How can a Director cut back on incidental overtime?

llg, PhD, RN · Sep 8, 2005

Step 1: Assess the causes of the incidental overtime. It probably varies from setting to setting. Until you know the causes of the overtime, you can not address the most relevant issues. Selecting interventions from a list of possibilities is like taking shots in the dark: you might hit something good, but you might not -- and you might cause more problems with your wild shooting.

Interventions in administration are no different than any other type of nursing intervention in that respect. You have to thoroughly assess the patient (unit) and have a thorough understanding the problem and its causes before you can begin to develop a plan of action.

Too many management strategies are based on what someone read in a book .... or heard at a conference ... etc. that may or may not apply to a specific setting. Bad managers do what's fashionable, the latest "hot thing" out there in the literature and/or on the internet. Great managers take the time to know their unit well enough to understand the underlying causes of the problem and address those underlying causes.

llg

prmenrs, RN · Sep 8, 2005

#1 reason for "incidental overtime": Charting.

nursemaa · Sep 8, 2005

#2 reason: offgoing nurse is afraid if she leaves anything unfinished, ongoing nurse will be angry with her. (e.g. patient arrives 20 min before end of shift, offgoing RN feels she has to stay to "finish" the admission).

prmenrs, RN · Sep 9, 2005

#3 not getting lunch because there wasn't enough staff to cover.

childrensrn · Sep 13, 2005

Thanks for the advice. You brought up a good point about focusing too much on research. I am in that school mindset and everything we write including our journals is based on research. I will need to spend time observing on the unit and asking for the nurses' feedback.

xrockstheheart · Sep 13, 2005

While it is true that some people like the overtime and hang around the extra hour everyday. the fact is that most charting is done retrograde style at the end of the shift. It works different in the different departments.

Thanks for the advice. You brought up a good point about focusing too much on research. I am in that school mindset and everything we write including our journals is based on research. I will need to spend time observing on the unit and asking for the nurses' feedback.

Daytonite, BSN, RN · Sep 13, 2005

It's because of the charting. One strategy is to give an hour overlap to the oncoming and offgoing staff so the offgoing nurses have some extra time to finish up their charting. (In effect, 11 hour shifts) Another strategy is to move a work shift from 7am-7pm to 6am-6pm. That way instead of the offgoing shift having to finish off a whole bunch of 6am routine tasks by 7am, the oncoming shift picks that up. This gives the off-going people a chance to finish up their paperwork. I've heard of places that even went to 3a-3p shifts. If the shift hours cannot be changed then the times for the routine nursing procedures get changed.

childrensrn · Sep 18, 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.

jnette, ASN, EMT-I · Sep 18, 2005

Steph does ! (Stevielynn)

She works part time, but she works 0300- 1500.

You might pm her and get her input ? :)

donmomofnine · Oct 4, 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.........

FroggysMom · 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.

Never fails! The last minute admission or discharge will cause me to work past my shift, usually with charting. Then secondly is the "needy" or "difficult" patient who requires much of my time just for Q&A and support. Spend 10 or 15 extra minutes with these patients throughout the shift and you are behind on everything from that point on.

I don't know how the other nurses on this board feel, but I feel that the work I should have gotten done by the end of my shift should not be left over for the next nurse to finish. All that will accomplish is to put THAT nurse behind to the point he/she may have to then work OT. Nothing is accomplished here but pushing work off to the next shift. But I doubt there will be any extra time to finish the tasks within the shift. The work may tend to "snowball" if the nurse responsible is not allowed to finish that work himself/herself, IMHO.

Give us a reasonable nurse to patient ratio and things will improve hopefully. But until basic staffing issues are addressed, I don't know what else can be done. I arrive 15-25 minutes before my shift and spend my OWN time getting info on the patients I will have assigned to me...checking charts, new orders, labs, radiology reports, etc. and familiarizing myself with any new patients (read H&P, Admission Notes, etc). From the time I get report to the end of my shift (whether 8 or 12 hours) I am on the go. There is no time for anything else. SOMEtimes no time for lunch. The nurse patient ratios do not give any leeway for anything "extra", such as the new admission, kardexing extensive changes to orders, medications, etc.

I'm sure there will be many others out there who can give you even more info that this, but as a floor nurse "grunt", this is what is happening from my point of view.