Feeling guilty about working over shift end

[CareteamRN70]

Hi,

I just started my first nursing job at a LTC facility on the night shift for a 52 bed unit (well 52 current residents).

I feel like I am a living contradiction. When I graduated Sept 2010 I was told I would hate LTC (I love it).

I was told since I was new it was unlikely I would get a night position (Out of 55 applications put out only offer I got was my current position 11p-7a).

I was told I would not have to worry about charge nurse duties at first (after 5 days of orientating on days and eves I found myself alone on nights as charge).

I was told I would have trouble with my aides..and this is a half truth as my aides are a mixed bag of great wonderful workers and a few that hide from me after shift start and I have to hunt down in breakrooms, on other units visiting friends, or out on the parking lot.

I had never worked (tbch I had never worked as a nurse so this may not be that great a revelation) with QMA's before and God bless each and every one of them. I did not know how much I appreciated them until I came in one night and I was paired with another nurse and no QMA. I swear the next time I worked and I saw I had a Q working with me I wanted to buy them flowers cookies and coffee.

My main problem is (and please no snickering from you more experienced LTC nurses) it was stressed that I had to be out of the building after about 10 minutes or so after shift end...

Well when I was orientating that was not a problem...but I noticed the rest of the nurses would just start charting as I was leaving. Once I started working I saw why. They have med passes, tx's, plus a ton of other stuff to do, and at shift end getting the last of the blood sugars, temps, vitals, etc. That doesnt include the fact that the next shift of nurses seem to show up when they feel like it (anywhere from 15 minutes to an hour after shift end). So Im waiting around to do narc counts, give report, and to pass on any other info.

First "real" shift I worked by myself I ran about 40 minutes over shift..I told myself I was new and I suppose that was to be expected. The next time we were short aides and so I helped with AM adls, I worked an hour past shift playing catch up. Then next night I had a hell night (again no snickering..this may be a walk in the park to some of you but for me it was pure chaos). Had a resident fall, spent time looking for every form i needed that were scattered around the station, calling Dr, DON, family members, and doing 15 min Neuro checks plus full skin assesment. Was at work hour and a half past shift end. I was positive I would come in to at minimum a written warning or verbal warning. Nope...Unit manager I spoke with just chuckled and said "Welcome to LTC".

I am really torn over this. I am trying to find ways to have better time management, I ask every other nurse I come into contact with how they do it (and they all say for the most part they still work over shift). I've made todo list for myself with times I should have x amount of things done..I budget time for emergencies such as falls, change of status events, short staffing of aides, etc...but nothing seems to help much.

Some of the aides have insinuated that the RN's work over on purpose for OT..I just don't see that.

So am I being naive?

Should I just accept that my shift ends when I have finished all tasked and not what my clock out time is supposed to be? - and I refuse to work "off-clock" in anyway if I may be expected to actually do patient care in my finishing up tasks.

Looking for advice, suggestions, or at least encouragement that it is possible to squeeze an 8 hr shift into 8 actual hrs.

Big J

[Noimanurse]

First of all, NEVER work off the clock. Second of all, NEVER work off the clock.

[tyloo]

It all depends on the place you work at. I found that if the place is staffed right with the correct/doable patient: nurse ratio, you have an outstanding aide, and not off the wall thing happens like a code, fall, decannulation, etc, than YES you can clock out on time . Guess what sounds like it doesn't happen often because it doesn't.

I have also followed nurses that get out on time and they didn't do what they were supposed to do. They left the assignment in shambles. Be wary if a nurse who always leaves on time or seems to be sitting alot during the shift not busy. The nurse may not be busy because shortcuts are being done. I have read past charts where nurses write down assessments that make the patient look as if there was no abnormalities at all or they write verbatim the past shift's assessment. Sometimes wound care wasn't done. Sometimes you get report and you look at the patient and it is nothing that you got in report and you wonder did the nurse even have a visual on this person?

Each nurse has their own methods too. You just need to find yours. Some nurses gather their charts first and look at them and others like myself go out on the floor and look at the patients. Give yourself some time to develop your routine. You certainly sound like you are analytical enough to find what works for you and what doesn't. I would just be wary on who to ask for advice that's all. Find the good nurses and seek them out for advice.

I am happy for you to find your niche with your first job! Congrats!!

[skittlebear]

I think you are doing a fantastic job! I would not feel guilty about staying past your shift if you are caring for your patients. Jaimeg40 was right on with her post.

[caliotter3]

I have worked at places where I was told upon hire that I was to clock out before finishing charting if I ran over. In such situations, one weighs their need for a job versus their need to be precise with the time clock.

[Minnie2006]

Sometimes it's a no win situation. Not enough time/staff to do the job right. Management doesn't like to pay overtime and oncoming staff sometimes want everythiing to be done so their job is easier. You have to be satisfied with the care you give. Give it time, you seem to have a good handle on the situation. Do try to seek out the "good" nurses whom you can learn tips from. They are a great source of support.

[Scarlette Wings]

i loved the "brand spanking new nurse" intro you have. i remember those days! having read your entry i can tell you have already learned a great deal.

1. never believe something just because you were 'told' that is they way it is. everyone and everything is unique.

that said, my daughter has loved, adored, and cherished the elderly since she was old enough to toddle over to an old person in their wheelchair and baby chatter and talk to them. she has remained in love with the elderly and has worked her way through the nursing assistant days into lpn and now rn, all in long term care. she still loves those old people and i have always felt nursing home care is a calling.

i am so thankful there are nurses who are called to care for and cherish our older adults. i have worked in ltc for a few years and yes, i loved it to no end. i thank you for honoring the ones who have lived before computers and televisions and air conditioning or indoor plumbing. they have wealth of wisdom and every culture that i have ever studied says that the civilizations that thrive are the ones who honor their ancestors.

you will gain time management skills as you gain experience. you will manage a system that works for you and find a way to get things done and get the charting as well. it is an ever present challenge all of us endure. there will always be days you run over on your time for one reason or another from day one until day of retirement.

you will find a balance, it just takes time. i would not worry. i agree never work off the clock, there are so many legal reasons that protect you i wouldn't dare try to list them here. you will also find out how to word things without writing all the tinest details while putting the important things most needed into your notes. again that comes with time, experience, and trial and error. you are doing a good job. hang in there.

i used to do first rounds with one of my assistants. i would choose to go with the assitant that was not on the med cart i was working on that particular night which allowed me to physically see that group. that way i would see of at least half the patients during first rounds of turning and changing of the briefs. then i did my med pass on my own group and by the end i had seen pretty much all of the ltc ones. (we had a ltc skilled side and assisted living side).

i would then try to open half of my charts or as many as possible before i would go down the hall for treatments and another round of turning and checking of the briefs. lol. then open more charts and so on. it is hard but you work out a rhythm. you'll get it, just be patient with yourself.

[Who?Me?]

I absolutely agree with everyone who mentioned not working off the clock. You may love your job, but get your money for it-you worked for it!

I have worked LTC, hospital-based, and public health and in all of those areas I have had days when I get out on time and plenty of days when I have had to stay over to help my coworkers, finish charting after a hellacious shift, or the next shift didn't show up and someone has to take care of the patients/residents.

As you work you will pick up "tricks of the trade" for increasing your efficiency, grouping cares, etc. All of this comes with time and experience. Perhaps you could be the one to initiate filing all of the fall paperwork in packets?

Good luck.

[Forever Sunshine, ASN, RN]

Just be patient and DON'T GIVE UP. Things are going to be terrible and to be honest I've went in a supply closet to cry a couple times because things were just so stressful and nobody was cooperating with me.

I have started to be able to say to the CNAs when they are whining about the assignments.. This is what it is.. and this is what we are going to do. And that will be that. If you need help, please ask.

After a few shifts as charge nurse you feel strong enough to say that.

Don't work off the clock either. Sign out the exact time to the minute that you leave. If its more than an hour and a 15 minutes past the time I'm supposed to leave I circle it. If its more than 2 hours. I underline and circle it. If its anymore than 3.. I'm drawing stars, faces, exclamation points, etc.

If I get a write up(I haven't yet) for ever staying past my shift on the clock. I will refuse to sign it.

I am there until 1:30am finishing up charting, stuff for the admission, MD orders(which need to be documented in 4 sometimes 5 different places).

If you feel comfortable doing so, give all meds at one time. For instance if they get a b/p pill at 6p, a coumadin at 5p, and a colace at 9pm. Give it at all once.

The only things I go back for are 4x a day meds, late b/p pills at 10pm, ATC narcotics, antibiotics, lantus and ambien. Everything else gets given in the first med pass. Now I might get flamed for doing this but .. I need all the time I can get. If I didnt do it this way I would be leaving at 3am.

Treatments squeeze them in as the CNA is putting them to bed and changing them. If you have the worlds best CNA's like I do. .they will come to you and ask for Mary's treatment or the cream for her rash because shes going to bed now.

[robby5313]

I agree that giving meds at the same time would be helpful......if state walks in at 7 p.m. (and they have for me!) you would be screwed! And unfortunately they don't really care that you have way too much work to do! I'm not flaming you.....trust me..I've been there. Just my 2 cents!

[blondegenes]

Never chart when off the clock. I read of one instance in which a RN had her license suspended by the state nursing board for doing so.

The executive director said it a thousand times, if she said it once; "it's doable on paper",,,interpretation; she would rather you do it on paper, make it look good and neglect the patients. Why? Because, given the skilled nursing load, it wasn't doable at all. Previously, the skilled nursing unit was staffed by two nurses, but the executive director enjoys a rich bonus by nickel and diming the patients, literally, to death. (Yes, I've documented and reported neglect to the appropriate agencies).

Subsequently, all of the other night nurses that were hired and retained for any length of time were the kind who started charting the moment after they took report from the previous shift, and never got up to check on patients, pass pain meds, check blood pressures, blood sugars or any vital change on the skilled nursing unit.

Previously, any nurse who would not risk their license by following suit took employment somewhere else as quickly as possible, or was fired under false pretenses just to open up a slot for another nurse.

The executive director and DON publicly praised the nurses who clocked out on time, even knowing full well that they slept on the job and refused to get off their duffs. The executive director is unaware that I know she had dialup service on which she could get four different camera angles (at any given time, on her cell phone) of the nurses and CNAs who were sleeping and/or watching tv.

There are mediocre LTC/skilled nursing facilities, and then there are horrific LTC/skilled nursing facilities. They all receive the same amount of money from Medicare and Medicaid as every other facility, but you can tell if the facility is taking care of the patients, by the appropriate nurse:patient ratio.

If you are uncomfortable with working over at the end of the shift, ask yourself if it is because you are in fear of losing your job by justifiably doing so. If that's the reason,,find employment somewhere else, quickly.

It's a lot easier to find another job when you already have one.

[CareteamRN70]

I want to thank everyone for you comments, encouragement and advice.

I must stress since this seems to be a focus in a lot of the replies:

I do not work off the clock for any reason...if for no more reason then I want to practice under my companies liability. IF I did clock out and chart I wouldn't feel guilty like I do..I'd feel po'd.

That being said, yes my place of work is rough..it "feels" understaffed (remember I am new to LTC and Nursing in general), but I love the work and my residents. I just feel bad that I can not seem to fit my shift into my 8 hours alloted, it is a combination of wanting to not hit my company up for OT money just because I can't seem to get done on time..but mostly it is a prideful thing within me.."I" feel like I should be able to do this within my shift and tbh my pride is taking a hit.

The advice given here will be very helpful in both helping me with my time management as well as rewireing my brain to deal with the old saying &*$# Happens...ie there are going to be long shifts no matter what I do.