Head Nurses and Supervisors - What They Do

Nursing co-ordinators and supervisors co-ordinate and supervise the activities of registered nurses, registered psychiatric nurses, licensed practical nurses and other nursing personnel in the provision of patient care. They are employed in health care institutions such as hospitals, clinics and nursing homes, and in nursing agencies.

Job duties

This group performs some or all of the following duties:

Supervise registered nurses, licensed practical nurses and other nursing personnel
Evaluate patients' needs and ensure that required nursing care is delivered
Set up and co-ordinate nursing services in conjunction with other health services
Ensure quality nursing care is provided and appropriate administrative procedures are followed
Assist in the establishment of unit policies and procedures
Administer nursing unit budget and ensure that supplies and equipment are available
Assist in the selection, evaluation and professional development of nursing personnel
Collaborate on research projects related to nursing and medical care and multidisciplinary services
May provide direct patient care.

Job titles

nursing services co-ordinator
patient care co-ordinator - nursing
nursing care co-ordinator
nursing supervisor
psychiatric nursing supervisor
public health nursing supervisor

Employment Requirements

This is what you typically need for the job:

Completion of a university, college or other approved registered nursing, or registered psychiatric nursing, program is required.
Courses in management studies or a degree, diploma or certificate in management or administration may be required.
Registration as a registered nurse by a provincial or territorial regulatory body is required or registration as a registered psychiatric nurse in Manitoba, Saskatchewan, Alberta, British Columbia and the Yukon is required.
Clinical experience as a registered nurse, or as a registered psychiatric nurse, is required.

Essential Skills

Reading

Read directions for use, caution statements and storage instructions on the labels of medications and medical supplies. (1)
Read entries in referral, admitting, discharge, treatment and consent forms. They read these entries to learn about patients' medical histories, diagnoses and treatment plans. For example, they read discharge forms to determine specific release plans and care for patients. (2)
Read shift reports to learn about problems encountered and concerns expressed by nursing staff and patients during previous shifts. For example, a head nurse in a long-term care unit may read a shift report entry about damage to the hydraulic equipment which is used to lift patients in and out of baths. (2)
Read drug abstracts, such as those found in the Compendium of Pharmaceuticals to obtain information about the benefits and limitations of new and unfamiliar drugs before administering them to patients. (3)
Read a variety of manuals for information about healthcare, budgeting and regulations. For example, they may read long-term care manuals to review legislation governing health care provision. They may read their organizations' policy and procedures manuals for information about budgeting and scheduling. They may read union collective agreements to understand contract clauses governing human resource matters such as scheduling, overtime pay, holidays, grievance procedures and benefit plans. (3)
Read articles in medical journals and reference textbooks. For example, they may read articles about new cures for breast cancer in the Journal of the American Medical Association and in textbooks such as Best Practice Guidelines, Benign Disorders and Diseases of the Breast to understand clients' diagnoses and learn about recommended treatments. (4)

Document use

Scan labels to locate ingredients, expiry dates and recommended dosages when administering medications. (1)
Scan lists and tables. They scan contact lists for data such as the names, telephone numbers and e-mail addresses of health care professionals. They view tables showing budget variances, workloads and scheduling data in staff reports. (1)
Scan a variety of patient care forms. For example, they read health assessment forms to learn about patients' medical histories, lifestyles and current health statuses. They read doctors' order forms to ensure care, medications and instructions have been carried out by nursing staff. They scan entries on patient tracking forms to ensure that nursing staff are entering data correctly and following prescribed treatment plans. (2)
Complete medical reporting forms such as daily logs, hospitalization records and level of care directives. They record measurements such as temperatures, blood pressures, heart rates, bowel movements, fluid intakes and outputs and observations of patients' conditions. They record medications administered, unusual findings and medical problems that require attention. (3)
May interpret anatomical drawings and diagnostic imagery to understand and explain medical procedures. For example, they may interpret angiograms to trace blood flow throughout the body and identify blocked arteries. They may use anatomical drawings to illustrate normal heart anatomy and to answer questions from other nurses regarding cardiac patients. (3)
May interpret a variety of graphs. For example, they may analyse electrocardiograms to understand patients' heart functioning. They may interpret graphs showing changes in patients' temperatures and blood pressures. (3)

Writing

Write e-mail and memos to the nurses they supervise. For example, they write e-mail responding to scheduling and vacation requests. They write memos outlining patient care directives and upcoming courses and seminars such as cardio-pulmonary resuscitation training. (2)
Write descriptions of examinations and treatments in patient care records. They may include longer passages to explain patients' medical conditions and histories. (2)
Write job postings to advertise for nurses. They outline the positions' tasks, responsibilities, skills and educational requirements using information from previous postings. (2)
Write shift reports. They describe the work completed on their shifts, outline patients' treatment needs and describe behaviours that may be problematic or of concern to following shifts. (2)
Complete personnel evaluations and incident reports. They write annual performance evaluations of nurses describing their strengths and weaknesses. They complete incident reports to document medical errors and substandard patient care. (3)
May write letters. For example, they may write letters in response to complaints from patients and their families explaining the investigations conducted, discussing the findings and outlining corrective actions. They may write reference letters for nurses applying for transfers, senior postings and further educational opportunities. (3)
May write and adapt patient care policies and procedures. For example, they may write new guidelines for staff to follow when accompanying and assisting patients in examination rooms. They use various regulations, codes and nursing standards as their models. (3)
Write operational reports and proposals for their managers. They describe reviews of programs, nursing care initiatives, financial operations, staff scheduling, human resources and incidents that have occurred. They include recommendations on caseloads, nursing responsibilities and patient care plans to ensure set standards of practice continue to be met. They write proposals requesting additional funding. For example, a head nurse may write a proposal requesting funding to extend a teen education program and provide background information and rationale for continuation of the program. (4)

Numeracy

Money Math

Verify invoice amounts before approving payments. They calculate costs for quantities of medical supplies, apply discounts and applicable taxes. (3)

Scheduling, Budgeting & Accounting Math

Create work schedules for nursing staffs. For example, unit supervisors in large hospitals create six- week work schedules for more than one hundred nurses. They consider numbers of full-time, part-time and casual nursing staff, years of experience and vacation and leave requests. They frequently adjust the schedules due to staff illnesses and emergencies. They ensure that government-mandated nurse-to-patient ratios are met and collective agreements respected. (3)
Develop and monitor budgets. They project costs of salaries for nursing staff, purchases of equipment and supplies, costs of new programs to be developed and operational costs such as travel expenses. They monitor budget expenditures which can fluctuate due to overtime wages and variations in the numbers of patients admitted. (3)

Measurement and Calculation Math

Measure vital health functions when providing care to patients. For example, they use scales to measure weights, sphygmomanometers for blood pressures and glucometers for blood glucose levels. (2)
Determine quantities and dosages of medications to administer to patients. For example, they measure volumes of liquid dosages when administering prescribed medications. They count the number of drops per minute flowing through intravenous drips to ensure they administer correct amounts of medications. (2)

Data Analysis Math

Analyze patients' vital health measurements over time to monitor health changes. For example, they compare measurements of pulse rates, temperatures, blood pressures and weights over time to identify changes in patients' health. (2)
May collect and analyze operational and demographic data. For example, supervisors of public health nurses may analyze data on quantities of influenza vaccines used during previous years in their areas and calculate average numbers of people who were inoculated per year. (3)

Numerical Estimation

Estimate time. For example, head nurses in clinics estimate lengths of wait times for next available examination rooms. They consider the needs and health problems of patients' currently being served and the numbers of patients waiting. (3)

Oral communication

May discuss products, prices, delivery dates and other matters with suppliers and service providers. For example, nursing supervisors in long-term care facilities place orders for a variety of items such as incontinence supplies and hydraulic lifts to assist nurses in moving patients. Supervisors of public health nurses check with suppliers to ensure that influenza vaccines will be ready for vaccination clinics. (2)
Discuss patient care plans with nursing staff and assign duties. They exchange health care information with nurses, explain operating practices and confirm modifications to schedules and assignments. (2)
Discuss learning goals with nurses, monitor learning plans, suggest further training and provide feedback during annual performance reviews. They lead staff meetings. (3)
Discuss the care of patients with doctors, psychologists, therapists and nurses. They exchange information about patients' health, seek professional opinions and coordinate patient care. For example, they contact medical specialists to make patient referrals and to discuss details of patients' medical histories. (3)
Discuss health and medical treatments with patients and their family members. They explain medical procedures, reassure them of the quality of care and answer questions. (3)
May make presentations and deliver educational seminars. For example, they may present information to community groups and to colleagues and peers at seminars and conferences. For example, supervisors of nurses in long-term care facilities may make presentations to small community groups and organizations on issues pertinent to geriatric care and fall preventions. They adapt their presentations to suit their audiences. (4)

Thinking

Problem Solving

May find there are shortages of beds. Head nurses in hospitals contact other hospitals and related community health services in the surrounding areas to find places where patients can be treated. If they cannot find suitable facilities, they may have to suggest patients be placed in hallways until beds become available. (2)
Find that operational and financial data contains mistakes. For example, nursing supervisors in hospitals may find that beds have been charged to the wrong units. They contact their finance departments to report the errors and request the charges be reversed. Supervisors in long-term care facilities may find they have been overcharged for incontinence products and linen supplies. They contact suppliers to report discrepancies and request reimbursements. (2)
Find that they are short staffed. In unionized workplaces, they contact nurses with the most seniority when replacement and additional staff members are needed. In non-unionized workplaces, they contact nurses who have placed their names on call lists. (2)

Decision Making

Decide to assist with patient care when there are staff shortages and when patients require increased care. (1)
Select tasks to assign to nursing staff. They consider the nurses' qualifications, skills and previous experience. For example, they may select the most senior nurses to act as charge nurses and choose experienced nurses for triage in emergency departments. (3)
Decide which nurses to send for external training programs. They consider available training budgets, schedules, collective agreement provisions and the urgency of nurses' learning needs. They must be perceived to be acting fairly to avoid grumbling and disharmony. (3)
Choose disciplinary actions to take with nursing staff who have violated rules. They investigate the allegations and review the employees' past records to search for any previous violations. They consider the seriousness of the violations, precedents and human resources policies and procedures. (3)

Critical Thinking

Assess the suitability of nursing candidates for available positions. They review candidates' academic credentials, work experiences, responses to interview questions and references. They recommend candidates whose skills, experiences and attitudes match the needs of their workplaces. (3)
Evaluate the work performance of nurses. They review completed medical forms to assess record keeping abilities and inspect work areas for organization and cleanliness. They observe nurses' interactions with co-workers and patients and talk directly with them to gather feedback about patient care. They use this information to complete performance reviews and to ensure patients receive quality health care services. (3)
Evaluate patients' health. They analyze vital signs and compare measurements over time to identify signs of improvement and deterioration. They seek physicians' opinions, consider patients' feedback and look for signs of improvement such as increased appetite, regular bowel movements and increased energy. (3)
May judge the merit of patients' complaints about nursing care and take appropriate action. They investigate the complaints by asking the individuals involved to describe the circumstances and actions of those involved, consider the information gathered and assess if a nursing violation can be substantiated. They facilitate discussions between the individuals involved to resolve the complaints. If complaints cannot be resolved they may follow procedures to file formal complaints. (3)
Judge the suitability of various types of patient care. They consider the health of patients and benefits and risks of treatments before discussing choices with patients and their families. For example, they may recommend that the best care plan for a terminally ill patient in palliative care is to keep the patient as comfortable as possible as additional treatments may do more harm than good. (3)

Job Task Planning and Organizing

Own Job Planning and Organizing

Head nurses and supervisors organize their own job tasks and plan their daily activities in order to meet the overall objectives of health units and care facilities. They juggle multiple duties such as attending meetings, developing operational policies, communicating with nurses and patients, adjusting schedules and overseeing budgets. Although many of the same activities occur over the course of a day, their schedules vary considerably because of unexpected events such as patient care emergencies. (3)

Planning and Organizing for Others

Head nurses and supervisors plan work schedules and assign duties to nurses, practical nurses and nurses' aides. (3)

Guest services attendants have a checklist to follow for their job tasks. The order of the tasks that they do is flexible; however, some tasks have priority and will affect hotel operation if they are not done. (2)

Significant Use of Memory

Remember names of nurses, doctors, office staff and patients so they can address them by name and build rapport.

Finding Information

Seek current information about the medical conditions of patients by conducting physical examinations, taking measurements of vital signs and listening to patients' feedback. They may also read medical charts, seek the opinions of doctors and co-workers and look for information in patients' files. (2)

Digital technology

Use word processing. For example, they use programs such as Word to write and format referral letters, articles for newsletters, reports and policies. They use basic text editing and formatting features to create documents. They may use templates to minimize text editing and formatting. (2)
May use graphics. For example, they may use presentation software such as PowerPoint to create slides for healthcare presentations. (2)
Use databases. For example, they use management databases to view master schedules and monitor budgets. They use medical record databases to review patients' files and to record details of patients' care. (2)
Use spreadsheets. For example, they create spreadsheets for scheduling purposes and use existing ones to record budget expenditures. (2)
Use communication software. For example, they exchange e-mail and attachments with co-workers and colleagues in various health care facilities. They enter appointments in their calendars and set reminder notices. (2)
Use the Internet. For example, they search the Internet for medical research papers and articles about healthcare initiatives. (2)
May use other computer and software applications. For example, supervisors in hospital cardiac units may use telemetry receivers to monitor patients' vital signs. Head nurses in community health programs may use personal digital assistant devices to download and display patient files. They may use specialized software such as Baycrest On-line Documentation to retrieve and view patient charts. (2)

Other Essential Skills:

Working with Others

Head nurses and supervisors work as members of teams. Their work is closely integrated with that of physicians, nurses and other health care specialists in an environment that requires constant attention. They plan, direct and supervise nurses' activities. (3)

Continuous Learning

Continuous learning is an integral part of the work of head nurses and supervisors. They learn by discussing cases with co-workers, colleagues and other health care providers. They keep abreast of new technologies, diseases, practices and treatments by attending conferences, seminars, workshops and by reading medical and nursing journals, professional association bulletins and papers on the Internet. They attend refresher courses to maintain provincial certification in areas such as CPR and fire and safety training. Head nurses and supervisors belong to provincial Nursing Associations which may require and track their participation in professional development seminars. (3)