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Brief analytical summaries or syntheses #54

The evolution of healthcare managers’ role:

a comparison France/United Kingdom


This study on nurses’ job satisfaction from the University of Lyon compares the expanding role of healthcare managers in France and the UK. It concludes that the evolution of the healthcare manager role has negative consequences for workplace relations and staff retention in both countries, and suggests research into new modes of leadership.


Nursing shortages are a problem in all countries (Hayes et al., 2010; Lu et al., 2005). More than 70% of expenses at the UK National Health Service (NHS) go to human resources. Optimal use of the workforce is therefore a key issue. Job satisfaction is recognized in the international nursing literature as being related to turnover rate, staff retention and intention to leave (Hayes et. al., 2010; Lu et. al., 2005; Caers et al., 2008 ; Van Saane, 2003 ; Irvine & Evans, 1995 ; Blegen, 1993 ; Coomber & Barriball, 2007).

One of the important facets of human resources management is nurses’ job satisfaction. Some authors note the importance of the healthcare managers’ role in the improvement of nurses’ job satisfaction (Hayes et. al., 2010; Adams & Bond, 2000). The aim of this study is to explore the consequences of the evolution of the healthcare manager role from a nursing role to a management role. For this reason, the study focuses on the healthcare manager role in the UK and compares it with the evolution of the healthcare manager role in France in order to highlight the dangers and benefits of this evolution on nurses’ job satisfaction in particular.

Analysis and results

The importance of quality

In France and the UK, quality is becoming an increasingly important part of the healthcare managers’ mission and this has an impact on nurses’ work, particularly due to the increase in administrative tasks. The analysis of interviews conducted in the UK shows the importance of quality in the missions of healthcare managers.

The influence of managers’ background

Healthcare managers in France have a nursing background, while the UK also has healthcare managers with non-clinical backgrounds. Questions were raised about both types of background. In France, management training is judged insufficient to produce good managers, while in the UK nurses are dissatisfied with the emphasis on management in the healthcare manager profile.

Managers are less present on the wards

In France and in UK, healthcare managers are less and less present on the ward, either because their offices are moved next to Administration or because they are constantly in meetings.

Leadership style

The difference in leadership style between healthcare managers in France and the UK can be explained by differences in the managers’ backgrounds. In the UK a nursing background is not required to be a healthcare manager, while in France healthcare managers must have a nursing background.

Implications for nurses’ job satisfaction

The UK conducts an annual NHS staff survey, while France has no national survey of nurses’ job satisfaction. However healthcare managers in France have taken action to improve job satisfaction of their staff and have been looking for ways to reduce turnover and absenteeism, despite lacking official targets like the UK.

Focus on the budget

Although budgets are increasingly constrained, nurses in France do not perceive budget management as an impediment to their job, as they do in the UK, where many nurses complain about them.


The small size of the samples in this study (in UK, n=8 and in France, n=8) does not enable results to be generalized. However, this study brings better understanding of the evolution of healthcare managers’ role in France and enables a comparison between healthcare managers in two countries that share some common points but also exhibit differences. The comparison highlights the dangers of the evolution of healthcare managers’ role from a nursing role to a management role.

Implications and recommendations

This study shows that the evolution of healthcare managers’ role can harm staff relations. In the UK, though the last NHS staff survey indicated that more of half the staff is satisfied with the support they received from their immediate manager, the analysis of the interviews show that some reservations persist. In the interviews, most of the nurses complain about the lack of support from their managers. The evolution of the healthcare manager role takes managers away from their teams. This observation is valid in France as well as in the UK, but is not as critical in France. Indeed, in this study, French nurses had fewer complaints about the level of support they received from their manager and did not have the feeling that managers were taken away from the teams. But some French nurses and healthcare managers are beginning to find that healthcare managers are too often absent from the ward and are too often in meetings.

The focus on budget is a real problem for nurses in UK and in particular, for their job satisfaction. Healthcare managers often play multiple roles, which has consequences on the style of leadership used by the manager and on a nurses’ job satisfaction. One important finding of this study regards the importance to nurses of the health care manager’s background and of the relationship between healthcare managers and their teams.


The evolution of healthcare managers’ role : a comparison France/United Kingdom