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theses

The current model of off-shift management or supervision in acute care hospitals in the United States is having an administrative supervisor, who is the nurse leader present on the evening, night, and weekend shifts. Despite the existence of the administrator supervisor role in hospitals for more than 100 years, research on this role is lacking. The purpose of this focused ethnographic study, which was conducted in two parts, was to explore the administrative supervisors’ perspective of their managerial practices and how these practices contribute to nurse and patient safety. The first part consisted of seven focus groups with off-shift staff registered nurses to identify the administrative supervisors’ role in nurse and patient safety. The second part consisted of in-depth telephone interviews with 30 administrative supervisors, recruited nationally from 20 different states, to describe the managerial safety practices and role responsibilities of the supervisor. The overall theme identified in this research study was the administrative supervisor as the shift leader who does whatever is necessary to get the patients, staff and hospital safely through the shift. The administrative supervisors viewed themselves as leaders, not managers, and felt disconnected from the nursing leadership team. Regardless of the size, type or location of the hospital, the findings revealed the administrative supervisors achieve nurse and patient safety when performing their role responsibilities, of staffing, patient flow, crisis management, and hospital representative, and through processes of making it work. The supervisors, who function as off-shift safety officers, establish trust with the staff, do rounds, educate, and provide support by which they “make it work” and achieve the outcomes of nurse and patient safety. This is the first time that research has identified the administrative supervisor role responsibilities and processes through which they achieve safety. The often-invisible administrative supervisor role is now being brought to the forefront, revealing the impact this shift leader has on safety. Thus, the findings from this groundbreaking research study identify emerging questions and implications for hospitals regarding the nursing leadership structure and nurse and patient safety, and are relevant for hospital nurse leaders, nurse leader organizations, nurse scientists, and administrative supervisors.

ETD_7145

Ph.D.

Includes bibliographical references

by Susan H. Weaver

doi:10.7282/T3XG9TB4

ETD doctoral

The author owns the copyright to this work.