6. Supervision
Open Resources for Nursing (Open RN) and Amy Ertwine
The licensed nurse has the responsibility to supervise, monitor, and evaluate the nursing team members who have received delegated tasks, activities, or procedures. As previously noted, the act of supervision requires the nurse to assess the staff member’s ability, competency, and experience prior to delegating. After the nurse has made the decision to delegate, supervision continues in terms of coaching, supporting, assisting, and educating as needed throughout the task to assure appropriate care is provided.
The nurse is accountable for client care delegated to other team members. Communication and supervision should be ongoing processes throughout the shift within the nursing care team. The nurse must ensure quality of care, appropriateness, timeliness, and completeness through direct and indirect supervision. For example, an RN may directly observe the AP reposition a client or assist them to the bathroom to assure both client and staff safety are maintained. An RN may also indirectly evaluate an LPN’s administration of medication by reviewing documentation in the client’s medical record for timeliness and accuracy. Through direct and indirect supervision of delegation, quality client care and compliance with standards of practice and facility policies can be assured.
Supervision also includes providing constructive feedback to the nursing team member. Constructive feedback is supportive and identifies solutions to areas needing improvement. It is provided with positive intentions to address specific issues or concerns as the person learns and grows in their role. Constructive feedback includes several key points:
- Was the task, activity, care, or procedure performed correctly?
- Were the expected outcomes involving delegation for that client achieved?
- Did the team member utilize effective and timely communication?
- What were the challenges of the activity and what aspects went well?
- Were there any problems or specific concerns that occurred and how were they managed?
After these questions have been addressed, the RN creates a plan for future delegation with the nursing team member. This plan typically includes the following:
- Recognizing difficulty of the nursing team member in initiating or completing the delegated activities.
- Observing the client’s responses to actions performed by the nursing team member.
- Following up in a timely manner on any problems, incidents, or concerns that arose.
- Creating a plan for providing additional training and monitoring outcomes of future delegated tasks, activities, or procedures.
- Consulting with appropriate nursing administrators per agency policy if the client’s safety was compromised.
Please review the following example regarding constructive feedback and task supervision
Nurse Sarah, an experienced RN, delegated a task to Peter, an unlicensed assistive personnel (UAP), to take the vital signs of a post-operative patient, Mrs. Johnson, and report any abnormalities immediately.
Sarah: “Hi Peter, I wanted to discuss the task you completed earlier with Mrs. Johnson’s vital signs. Thank you for your help with that. Let’s review how it went.”
Was the task, activity, care, or procedure performed correctly?
Sarah: “First, I noticed you recorded the vital signs accurately. Good job on that. However, there was a delay in reporting Mrs. Johnson’s elevated blood pressure to me. Can you walk me through what happened?”
Peter: “I took her vital signs, and her blood pressure was high. I was going to inform you, but I got called to assist with another patient immediately after.”
Were the expected outcomes involving delegation for that client achieved?
Sarah: “Ultimately, we did address the elevated blood pressure, but the delay could have impacted her care. It’s crucial to report such abnormalities immediately.”
Did the team member utilize effective and timely communication?
Sarah: “While you communicated the vital signs correctly, the timing was off. In future, if you can’t find me immediately, please inform any available nurse or use the intercom system.”
What were the challenges of the activity and what aspects went well?
Peter: “The challenge was managing multiple tasks at once. I did feel confident in taking and recording the vital signs accurately, though.”
Sarah: “It sounds like you’re balancing a lot of responsibilities well, but prioritizing urgent communications is key. You handled the technical part perfectly.”
Were there any problems or specific concerns that occurred and how were they managed?
Sarah: “The main concern was the delay in reporting the elevated blood pressure. Fortunately, there were no serious consequences, but it’s a potential risk we need to manage better. Let’s create a plan to support you moving forward.”
Recognizing difficulty of the nursing team member in initiating or completing the delegated activities:
Sarah: “I recognize that you were busy with multiple tasks. It’s important to prioritize patient safety over other duties.”
Observing the client’s responses to actions performed by the nursing team member:
Sarah: “I will check on Mrs. Johnson’s response to ensure there are no ongoing issues, and I’ll keep exploring how we can improve this process.”
Following up in a timely manner on any problems, incidents, or concerns that arose:
Sarah: “I’ll follow up with you soon to see how you’re managing your other tasks, and we can address any challenges you’re facing.”
Creating a plan for providing additional training and monitoring outcomes of future delegated tasks, activities, or procedures:
Sarah: “We’ll arrange some additional training on prioritizing tasks and urgent communication. Let’s monitor the outcomes of your delegated tasks over the next few weeks to ensure you’re supported.”
Consulting with appropriate nursing administrators per agency policy if the client’s safety was compromised:
Sarah: “Fortunately, Mrs. Johnson is fine, but if there were any safety concerns, we’d need to report it according to our policy. Keep this in mind for the future.”
Sarah: “Peter, you’re doing a great job with your responsibilities, and with a bit more focus on communication priorities, I’m confident you’ll excel even more. Let’s touch base again in a week to see how things are going. Feel free to come to me with any questions or concerns in the meantime.”
Peter: “Thank you, Sarah. I appreciate the feedback and will work on prioritizing urgent communications.”
Sarah: “Great. Keep up the good work, and let’s keep improving together.”
Licensure is the process by which a State Board of Nursing (SBON) grants permission to an individual to engage in nursing practice after verifying the applicant has attained the competency necessary to perform the scope of practice of a registered nurse (RN).[1] The SBON verifies these three components:
- Verification of graduation from an approved prelicensure RN nursing education program
- Verification of successful completion of NCLEX-RN examination
- A criminal background check (in some states)[2]
In the United States there are three common types of prelicensure educational programs that prepare a student to become an RN, including a two-year associate degree of nursing (ADN), a hospital-based diploma program, or a four-year baccalaureate degree (BSN). Some universities offer an "Entry Level Master of Science in Nursing Track" for non-nurses holding a baccalaureate or master's degree in another field who wish to become a nurse. All graduates must pass the same NCLEX-RN to obtain their RN license from their SBON (or other nursing regulatory body).
Requirements for licensure renewal vary from state to state. Some states require continued education credits (CEUs), along with the payment of fees. In Wisconsin the nursing license is renewed every two years.
- Use this map for contact information for the State Boards of Nursing.
- Read more details on obtaining a Wisconsin RN license at https://dsps.wi.gov/Pages/Professions/RN/Default.aspx.
Nurse Licensure Compact
When applying for your nursing license from your State Board of Nursing (SBON), you may also be eligible to apply for a multistate license. The Nurse Licensure Compact (NLC) allows nurses to practice in other NLC states with their original state’s nursing license without having to obtain additional licenses, contingent upon remaining a resident of that state. Currently, 38 states have enacted the NLC. Read more information about the NLC using the information in the following box.
View the current Nurse Licensure Compact Map.
Read this algorithm on how to Navigate the Nurse Licensure Compact.
Read more information about the Nurse Licensure Compact Rules.
Watch a video for nursing students on the Nurse Licensure Compact.
Temporary Permit
In some states before taking the NCLEX, an applicant may apply to receive a temporary permit from their State Board of Nursing (SBON). A temporary permit allows the applicant to practice practical nursing under the direct supervision of a registered nurse until the RN license is granted. A temporary permit is typically valid for a period of three months or until the holder receives failing NCLEX results, whichever is shorter.
Read about the temporary permit available in Wisconsin.
