Aim: To study structural conditions for first-line management practice in hospitals, focusing on structural empowerment and span of control (SOC).

Methods: Data were collected through observations, questionnaires, and interviews. The participating first-line managers (FLMs) and nursing staff worked in medicalor surgical units across Sweden.

Results: FLMs positioned at units where staff perceived access to empowering structures consistently worked to provide resources, information, support, and development opportunities to their staff. Interviews with the FLMs and nursing staff confirmed the observations and revealed a shared understanding of the importance of staff having access to empowering structures. Additionally, nursing staff’s ratings showed a relationship between these structures to the staff’s ratings of well-being and care quality. FLMs emphasized adequate staffing as a crucial resource for their management practice, along with effective information flows, supportive work relationships, and influence. The questionnaire used to measure SOC captured FLMs’ scope and complexity beyond the number of subordinates. Adjusting response options to reflect Swedish recommended ratios of staff per FLM increased the number of FLMs with results indicating that their SOC should be adjusted to be manageable.

Conclusions: The findings support Kanter's theoryof structural empowerment and demonstrates how staff access to resources, opportunities, and support relates to staff well-being, and that staff access to support and professional networks can be linked to staff perceptions of care quality. FLMs managing staff perceiving access to empowering structures, prioritize presence and availability to support staff in daily operations. FLMs’ own access to resources, networks, and inclusion in decision-making was described as enhancing their efficiency. Additionally, the tested questionnaire proved relevant for capturing managers’ SOC beyond headcount.