually isn’t another program layered on top of already-stretched supervisors. It’s supervisors equipped, and expected, to lead and develop their people well. Get that right, and the trust, the retention, and the patient experience follow.
Learn more about relationship building, engagement, and retention at the Rewiring Healthcare: Foundation to Future conference, October 20–21, 2026, in Nashville, Tennessee. To register, visit Rewiring Healthcare: Foundation to Future. Early-bird pricing is available through August 16.
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