Restructuring Nurse Leader Roles - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

The transition of leadership from one generation to another is beginning to happen with great frequency in our healthcare settings today. Many nurses who are relatively new to leadership are assuming roles that almost seem unmanageable in their scope and span of control. What has happened in many organizations is that during the economic downturn, their experienced nurse leaders assumed more responsibility often managing multiple units or departments. What we can easily forget is that these leaders assumed these responsibilities incrementally. Now we have new leaders being recruited into these same roles and struggling to manage all of the responsibilities. In recent national research that we conducted with Perioperative leaders, we found that more than 50% directly supervised 80 or more staff. 64% of these leaders believed their roles needed to be restructured to reduce their scope of responsibilities and span of control.

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.

Scope of Responsibility

While span of control is critical in leadership roles so too is the scope of responsibilities. Scope of responsibilities would include the budgetary responsibilities of leaders (ie, cost centers), department activity and performance monitoring, hours of operation and other expectations set by organizational leaders.

The Evidence in Nursing on Span and Scope of Leadership Roles

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 quality improvement project was published in the May issue of the Journal of Administration by nurse leaders from the University of Pittsburgh Medical Centers. They developed an evidence-based approach to studying scope/span of control using an objective business and measurement model developed by Ottawa Hospital. 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. In recently published research that we conducted with Generation Y Nurses related to factors that would lead Generation Y nurses to accept or reject leadership roles, we found that fear of failure was the number one concern. It is important and we don’t set up our younger nurses for failure in these roles because they are not doable.

Download Research Study on Generation Y and Leadership here: Factors that would lead Generation Y nurses to accept or reject leadership roles

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

Jones, D., Gebbens, C., McLaughlin, M. & Terhorst, 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.