A peek behind the curtains

From a small interior office on the sixth floor of Arnett Hospital, a team of nurses known as Associate Administrators (AAs) are pivotal in ensuring smooth operations and exceptional patient care. Their work, often behind the scenes, is vital to the hospital's success and the well-being of its patients and staff.

Two AAs, Liz Wysong and Wesley Oliver, shed some light on the importance of this lesser-known role.

Multifaceted responsibilities

It’s difficult to overstate the impact of the AA team, both because of the importance of their work, but also because of the sheer number of responsibilities an AA must manage on any given shift.

“We do a little bit in a lot of places,” says Wysong, who leads the AA team as assistant nurse manager. “We’re constantly looking at the bigger picture.”

“The full scope of our duties is hard to list,” says Oliver, who primarily works the night shift.

Wysong agrees, describing the Associate Administrator role as akin to being the charge nurse of the hospital. AAs are a go-to resource for many departments, handling a myriad of responsibilities that keep the hospital running efficiently. Their key duties include:

• Staffing: AAs collaborate with charge nurses across the hospital and at the region’s critical access hospitals to ensure all areas are appropriately staffed.
• Patient flow and hospital capacity: AAs help ensure patients are assigned to the right bed with the right nurse, covering not only inpatient areas, but also the Emergency Department, Operating Rooms and procedural areas like the Cardiac Catheterization Lab). When there is a capacity concern, AAs work with the hospital’s capacity management team to strategize solutions.
• Unit support: During her shifts, Wysong rounds on every unit in the hospital, assisting when needed with addressing staffing challenges, patient behavior issues and potential hot spots where patients may decompensate.
• Diversion management: AAs are the point person for diversion, ensuring alignment across stakeholders including hospital leaders and community partners to determine the best course of action for the community.
• Emergency response: AAs respond to all rapid response team calls, Code Blues, medical emergencies and aggression prevention/behavior alerts throughout the hospital to support patient and team safety.
• Leadership: On nights and weekends, Wysong, who leads the AA team, is often the only leader in the building and frequently is called in to provide onsite support for teams and to aid in service recovery and address patient issues.

Picture an air traffic controller, but instead of airplanes and runways, the AAs are managing patients and hospital beds. It requires a combination of carefully designed procedures and precisely crafted algorithms, with a healthy dose of intuition for the dozens of in-the-moment decisions that are sometimes required on-shift.

Collaboration is key

In other words, being an AA is a big job. It can’t be done alone.

“Effective collaboration is an integral part of the role,” says Oliver. “We must foster and maintain professional relationships with everyone we work with to create the environment that is best for staff and patients.”

Nursing expertise matters

Both Wysong and Oliver say that their nursing backgrounds (both began in bedside care in critical care units) are critical to their AA roles.

“We’re nurses first and last,” says Oliver. “Everything about what it means to be a nurse helps guide the decisions we make in our job.”

“My bedside background helps me in emergent situations, and my charge nurse experience prepared me for understanding ‘bed math’ and nursing ratios with different levels of care,” says Wysong. It also helped me with triaging patients — in the AA role, the puzzle is just bigger!”

Challenges and rewards

AAs like Wysong and Oliver face the challenge of often being called upon to make difficult decisions during their shifts, especially during times when they are the only leaders in the building. They strive to keep staff and patients in mind, hoping their fellow team members understand that every decision has a purpose.

“At the end of the day, knowing that team members will come to me with their concerns, both big and small, and their confidence is thanks enough,” says Oliver.