ADMINISTRATIVE SUPERVISORS are the nurse leaders during the evening, night, or weekend shifts. Sometimes referred to as nursing supervisors, house supervisors, administrative managers, house managers, nurse administrators, and administrators on duty, these leaders often serve as a resource and mentor to the nursing staff to ensure patient safety. They have a range of responsibilities, including staffing, administrative and operational emergencies, and patient and staff concerns.1 As key stakeholders on the nursing leadership team, administrative supervisors are essential to ensure high-quality patient care.2
These nurse leaders must be knowledgeable, experienced, and flexible enough to make decisions quickly in high-stress situations (see Lessons learned). Effective communication, troubleshooting, and problem solving are key leadership skills to maintain a safe environment and optimal patient care. This article discusses the role of administrative supervisors and offers insight for nurses interested in the position, illustrated with examples from the personal experiences of authors Suzanne Crincoli and Susan H. Weaver.
Administrative supervisors have been around for more than a century, with night supervisors conducting formal rounds, completing reports, and supervising nursing students as early as the 1930s.3 The role has evolved over the years, and, in 1960, the Handbook for the Nursing Supervisor in the Small Hospital was published to assist supervisors with administrative duties for which they may not have had any prior training.4 These included obtaining permission for autopsies, medical examiner cases, and patient refusals of certain treatments, especially blood transfusions.
Today, administrative supervisors still conduct rounds, oversee patient care, and manage staff on evening, night, and weekend shifts. Nurses in this role usually report to the CNO or the director of nursing and have the support of an on-call administrator. As part of the leadership team, administrative supervisors have a bird's-eye view of the organization's care delivery process and provide feedback to implement improvement plans and increase patient satisfaction in specific units.
The minimum educational requirement for the role is a bachelor's degree in nursing, but a master's degree is preferred. In addition, many candidates are certified by a national nursing specialty organization. In two research studies from the mid-Atlantic region of the US, most participating administrative supervisors had national nursing certifications as nurse executives, emergency nurses, critical care nurses, or medical-surgical nurses.5,6
Many administrative supervisors enter this leadership role with charge nurse experience and as experienced clinicians. Experience in the critical care unit or ED is beneficial, as these leaders must respond to all patient-care emergencies, including rapid responses and cardiac arrests.
An administrative supervisor's primary responsibility involves staffing, including managing sick calls and ensuring the appropriate staff coverage for patients, but crisis management and patient flow and placement are also key responsibilities. Similarly, promoting patient satisfaction and responding to patient concerns are important and challenging responsibilities. Other functions include acting as a liaison between staff, patients, families, and other members of the care team.
Additionally, administrative supervisors ensure adherence to all hospital policies and procedures and provide education to the nursing staff. This may include helping new nurses with procedures they have never done, demonstrating how to use a new piece of equipment, acting as a coaching resource for charge nurses, and providing information about hospital changes. Because they typically have extensive clinical experience, they can be a ready resource for common nursing procedures such as inserting I.V. catheters and nasogastric tubes.
Besides leadership and clinical expertise, recent research identified the following key skills necessary for this leadership role.7,8
- Effective communication is essential when discussing an issue with patients, nursing staff, physicians, or other departments, as well as when listening to their concerns and working together for a solution.7 It also fosters teamwork, as administrative supervisors keep staff updated on admissions and what is going on in the rest of the hospital, enlist the cooperation of other departments, and support other units with additional nursing staff during busier times.7
- Conflict management involves fielding any complaints and concerns that escalate during a shift. Conflict resolution approaches help administrative supervisors to handle a multitude of issues that may arise between staff, physicians, patients, and families. Sometimes, patients and families respond differently to someone in a white lab coat; other times, the supervisor may have to deescalate a situation before discovering what the patient really needs. Occasionally, the assistance of the on-call administrator is needed to help resolve an issue.
- Time management is critical because administrative supervisors often need to respond to multiple situations happening at the same time. With less staff on the evening and night shifts, delegation is not typically a possibility for these leaders. Supervisors must learn how to complete their time-sensitive responsibilities while responding to emergencies and weaving in their other responsibilities throughout the shift.
Putting skills into practice
As an ED nurse, I had responded to many rapid response calls. As administrative supervisor, however, I had to learn how to respond when multiple rapid responses were called at the same time.
Typically, a resident, a critical care nurse, and the administrative supervisor each respond to rapid responses as decision-making support at my facility. One evening, multiple rapid response pages went out simultaneously. As administrative supervisor, I acted as a patient safety officer and triage nurse. I responded to each rapid response, assessed each patient for acuity, and ensured that a resident and a critical care nurse were available to care for each patient. Later, both the residents and the nurses expressed a sense of security in knowing that an experienced administrative supervisor was there to assist and support their clinical decisions.
On another occasion, I received a phone call from a charge nurse to discuss medication safety with a group of residents. After arriving on the unit, I learned that the residents wanted to administer a high-alert medication without following the proper protocol. I discussed the policy and procedures with the residents and explained that high-alert medications needed to be administered by staff who have successfully completed an Advanced Cardiovascular Life Support course while patients are appropriately monitored. We worked together, the patient was placed on a cardiac monitor, and the medication was administered per hospital policy and procedure. Before I left, I commended both the nurse and the charge nurse for contacting me and advocating for their patient's safety.
In the seminal study of Magnet® hospitals, evening and night supervisors were recognized by the nursing staff as supportive, accessible, and willing to help with care, but empirical research on this role has been lacking.9 Recent interviews with 30 administrative supervisors across the US revealed that, as shift leaders, these healthcare professionals do whatever is necessary to get the patients, staff, and hospital through the shift safely.2 Additionally, this study demonstrated that, regardless of the size, type, or location of the hospital, administrative supervisors achieve nurse and patient safety when performing the responsibilities of the position, including staffing, patient flow, crisis management, and representing the organization.2 These nurse leaders function as safety officers, establishing trust, conducting rounds, and educating and supporting the staff.10
Now is an opportune time for those interested in the position for several reasons. First, most administrative supervisors indicated that they are satisfied or very satisfied in their work.5,6 Second, role-specific education programs are being held for the position. For example, one state in the mid-Atlantic region of the US holds an annual education program featuring presentations on leadership, substance use disorders and dealing with impaired nurses, and testimonials from administrative supervisors regarding their experiences with mass shootings and hospital evacuations.
Seasoned nurses with expert clinical skills, the ability to mentor colleagues, and an interest in leadership should consider an exciting role as an administrative supervisor. These nurse leaders are vital in maintaining the highest standards of care for patients and families.
During my orientation as an administrative supervisor, I learned firsthand what an effective nurse leader looks like in the face of crisis. I had been training for a few weeks, following my preceptor from unit to unit as she introduced me to the staff, and had started to develop my own rhythm.
One evening, the fire alarm sounded, and my preceptor instructed me to call security to identify the location of the alarm. We arrived on the unit, smelled smoke, and sprang into action. Ensuring patient and staff safety, we secured the corridors and waited for the fire department. Shortly after they arrived, the small fire was contained, and all patients and visitors were safe.
I will always remember the calm, cool demeanor of my preceptor as she instructed me to follow her lead. We made sure all patients were out of harm's way in a safe location, identified any hazards, and assured the staff that they were safe. Not only did she handle the situation in the moment, but she also taught me what to do because a crisis was bound to occur in the future. As the unit returned to normal, we continued with business as usual.
One thing that stood out was is the way the nursing staff came together, asked what they needed to do, and looked to us for guidance. The nurses thanked us for staying calm and maintaining a safe environment. That night, the culmination of my training and years of experience as an ED nurse helped me evolve into an administrative supervisor.