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Reexamining Nurse Manager Span of Control With a 21st-Century Lens

Omery, Anna DNSc, RN, NEA-BC; Crawford, Cecelia L. DNP, RN; Dechairo-Marino, Ann PhD, RN, NEA-BC; Quaye, Beverly S. EdD, RN, NEA-BC, FACHE; Finkelstein, Jim MBA, BA

doi: 10.1097/NAQ.0000000000000351
Original Articles

The primary aim of this literature review was to examine the quantity, quality, and consistency of evidence regarding the span of control (SOC) specific to nurse managers. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century nurse leaders. The review results were categorized using Donabedian's (2003) Structure-Process-Outcomes model. The Structure-Process-Outcomes approach was used to review the literature and consider SOC recommendations for today's health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources, and organizational characteristics. Processes were defined as activities or actions stemming from identified structures that led to outcomes. Examples included management/administrative activities, as well as frontline staff participation in these tasks. Outcomes were performance measures of human resources, financial, and quality metrics. The review revealed that an SOC model built on a simplistic full-time employment ratio is outdated. Yet, nurse managers remain in their role in the face of these simplistic models despite feelings of inadequacy, exhaustion, and failure because they passionately care about patients and staff. New attitudes and integration of advanced technologies, pioneering tools including SOC assessment tools, and ongoing competency developments will result in different needs of SOC as health care moves deeper into the modern era. This evidence is offered to inform and drive conversations focused on providing optimal nurse manager SOC for maximum effectiveness within unique and ever-evolving care environments.

Clinical Practice (Dr Omery) and Evidence-Based Nursing Practice (Dr Crawford), Kaiser Permanente Southern California, Regional Patient Care Services, Pasadena; Providence Holy Cross Medical Center, Mission Hills, California (Dr Dechairo-Marino); California State University, Fullerton, School of Nursing, College of Health and Human Development, Fullerton (Dr Quaye); and FutureSense, LLC, San Rafael, California (Mr Finkelstein).

Correspondence: Cecelia L. Crawford, DNP, RN, Evidence-Based Nursing Practice, Kaiser Permanente Southern California, Patient Care Services, 393 E Walnut St, Pasadena, CA 91188 (

The authors declare they have no conflicts of interest, including financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest

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