Effective Onboarding for Front-Line Nurse Managers in Healthcare: A Descriptive Qualitative Study.

AIM: To describe nurse managers' perceptions of effective onboarding for front-line nurse managers in healthcare. BACKGROUND: Many front-line nurse managers are retiring, resulting in a loss of expertise. New competence requirements and widespread turnover intention among front-line nurse managers are challenging healthcare organisations. Organisational support and effective onboarding are needed; however, qualitative research on the content of onboarding for front-line nurse managers is lacking. DESIGN: A qualitative descriptive study. METHODS: In 2023, data were collected remotely through six semistructured group and five individual interviews with 18 nurse managers in Finland. The participants worked in specialist and emergency care, primary healthcare and medical services within a single healthcare region. The data were analysed using inductive content analysis. RESULTS: The data yielded 33 subcategories and 12 categories that describe nurse managers' views on effective onboarding for front-line nurse managers in healthcare. The main categories were developing leadership growth through onboarding, clarifying leadership foundations in onboarding, designing a high-standard and up-to-date onboarding process, ensuring well-rounded onboarding support and strengthening workplace bonds through onboarding. CONCLUSIONS: Front-line nurse manager onboarding requires systematic execution that includes personal, organisational and social aspects. Onboarding should focus on developing managers' leadership qualities. Ensuring a structured and comprehensive onboarding programme that highlights the professional requirements of front-line nurse managers, as well as the relevant theoretical and practical aspects of managerial work, can support a smooth transition into the new role. A primary limitation of this study is the potential influence of researcher subjectivity in data interpretation and analysis. To mitigate this, multiple researchers were involved in the analysis process to enhance credibility and reduce individual bias. IMPLICATIONS FOR NURSING MANAGEMENT: Individual onboarding should help new front-line nurse managers grow into and develop attachments to the manager role while receiving support from top management, supervisors, colleagues and employees. IMPACT: This study highlights the need for a structured, personalised onboarding process for front-line nurse managers, focussing on leadership development and multidimensional support. A well-designed onboarding programme can enhance leadership skills, facilitate integration into the work community and support smoother transitions, ultimately contributing to improved organisational performance and healthcare outcomes.