Span of Control in Nurse Leader Roles

By Rose O. Sherman, EdD, RN, FAAN

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 staff. In non-healthcare industries, he informed me that over 15 would be considered a large number. 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 organizations look for ways to reduce costs.

What is Span of Control

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

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 workforce. The factors include the following:

Complexity of the work – a high intensity speciality 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.
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 high turnover or a larger number of new graduates, the manager will need to do more coaching and needs a smaller 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 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.
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), the presence of a union contract or an organization that is financially troubled or in turbulence.

The Evidence in Nursing on Span of Control

There is limited evidence on the impact of span on control in nursing. Researchers Dr. Amy McCutcheon and Dr. Diane Doran from the University of Toronto have studied the effect of span of control on leadership and performance. They have found in their work that patient satisfaction is lower on units where managers have larger spans of control and staff turnover is higher. Even a transformational style of positive leadership does not overcome having a larger number of staff reporting to managers.

So What’s the Solution?

There is no magic ratio for span of control but organizations do need to carefully study what is happening in their own environments. A best practice was recently presented at the 2013 AONE conference 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. Span of control adjustments and additional administrative support assignments were 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 currently have a very seasoned group of nurse leaders in place in healthcare agencies across the country. Many will retire by the end of the decade. Their replacements will be less experienced leaders who may not be able or willing to assume the same span of control.

Read to Lead

Doran, D., McCutcheon, A.S., MacMilan, K., Hall, L, Pringle, D., Smith, S. & Valente, A. (2004 Whitepaper Canadian Health Services Research Foundation) Impact of Nurse Manager’s Span of Control on Leadership and Performance

Jones, D., Gebbens, C., McLaughlin, M. & Brock, L. (AONE Conference 2013 presentation). span of control UPMC