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Time for a Change: From Span of Control to Span of Accountability in Nursing Leadership
Karen Drenkard1, Brandy Mathews
1Author Affiliations: President (Dr Drenkard), Drenkard Healthcare Consulting, Fairfax, Virginia; and Chief Nursing Officer (Dr Mathews), University of Kentucky HealthCare Good Samaritan Hospital, Lexington.
Abstract:
In the evolving landscape of healthcare, nurse managers are expected to lead across systems, influence patient outcomes, and drive strategic priorities, far beyond the traditional scope of direct supervision. Yet, the term "span of control" remains a default metric for evaluating their workload and effectiveness. Rooted in industrial-era management theory, this language no longer reflects the complexity of contemporary nursing leadership. These authors propose a shift to "span of accountability," a more accurate, empowering, and future-ready framework. This commentary explores the theoretical rationale, practical implications, and strategic benefits of updating this lexicon to align with modern healthcare realities.
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