Non productive overtime

Nurses General Nursing

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Recently our hospital HR/ leadership team made an announcement declaring that nurses are only to be accessing charts when punched in. Personally to me this is a non issue because I show up literally minutes before punching in, however there are nurses who I work with that get there early (sometimes even an hour early).

* Just curious if any other hospital has this policy?

* If there is a legal issue associated with accessing charts of assigned patients when not punched in?

* What can I do to support my peers who have the desire to access patients charts early?

Thank you all!

Some of the nurses I work with like to print off the H&P first thing just to have all the background there in one easy-to-access place. I've had nurses hand me their highlighted H&P during shift change, which saves me from having to hunt for the information. Sometimes our computers are glitchy or take forever to boot up, or we have to wrestle them away from the off-going shift, so having a paper copy of the basics during report is helpful. Maybe suggest those nurses take 5 minutes to print out (but not read right then) that basic info, or if those nurses follow your shift, you could print out copies on your patients and hand over the sheets at shift change to the next nurse.

I agree that those nurses who feel they need to know everything before seeing the patient will need to adjust. The above is just one suggestion to make the transition a bit easier.

I can't think of why you would need to come in an hour early to look at charts. Get report, then if you feel you are missing information look at their charts.

You shouldn't need to be digging into every aspect of a chart to do your job.

Now, if I have extra time during the day, yes, I may really comb through a chart. Especially if the pt has been there a bit.

For the most part, it's unnecessary.

This!

Think about this scenario. If a nurse comes in early and starts looking at charts based on what the assignments might be, and then before that nurse's shift begins something occurs where the charge nurse needs to change the patient assignments and that nurse is no longer going to be assigned to those patients, then looking through those charts was a HIPAA violation.

I would not work somewhere where I needed to come in early and/or stay late and be in patient charts off the clock. I don't look at charts before I clock in and officially take over my assignment. I don't look at charts after I clock out. Ever.

This can be a confusing issue and a very grey issue. Unlike popular belief, coming in early to review charts is not a labor issue. What??? you are probably saying.

The 2014 landmark Supreme Court ruling from the Integrity Staffing Solutions v. Busk case settled the questions around the 1947 Portal-to-Portal Act that did not require employers to pay for preliminary or postliminary activities to the primary productive activity that the employee was paid for.

Technically, the hospital would be on very firm ground to not pay for chart reviews before shift nor charting after the shift once care for the patient was handed off to the next nurse.

Of course many hospitals do pay to avoid the nightmare that would ensue from such an action but they try to limit it to reasonable exceptions. Many hospitals see staying after as avoidable but reasonable, coming in before is just unnecessary.

Interesting.

Specializes in CCRN.

Nurses are way too important to work for free.....just saying.

I doubt working off the clock is "allowed' anywhere- it is either ignored or forbidden. The hospital can't acknowledge employees working for free. It's like pretending to believe nurses all get lunch breaks even in some workplaces where that is clearly impossible. A convenient fiction.

And, no- it is not a privacy violation.

Specializes in Pediatric Critical Care.
This!

Hi Bronx! I see that you are new here, welcome! Take a look in the bottom right hand corner of my post - see the "reply" and "quote" buttons? If you are responding to a specific post, click "quote" on their post and it will link it to your response so that everyone can follow the conversation better. :)

Specializes in Adult and pediatric emergency and critical care.

Like many of the others I can't imagine why I would show up early to look at charts before taking report. I also don't work for free, so you will never find me at the hospital working on my time off. The twelve hours I put in are enough.

I think the concerns about HIPAA are a bit of a stretch, if there was a genuine need for information at the time then it doesn't really matter if the assignment changes. I have given report plenty of times and then the patient decompensates or develops the need for some specialty treatment only available on certain floors/units so some nurse got report on a patient they didn't end up having; this isn't a HIPAA violation. But as a charge I don't tell nurses who come in early their assignments, they are free to hang out in the break room unless we are slammed in which they can clock in if they so choose.

I'm not really sure why some nurses are so obsessed with knowing every single detail and want to come in early anyway. What if you got floated to a different unit? I come into shift on time and can take 2-3 intensive care patients with limited known history and a short report, or 5 and up non-critical patients; I just don't understand this strong desire for being that type A. Even our lifer ICU/PICU nurses get code patients from the ED where I tell you what interventions we did but otherwise we may know essentially nothing about the patient; they manage to figure it out and give great care.

Our hospital policy is that no non-except employees (every nurse who isn't a manager or above) may not perform any work while off the clock. This goes for anything whether it be online training, required classes like ACLS, or patient care. We are happy to pay for nurses to work on their time off on things like online education if shifts are too busy (or to take their ACLS/NIHSS/PALS/NRP/Chemo cert/whatever else in addition to their regular shifts), but I can't imagine why staff nurses would need to access charts outside of their normal shifts.

Think about this scenario. If a nurse comes in early and starts looking at charts based on what the assignments might be, and then before that nurse's shift begins something occurs where the charge nurse needs to change the patient assignments and that nurse is no longer going to be assigned to those patients, then looking through those charts was a HIPAA violation.

No/wrong.

Aside from being punched in or not punched in, that activity is not a HIPAA violation. It only ever "became" one d/t people with altered intellect being given the role of privacy officer, or fake rules made up to scare and control employees.

I just don't understand this strong desire for being that type A.

I like how you keep those assignments under wraps as the CN, though! That's clever - employing a little Type A to combat the Type A-s!

Anyway...the quote is a little bit problematic, Peak. Type A's might say they can't understand why others have such a strong desire to be lazy/half a$$ed about things.

Both are wrong-headed, since people are people and we most certainly aren't all the same. Secondly, whether people have "strong desires" to "be" what are sometimes the more difficult aspects of their natural personalities is a discussion for another day.

Disclosure: Type A-ish. Perhaps secondary to that, I poured over every one of my patients' charts as a new grad whenever there was the slightest down time. I'm not ashamed of it and don't regret it; I learned a ton and, along with my excellent preceptor, it's a big part what helped me get on solid footing AFAP. I've made the transition now to knowing a lot less than what I used to know about people while I'm taking care of them. I'm not willing to say that's better or worse than anything else. It just is what it is.

Specializes in Adult and pediatric emergency and critical care.
I like how you keep those assignments under wraps as the CN, though! That's clever - employing a little Type A to combat the Type A-s!

Anyway...the quote is a little bit problematic, Peak. Type A's might say they can't understand why others have such a strong desire to be lazy/half a$$ed about things.

I work mostly with what we label ourselves type Z. We keep it chill and relaxed unless it really matters and then it goes into type A mode.

We do enough elective continuing education that no one can ever accuse me of being lazy. If we are slow there is a good chance I'm gonna take a couple of the new nurses upstairs so they can brush up on respiratory stuff (especially rare things like oscillators and nitric), managing multiple vasoactive meds, titration vec drips, assessing patients on ECMO, delivery and neonatal resuscitation, or whatever else interesting is going on in the house overnight. There are also often nights where it is slow and we just hang out and watch movies together.

I keep up to date and read journals and studies on my time off, so it isn't like I'm not interested in the medicine/nursing (and I have more post-nomial certifications than you can shake a stick at); but I just don't care enough to dig through charts all day if it doesn't really matter.

I guess that I probably have some pretty strong bias because we have such extensive mandatory and elective education. At my current system we require new grads to have 4 weeks of ED specific training before they are allowed to start having clinical shifts, and are required to have ACLS and PALS before we even consider them for the program; and they are required to have NIHSS and TNCC (or ENPC for peds side) before they are allowed on their own, and their orientation is the better part of 6 months. I don't think there is a month that goes by that we don't have some 2-4 hour in-service about TPA, new medications, changing policies and legal issues, updates in trauma care, human trafficking, child abuse, new invasive monitors, congenital disease updates, or some other topic.

We seem to break people out of their type A or B personalities pretty quick. The true type Bs typically go to larger/lower acuity systems, they true type As typically end up on one of our ICUs.

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