Night Shift Administrator

My Specialty

Night Shift Administrator

Managing clinical operations and emergency response during off hours

By Keith Carlson, RN, BSN, CPC, NC-BC
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Can you describe the arc of your nursing career?

I started my nursing path attending Cal State Sacramento. While pursuing my degree to become an RN, I detoured and became an LVN in order to enter the nursing workforce more quickly.

During the course of my studies, I was fortunate to be hired on with Methodist Hospital in April 1984 as an LVN. I then transitioned into the RN role after a few years. I spent two years in oncology and then transferred to critical care. I finished my BSN at Azusa Pacific University in 1986.During the course of my studies, I was fortunate to be hired on with Methodist Hospital in April 1984 as an LVN.

I then transitioned into the RN role after a few years. I spent two years in oncology and then transferred to critical care. I finished my BSN at Azusa Pacific University in 1986. Along the way, the administration and staff at Methodist noticed my leadership abilities and encouraged me to work as a per diem house supervisor. I eventually earned a fulltime position as night shift administrative coordinator and have been active in that role for 25 years. It’s been wonderful and I loved it from the very first day. 

What leadership skills did your colleagues see in you?

They saw that I was task-oriented, focused and had compassion in my heart. I’m a dedicated person who’s always willing to help others and pitch in. I’m sure they also noticed that I have strong communication and delegation skills as both a peer and a supervisor.

What was it like to go from bedside to administration? 

I actually felt as though I’d gained something and not lost anything. I gained responsibility and the trust of so many nurses.  When I first started in the per diem leadership position, I was working as both an administrator and a nurse in critical care. My focus is and always will be on positive outcomes for staff and patients. The staff always knows that when I’m working, things are going to go well.

What is your role and responsibilities?

I serve as the night shift house supervisor, which means that I’m responsible for representing administration during off hours.  The core of my role is managing clinical operations and emergency response during night hours, including directing and coordinating services for patient safety according to hospital guidelines. I also support staff development and patient throughput. 

We have access to a rapid response nurse. If any issues arise, she or he can evaluate a patient and choose a course of action. The rapid response nurse interacts with physicians and determines if patients need to be transferred to the ICU.  We also rely on our critical care charge nurses and hospitalists.

Although we may not have clinical nurse specialists during the night shift, we have highly experienced charge nurses who are just wonderful to work with.

What do you like about night shift? 

One of the things I love about night shift is that we depend on one another. Our bond is strong and we are highly interdependent.  Every night, we have a huddle in the nursing office with the charge nurses. We talk through issues, seek resolutions, discuss pending discharges, examine the patient census and remind each other about pending surgeries and possible transfers to other units.  We’re essentially looking for safe, efficient patient throughput and optimal outcomes in a highly collaborative environment. 

What are some areas on which you focus in terms of outcomes?

Throughput is a central concern these days. We need to get patients admitted, cared for and discharged in a reasonable amount of time. Our throughput is designed to improve patient flow.  Fall prevention and keeping patients safe are incredibly important, as is paying close attention to our processes related to code STEMI and code stroke. 

What other changes have you seen?

A lot of the technology with code STEMI and code stroke requires a higher level of training for our nurses. While this has opened up new pathways and responsibilities, nurses also need ongoing education to care for critical patients. Our nurses have to be prepared for every potential clinical situation.  Acuity has also changed. Patients who would have been in the ICU in the past are now on the regular floor. Patients are sicker and more acute and comorbidities are greater. Nurses have to be very advanced in their technical knowledge and assessment skills.

What level of education do you recommend for nurses?

I recommend nurses be baccalaureate-prepared because that educational path offers more courses in subjects like theory and evidence-based practice. This prepares nurses for opportunities to advance to higher positions that require a BSN, such as director of nursing, or positions requiring a master’s degree, such as the nurse practitioner role.

What do new nurses need when they begin their first position? 

I think the most important thing they need is support — that’s No. 1. It’s a new environment and they need to absorb so much more beyond mere book knowledge.  New nurses need positive role models, someone they can go to when they have questions. They need strong preceptors who can really explain things so that their knowledge base can grow.  We also recognize that many new nurses come from other disciplines and prior careers. They can bring new knowledge and viewpoints to the Methodist community. 

How do you address bullying among nurses? 

Bullying is not tolerated here. If any type of bullying comes to our attention, the nurse in question is pulled aside and we openly discuss the situation. We never have the two parties together in order to avoid escalation. Instead, we seek to defuse the situation, get to the source of what ignited the flame and put it out as quickly as we can.  “Eating our young” is not acceptable. We need to take new nurses under our wings.

What challenges do you see for 21st century nurses?

Technology can be a challenge for some of the older nurses. We can learn from the younger nurses, who have much more facility with computers, apps and software.  We also need to be increasingly aware of patient safety. For example, we’ve seen a trend of homeless patients with psych issues being admitted to our facility and the nurses are challenged by that. The nurses need to be aware of the clinical aspects, but also cognizant of the mental and psychosocial health issues at hand. 

Cultural awareness and sensitivity are also extremely important. We now have mandatory classes on cultural awareness, the use of language and how to respect patients from varying cultures and backgrounds.

What career strategies do you recommend for nurses interested in leadership? 

Nurses need to demonstrate their leadership abilities no matter what positions they hold. A nurse needs to show the qualities of a leader at all times.  Leaders need to be active listeners and skilled communicators. On night shift, you’re the nucleus, so you must have the ability to hear all points of view and reflect back what you’ve heard. If you don’t listen, everything gets lost in translation.  If you have the goal of officially stepping into nursing leadership as a career move, you should educate yourself on the qualities, knowledge and skills that will help you develop. This will prepare you for future opportunities and make you an attractive candidate for leadership positions.

What are your professional goals? 

One day, I’d like to teach nursing. With all of the advances in technology and the future looking so bright for our profession, I’d like to earn a teaching credential so that I can make an impact on the next generation of nurses.  I have a lot of energy, so I could do what I do now while also being an engaged and dedicated educator in a nursing program.

Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

This article is from workingnurse.com.

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