Why Span of Control Isn't the Whole Story
In 2024, Nursing Catalyst measured nurse manager span of control across more than 1,700 frontline managers and 20 workload variables using an AONL-validated assessment tool. That research found that headcount alone does not determine workload and is rarely the most actionable lever.
Nursing Catalyst's 2026 follow-up asked health system leaders how they are responding, and surveyed nurse managers themselves on how the role has changed. Nurse managers report their scope has expanded in every direction with nothing removed. In response, the systems making durable progress are redefining the role rather than adjusting headcount. This page lays out the three-decision framework that emerged, the four enablers that make a redesign durable, and how Baptist Health Jacksonville, ChristianaCare, CoxHealth, and Emory applied it.
Key Takeaways
Administrative burden is the single largest driver of role expansion, cited by 42% of nurse managers
Meetings and administrative tasks rank first and second in how managers spend their time, while staff development and strategic planning rank near the bottom.
Managers with the widest gap between their actual and ideal time allocation report satisfaction scores nearly 30 points lower than well-aligned peers.