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The primary aim of this literature review was to examine the quantity, quality, and consistency of evidence regarding the span of control (SOC) specific to nurse managers. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century nurse leaders. The review results were categorized using Donabedian's (2003) Structure-Process-Outcomes model. The Structure-Process-Outcomes approach was used to review the literature and consider SOC recommendations for today's health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources, and organizational characteristics. Processes were defined as activities or actions stemming from identified structures that led to outcomes. Examples included management/administrative activities, as well as frontline staff participation in these tasks. Outcomes were performance measures of human resources, financial, and quality metrics. The review revealed that an SOC model built on a simplistic full-time employment ratio is outdated. Yet, nurse managers remain in their role in the face of these simplistic models despite feelings of inadequacy, exhaustion, and failure because they passionately care about patients and staff. New attitudes and integration of advanced technologies, pioneering tools including SOC assessment tools, and ongoing competency developments will result in different needs of SOC as health care moves deeper into the modern era. This evidence is offered to inform and drive conversations focused on providing optimal nurse manager SOC for maximum effectiveness within unique and ever-evolving care environments.