NURS 623 Week 4 Discussion Board Forum 1 on Nurse Manager Span of Control Example

Discussion Board Forum 1: Nurse Manager Span of Control and What It Costs

NURS 623 Nursing Administration I: The Role of the Nurse Administrator, Discussion Board Forum 1

Thread by [Student Name]

The hospital, managers and classmates replied to are composites written for a model discussion.

Last month I shadowed a nurse manager at my practicum hospital who is responsible for three medical-surgical units, 96 beds and about 140 staff. In a single week, the manager attended eleven meetings, completed forty-two timecard corrections, interviewed four applicants and handled two patient complaints, and managed to round on each unit only once. Staff on the third unit told me they had not had a one-on-one conversation with the manager in over a year, and the unit's two most experienced nurses had both applied for positions elsewhere. The charge nurses were filling the gap informally, making decisions about staffing and conflicts that should have been the manager's, without the authority or the pay to match. My position is that this is not a problem of personal time management. It is a problem of span of control, the scope of what one manager is asked to lead, and span of control is an administrative decision that nurse administrators must treat as seriously as staffing ratios.

Roussel (2018) describes span of control as the number of people and units a manager is responsible for, and explains that organizational structure determines how much attention a manager can give to each. A wide span may look efficient on an organizational chart, but it shifts costs elsewhere.

Recent evidence shows where those costs appear. Warshawsky et al. (2026) collected data from 255 nurse managers who oversaw 296 units in 47 hospitals and found that nurse turnover was significantly correlated with the ratio of staff full-time equivalents and beds per manager, and that higher fall rates were associated with higher daily census and more beds per manager, while pressure injuries showed no significant association. They also found wide variation in span of control and organizational support across hospitals. When the same job is three times larger in one hospital than in another, the difference is a choice made by leaders, not a fact of nature.

Qualitative research describes what goes missing. Chiappinotto et al. (2026) interviewed 22 nurses in management, clinical, executive and education roles and identified four kinds of missed nursing management: systemic planning and monitoring, effective presence in the clinical environment, coordination and alignment with goals, and promoting staff development. Those are exactly the functions the manager I shadowed could not perform.

For a nurse administrator, three actions follow. First, measure span of control with workload, not just headcount, including the number of units, beds, staff and shifts. Second, set a maximum span and add assistant managers or charge nurse leaders where it is exceeded, giving those leaders real authority and protected time. Third, remove administrative tasks, such as timecard corrections, from managers through better systems or clerical support.

Moses tried to judge every dispute among the people himself until his father-in-law warned him, "What you are doing is not good. You and the people with you will certainly wear yourselves out" (English Standard Version Bible, 2001/2016, Exodus 18:17-18). The solution was a structure of leaders over smaller groups. Nurse administrators can learn from that ancient advice.

Reply to Renee

Renee, I agree with your point that adding assistant managers costs real money that many hospitals feel they cannot spend, and I think the strongest answer is to make the financial case alongside the clinical one. Recent work on the partnership between chief nursing officers and chief financial officers suggests how. After a national dialogue among CNO-CFO pairs, an organization for nurse leaders developed guiding principles encouraging the two executives to treat their relationship as strategic rather than transactional, engaging finance partners early, creating shared measures of success and aligning nursing priorities with the organization's value (Mathews et al., 2026). For span of control, that could mean building a shared measure with finance, such as turnover cost per unit, and showing how it changes when managers' spans are reduced. If the turnover data from the study I cited hold in your hospital, an assistant manager position might pay for itself by preventing a few resignations a year. Proverbs 15:22 says plans succeed with many advisers (English Standard Version Bible, 2001/2016), and a CNO who brings the CFO into the plan early is more likely to see it funded. Has your hospital ever calculated what turnover costs on a single unit? That number might be the most persuasive one you could bring to a budget meeting, especially if you can show it next to the manager's span on the same unit. Finance leaders tend to respond to a comparison between two units more readily than to a general argument about workload.

Reply to Thomas

Thomas, your suggestion that unit councils could take on some of the work that overloads managers is a good one and deserves a trial, and there is recent evidence that councils can strengthen units in ways that also support managers. When a Dutch academic hospital set up practice councils on four of its wards, the next year brought over a year by small improvements in nurse engagement and the practice environment, with larger gains among nurses who served on the councils, and the councils became a routine part of unit life (Jans et al., 2026). If councils lead practice improvements such as handoff redesign or patient education, the manager no longer has to drive every change personally. I would add one caution: councils need a manager's support to work, so they lighten the manager's load only if the manager has enough time to coach them at the start. Paul wrote that leaders are given "to equip the saints for the work of ministry" (English Standard Version Bible, 2001/2016, Ephesians 4:12), which describes the manager's role in a council model very well: equipping others rather than doing everything alone. How would you protect a manager's time during those first months, before the new councils are able to carry their share of the work? One option might be a temporary assistant manager funded for six months as a pilot, with the expectation that the councils will absorb some of that work afterward, which would also give you data to bring back to finance.

References

Chiappinotto, S., Eskici, G. T., Miorin, F., & Palese, A. (2026). Functions and activities missed by nurse managers, their antecedents and consequences: Findings from a qualitative study. Journal of Nursing Management, 2026(1), Article e4992301. https://doi.org/10.1155/jonm/4992301

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Jans, M. M., Stallinga, H. A., Olvers, M. A., Ter Sluysen, J., de Brouwer, B. J., Finnema, E. J., de Vos, R., & Heemels, M. I. (2026). The impact of introducing unit practice councils on nurse engagement, the nurse practice environment and evidence-based practice: A longitudinal observational study. International Journal of Nursing Studies Advances, 11, Article 100584. https://doi.org/10.1016/j.ijnsa.2026.100584

Mathews, B., Watson, J. L., & Drenkard, K. (2026). The CNO-CFO dyad: A strategic driver of organizational performance. The Journal of Nursing Administration. Advance online publication. https://doi.org/10.1097/NNA.0000000000001771

Roussel, L. (2018). Management and leadership for nurse administrators (8th ed.). Jones & Bartlett Learning.

Warshawsky, N. E., Pascale, A., & Duemig, M. J. (2026). Impact of nurse manager span-of-control on turnover and patient safety in acute care. The Journal of Nursing Administration, 56(4), 186-190. https://doi.org/10.1097/NNA.0000000000001709