In 2024, Nursing Catalyst surveyed more than 1,700 nurse managers to understand drivers of workload strain and unsustainability in frontline leadership. This snapshot builds on that work, highlighting how one health system reduced overload through structural redesign. Click here to explore the full series.
Executive Summary
After an initial restructuring of three of its largest units, CoxHealth used Nursing Catalyst’s span of control benchmarking report to build the case for system-wide redesign. Nurse managers at CoxHealth faced two challenges: large units and a mounting payroll burden. To address both, the organization restructured five of its largest nursing units, centralized payroll, and gave assistant nurse managers direct reports across the entire system. These changes freed nurse managers to be true frontline leaders: building staff relationships, overseeing unit operations, and focusing on the high-impact work of the role. Since the redesign, CoxHealth has seen sustained improvements in RN retention and nurse-influenced quality metrics.