New Rule on My Unit......

[SheriLynnRN]

We have been having some teamwork issues on evening shift, so yesterday our nurse manager implemented a rule that we are to "try for a week." We are not to leave at the end of the shift until everyone else is finished and able to leave too. She did put a limit on it, so it's no ridiculous. The shift ends at 2330, but she said if you've done all you can to help and someone is still charting at 0030, then you can go home.

I'm not sure exactly what I think about this. I usually get out on time, or 20-30 minutes late. It does make me nervous though, that I will have a bad night and hold everyone else up. We do have a couple of people though that don't help others much and ALWAYS get out on time, so maybe this will encourage them to help more.

The NM also mentioned that on nights when we have four nurses on the floor, instead of five, which is our full staff for 28 pts, that we may be trying out team nursing. We would have the same number of nurses and aides on the unit, we would just divide the work differently. I'm not sure how I feel about this either. I've gotten quite settled into my routine and the way I do things during a shift, and I know the other nurses have too. I wonder how much conflict it will cause when trying to intermesh seperate work styles? I guess I'll have to wait and see how it works out.

[CarVsTree]

Sounds like elementary school and y'all have to "stay after school." If we're professionals than we should be treated like professionals. I help out, but I don't feel the need to stay after my shift to watch someone else chart on their patients.

[SheriLynnRN]

As far as the new rule about everyone staying to help out: The key to making that work without holding up your co-workers while you chart is to keep up with your charting all shift long. That way, come the end of shift, your co-workers can help you complete "tasks" such as passing the last few meds, doing I&O, checking on orders, etc. If you are late in leaving because you've completed every task, but not charted a word all shift, no one can help you!

This is a really good point. It will take a huge change in mindset for me to do this though. I feel like I just CANNOT sit down to chart unless I am caught up with all of my other "tasks". At 2000, for example, if I have a choice between charting or starting my 2100 med pass, I will always choose the med pass. I was just "brought up" to "work" first, chart later.

Someone else mentioned the control issue when it comes to team nursing. We haven't tried that concept yet, but I am concerned about my own control issues. I like to do things my own way, and I'm sure others do too.

There's just no one perfect solution to this issue.

[SmilingBluEyes]

I think the OT this might cause will cause the manager to re-think this whole thing. And it will divide more than unite. I agree w/the principle: I always ask my coworkers if there is anything I can do to get them out the door faster, if I am the first one ready to go.....

but lots of people clocking out late is gonna cost the company money they are not gonna want to spend. And people are going to come to resent the so-called "slow ones" PDQ!!!!! What about those who HAVE to be out on time, due to outside constraints, like having to get kids to school or daycare? What will they do if they have to be an hour late? Many don't have that hour to GIVE.

I see real problems w/this all around.

Maybe, a better way is to look at pt assignments to be sure acuity workload is more evenly spread. Maybe some training on time management is in order for some.....there are other ways than mandating all staff up to an hour of costly OT. Just my take.

[ZASHAGALKA, RN]

Sounds like an attempt to guilt the 'slower' nurses into getting out on time so as not to alienate their peers. Management probably feels its worth the short term OT of everybody to get the few long term OT-ers to get used to getting out on time.

In that vein, it's another short-sided management 'scheme'. Too much work, not enough time - and then the gall to complain about the lack of 'efficiency'. No wonder we have a shortage created by nurses voluntarily leaving the bedside.

But I don't really mind. This effort to recoup the pennies in overtime is driving so many nurses out of the field, my salary just keeps going up by the dollars. I don't mind at all if management wants to stupidly continue to be penny-wise/dollar foolish because, in this case, their dollars are coming to ME as a result.

~faith,

Timothy.

[MamaTheNurse, BSN, RN]

this is funny - it reminds me of when my friend's husband was in between jobs and worked afternoons at Wal-Mart - our store closed at 11 pm and no one was allowed to leave until every department had all of their merchandise placed just so on the shelves, abandoned merchandise returned to the appropriate department, etc. - if you finished up in your department, you had to go to another and help those people - even after he got another job and left, my friend's husband always ragged on my friend and their 3 daughters if he saw them mess stuff up in the store or put items in the wrong place or abandon a DVD in the shoe department or something because he had shifts where he stayed over 1-2 hours before he could leave!

anyhoo, anytime I've stayed late, it's for paperwork reasons, which, until someone figures out how to do a Vulcan mind-meld so another person can get in your head and know what you need to write down, is something that you don't need the entire previous shift staying late for because those people can't help you anyway!!!!!

where I used to work, staying late repeat offenders were "counselled" on their need to change their work habits or time management skills or they received extra training if that was the issue - it did not go unnoticed because of the $$$ aspect!

[Antikigirl, ASN, RN]

In the ALF I worked in I had a nurse that was always late coming in, and always late going out and she threw us constantly out of sync!!!!

The management, after months and months of us other nurses complaining finally made a choice. NO OVERTIME! Uhgggggg...that wasn't the solution! Now things got worse, things didn't get done because knowing you CAN'T stay made the nurse before you basically stop all care an hour early and you had to play catch up from the start!

Finally this was seen, again months later with us all complaining...and they chose to watch time cards more carefully and you had to document the reason you stayed even 5 minutes over your shift. That helped us find out what was the main offenders of overtime..and helped get plans together to hinder that...that worked better (even though it was more paperwork).

Actually finding the reasons for this was much better than slapping rules on professionals who are responsible for so very much! Our jobs are never done, and if we have to stay we should get our tasks caught up before leaving...it is a management deal to solve why those occur during shift changes and take steps to avoid complications during shift change (within reason of course).

[Belinda-wales, RN]

I find this all very intresting as a british soon be us RN with over 20yrs experience in uk - we tend to use the team work approach helping your team members out when you can and then getting the same back hopefully when you are snowed under but it is not always the case as there are always some who are work shy. As to documenation or charting as called in us I not quite sure how different it is but soon to find out any way we tend to document as we do things producing contemporaneous documentation is this possible within nursing in the us

cheers Belinda

[TallGirlAni]

Any kind of change is scary, especially when one has a routine. But, change can be good, because it can expose the good and bad things about the particular unit and workers. Fortunately, your manager is just trying this out for a week. I would definitely use the week to pay attention (keep a daily journal) of the the days events to who and what are the weakest links in regards to this system. If you all are silent and do not give honest and forthcoming feedback, then your manager may think that he or she has made a good change.

Sounds like you at least have a manager who is willing to try out new things to improve the quality of your floor. I would be wary of the manager who avoided conflict or change. This could lead to mediocrity for your floor--or worse! Also, the people who find a way to abuse the current setup and policies will just have a license to go about their frivolous activities (talking, gabbing, working slowly on purpose, hiding, not pitching in to help others, etc).

This change also opens up discussion amongst the staff about the improvement of quality for the floor. How many times have any of us been run ragged throughout the shift, not having a dinner break or even a bathroom break, while we see co-workers eating and laughing in the breakroom?

The bottom line is teamwork, because the other staff members are our anchors, especially during the difficult times during our shift. I am sure that most of the staff would want to leave on time, thereby contributing to an atmosphere of "we are all in this together so let's help each other out so that we can go home and get out of here." The ones who are not team players will surely be exposed after the majority of nurses band together and get fed up with the ones not contributing.

The manager can not always be on the floor, so the staff must find a way to ensure that staff are contributing their fare share of the work that must be done. Even if patients are assigned fairly at the beginning of the shift, a lot can happen during the shift that can cause the heavy workload to lean to one or two staff.

I, for one, ask of my fellow staff members if I am not busy, "Is there anything you need done?" In doing so, I hope to promote teamwork, colleagiality, a positive work environment, and the hope that these staff members would do the same for me. This is something that should be expected, not just merely hoped for or neglected.

Of course, this does not always work out, but it is something that I strive for and gives me the sense that I am not alone on the floor providing care by myself for only those that I am assigned. After all, four eyes are better than two, etc.

I applaud your manager and hope that whether or not this works out for your floor, reminds the staff that you work for to look at the bigger picture---the best working conditions possible and the best quality of patient care one...or more can give.