Can hydralazine be given via an I.V. push on a medical-surgical unit? Is the chest tube set up correctly? A patient's family member is upset and wants to speak with the administrator. A patient wants to leave against medical advice, what needs to be done? Two RNs just called in sick for the night shift on the oncology unit. These are just some of the problems you may need to resolve if you'd like to be an off-shift supervisor.
Throughout our nursing careers, we've all had interactions with off-shift supervisors—nurses who are in charge of the hospital on the off shifts (weekends and holidays) when unit managers, directors, and administrators aren't in the hospital. Depending on the size of the hospital, there may be one, two, or three off-shift supervisors working each shift. It's preferred that off-shift supervisors have an MSN degree, although some employers accept those with the BSN credential. The American Nurses Credentialing Center nurse executive certification is also recommended for the off-shift supervisor role.
Two important qualities that an off-shift supervisor must possess are nursing experience and excellent nursing skills. Generally speaking, institutions require an ACLS certification and prefer that applicants have critical care experience. The off-shift supervisor, at most hospitals, is a key member of the rapid response and code blue teams. During these emergency procedures, the supervisor ensures that patients receive necessary care and the appropriate team members are present, and assists in any other roles as needed. It may be the off-shift supervisor who brings family members to the bedside during a code, coaches the critical care nurse with her first defibrillation, or encourages the student to assist with chest compression.
The off-shift supervisor is the whole-house administrator for the hospital and must integrate the services and resources within the hospital, as well as determine staffing patterns and project coverage needs based on census and acuity. Responsibilities may also include patient advocate, I.V. nurse, nurse educator, staffing coordinator, administrator, dietitian, social worker, and fire safety official.
Instead of taking care of patients, the off-shift supervisor is taking care of the nursing staff. This supervisor is always acting as a role model and may guide a new RN in the charge nurse role or mentor nurses regarding their career, whether continuing their education, obtaining certification, or moving to another position.
Ensuring that there's appropriate staffing based on the unit census is an important way to start the shift. Some hospitals have staffing coordinators to assist with this, however, it's the off-shift supervisor's ultimate responsibility to make certain that the nurse-patient ratio is appropriate. This can be challenging, whether in obtaining additional staff during increased census or reducing staff when the census is lower. Remember to ask yourself, “Would I be comfortable caring for this number of patients or working on this unit?”
Another difficult part of this position is reassigning RNs to different nursing units. Most nurses, even though they're more than competent to work in new departments, are nervous and scared to leave the comfort of their own unit. Off-shift supervisors should spend time listening and supporting these reassigned nurses who say, “I've never worked there before” or “I don't know anyone on that unit.” Simple gestures such as taking them to the new nursing unit, introducing them to the staff, showing them where to put their belongings, and maybe even getting them a cup of coffee make this transition smoother. Nine times out of 10 you'll yield more positive results from this approach than with, “You work for the hospital and not the surgical unit and if you refuse this assignment disciplinary action will result.” At the end of the shift, some reassigned RNs may even prefer the new unit and will offer to help out if needed.
Making rounds to the nursing units is a critical job component because it's during these rounds that the supervisor can speak with the charge nurse and other staff to obtain a sense of the activity on the unit. Just as the staff nurse makes patient rounds and assesses patients, the off-shift supervisor makes rounds and assesses the nursing units and staff. During rounds, nurses and physicians may ask the off-shift supervisor questions that might otherwise go unasked, such as how to find a policy, where to find job opportunities, or how to decipher medication orders.
When questions can't be answered by the unit charge nurse, it's the off-shift supervisor who comes to the rescue. Questions can range from simple, such as how to use a new piece of equipment, to complex, such as should this ED patient be coming to a medical-surgical unit?
As with any position, there are positive and negative aspects of being an off-shift supervisor. It can be very rewarding when you deescalate a situation with a patient's husband and then a few months later he calls to thank you, or when you calmly lead the staff through an evening of multiple admissio ns and high acuity by just lending a hand. However, it's difficult when you must deal with an impaired nurse or receive a phone call from an angry physician. In addition, at some institutions, the off-shift supervisor covers hospital departments that are closed, so the supervisor may need to get sandwiches from the kitchen or supplies from medical supply. Remembering that the goal of this position is to facilitate effective patient care can assist the supervisor through these aspects of the role.
Imagine having an evening when you must answer/resolve the following situations that happen simultaneously: a psychiatric patient has managed to get outside and the police want to speak to the supervisor, two nurses on the telemetry unit are having a loud verbal disagreement and won't work together, and an ICU nurse just received a needlestick injury. On another evening, you might have to lead the hospital through a bomb scare or disaster event such as a bus accident with 50 victims. If this sounds exciting to you, then speak with your nurse recruiter or return to school and embark on a journey into leadership as an off-shift supervisor. If you love to lead and mentor others and enjoy a fast-paced environment with constant variety, this job is for you. Your time and energy will be spent supporting the nursing staff and reaping the reward of your own professional growth.
What's in a name?
Off-shift supervisors may be referred to as:
- clinical administrative coordinator
- assistant director of nursing
- shift administrator
- evening/night nursing supervisor.