Constantly stays late

eatmysoxRN, ASN, RN · Feb 13, 2013

Why is it only on weekdays? Is there adequate staffing? Are they working the whole shift or chatting?

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

Ccymom · Feb 13, 2013

Gets out when she wants to. 60 to 65 residents 2 nurses 8 aides

litbitblack, ASN, RN · Feb 13, 2013

Does the facility have a policy on overtime? That is something that will have to be addressed before you can start disciplining. I would start with observation and conversation. Is there enough staff on the floor? Is it time management as the weekdays are definately busier than the weekends. Those are just a few ideas...

NotFlo · Feb 13, 2013

Yeah I have a few ideas but I'm sure you wont like them.

Some questions, is everyone else really leaving on time or are they punching out and staying late? Is everyone else really completing their work? Sure there are nurses at my job who leave every day at 3pm. They must be the best nurses in the building, right? Well the DON and bean counters sure think so. It really doesn't matter that after a day off I find most of my dressings still on that were have supposed to have been changed the day before, most of the charting not done at all or totally inadequate and tons and tons of holes in the MAR. If they happen to get an admission only the bare bones will be done, none of the wounds measured, and all the paperwork stuffed in the front of the chart. But hey, at least they punched out on time!

Pressure to fit 12 hrs of work into 8 hrs is the worst.

Orange Tree · Feb 13, 2013

Yeah I have a few ideas but I'm sure you wont like them.
Some questions, is everyone else really leaving on time or are they punching out and staying late? Is everyone else really completing their work? Sure there are nurses at my job who leave every day at 3pm. They must be the best nurses in the building, right? Well the DON and bean counters sure think so. It really doesn't matter that after a day off I find most of my dressings still on that were have supposed to have been changed the day before, most of the charting not done at all or totally inadequate and tons and tons of holes in the MAR. If they happen to get an admission only the bare bones will be done, none of the wounds measured, and all the paperwork stuffed in the front of the chart. But hey, at least they punched out on time!
Pressure to fit 12 hrs of work into 8 hrs is the worst.

Exactly. I rarely stay late, but I do have to cut a LOT of corners to get out on time. If anyone says anything to me about the 12 repetitive forms I didn't fill out, I invite them to come in and follow me around for a night. If they can find any mismanaged or unused time on my shift, I'll be happy to take my lunch and breaks! And if they can find a little bit more time, I'll be happy to fill out the forms, too.

I draw the line at cutting actual care/treatment and patient assessments, but I see plenty of nurses who do cut those things.

amoLucia · Feb 21, 2013

Sorry to be checking this out so late -

Suggestion - look at who comes on before and after your chronic overtimers. An unready, previous shift nurse or a late, not-ready-to-start new shifter can really bog down your problem nurses. A really late start or delayed replacement may be contributing to your staff's problems. Also, be aware of any staff who may be ADD/ADHD types; keeping them focused is difficult.

Another suggestion - can a shift supervisor or mgr run interference for them ? As a floating supervisor, I believe one of my responsibilities is to ensure that my staff is getting out on time. I feel guilty if I leave on time and my staff can't. I know who was having a bad 11-7 that nite. So I'd stick close & TRY to help out to do something - a couple fingersticks or end-of-shift GT flushes, an IVABT or 2 (there were 4 for that morning with a vanco peak & trough that I would pull off for them). I know the status of a fresh faller so I can make those family and MD phone calls. Anything to help, ASSUMING I'm not being suckered, or that I can make the time myself. And yes, this is a sometimes, not always type of remedy.

Question - are your problem nurses the units' social butterflies, the yakkers who spend time yakking with the oncoming shift? I have had to stop 3-11 staff to hurry them along and let my 11-7 shift get started. Or do they just yak & yak & yak with staff, visitors & pts to the point that they start to fall behind (yet they don't see it)? Esp the alert & orient pts and many families just LOVE to talk with the staff, and some staff just LOVE to talk with them in return.

Another point - as NotFlo brings up, can the quantity of required tasks, incl paperwork be reviewed to better allocate the burden and/repetition. At her facility, much is being missed which is another problem unto itself. But ... some meds & treatment can be rearranged & some parts of new admission process can be shared among the shifts. It is a 24/7 operation - an overworked phrase, but true.

Just a few thoughts. Hope they help.

SuzieVN · Apr 1, 2013

There are nurses like that everywhere- they play the $ game, is all. How long have they been working there? If they can't or won't get the work done on time, fire them. Besides- if they can't or won't, they are also adversely affecting everyone that follows them, and it causes a ripple effect. There's too much to be done to have the prior shift nurse in the way, FACT. There are lots of folks waiting to replace them...I'm ONE of them. Besides, as DON, your job is on the line for the overtime, possibly.

SuzieVN · Apr 1, 2013

A SNF is like a factory- an assembly line. Each worker on the line has to keep up, to 'make rate'. If not, they impact everyone behind them and in front of them, and the assembly line collapses (recall Lucy in that chocolate factory skit? She couldn't 'make rate', so she tried to shove the candy in her mouth??). Same with nurses that can't or won't 'make rate'. There's an amount of work that simply must be done. Maybe when you hire people, tell them after their orientation is over that they have 30 days to 'make rate', or they'll be "hasta la vista, sister"!? And another thing about the OT- that money comes from somewhere, usually detrimental to the patients- like cuts to actvities, or housekeeping, snacks, etc.

benegesserit · Apr 3, 2013

Yeah I have a few ideas but I'm sure you wont like them.
Some questions, is everyone else really leaving on time or are they punching out and staying late? Is everyone else really completing their work? Sure there are nurses at my job who leave every day at 3pm. They must be the best nurses in the building, right? Well the DON and bean counters sure think so. It really doesn't matter that after a day off I find most of my dressings still on that were have supposed to have been changed the day before, most of the charting not done at all or totally inadequate and tons and tons of holes in the MAR. If they happen to get an admission only the bare bones will be done, none of the wounds measured, and all the paperwork stuffed in the front of the chart. But hey, at least they punched out on time!
Pressure to fit 12 hrs of work into 8 hrs is the worst.

Agreed about this. I'd get out on time a lot more often if I only had to worry about doing my own job. I also agree about figuring out if people are clocking out and then coming back to finish charting - maybe the late nurses haven't figured out that this is what everyone is doing, or just refuse to play that game.

Are there commonalities in the nurses who are late? Are they new employees, recent grad nurses, or nurses who are new to LTC? Or following nurses who are one of those? Do they all work the same floor? There's one floor where I'll almost always be out on time (and often sitting around doing make-work for half the afternoon), and another where I'm almost always out late - the distribution simply isn't equal, both in terms of numbers and acuity (ie. 30 total care vs. 20 walkie-talkie). Is it nurses who are on with particular CNAs? Is the late nurse doing an excellent job of finding/reporting problems which require time-consuming follow-up (charting, reporting to MD and family, etc)?

What do the nurses themselves say is the problem? If I were asked why I stay late, I could tell you exactly why (and, I admit, sometimes that includes talking too much or other poor time management).

Babynurse2013 · Apr 18, 2013

I completely agree with some of the other comments regarding how other nurses are handling situations, paperwork etc and why they are able to punch out on time. When I began in LTC as a staff nurse, I consistantly could not get out on time. In part, it was obviously my own time management skills and getting used to the residents and flow of the floor. The other part, I realized quickly, was the nurse reporting off to me almost always had at least two or three things she handed of to me to take care of on my shift. It was always very vague and by the time I had assessed the situation, called the MD and filled out loads of paperwork, I was over an hour behind on my med pass. The other nurse on the floor did not do this. She stayed late and made sure all of her responsibilities were cared for before leaving the building. I've watched my reporting nurse play on her phone and gossip, riding the clock until she could officially clock out, with mounds of paperwork right in front of her. Then she would say something like, "I can only do so much, I'm getting out of here"

As a staff nurse, I'd highly reccomend talking to all your nurses. See who is doing what and why some are getting out while others arent. I can almost guarantee that the ones getting out on time are cutting major corners or not doing treatments at all and most likely leaving paperwork and such for the oncoming nurse.

Best of luck with the new position!