Span of management: concept analysis

Nurse Manager Span of Control in Hospital Settings: An Integrative Review

BACKGROUND

Nurse managers face great challenges in responding to organizational demands. There exists a general mismatch between managerial span of control and the demands of the job post, which can lead to overburdening and attrition. The aim of this review was to identify the effects of the nurse manager span of control on hospital organizations.

METHODS

An integrative literature review was carried out on nurse manager span of control using the Medline, Embase and Web of Science databases.

RESULTS

21 articles were included. Our findings indicate that the span of control of nursing managers influences outcomes in inpatients, professionals, nurse managers, and the organization.

CONCLUSIONS

The span of control of each nurse manager must be assessed and adjusted to each case. An appropriate span of control will lead to improved outcomes for stakeholders and the organization as a whole.

IMPLICATIONS FOR NURSING MANAGEMENT

Tools must be developed and implemented to measure and evaluate the span of control of nurse managers. This study was not registered.

Understanding the Impact of Span of Control on Nurse Managers and Hospital Outcomes

GOAL

Span of control is a multidimensional concept requiring a comprehensive definition that captures the complexities of the nurse manager's role in acute care settings. This concept analysis aimed to identify factors associated with span of control and provide a comprehensive definition outlining the breadth of this concept.

METHODS

ProQuest, PubMed, and Scopus databases were used to search peer-reviewed literature addressing the span of control in acute care nurse management. The search produced 185 articles; 177 titles and abstracts were screened for eligibility. Data from 22 articles were included in this analysis.

PRINCIPAL FINDINGS

This analysis includes antecedents, attributes, and consequences of expanded nurse manager spans of control. Work-related factors such as staff and manager experience levels, work complexity, and patient acuity are attributes of a nurse manager's span of control. Our findings suggest that expanded spans of control can have negative consequences on nurse managers such as role overload and burnout. Low satisfaction among staff and patients can result from excessive spans of control.

PRACTICAL IMPLICATIONS

An awareness of span of control can promote sustainable nursing practices by improving workplace conditions, staff satisfaction, and patient care quality. Our findings may translate across other health disciplines and thus contribute to scientific knowledge that can support changes in job designs and encourage more manageable workloads.

Size does matter – span of control in hospitals

Purpose

Centralization, mergers and cost reductions have generally led to increasing levels of span of control (SOC), and thus potentially to lower leadership capacity. The purpose of this paper is to explore how a large SOC impacts hospital staff and their leaders.

Design/methodology/approach

The study is based on a qualitative explorative case study of three large inpatient wards.

Findings

The study finds that the nursing staff and their frontline leaders experience challenges in regard to visibility and role of the leader, e.g., in creating overview, coordination, setting-up clear goals, following up and being in touch. However, large wards also provide flexibility and development possibilities.

Practical implications

The authors discuss the implications of these findings for decision makers in deciding future SOC and for future SOC research.

Originality/value

Only few studies have qualitatively explored the consequences of large SOC in hospitals.

Examining the relationships between span of control and manager job and unit performance outcomes

AIM

Our aim was to examine the combination of frontline manager (FLM) personal characteristics and span of control (SOC) on their job and unit performance outcomes.

BACKGROUND

Healthcare downsizing and reform have contributed to larger spans for FLMs in Canadian hospitals and increased concerns about manager workload. Despite a heightened awareness of SOC issues among decision makers, there is limited empirical evidence related to the effects of SOC on outcomes.

METHODS

A non-experimental predictive survey design was used to examine FLM SOC in 14 Canadian academic hospitals. Managers (n = 121) completed an online survey of work characteristics and The Ottawa Hospital (TOH) SOC tool. Unit turnover data were collected from organisational databases.

RESULTS

The combination of SOC and core self-evaluation significantly predicted role overload, work control and job satisfaction, but only SOC predicted unit adverse outcomes and neither significantly predicted unit turnover.

CONCLUSIONS

The findings contribute to an understanding of connections between the combination of SOC and core self-evaluation and manager job and unit performance outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisational strategies to create manageable FLM SOC are essential to ensure exemplary job and unit outcomes. Core self-evaluation is a personality characteristic that may enhance manager performance in the face of high spans of control.

Advancing nursing leadership: a model for program implementation and measurement

Despite the abundant literature documenting the need for nurse management education and career development, only recently have professional standards been targeted for this group. Competency standards for nurse leaders repeatedly identify systems-level concepts including finance and budget, communication skills, strategic management, human resources management, change management, and computer technology skills. However, educational initiatives to meet these standards are still at the early stages and most nurse leaders continue to acquire knowledge and experience through "on-the-job" training. This article will illustrate the need for partnerships and collaboration between academia and hospitals to advance nursing leadership to the next century. In addition, a tool to measure the impact of a graduate certificate program in nursing administration on nurse leader competencies is presented. Overall, the certificate program has been successful in multiple ways; it has "graduated" almost 80 nurse leaders, improved participant competence in their role at the systems level, as well as providing an impetus for completion of a graduate degree post program.