AIMS: To assess turnover and health of Swedish healthcare managers, and identify important supporting factors relating to work and individual resources. BACKGROUND: Individual managers' own sustainability in terms of turnover and health may be influenced by managerial working conditions and individual resources. METHODS: A 4-year prospective questionnaire study of 216 healthcare managers. Turnover and indicators of good health (healthy work attendance and no burnout) were related to work factors and individual resources using Cox regressions with constant time at risk. RESULTS: Forty per cent of the healthcare managers had left after 4 years. Fifty-two per cent had a healthy work attendance record and the proportion with no burnout had increased. Experiencing moderate/high job control was a predictor of remaining in the managerial position. Good health was predicted by having energy left for domestic work and being thoroughly rested after sleep. CONCLUSIONS: Managerial turnover seems high in Swedish healthcare and linked to working conditions, while sustained health are linked to individual resources. IMPLICATIONS FOR NURSING MANAGEMENT: Healthcare organizations should focus not only on developing individuals in their managerial role but also on strengthening the conditions that allow managers to exercise their leadership and to ensuring that the managers most suitable for their posts do not leave.