Looking at Span of Control in Frontline Nurse Leader Roles

By Rose O. Sherman, EdD, RN, FAAN

Findings from recent research seem to overwhelmingly support that it is frontline managers who are the linchpins in staff engagement, satisfaction, and retention. Nurses don’t leave organizations, they leave managers. A business consultant working on a leadership project with me recently asked me about the span of control in nurse manager roles today. My answer stunned him as I told him that in recent research I have done – the number now exceeds 60 FTE which often translates into much more staff when part-time, per diem staff and travelers are added to the mix. In non-healthcare industries, he informed me that over 15 would be considered a large number. He is right in that this is what Gallup now recommends as a best practice in leadership. This is certainly not the case with nurse leader roles. Over the past four years, I have seen a trend toward multiple unit management as some organizations look for ways to reduce costs and others grapple with nurse manager turnover.

What is Span of Control

The span of control defined as the number of people directly supervised by a manager. This would include all full-time, part-time and per diem staff who regularly work on a unit or in a department.

The span of control theory suggests that there is a point at which there are diminishing returns in the ability to be an effective supervisor as more staff are added. Over the years, there have been differing viewpoints about what constitutes an optimal span of control. The ideal span of control is dependent on a number of variables depending on the nature of the work involved and the workforce. The factors include the following:

The complexity of the work – a high-intensity specialty area such as an ER might warrant a much lower span of control than a long-term care department where the work is more predictable and routine.
Experience of the manager – novice managers typically need a smaller span of control than more seasoned managers to be effective.
The capability of the workforce – managers can be given a larger span of control if the staff on their unit are very experienced and self-directed. If the unit has a high turnover or a larger number of new graduates, the manager will need to do more coaching and needs a smaller span of control. If you look at the skill mix in the current workforce, a business can be made that nurse managers need a much lower span of control.
Geographic dispersion – if work units are geographically distant from one another and require that a manager round daily, a smaller span of control is needed.
Administrative tasks and support – a key element in determining the span of control is a review of what is being expected of the manager and the level of administrative support that he/she has been given to help them in their work. If the manager has no administrative staffing or budget support, they will need a smaller span of control to effectively manage their responsibilities. Managers who have assistant managers to whom work can be delegated may be able to assume a higher span of control.
Organizational environment – other factors which can a span of control include the presence of a large number of interdisciplinary teams needing more oversight (such as in academic settings), whether the organizational structure includes directors, the presence of a union contract or an organization that is financially troubled or in turbulence.

So What’s the Solution?

There is no magic ratio for the span of control but organizations do need to carefully study what is happening in their own environments. A best practice in this analysis has been written by nurse leaders from the University of Pittsburgh Medical Centers. They developed an approach to studying span of control using an objective business and measurement model. The model considered the complexity of the unit, staff skill level, and volume and program focus including budget responsibilities. The span of control adjustments and additional administrative support assignments are made after a careful organization study. This has resulted in lower staff and leader turnover, better support for new hires, a higher percentage of staff returning to school and improvement in organizational performance measures.

The time to begin working on this challenge is now. We are seeing the loss of many nurse leaders to retirement. Their replacements are less experienced leaders who may not be able or willing to assume the same span of control.

Read Rose Sherman’s new book available now – The Nurse Leader Coach: Become the Boss No One Wants to Leave

Read to Lead

Elrich, M. (March 16th, 2018 Gallup Article). How to reduce spans of control in nursing.

Jones, D., Gebbens, C., McLaughlin, M. & Brock, L. (2015). Utilizing a scope and span of control tool to measure workload and determine supporting resources for nurse managers. Journal of Nursing Administration. 45(5) 243-249.