Background: Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within today’s complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. Method: We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. Results: Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. Conclusion: Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role.