Nurse Manager Span of Control and Role Scope

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

A troubling trend is emerging from my discussions with nurse managers. Not only have the managers’ spans of control continued to grow, but so has their role scope. With shortages across all disciplines and departments, nursing is the default for tasks needing reassignment, and the responsibility for the task is shifted to the manager. Typical task shifting has included the following:

• The lab lacks support staff, so nurses now draw the labs.
• Environmental services are short-staffed, so that nurses will clean rooms.
• IT and Biomed are not on site, so nurses must repair equipment or receive detailed phone instructions about EHR workarounds.
• The dietary section lacks workers, so nurses deliver patient trays and record menu choices.
• Supply service is short of staff, so nurses pick up supplies.

I now commonly also hear that crucial services such as human resource management are contracted out or done remotely. Nurse Managers are in HR databases reviewing candidates with no on-the-ground support. Union partnerships are deteriorating, and nurse managers are expected to navigate tough conversations with staff with their union representatives present but no facility HR support.

All of this comes at a time when nursing is also very short-staffed, volumes are high, and patient acuity continues to increase. Frontline nurse leaders are already overwhelmed with large spans of control and nurses who need their attention. They are beginning to ask why this shift in workload is seen as okay and why other department leaders are allowed to abdicate their accountability. The whole idea of these departments is to provide support for patient care, and this is not happening the way it has in the past.

Executive leaders are the trustees of their staff and leaders’ time. Whenever a responsibility is shifted to nurses or leaders, it inevitably means that other equally important things are not being done. Nurse managers note that nothing is ever removed from their plates – just added, and they see it as a zero-sum game. One CNO has told me that the new mantra in the C-Suite for nurse leaders should be, “If nursing were not the answer, how would we get this done?”

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