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Too many cooks in the kitchen?

Nurses often work outside traditional hospital units and report to a variety of leaders.

This story was published in the Fall 2022 issue of The Washington Nurse.

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As healthcare has evolved, the role and work setting of the registered nurse has changed. Nurses often work outside traditional hospital units and report to a variety of leaders. Reporting structures incorporate the use of non-nurses to supervise registered nurses. Common examples include interventional radiology RNs reporting to the non-nurse director of diagnostic imaging or a stroke program manager reporting to a non-medical administrator.

Is it acceptable practice for a registered nurse to be supervised by a non-nurse?

According to the Nursing Care Quality Assurance Commission (NCQAC), it is permissible for a registered nurse to be supervised/managed by a non-nurse for the purposes of administrative and/or human resources oversight. For example, it is acceptable for a non-nurse supervisor to perform activities such as work schedule preparation or employee work habit management (e.g., attendance and tardiness). A non-nurse supervisor may also provide nonclinical/non-nursing work performance information and feedback to a registered nurse.

What is out of scope for a non-nurse supervisor?

Registered nurse clinical practice and competency may only be evaluated and coached by a registered nurse or an advanced practice registered nurse. The non-nurse may not provide supervision for a nursing activity, defined by NCQAC as the “provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action.”

While it is true that a non-nurse may serve as a registered nurse supervisor for non-technical job functions, only a registered nurse or an advanced practice registered nurse is qualified to supervise registered nurse activities and practice.


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