Nurse Managers in long-term care supervise healthcare services for residents who have higher acuity levels and numerous health co-morbidities. There has been minimal research identifying the long-term care Nurse Manager‟ s skills and competencies and no research on a novice-to-expert scale. The purpose of this qualitative, phenomenological study was to define the Nurse Manager ‟s leadership skills, competencies, expertise, and embedded knowledge. Nineteen Nurse Managers, with a minimum of five years longterm care management experience, and their respective Directors of Nursing, completed the Nurse Manager Inventory Tool (NMIT) which was based on a 5-point Likert noviceto-expert scale. Interview questions were developed based on the survey results and the Nurse Managers were interviewed. The Nurse Managers rated their clinical skills at the proficient level. They rated their financial and strategic management skills at the novice and advanced beginner level respectively. All other categories, including leadership reflective practice, diversity, Human Resource leadership, relationship management, performance improvement, problem solving, information technology, and Human Resource management, were rated at a competent level. Themes that emerged included the Nurse Manager‟s visibility on the unit, trial and error learning, aloneness, peer support, and their primary focus toward supporting the resident during their final journey. It is recommended that long-term care administration support Nurse Manager leadership development, educational advancement, and networking opportunities