Report From the Night Shift

Abstract

The administrative supervisor role (the nurse leader on the evening or night shift) has been present in hospitals for more than 100 years, but research is just commencing regarding how this leader achieves nurse and patient safety. This focused ethnographic study was conducted in 2 parts. The first part consisted of focus groups with night-shift staff nurses, held at 7 hospitals in the mid-Atlantic region of the United States, with the objective of obtaining the staff nurses' perception of the supervisors' role. The second part consisted of interviews with 30 administrative supervisors, recruited nationally from 20 different states, to explore the supervisors' perspective on practices used to enhance safety. The focus group and interview transcripts were thematically analyzed, using an iterative, comparative method to identify codes and sort for patterns. The findings reveal that administrative supervisors "make it (whatever needs to be done) work" and achieve nurse and patient safety by building trust with the staff, doing rounds, educating, and providing support to the front line team. These shift leaders foster a culture of safety with their relationship-oriented leadership style. By gaining further understanding about the administrative supervisor role, new workflow processes can be explored; specific continuing education programs can be developed; and additional research can be conducted.

From dusk to dawn

“…39 Direct care nurses confirmed the importance of having an administrative supervisor who's approachable and trustworthy. 39 Considering that trust is a characteristic of authentic leadership, we can theorize that night-shift nurses rated authentic leadership as the second-highest standard because of their relationship with the administrative supervisors. 40 Administrative supervisors use their leadership skills and work with night-shift nurses to resolve concerns and ensure quality patient care.…”

Clinical nurse managers and administrative supervisors

“…AS are important in establishing a culture of safety within the organization. 1,2 At the facility for this study, AS are responsible for providing administrative and clinical support, and oversight for frontline nurses. Gist 3 found that far more knowledge was required for this role than is provided in a typical nursing school curriculum.…”

“…AS are important in establishing a culture of safety within the organization 1,2. At the facility for this study, AS are responsible for providing administrative and clinical support, and oversight for frontline nurses.…”

Medical–surgical nurse leaders' experiences with safety culture: An inductive qualitative descriptive study

“…Adequate staffing, managerial support for nurses and good nurse–physician relations contribute to a professional nurse work environment (IOM, 2004 ). Hospital manager behaviours that promote patient safety and transformational leadership styles influence and predict nurse‐perceived patient safety (Anderson et al, 2019 ; Campbell et al, 2021 ; Ferreira et al, 2022 ; Lee & Dahinten, 2020 ; Weaver et al, 2017 ). Transformational leadership had a significant indirect effect on adverse patient outcomes through structural empowerment (Boamah et al, 2018 ).…”