How can a Director cut back on incidental overtime?

nursemaa · Oct 4, 2005

Hi,
I am finishing my Masters Degree in Nursing Administration and working on a project for my final practicum. My preceptor is trying to come up with interventions to reduce incidental overtime (the extra 30min, hour, etc beyond your scheduled shift) for the staff nurses in the PICU. The nurse ratios are either 2:1 or 1:1 depending on acuity. I have done a literature review, and I am not having much luck. Any suggestions?
Thanks for your help.

I wonder if it would also be helpful to observe/talk with the nurses who DO manage to get out on time...what do they do differently? I'm sure she wants to focus on chronic OT, not the occasional "bad shift" that everyone has sometimes.

If your lit search doesn't turn up much, then perhaps this would be a good research project...

military spouse · Oct 4, 2005

Does anyone work or know nurses who work 0300-1500? There are a lot of nurses who would work 1500-0300, but I think it would be difficult to find nurses to come in at 0300. Starting at 0300 would be ideal because that is usually the slowest time, at least on our unit. From 0200-0300, nurses could finish all their charting, and when the new nurses come in at 0300 they would have time to ease into their day and plan it out before morning meds are due. I just don't know if 0300 is a realistic start time. Although, I know that flight dispatchers start at this time, at least where my brother works.

The L&D and nursery workers work 0400-1600 and people seem to like it. This is in AZ. The night people like it because they can get a couple hours sleep before the kids go to school.

CardioTrans, BSN, RN · Oct 5, 2005

I have a friend who worked on a unit that always had OT. Usually at least 3 or 4 of the nurses it was an hr each shift.

The manager decided to try to cut OT down. This is going to sound really strange.......... but everyone was told, that no one leaves unless everyone leaves.

Guess what......... in 3 months, the most OT that the unit had was 15 minutes.

Everyone thought the worst, but what actually happened.......... teamwork, everyone helping each other so they could all leave on time.

NurseyBaby'05, BSN, RN · Oct 5, 2005

One of the biggest time wasters on my floor is shift report. Usually the nurses who tape are the ones that get out on time or close to it. They are wrapping up their charting and other last minute details while the oncoming nurses listen. Verbal report often turns into coffee break and watercooler conversation. "How 'bout them Stillers?" "Guess what the baby's doing now?" "How's your mother?" etc. Of course this varies from place to place, but that's how it is on my floor.

childrensrn · Oct 24, 2005

Thanks for all the advice! I like the no one leaves until everyone leaves idea, but can a manager really enforce it? And wouldn't some nurses strongly oppose it?

Through my survey I found out that most of the nurses do not take their full lunch/breaks. So I need to come up with a way to provide lunch coverage. The biggest reason nurses stay late is because of charting on new admissions/transfers. Also nurses cited patient care as a big reason which leads to charting late. Interruptions by MDs at shift change (asking questions, writing new orders, or doing procedures) was also mentioned as well as precepting and the oncoming RN being late.

Thanks again for all the ideas. I will continue to work on this.

kadokin, ASN, RN · Nov 6, 2005

I formed a task force from staff from all shifts to ask THEM why the overtime was happening. We looked at things like workloads, feeling like it all has to be wrapped up at the end of the shift and ways to eliminate "time wasters" we identified. THEN.......
I started coaching and goal setting for chronic offenders. After one long year, it has worked. :)
for now.........

THANK YOU for getting input from the staff. Why don't more nurse managers do this? We ARE your colleagues, after all, even though we don't work in management, we can give you enormous insight into the actual reality of practice. And I'm not just talking about the staff nurses that happen to be in your "inner circle", I mean ALL of the nursing staff that actually get the job done.

Jennie RN, Bsn, an actual working nurse

FroggysMom · Nov 7, 2005

I formed a task force from staff from all shifts to ask THEM why the overtime was happening. We looked at things like workloads, feeling like it all has to be wrapped up at the end of the shift and ways to eliminate "time wasters" we identified. THEN.......
I started coaching and goal setting for chronic offenders. After one long year, it has worked. :)
for now.........

Just a question - and please, I don't mean this to be critical. I'm simply curious. Were your, as you call them, chronic offenders, simply not working hard enough, not working efficiently enough, or were they just too conscientious?

I've seen nurses leave a floor on time that passed on their work to others or spent time socializing so at the end of their shifts there was work left undone. I've seen caring and conscientious nurses take the time with their patients, maybe even foregoing their own lunch time, who wound up working over to finish their work.

I guess what I'm saying is that a nurse working overtime is not necessarily a bad or disorganized nurse. I fear the push to save the almighty dollar may make nursing simply robotic - push, get the work done - hurry hurry and give up on the extras like talking to the fearful patient, like giving the extra instruction to a homegoing patient who may need it for their well being.

I know most institutions don't want to hear the words "adequate staffing" but from my point of view, that is still where the problems lie.

gauge14iv, MSN, APRN, NP · Nov 7, 2005

I worked in a unit that was VERY fast paced, high volume, heavy workload etc - they way incremental OT got wiped nearly out was by the fact that each shift was willing and cooperative when it came to taking over what had not been finished in the last shift. There was no guilt or beating each other up about not getting that admission finsihed before 7 pm that showed up at 6 - the offgoing nurse did as much as she could and then the next nurse just picked right up and went on with it.

This was a rare unit let me tell you! We almost ALWAYS got out on time. It was the real spirit of teamwork and the willingness of the manager to handle bullies on the unit that fostered this. It was a great place to work because of that.

donmomofnine · Nov 7, 2005

The chronic offenders were only two or three. They were disorganized for the most part. I had their supervisors do the med run and help these nurses streamline their med pass and show them how to save time. This got the supervisor involved and this helped promote team work as well.

I had one nurse leave because of my "crackdown". She spent huge amounts of time putting residents to bed, singing to them, reading scripture etc. You know that I had upper management on me about the overtime. I validated her TLC, but told her that she should be showing her nursing assistants how to provide these little special things for the residents. The truth is, we are paying her to assess, document, pass meds, do treatments etc. I loved her heart, but I cannot be fiscally irresponsible.

I know "adequate staffing" is a problem as is "adequate funding" for LTC! I feel our staffing is quite adequate most of the time.:)

FroggysMom · Nov 8, 2005

The chronic offenders were only two or three. They were disorganized for the most part. I had their supervisors do the med run and help these nurses streamline their med pass and show them how to save time. This got the supervisor involved and this helped promote team work as well.
I had one nurse leave because of my "crackdown". She spent huge amounts of time putting residents to bed, singing to them, reading scripture etc. You know that I had upper management on me about the overtime. I validated her TLC, but told her that she should be showing her nursing assistants how to provide these little special things for the residents. The truth is, we are paying her to assess, document, pass meds, do treatments etc. I loved her heart, but I cannot be fiscally irresponsible.
I know "adequate staffing" is a problem as is "adequate funding" for LTC! I feel our staffing is quite adequate most of the time.:)

I see where you are coming from and I'm sure it is no picnic being responsible for adequate staffing and a finite and sometimes harsh, budget. Good luck to you in trying to maintain the balance. :)

donmomofnine · Nov 9, 2005

Thanks for your kind words!:)

ZASHAGALKA, RN · Nov 9, 2005

Why would you want to cut down on incidental overtime?

That's not as silly a question as it first sounds. Nursing has gone through a revolution of flexing up and down staff - many times intra shift.

A side effect of always keeping staffing at the edges is the incidental overtime to finish up/catch up.

To me, forcing staff to try clean up the 15-30 min over run is one step too far. (It's an insult - as in - stop milking the clock. As if . . .) I think it's a choice - flexing staff to the limits and incur incidental overtime, or stop flexing to the limits and pay the actual overtime for all those extra shifts that would require.

How can you cut back on incidental overtime? Pay more direct overtime and have more staff always at hand.

And I think a manager's job is to explain this to the bean counters - we're actually SAVING money - instead of passing off the complaints of the bean counters onto the staff.

There is a breaking point here. In my experience, in the times that I incur incidental overtime, I have normally been so busy that I didn't take a lunch break - a break that I wasn't paid for, whether I took it or not. If I was then griped at for that extra half hour, I danged sure learn the lesson and turn in 'no lunch' forms.

There's a give and take here. The bean counters should be made to understand that this is the 'give' part.

~faith,

Timothy.