This quantitative research study explored the correlation of five domains of nurse manager competencies (i.e, conceptual, technical, human, leadership, and financial) with outcome indicators for both nursing staff and patients. These outcome indicators included staff satisfaction measured by staff turnover, patient satisfaction with pain management, medication errors, and patient slips and falls. This study utilized a convenience sample of 33 first-line nurse managers of acute, adult, inpatient units from 12 hospitals within a health care system in the midwest. The sample included 30 females and 3 males with a modal age category of 45 to 54 years old. Participant surveys included the Nurse Manager Competency tool, demographic data and outcome indicator data. Data were analyzed utilizing correlational statistics that included the Pearson Product Moment Correlation Coefficient and the coefficient of determination. Central tendencies were also calculated to define the characteristics of the group that was studied. Results demonstrated that a significant relationship existed between patient satisfaction with pain control and the nurse manager competency domains of conceptual, human, leadership, and financial for a subsample of medical surgical murse managers. In addition, for the same subsample, there were negative correlations between patient falls and the human and conceptual nurse manager competency domains. Findings from this study have identified potential elements that most directly relate to staff and patient outcomes, and that should be considered in the development of educational programs, as criteria for selecting talent, and as performance indicators for evaluating nurse managers.