Too many cooks in the kitchen?

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.