Knowledge Bank

OBJECTIVE: The primary aim of the evidence-based practice change was to optimize the nurse manager's span of control by implementing standardized titles and functions. BACKGROUND: Nurse manager roles are critical in healthcare organizations to ensure a high-quality workplace, influence organizational performance, nurse satisfaction and empowerment, staff turnover, and patient outcomes. With the constant changes to healthcare and the complexity, healthcare organizations try to find different ways to reduce costs for day-to-day operations. In response, nurse manager roles may be redesigned or even eliminated, expanding the roles of the remaining nurse managers and increasing their workload and span of control. METHODS: A quality improvement evidence-based practice change was implemented to examine nurse manager span of control in eight inpatient units within a children's hospital in Southwest Florida. Nine newly promoted nurse managers out of 13 participated with a 69% response rate. The Ottawa Hospital span of control tool, nurse manager satisfaction, intent to stay, and time with direct reports were measured for baseline data, weekly post-implementation, and seven weeks post-implementation. RESULTS: Overall, nurse manager satisfaction level and intent to stay decreased seven weeks post-implementation of the new NM role. However, the time spent with direct reports and NM satisfaction level of the time spent with their direct reports increased seven weeks post-implementation from baseline data. CONCLUSION: Healthcare organizations, senior nursing leaders, and nurse managers must continuously evaluate and adjust nurse managers' span of control to maintain appropriate workloads and span of control in the appropriate range that allows nurse managers to function effectively in managing, supporting, and mentoring staff, thus increasing nurse manager job satisfaction and intention to stay.