Position: Nurse Manager
Reports To: Director of Operations
Supervises: Licensed Vocational Nurses (LVNs), Registered Nurses (RNs), and unlicensed medical support staff
Position Classification: Exempt
Location: On-Site
Hours: Full-Time, Salaried – includes scheduled shifts as the nurse on duty

Job Summary

The Nurse Manager is a dual-function role responsible both for direct, hands-on nursing care as the nurse on duty during scheduled shifts and for the overall supervision, coordination, and leadership of the nursing department at The Annex. During scheduled shifts, the Nurse Manager functions as the acting floor nurse, providing direct client care, medication administration, and clinical monitoring. Outside of direct care duties, this position ensures that high standards of nursing care are delivered across The Annex's treatment programs, manages the nursing schedule and staffing coverage, oversees medication and health-related procedures, and ensures compliance with regulatory, clinical, and organizational requirements. The Nurse Manager serves as the primary point of escalation for medical incidents requiring clinical judgment beyond the scope of frontline nursing staff and plays a key leadership role in promoting client safety, documentation accuracy, clinical competence, and interdisciplinary collaboration.

Supervisory Responsibilities

Direct supervision of Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), and unlicensed medical support staff
Assist with hiring, onboarding, training, scheduling, evaluating, and disciplining nursing personnel, in coordination with the Director of Operations and Human Resources
Assist with nursing operations including medication administration, storage, reconciliation, and documentation
Leads nursing meetings and skills trainings, and participates in leadership and quality improvement meetings

Detailed Responsibilities

Direct Patient Care – Floor Nursing Duties

Serve as the acting nurse on duty for the full duration of scheduled shifts, providing direct client care consistent with RN scope of practice.
Administer medications, conduct health assessments, and perform clinical monitoring for residents in accordance with physician orders and The Annex's clinical protocols.
Complete all required nursing documentation, MAR entries, and shift-level clinical notes in real time during scheduled shifts.
Respond directly to client medical needs, symptom changes, and urgent care situations arising during the shift.
Coordinate directly with prescribing providers, pharmacies, and other nursing staff on client-specific care needs during the shift.

Nursing Staff Management & Scheduling

Build, maintain, and adjust the nursing schedule to ensure adequate 24/7 coverage, accounting for census, acuity, PTO, and call-outs.
Manage the on-call nursing rotation and ensure timely, appropriate coverage during nights, weekends, and holidays.
Assist with recruiting, onboarding, and training new nursing staff, including orientation to The Annex's clinical protocols, EMR/documentation systems, and medication administration procedures.
Conduct ongoing skills validation, and annual competency evaluations for nursing staff.
Conduct regular performance evaluations of nursing staff, provide coaching and corrective action as needed, and escalate significant performance or conduct concerns to the Director of Operations.

Clinical Oversight & Compliance Adherence

Supervise all aspects of medication management, including storage, controlled access, dosing documentation, and disposal, across all shifts (not only their own).
Conduct regular MAR (Medication Administration Record) audits for accuracy and compliance.
Ensure nursing practice and documentation comply with Texas Board of Nursing regulations, DEA and controlled substance handling requirements, HIPAA, and applicable state and federal healthcare regulations.
Maintain and audit nursing licensure, certification, and required training records (BLS/CPR, medication administration competency, etc.) to ensure continuous compliance.
Oversee infection control practices, health screenings, and compliance with health and safety standards.
Participate in internal audits, licensing surveys, and regulatory inspections; support timely correction of any identified deficiencies.

Medical Escalation & Emergency Response

Serve as the primary clinical point of escalation for medical incidents, symptom changes, or safety concerns that exceed the scope of frontline nursing staff, including during shifts covered by other nursing personnel.
Exercise clinical judgment to determine appropriate response to medical escalations, including on-site management, provider notification, or emergency transfer, in accordance with The Annex's emergency hospitalization policy.
Provide leadership during emergency health situations and assist staff with urgent medical concerns.
Ensure timely and accurate documentation of medical incidents, escalations, and outcomes, and complete or oversee incident reporting in accordance with organizational protocol.
Lead incident reporting, root cause analysis, and development of corrective action plans for medical-related events.
Coordinate with the Director of Operations, medical providers, and Executive Management Team on notification and follow-up for significant medical events.

Interdisciplinary Collaboration & Administrative Management

Collaborate with the Clinical Director and Director of Operations to integrate nursing care within treatment plans.
Participate in clinical meetings, case discussions, and program development.
Serve as primary liaison with external providers, pharmacies, and medical partners.
Manage nursing department supplies, equipment, and medication inventory, including budget input and vendor coordination as needed.
Maintain organized, audit-ready nursing records and documentation consistent with The Annex's standards and workflows.
Support special projects and operational initiatives as assigned by leadership.

Quality Assurance / Performance Improvement

Maintain readiness for internal audits, external inspections, and accreditation surveys.
Participate in QA/PI activities, including data collection, incident trend review, and presentation of nursing-related findings during leadership review.
Identify opportunities for process improvement within nursing operations and recommend and help implement corrective action plans.

Required Knowledge, Skills, and Abilities

Knowledge Competencies

In-depth knowledge of nursing best practices, psychotropic medications, and behavioral health care
Knowledge of applicable accreditation standards, HIPAA, OSHA, and state health regulations
Understanding of infection control, medical documentation, and medication regulations
Knowledge of emergency protocols, crisis stabilization practices, and safety planning
Understanding of trauma-informed care and behavioral health clinical processes

Skill Competencies

Strong leadership and supervisory skills with the ability to mentor, coach, and evaluate staff
Ability to perform advanced nursing assessments and clinical decision-making
Skill in nursing documentation, EMR use, and medication management oversight
Ability to de-escalate clients, intervene in crises, and support clinical staff in high-acuity situations

Behavioral / Professional Competencies

Demonstrates sound clinical judgment and the ability to remain calm and decisive during medical emergencies
Demonstrates professionalism, accountability, reliability, and ethical conduct
Maintains composure under pressure and models therapeutic communication
Demonstrates cultural humility, empathy, and respect across diverse populations
Ability to maintain strict confidentiality and appropriate boundaries
Strong conflict resolution and collaboration skills across all departments

Population-Specific Competencies

Ability to supervise and deliver care for adults with complex mental health disorders, trauma, co-occurring conditions, and emotional dysregulation
Ability to recognize behavioral and physiological signs indicating changes in stability, risk, or medication side effects
Understanding of trauma-informed practices, including non-retraumatizing communication and interventions

Education / Experience

Graduate of an accredited nursing program; BSN preferred
Current Texas Registered Nurse (RN) license required
Minimum 3–5 years nursing experience in behavioral health, with at least 1 year in leadership/supervisory roles
Current BLS/CPR certification required
Cleared background check and pre-employment drug screen
Valid Texas Driver's License required

Working Conditions

This is a full-time, on-site position based at The Annex's Austin, TX location, including scheduled shifts as the acting nurse on duty.
Availability to respond to medical escalations outside of standard business hours, including nights, weekends, and holidays, is required.
May require direct involvement in emergency situations, including coordination with EMS, hospitals, and family members.
Regular attendance at leadership and clinical team meetings is required, in addition to scheduled floor shifts.

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