Supervising and delegating: Why I don't stay 3-4 hours late like the 3-11 supervisor

Adventures in supervising land: Wearing multiple hats and at the same time, being yourself

From the moment where I covered my first shift on 11-7 as a floor nurse for a no-show rather than primarily acting as the house supervisor, I knew that there was more this new role than just helping with admissions, paperwork, and auditing. I remember being told that a majority of my time spent on the clock would be babysitting GNAs and I thought, "Well, gee. I can do that." The administrator and ADON both stressed this point and I remember thinking, "There has *GOT* to be more to this than what they're telling me.

Let's start by seeing how many different "hats" I can list:

1. Relief for impatient 3-11 nurses
2. Coverage for no-shows
3. Liaison for nursing assistants who just can't communicate effectively
4. Bearer of bad news when I take call-outs on top of an already sparse schedule
5. Building census auditor
6. Admissions nurse
7. Second opinion when it comes to sending someone to the ED
8. Liaison between transportation services and nursing units
9. Confirmer of appointments and discoverer of appointments unknown
10. Filter of what's important and what's been dramatized by the 3-11 supervisor

Regardless of how many hats you're wearing, whoever you're talking to on the phone in the middle of the night has to see your best version of the hat, whether it's a call-out, the ADON, the 3-11 supervisor, an irritated doctor or the Emergency Department trying to dump a patient back on us after having seen that they're a nursing home patient.

And then of course, there's the 3-11 supervisor and dealing with her "report off", or lack thereof. She stays (no joke) at least 1-2 hours late every night. I understand the idea of staying late as a floor nurse, because there's a specific set of tasks and documentation to be performed. I'm a diligent lady and I'm not trying to say that I have more to get done on nights than she does, but I have a different set of priorities, routine tasks, and idea of what needs to be done before I leave. Last night, we had a guy with a critical H & H that had been drawn at dialysis but they didn't do anything about it because they "don't send people to the ER" and "don't 'do' transfusions." The H & H was unbelievable but the lab has a history of being untrustworthy, and the Medical Director has recently implemented a rule of a second H & H before sending someone to the ER. (Two labs are better than one and then you can match them against each other.) I worked 3-11 on the floor, so I watched her start to go into panic around 7 and watched her spin in circles, chasing her tail for the final 4 hours my time on the floor. The lab had come around 6 to re-draw and we still didn't have results by 10 on a STAT lab. I took over at 11:30 but she was still in the building until almost 1 a.m., calling EMS, the family, etc. There's a point at which it's OKAY to leave, because you've done your work and it's safe to pass on to someone else. Would she delegate anything to me or ask for help? No, so I had to start my night routine, run the house census and go through the happenings of the day, because she didn't have anyone to get report from (we have 3 unit managers during the day) and found herself with too much work to do.

I document what's important to me and what I think is best for the whole house. I take diligent notes, follow up on *important* information she gives me, and of course, I filter out what notes the 3-11 supervisor has given to me between what's actually in need of follow-up, and what she did while being nosy and finding busywork for herself. I'm good at my job and I'm efficient. I leave at 7:30 nearly every morning. The only days were I leave late are when I'm reporting off to the weekend supervisor or a day shift nurse/manager/the DON asks me to do a task. I have no doubt that the powers that be know how late she's staying, unless she's punching out and doing work off the clock, and even still. What possesses you to stay until 3-4 a.m. when your shift ends at 11:30? Last week, she stayed until 4:30 one morning. I wonder how she sleeps when she gets home.

It's hard to think my thoughts hold water when she writes down everything comes out of her mouth (she's even written notes about specific residents on a printed daily schedule that the whole house sees) and there's so much to sift through. Most of what I write doesn't even come from her. I run a 24 hour documentation report on the whole house, highlight notes (especially those from her shift) and go from there with how I prioritize patient information, status changes, such as falls, UTIs, skin alterations, etc. It's not that I don't take my work seriously or even her work seriously but information overload comes to mind.