Manage Up or Manage Out: When Coaching Isn’t Enough

The Leadership Struggle Nobody Talks About

Let’s be real—one of the hardest parts of leadership isn’t the scheduling headaches, the budget, or even compliance. Nope. The real struggle? People. Not the rockstars who show up, lean in, and make your team better. I’m talking about the ones who just… don’t.

The ones who shrug off coaching. The ones who don’t take a write-up seriously. The ones who keep doing the same thing over and over until you start questioning whether you’re the problem. (Spoiler: you’re not.)

That’s when the question comes creeping in: How many times can I address the same behavior before it’s time to let them go?


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What Does “Manage Up or Manage Out” Even Mean?

It’s simple in theory, messy in practice.

Manage Up → Coaching, guiding, mentoring, and giving people every chance to step into success.

Manage Out → Recognizing when you’ve done the work, given the coaching, offered the resources… and they still choose not to change. That’s when it’s time to let them go.


Neither path is easy. Both require courage.


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Why Don’t They Care? (aka The Million-Dollar Question)

You can sit across from someone, outline expectations, and connect the dots on why their behavior is an issue… and still get a blank stare. So why don’t they care?

Some truly don’t see their behavior as a problem.

Some haven’t connected their daily actions to the bigger picture (patient care, team morale, safety).

And some? They’re just not interested in changing. Comfort beats consequences—until the consequences get real.



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Managing Up: Coaching That Actually Sticks

If someone’s willing to try, it’s our job to give them every chance to succeed. Here’s how I approach it:

1. Be Crystal Clear – “Do better” is vague. “Arrive on time for every shift or call in if you’ll be late” is measurable.


2. Connect the Why – Staff buy in more when they understand the impact. Tie it back to patients, coworkers, or even workload.


3. Check In Often – One talk won’t cut it. Circle back. Encourage. Redirect. Repeat.


4. Support & Document – If they need training, mentoring, or a refresher, give it. And yes, keep the paper trail.




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Managing Out: Protecting Your Team

But here’s the thing—not everyone’s going to turn it around. And if you let that drag on too long, you’re not just dealing with one disengaged employee… you’re risking your whole team’s morale.

Signs it’s time to manage out:

You’re having the same conversation for the third (or fourth) time.

Their behavior is actively dragging down the team.

You’re spending more energy managing one person than leading everyone else.


Managing out isn’t cruel. It’s fair. It’s saying: I gave you the coaching, the chances, and the support. But if you’re not willing to meet us halfway, this may not be the right place for you.


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Final Thoughts

“Manage up or manage out” isn’t a catchy leadership phrase—it’s survival. It’s how we protect our patients, our teams, and our sanity.

And here’s the part leaders don’t say out loud: letting someone go doesn’t mean you failed. It means you tried. You coached. You led. And you chose to protect the bigger picture when they refused to step into it.

Because at the end of the day, your team deserves coworkers who are all in. And it’s your job to make sure they have them.