Rethinking Nurse Manager Span of Control

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

“I think we are all in agreement, a group of managers recently told me – our roles are no longer doable with the growing list of expectations and our ever-increasing spans of control.”

There is no doubt that things have radically changed in nursing over the past two years, and no role has been more impacted than that of frontline leaders. Nurses are younger and need more supervision. At the same time, we are seeing a first in nursing – a tsunami of staff moving to part-time roles sometimes as an outcome of childcare needs or desire for more work-life balance. Some organizations have centralized services such as human resource management, and as an outcome, frontline leaders have picked additional HR responsibilities.

In the pre-Covid environment, research with nurse managers indicated that the average number of FTE supervised was in the mid-sixties. That number was far beyond the HR recommended span of control of 20 FTE. But somehow, nurse leaders have made that work until now. A nurse leader with 60 FTE recently told me that only ten of those FTE now work full-time. She now has 90 nurses, most of whom have been with her for less than two years. She observed that accommodating everyone’s schedules is challenging, but she allows part-time conversions or risks losing her nurses.

What all of this has done is significantly increase the workload of frontline leaders. After thinking a lot about this dilemma, I have concluded that if we are to tackle the ongoing nursing shortage successfully – we need to rethink the span of control of our current leaders.

Defining Span of Control

The span of control is defined as the number of people directly supervised by a manager. This would include all full-time, part-time, travel, agency, 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 effectively lead as more staff are added. Over the years, there have been differing viewpoints about what constitutes an optimal span of control. The ideal control span depends on several variables depending on 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 or ICU 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 significant number of new graduates, the manager will need to do more coaching and requires a smaller span of control.
Geographic dispersion – if work units are geographically distant from one another and require 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 expected of the manager and the level of administrative support 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 manage their responsibilities effectively. Managers who have assistant managers 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 control span, but organizations must carefully study what is happening in their environments. Some organizations have objectively examined the problem and developed an approach to studying the span of control using an objective business and measurement model. The model used by one organization considers the complexity of the unit, staff skill level, volume, and level of administrative support. The span of control adjustments and additional administrative support assignments are made after a careful organization study.

In some cases, Assistant Managers are added or Co-Managers on the unit. Other organizations have taken vital and time-consuming functions such as staffing and scheduling out of the hands of the frontline leader to free up time to coach staff.

The time to begin working on this challenge is now. Nurse managers are linchpins in the retention of staff and the establishment of high-quality and safe cultures. We are now 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.

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