A hospital house supervisor is the RN in charge of the whole building on evenings, nights, weekends and holidays, when managers are gone. In a small rural hospital they place new admissions and fill call-ins. They line up transfers to larger hospitals, back up the ER and unit nurses, and call the administrator on call when something can't wait.
By the HireBus team · Updated · Pay data: BLS, May 2025
We're hiring an RN house supervisor to lead the whole hospital on evenings, nights, weekends and holidays, when managers are off site. You'll place patients in beds, fix staffing gaps shift by shift, help coordinate transfers, back up nurses in the ED and on the unit, and call the administrator on call when something can't wait until morning.
2. Essential Duties and Responsibilities
Serve as the on-site leader for the whole hospital after hours, and call the administrator on call as your escalation policy requires.
Place ED admissions, observation patients and incoming transfers in beds, and match each patient to a nurse with the right skills.
Fix staffing gaps for the current and next shift: call in staff, move floats, and approve overtime within the CNO's guidelines.
Respond to every code, rapid response and trauma activation, and help organize staff, supplies and family support.
Help the provider arrange transfers: confirm the receiving hospital's bed, book ground or air transport, and track the patient until departure.
Handle after-hours complaints, safety events and deaths, including calling the organ procurement organization about every death or imminent death.
Get medications from the after-hours pharmacy supply when no pharmacist is on site, only as your state's pharmacy rules and hospital policy allow.
3. Key Tasks / Daily Activities
Take report from the day leaders on census, staffing, pending admissions and patients at risk of getting worse.
Round on every unit and department during the shift, including the ED, lab, imaging and entrances.
Update the staffing grid for the next shift, and call staff about open shifts and call-ins.
Cover breaks or a patient assignment when the ED or inpatient unit is short.
Write the shift report for the CNO and nurse manager: census, events, staffing changes and open issues.
4. Key Performance Indicators (KPIs)
Open shifts filled before the shift starts: [your target].
Time from ED admit decision to inpatient bed: [your target].
Shift reports completed: [your target].
Organ procurement organization calls made within policy: [your target].
Urgent events escalated within policy: [your target].
5. Required Qualifications and Skills
Active [State] RN license, or a Nurse Licensure Compact multistate license if your state is a member, plus current BLS, ACLS and PALS.
[3+] years of acute care nursing, including emergency nursing and charge nurse experience.
Sound judgment making staffing, bed and escalation decisions without a manager in the building.
Working knowledge of EMTALA transfer rules, restraint rules and your hospital's emergency codes.
Clear, calm communication with providers, staff, families and the administrator on call.
6. Preferred Experience
Experience as a house supervisor or nursing supervisor in a small or rural hospital.
Emergency nursing certification (CEN) or TNCC.
BSN, or enrolled in a BSN program.
Experience coordinating ground and air transfers from a critical access hospital.
7. Physical Requirements
Walk the whole hospital on rounds, and stand for long periods during codes and busy shifts.
Help move patients and push stretchers and beds when units are short, using lift equipment.
With or without reasonable accommodation.
8. Work Environment and Schedule
Evening, night, weekend and holiday shifts: [schedule].
Often the senior leader in the building, with the administrator on call by phone.
Exposure to bloodborne pathogens, infectious disease and upset patients or families, with PPE provided.
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new house supervisor gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
Need help filling this role? HireBus posts the ad, Iris interviews every applicant by phone before you do, and you decide who to hire. Start hiring now
At a large hospital, the house supervisor works from a command center with charge nurses on every floor. In a critical access hospital, the supervisor may be one of two or three RNs in the building, and everyone calls them.
Transfers to bigger hospitals are routine
Patients who need a cath lab, surgery or intensive care leave by ambulance or helicopter. EMTALA covers critical access hospitals. For an unstable patient, a transfer is appropriate only when four things are true. The sending hospital has treated the patient as far as it can to lower the risk. The receiving hospital has room and staff and has agreed to take them. The records go along. Qualified staff and equipment make the trip. The provider makes the medical call, and the supervisor lines up the bed and crew. Source: 42 CFR 489.24: EMTALA, special responsibilities in emergency cases.
Every death is a call to the OPO
The hospital must tell its organ procurement organization (OPO), in a timely way, about every patient who has died or whose death is near. The OPO decides who is medically fit to donate organs. Hospital staff who ask a family about donation must be designated requestors, which means they finished a course the OPO offers or approves. A supervisor without that course makes the referral call. The OPO or a trained requestor talks with the family. Source: 42 CFR 485.643: organ, tissue and eye procurement.
Restraints come with strict limits
A patient in a mental health crisis may wait in the ER for a bed elsewhere. Federal rules allow restraint or seclusion only to keep someone physically safe right now, only when less restrictive steps won't work, and only until it can safely end. A death during restraint, within 24 hours after, or within a week when restraint likely played a part goes to CMS by the next business day. If only soft wrist restraints were used, with no seclusion, the first two go in an internal log instead. Source: 42 CFR 485.614: patient's rights in critical access hospitals.
Disasters don't wait for daylight
The emergency plan must say who takes over when leaders are out. The hospital's procedures must track where on-duty staff and sheltered patients are, and record where anyone who is moved went. A storm can knock out power at night, or a highway crash can send in several patients at once. Then the house supervisor may start that tracking until leaders arrive. Source: 42 CFR 485.625: emergency preparedness.
Every department's problem lands here
With no managers in the building, the supervisor hears about the lab's broken analyzer, the on-call imaging tech who is still on the road, a visitor who won't leave and a kitchen that ran short. Most of it can wait for morning with a clear note. The skill is spotting the few problems that can't, and calling the right person about them.
How much hospital house supervisors make
The closest BLS group for hospital house supervisors is registered nurses. Registered nurses who work for general medical and surgical hospitals earned a median of $48.18 an hour ($100,210 a year) in May 2025, according to the Bureau of Labor Statistics. That’s about the same as the $97,550 median for registered nurses in all industries. About 1,902,960 of the 3,379,720 registered nurses in that survey work for general hospitals.
Usually paid by the hour as an RN, with a supervisor differential on top of the night and weekend differentials. BLS counts house supervisors with registered nurses, so plan to pay above the RN figures on this page.
General hospitals
$100,210$100,210 median Middle half $81,610–$118,990 10th–90th $76,270–$138,990
All industries
$97,550$97,550 median Middle half $80,330–$112,350 10th–90th $68,940–$137,470
$50k$75k$100k$125k$150k$175k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
General hospitals
$76,270
$81,610
$100,210
$118,990
$138,990
All industries
$68,940
$80,330
$97,550
$112,350
$137,470
These figures cover general medical and surgical hospitals of every size. Rural hospitals often pay less than city hospitals. Post a real range for your market in the ad.
Skills to hire for, and what you can teach
Hire for these
Strong ER and acute care skills, ready to step into any assignment
Makes bed and staffing calls alone and writes down why
Knows a transfer from the first phone call to the ambulance leaving
Steady in codes, and gentle with families after a death
Judges when the administrator on call needs a call right now
Teach these on the job
Your escalation policy and administrator-on-call list
Transfer centers, ambulance services and air medical numbers
Your OPO referral line and donation protocol
The staffing grid, call-in list and overtime rules
Your after-hours pharmacy steps
The shift report format the CNO wants
House supervisors run the shift from the EHR's bed board and census, the staffing and call-in system, and a phone or radio that stays with them all night. Keep transfer center, ambulance, air medical and OPO numbers on one sheet at the supervisor's desk.
Hospital house supervisor interview questions
They have their own page: 6 questions that test this job, what strong and weak answers sound like, and a work exercise to run with your finalists.
The template leaves the targets blank. Nights at a small hospital swing from quiet to all hands, so set each one from a season of your own shift reports and look for patterns, not single shifts.
Open shifts filled before the shift starts
Open and called-in shifts with someone in place by start time, from the staffing grid. Count shifts filled by holding a nurse over apart from those filled by someone new.
Time from ED admit decision to inpatient bed
Minutes from the admit order to the patient reaching the room, from EHR time stamps. Note why each long wait happened: no clean room, no nurse, or no report given.
Shift reports completed
Shifts with a report sent to the CNO and nurse manager covering census, events, staffing changes and open issues. Pull a handful each month and check what's missing.
Organ procurement organization calls made within policy
Deaths and imminent deaths from the census and death log, matched with OPO referral numbers and call times. Compare with the death record reviews the hospital does with its OPO.
Urgent events escalated within policy
Events your policy sends to the administrator on call, such as a serious safety event or a utility failure, matched with call log and shift report times.
Career path
Registered nurseWorks ER and inpatient shifts and learns every patient type.
Charge nurseRuns one area's shift and fills in for the supervisor.
House supervisorLeads the whole hospital when managers go home.
Nurse managerTakes over one unit's staff, schedule and quality work on days.
For this job, yes. The template requires an active RN license plus BLS, ACLS and PALS, and acute care experience that includes ER and charge nurse work. The job rests on nursing judgment: deciding which nurse can take an unstable admission, responding to every code, and stepping in to care for ER patients. A small hospital needs its night leader to be a nurse who can also work the floor.
How much does a hospital house supervisor make?
Registered nurses who work for general medical and surgical hospitals earned a median of $48.18 an hour ($100,210 a year) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $81,610 and $118,990 a year. Pay also depends on your local market, experience and overtime.
How is a house supervisor different from a charge nurse?
A charge nurse runs one area's shift: assignments, admissions and questions on the unit or in the ER. The house supervisor has the whole building, including lab, imaging, the entrances and every staffing gap, and decides where each patient goes. On a quiet night in a small hospital one RN may hold both jobs. Write down who holds which when that happens.
Should a house supervisor take a patient assignment?
Sometimes there's no way around it, but plan for it to be rare. A supervisor with a full assignment can't easily leave to run a code, meet a helicopter or sort out a bed. If you expect them to take patients, give them the lightest assignment and a charge nurse who can take it over in a pinch.
What should you ask a house supervisor candidate?
Use night-shift scenarios. Two ER admissions arrive and the unit has one nurse: what happens? The receiving hospital has no bed for a patient who needs to go: who do you call? A swing bed patient dies at 3 a.m.: walk me through the next hour. Listen for clear steps, calls made in the right order, and when they would wake the administrator on call.
Why does a house supervisor need ER experience?
Because the ER is where a quiet night turns busy. The supervisor responds to every code and trauma activation, helps the provider arrange transfers, and covers ER patients when it fills up. A supervisor from a large hospital's med-surg floor may manage staffing well and still freeze when two ambulances arrive at once. The template asks for emergency nursing and prefers CEN or TNCC.
