What the data says
A manager’s span of control has a high influence on early-tenure nurse turnover. In the figure above, all-tenure RN turnover is shown in light blue and early-tenure RN turnover in dark blue, arranged in order of rising span of control.
As illustrated in the chart, early-tenure RN turnover increases as the number of employees a manager oversees increases. The pattern is striking, with rates increasing significantly as a manager’s span of control grows—rising from 27% at about 45 headcount to as high as 40% at about 90 headcount.
What it means
Higher early-tenure turnover in larger teams results not only in workforce instability and exacerbated nurse manager burdens, but also in substantial financial costs - higher costs which may be partly avoidable.
Consider two team models, as shown in the table below. On both teams, 30% of the members are RN headcount are in their first 18 months:
In the 90-headcount team (“A”), approximately four more RNs leave compared to the smaller teams (“B”): 11 versus 7.2. This results in over $300,000 in additional annual turnover costs based on national averages (NSI 2024).
For teams with large spans of control and a high proportion of early-tenure RNs, it may make financial sense to split them into two units with separate managers. The savings from reduced turnover—estimated at over $300,000—would more than offset the cost of an additional nurse manager.
Although reducing the number of beds is rarely an option, one community hospital addressed high spans of control by designating rooms on a large Med Surg floor as a separate intermediate care unit with its own manager. This adjustment lowered spans of control with two managers without physically relocating beds.
Implications for healthcare executives
The Spring 2025 AONL-Laudio report, which these charts were first published in, “Early-Tenure Nurse Retention: Trends and Leader Strategies,” includes a few key recommendations for executives to support managers, especially those with large teams, by reducing administrative burden.
AONL's whitepaper on Span of Control also provides valuable guidance for leaders in assessing the workloads of managers. It highlights the availability of tools for evaluating workload and manager performance based on evidence.
In addition, digital tools can help reduce the administrative tasks that managers face, allowing them more time to engage with their staff. Additionally, these tools can facilitate better communication between leaders and their teams.
To support new check-ins, which the new report also underscores, are a powerful way to support and retain early-tenure RNs, one organization has the entire team participate. Touchpoints occur every two weeks for the first four months, along with additional meetings at 30, 60, and 90 days. The manager conducts evaluations at six months and one year, while other meetings may be led by assistant managers, charge nurses, master nurses, or educators. Involving various leaders and experienced clinicians in these check-ins helps create a broader network of support for new nurses.
For more on what the data shows about proven ways to drive early-tenure RN retention and better support nurse managers as they work to retain their new nurses, download the AONL-Laudio report here.
This article is based on data and analysis that first appeared in the AONL-Laudio Spring 2025 report, “Early-Tenure Nurse Retention: Trends and Leader Strategies.”
References
AONL Workforce Committee, Span of Control Subcommittee. (2024). Span of Control. Retrieved from https://www.aonl.org/system/files/media/file/2024/07/workforce-spanofcontrol.pdf