House Supervisor (Nursing Supervisor) 

Department: Nursing Administration Reports to: Chief Nursing Officer  

Supervises: All on-duty nursing and nursing support personnel for the assigned shift (functional shift authority; disciplinary authority rests with the CNO)  

License required: Current, unencumbered Louisiana Registered Nurse license  

FLSA status: Non-exempt 

Position Summary 

The House Supervisor is the on-site nursing and operational authority for the assigned shift. The position exists to provide administrative continuity when the CNO and administration are not on site, to maintain clinical and regulatory oversight across the inpatient/swing bed unit and the Emergency Department, and to serve as a licensed clinical resource who can flex into direct patient care during surges. 

The House Supervisor is not assigned a routine patient load. Direct care is a surge and coverage function, not the baseline expectation of the role.

1. Shift Command and Administrative Authority 

• Serves as the ranking on-site administrative representative in the absence of the CNO, CEO, and department leadership. 
• Conducts and documents a shift-start huddle covering census, acuity, pending admissions/discharges/transfers, staffing gaps, equipment or facility issues, and open safety concerns. 
• Maintains the Supervisor Shift Log for every shift and forwards it to the CNO. This log is the primary record surveyors will ask for to demonstrate the oversight function exists. 
• Makes real-time staffing decisions within CNO-approved parameters; escalates anything outside those parameters. 
• Authorizes call-in and overtime within approved thresholds set forth by the CNO. 
• Serves as the after-hours point of contact for visitors and staff.  
• Initiates the unannounced survey protocol if a surveyor arrives after hours: verifies credentials, notifies CEO/CNO immediately, provides entrance access, begins the document pull. 

2. Patient Flow, Admissions, and Transfers 

• Owns bed control and bed assignment. 
• Monitors bed count against the 25-bed limit as well as unit-specific capacity.  
• Communicate ER admissions to UR in addition to coordinating with UR, ED physician, and CNO for appropriate patient admission according to the staffing grid and facility capability.  
• Reviews each admission for correct patient status (inpatient / observation / swing bed) during hours UR is not present and confirms the order matches the clinical documentation. Escalates status mismatches to UR before they age. 
• Supervise swing bed conversions & be on standby for support: acute discharge order and discharge summary present, swing bed admission orders written. 
• Assists with all transfers out: accepting facility and accepting physician confirmed, EMTALA transfer certification signed, transport arranged, records packet complete before the patient leaves. 
• Coordinates direct admissions from clinics and physician offices. 
• Assist & support with rounds on discharge readiness and clears barriers — transport, DME, home health referral, medication access, family availability. 

3. Emergency Department Operational Support 

• Responds to the ED for volume surge, high-acuity arrivals, trauma/STEMI/stroke/sepsis activations, pediatric arrivals, and any multiple-simultaneous-patient event. 
• Provides second-RN coverage when the ED RN is committed to a critical patient and the second ED staff member is outside RN scope for what is needed. 
• Assists with triage during surge, performing only functions within RN scope. 
• Verifies EMTALA compliance each shift: central log entries complete and legible, medical screening exam performed and documented by qualified medical personnel, on-call physician roster posted and current, transfer forms and physician certifications complete, signage posted. 
• Supports behavioral health holds and restraint events: assists with application, monitoring, documentation, sitter coverage, and law enforcement coordination. 
• Coordinates with EMS and LERN on incoming patients, diversion status, and drop-offs as needed. Updates LERN portal every shift.  
• Handles point-of-care logistics so licensed ED staff stay at the bedside during surges.  

4. Clinical Oversight and Regulatory Rounding 

• Rounds on inpatients at least once per shift and documents the round. 
• Spot check for documentation: RN assessment completed and signed, current nursing care plan (required for every inpatient), orders reconciled, allergies documented, code status documented, and fall/skin/nutrition risk screening completed. Appropriate utilization of the electronic health record by clinicians.  
• Immediate support in times of surge or staff guidance.  
• Conducts environment-of-care rounds: crash cart checks and seals, medication room and refrigerator temperature logs, egress and life safety, unit stock, expired-supply sweep. 
• Tracks open items from any active plan of correction and reports status to the CNO/Quality Improvement and Risk Management RN. 

5. Nursing Practice Supervision and Scope Enforcement 

• Functions as the registered nurse providing direction and supervision for LPN practice consistent with Louisiana LPN scope and hospital policy as needed. 
• Oversees that every assignment matches documented, on-file competency — LPN IV therapy and IV push, blood product administration, paramedic-performed tasks in the ED, and any delegated function. 
• Directly supervises orientees, agency and contract staff, and cross-trained floats; validates the competency checklist before releasing anyone to independent assignment. 
• Provides real-time coaching and correction; documents performance concerns and routes them to the CNO. 
• Supervision of structured, documented handoff at every shift change and at every transfer of care between departments. 

6. Emergency and Code Response 

• Responds to all codes house-wide; leads the resuscitation until a provider assumes the code, per policy. 
• Assigns or performs the recorder role. 
• Post-event: leads debrief, completes the event report, forwards to QAPI. 
• Serves as incident commander after hours for internal and external emergencies — severe weather, utility failure, mass casualty, IT/EHR downtime, facility evacuation. 
• Initiates downtime procedures for EHR outage and maintains downtime packet readiness. 
• Serves as the hospital's designated contact for local EMS, sheriff's office, and parish emergency preparedness after hours. 

7. Staffing Operations 

• Builds and adjusts the daily assignment sheet across the floor and ED. 
• Manages call-ins, replacement staffing, float decisions, and mandatory-hold decisions per policy. 
• Maintains the shift staffing record in the format surveyors request: personnel on duty, license/certification verified, hours worked, census, and acuity for each shift. 
• Tracks and flags overtime as well as consecutive-hours-worked exceptions. 
• Work as RN on shift when call ins occur, and census does not allow another nurse to be called in. 

8. Quality, Risk, and Compliance 

• Initiates incident and event reports; secures immediate patient safety before documentation. 
• Performs small-sample, rotating-focus chart audits assigned by the CNO (for example: swing bed care plans one week, restraint documentation the next). 
• Collects and submits shift-level QAPI indicator data. 
• Reports suspected abuse, neglect, or exploitation per Louisiana mandatory reporter law and the swing bed freedom-from-abuse requirement. 
• Preserves evidence and initiates the serious event review process for sentinel or near-sentinel events. 

9. Patient Experience and Service Recovery 

• Responds to patient and family complaints and grievances after hours; documents and routes into the formal grievance process within required timeframes. 
• Rounds on patients and families for service recovery. 
• Manages real-time physician, staff, and family conflict; escalates when unresolved. 

10. Professional Conduct, Communication, and Leadership 

• Communicates clearly, directly, and professionally with patients, families, staff, providers, EMS, and outside agencies, adjusting approach to the audience and to the urgency of the situation. 
• Uses therapeutic communication with patients and families, including during grief, agitation, intoxication, behavioral crisis, and the delivery of difficult news. 
• Applies verbal de-escalation as the first-line response to escalating patients, families, or visitors. Restraint, security involvement, and law enforcement are used only after less restrictive measures have failed or when safety is immediately threatened. 
• Maintains strict confidentiality of patient information, personnel matters, performance concerns, staffing decisions, investigations, and administrative discussions. Information learned in the supervisory role is not shared with staff, including staff the supervisor works alongside in any other capacity. 
• Maintains professional composure and demeanor under pressure, during conflict, and when personally in disagreement with a decision. 
• Exercises supervisory authority with fairness and consistency. Policy is applied the same way regardless of friendship, tenure, department, or personal history with the employee. 
• Does not participate in, encourage, or tolerate gossip, side conversations about staff performance, or discussion of hospital business in patient care areas or public spaces. 
• Follows and models the established chain of command, both in escalating issues and in receiving direction. 
• Addresses conflict directly with the individual involved and escalates to the CNO rather than discussing concerns with uninvolved staff. 
• Represents hospital and leadership decisions accurately and supportively to staff, raising disagreement through the chain of command rather than in front of the team. 
• Demonstrates sound critical thinking and independent judgment: anticipates problems, prioritizes under competing demands, acts decisively within scope and authority, and recognizes when a situation exceeds that authority. 
• Gives and receives feedback constructively, in private, and in a manner that preserves the dignity of the employee. 
• Does not use the title or authority of the position for personal status, advantage, or leverage among staff. 

Performance Expectations 

Expectation 

Target 

Supervisor Shift Log & LERN portal completed and submitted 

100% of shifts 

Safe staffing & patient assignments 

100% of shifts 

Environment-of-care and crash cart checks completed 

100% of assigned shifts 

Operational support for all nursing units 

100% of shifts 

Time spent in assigned direct patient care 

Below the threshold set by the CNO (recommend =40% of shift hours) 

Shift-level QAPI indicator for submission to QAPI nurse 

Per incidence 

Confidentiality and professional conduct 

No substantiated breach 

Verbal de-escalation attempted and documented prior to restraint, when safety permits 

100% of applicable events 

Employee Signature: ________________________________ Printed Name:________________________ 
CNO Signature: ______________________________ Printed Name: _____________________________ 

This job description reflects the general nature and level of work performed and is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Bunkie General Hospital reserves the right to amend this description at any time. 

Required 

• Current unencumbered Louisiana RN license 
• BLS, ACLS, PALS, TNCC or trauma training equivalent – all certifications to be obtained within 3 months of start date. 
• Minimum five years acute care, emergency, or combined experience 
• Prior charge nurse or comparable shift-leadership experience 
• Demonstrated competency to function clinically in previous assigned setting with the understanding and agreement to maintain competency in both the inpatient/swing bed unit and the ED if serving in the House Supervisor role 
• Demonstrated ability to maintain confidentiality regarding patient, personnel, and administrative matters. 
• Demonstrated professional and therapeutic communication skills and verbal de-escalation technique. 
• Demonstrated fair, impartial, and consistent leadership. 
• Demonstrated adherence to the chain of command. 
• Demonstrated critical thinking and independent clinical judgment under pressure. 

Preferred 

• BSN 
• NRP, TNCC or ENPC 
• Swing bed or skilled nursing experience 
• Prior formal supervisory experience 
• Stroke scale certification 
• Formal crisis prevention and de-escalation training (CPI, MOAB, or equivalent).