Workforce turnover held steady at 18% in the most recent period and was remarkably consistent across bed sizes and geographical regions. The notable exception is in the West, where median turnover rates remain below the all-hospital median for two consecutive years. The West, most specifically the west coast, has more rigorous labor laws than other regions, including higher minimum wage and nurse-to-patient ratios, which may contribute to lower turnover.

Nationally, median turnover within nursing departments is more than double that of the hospital overall. This holds true for all regions. One thing to keep in mind when examining this data: In this dataset, nursing turnover includes all roles within nursing, including RNs, LPNs, and CNAs. This is important to note because nursing support roles have a higher rate of turnover than registered nurses, which is why this number is higher than we normally see reported for nursing turnover.

While turnover has remained stable in the workforce overall, it remains highest for the roles closest to the bedside. Recruiting and retaining nursing and support roles in acute care continues to be challenging, as bedside nursing staff face workplace violence, incivility, and unsustainable workloads. A recent Advisory Board survey found that only 36% of nurses in bedside roles still plan to be working at the bedside in three years. So even though turnover held steady from 2024 to 2025, the long-term stability of the nursing workforce is eroding. As a result, retention is critical for workforce sustainability and will require leaders to double down on efforts to improve the work environment and make bedside roles more attractive to nurses across their careers.

Reducing turnover has been an ongoing priority for health systems for years. While we can’t back down on traditional retention efforts, it’s important to understand the root causes of turnover and increase support provided to staff. Leaders should:

• Understand key factors driving instability and implement strategies to address them.
• Create engaging career pathways that appeal not only to early career, but to all tenures.
• Implement strategies to prevent early turnover by uncovering discontent before it’s too late.

We observe wide variation in span of control across the percentile rankings. This dataset includes all hospital types from critical-access hospitals to academic medical centers, which likely contribute to the spread from the 10th to 90th percentile. Additionally, there are differences in how roles are defined and how reporting structures are arranged among the reporting hospitals. For example, not all hospitals will have supervisors for every department, and some hospitals may have managers who report directly to a chief executive instead of a director. These individual hospital characteristics will impact span-of-control calculations across the various levels of leadership.

The median ratio of staff and supervisors to manager head count ranges from 9.5 for over 500 beds to 20.4 for 300–499 beds.  Hospitals with less than 100 or more than 500 beds have the lowest span of control.

Span of control also varies across the regions, with the West having the overall lowest median span of control ratios and the Northeast/Mid-Atlantic and South having the highest span of control.

Across the different functional groups, nursing has the highest span of control across all bed sizes. The nursing functional group, which includes all staff employed in all nursing departments at a hospital, also shows the largest variation between bed size cohorts, especially with median staff-to-supervisor head count ratios more than doubling in hospitals with 200 beds or more.

It is important to note that larger organizations often have additional roles that support nurses and nurse leaders, such as educators, resource nurses, or clinical nurse specialists, who are not represented as supervisors or managers in this data. This could make clinical leadership roles at large hospitals appear less prevalent than they are. In smaller organizations, these roles are either not present or may function across multiple units, leaving the nurse supervisor or manager to shoulder more responsibility.

Nursing functional groups consistently show the highest span of control regardless of region, with the exception of the West.

Our all-hospital nursing department-level analysis shows variation in span of control across the acute care unit types.  These department-level ratios are by full-time equivalent (FTE).

Leaders can use span of control as a valuable measure of leader workload. However, national data does not clearly account for variation in reporting structures and role definitions between hospitals. While span of control can serve as a valuable metric, it should not be the only consideration when evaluating leadership capacity. Presence of leadership support roles, experience of the leader, tenure of the staff, and complexity of the environment are all factors that impact a leader’s capacity beyond span of control.

Regardless of how span of control is measured, leader workload is an essential consideration for all health system executives. If leaders are spread too thin, they are unable to focus on key strategic priorities that frontline leaders are well positioned to impact, such as staff retention and patient experience. Leadership can be the difference between an efficient, effective department and one that struggles — and organizations often overlook leadership in conversations about staffing challenges.

Leaders are critical to organizational performance. Executives must equip them for success, even beyond span of control. This looks like:

• Understanding why nurse leaders are leaving and what to do about it.
• Equipping leaders with the skills to lead in volatile, uncertain times and foster a culture that builds resilient, adaptive leaders.
• Working with your leaders to understand how they feel about their workload and employ strategies to make it more manageable.

¹ Certain data in this study were supplied by Strata Decision Technology, LLC (“Strata”). Any analyses, recommendations or advice based on these data are solely that of the author(s) and not Strata.