Nurse managers, the linchpins of hospital operations, are facing unprecedented challenges. With expanding spheres of control and mounting administrative duties, these crucial roles are often being stretched to their limits. The current state is unsustainable:

• 41% of nurse managers work 51+ hours per week

• Many are responsible for accomplishing 24.3 hours of work during an 8-hour workday, according to one study

• Most report spending minimal time with their nursing teams due to administrative burdens.

As one nurse manager lamented, "I don't even know why I have clinical in my role; I don't get to spend time with my team because I'm so bogged down by everything else."

The Imperative for Change

Chief Nursing Executives (CNEs) recognize that transforming the nurse manager role is not just a goal—it's essential for the future of healthcare delivery. The stakes are high:

• Burnout and turnover among nurse managers directly impact frontline nurse retention and patient care quality,

• The role's current structure is deterring potential leaders from pursuing management positions,

• Inefficiencies in nurse management are contributing to rising healthcare costs.

A Five-Step Approach to Reimagining the Role

Our Nursing Catalyst team has spoken with dozens of organizations trying to update the role of the nurse manager amidst the changing healthcare landscape. They suggest taking a five-step approach to this process:

1. Assess and Analyze

Begin by conducting a comprehensive analysis of the current nurse manager role:

• Use time studies and surveys to understand how nurse managers allocate their time

  • They suggest looking beyond just headcount of each nurse manager to get a more comprehensive look at how much each nurse manager actually has on their plate

• Identify tasks that could be delegated, automated, or eliminated

• Gather input from nurse managers on their pain points and aspirations for the role

2. Redefine Core Responsibilities

Based on the assessment, redefine the core responsibilities of nurse managers:

• Focus on leadership, mentorship, and clinical oversight

• Shift administrative tasks to support staff or technology solutions

• Align responsibilities with organizational strategic goals and value-based care initiatives

3. Restructure Support Systems

Develop a robust support system to enable nurse managers to focus on their core responsibilities:

• Create or expand roles for administrative assistants to handle non-clinical tasks

• Implement technology solutions for scheduling, budgeting, and performance monitoring

• Consider shared service models for functions like HR and finance support

4. Leverage Technology and AI

Identify and implement technology solutions to streamline nurse manager workflows:

• Explore AI-powered tools for predictive staffing and resource allocation

• Implement automated systems for routine reporting and data analysis

• Utilize virtual platforms for more efficient team communication and management

5. Cultivate Leadership and Career Pathways

Develop programs to support nurse manager success and career growth:

• Create mentorship programs pairing new managers with experienced leaders

• Offer specialized leadership training tailored to the unique challenges of nurse managers

• Establish clear career pathways for advancement within nursing leadership

What Does this Look Like in Practice?

After following these five steps, we've seen several health systems make several concrete changes. For instance we've seen some:

1. Narrow Span of Control

Some health systems are experimenting with reducing the number of direct reports for nurse managers. For instance, some are:

• Implementing a tiered management structure with team leads or charge nurses

• Creating specialized roles to handle specific functions (e.g., quality improvement, education)

2. Use Technology More Widely

Other systems are leveraging technology to ease the burden on nurse managers:

• Implementing AI-powered scheduling systems that optimize staffing based on patient acuity and staff preferences

• Using predictive analytics to anticipate and prevent potential issues (e.g., staffing shortages, patient flow bottlenecks)

• Deploying mobile apps that streamline communication and task management

3. Adopt Flexible Leadership Models

Some innovative organizations are rethinking traditional management structures:

• Piloting shared leadership models where responsibilities are distributed among a team of nurse leaders

• Implementing hybrid roles that allow managers to maintain clinical practice while handling leadership duties

Why This Matters

Reimagining the nurse manager role is not just about improving job satisfaction for a select group of leaders—it's about transforming healthcare delivery from the ground up. By empowering nurse managers to focus on leadership, mentorship, and clinical excellence, health systems can:

• Improve nurse retention and recruitment

• Enhance patient care quality and safety

• Drive operational efficiencies and cost savings

• Cultivate a pipeline of future nursing leaders

As healthcare continues to evolve, those organizations that successfully reimagine the nurse manager role will be best positioned to thrive in the face of ongoing challenges and seize new opportunities for innovation in care delivery.

How Nursing Catalyst Can Help

The Health Management Academy’s Nursing Catalyst research collaborative recently conducted research aiming to build a comprehensive, quantifiable definition of manager span of control. Nursing Catalyst researchers surveyed over 1,700 frontline managers on their spans of control, as well as the variables within their work environment that impact their workload.

Click here to find out more about Nursing Catalyst and learn more about their findings.