"Night shift nurses don't do wound care?" If I've heard it once, I've certainly heard it at least twice in the last two weeks. This erroneous belief from some day shift nurses that "night shift doesn't do wound care."
Oh, really? Where did that idea or belief or 'rule' come from? Well, I had to do a little research, and here's what I found. The Economic Costs of Wounds & Wound Care - According to the American Professional Wound Care Association (Carver, 2017) "Chronic non-healing wounds impact nearly 15% of Medicare beneficiaries (8.2 million). A conservative estimate of the annual cost is $28 billion when the wound is the primary diagnosis on the claim. When the analysis included wounds as a secondary diagnosis, the cost for wounds is conservatively estimated at $31.7 billion. Surgical wounds and diabetic foot ulcers drove the highest total wound care costs (including cost of infections). Medicare spending for arterial ulcers is the most expensive, followed by pressure ulcers. Along with surgical infections, hospital outpatient services are a significant driver of the greatest proportion of costs for wounds & wound care (Carver, 2017).
Nurses at the Gate
On All Shiftscare as much as the medical outcomes, nurses are on the frontline to prevent or reduce hospital readmissions. Nurses are also more aware of the financial impact of providing quality care (or not). As such, nurses today are more aware of how they directly or indirectly impact their company's financial & medical goals. Penner (in Thew, 2015), suggests that nurses need to link their care with costs & savings for the institution. Since wounds are a significant contributor to healthcare costs, nurses on each shift must be ready to provide the therapeutic care & interventions that promote healing, reduced hospital stays, fewer admissions, & reduced hospital-acquired conditions that worsen the original condition. In this light, nurses on both shifts are licensed & capable of providing wound care, reading wound orders, & following through on the tasks & plan of care. Just like their day-shift counterparts, night shift nurses DO change dressings, apply wound interventions, monitor progress & healing, and of course, they notify the physicians when unexpected changes occur. According to Sollars (in Brooks, 2016), "though the peaceful setting of a hospital at night may appear less stressful, there are still plenty of trying job duties for night nurses to deal with. "Night work is just as hard as the day shift, but in a different manner."
So, why does the erroneous belief that "night shift nurses don't do wounds," persist? In general, this may be due to what is called 'Shift-to-Shift Animosity,' (Lampert, 2016) and it is just what it sounds like. But, let's explore it a little further. Shift-to-Shift animosity occurs when nurses on one shift think that nurses on another shift are "lazy or just don't understand the particular hurdles that the other shifts have to deal with." Needless to say, these thoughts & attitudes lead to a breakdown in communication & a decrease in the sense of teamwork for the whole unit. When this animosity reaches very high levels, it leads to nurses feeling demoralized & personally attacked or accused of being incompetent, lazy, & demeaned as professionals & as human beings (Lampert, 2016). One of the main culprits of shift-to-shift animosity is nurses leaving work undone for the next shift to complete. It's easy to see that this can quickly go from shift-to-shift, with each shift passing off uncompleted work to the next shift. It's also easy to see how if this is regularly done, these hand-offs can lead to negative emotions building & building, ready to explode.
How can we resolve this animosity?
In a nutshell, professional communication, empathy, & looking at the macro-systemic challenges of the unit/organization. First, if we communicate professionally, courteously, & clearly, we can convey to our colleagues that some things were not done on our shift, due to one or two reasons. Along with this communication, we should offer to help the oncoming nurse by doing as much as we can for our patients before we clock out. This way, our colleagues will see that we are putting forth the effort to work as a team and we are doing our best to not leave extra work on our colleagues (Lampert, 2016). Secondly, step back and try to understand what our colleagues are feeling & then, understand that EACH shift leaves work undone for a myriad of reasons. If we take the approach that we are not in competition with each other or with the other shift, then, we might better understand that the 24/7 workload is experienced by the whole unit.
The System is out of our Control
Finally, systemic challenges that are out of our control are staffing, patient acuity, patient plans of care, & just the abundance of paperwork, legal, and statutory requirements that are placed on every medical institution. If we stop and remember that we have no control over these things, we may be less apt to point fingers at our colleagues on the other shift and realize we are all experiencing the same consequences of these challenges. Other systemic challenges include accruing overtime to complete work, then having to explain to your manager why you accrued overtime. Either you're noted for not completing work due to an excessive demand for care; or, you have to justify overtime accrual to finish your work. It's that old adage, 'damned if you, damned if you don't,' that's in play. The bottom line is this: we each need to take responsibility for what we do/don't do, and when we can't complete some task, for whatever reason, communicate that to our colleagues. Most of all, we need to remember that not everything is in our control or our colleagues control. Nurses have no control over when doctors write orders, when phlebotomy draws labs, or even when unexpected events happen with our patients. Every nurse, on every shift, has left some work undone and passed onto the next shift and if you haven't, you will, so, remember how you want to be treated. Then, treat your colleagues that way. Carver, T. (2017).
"New study demonstrates the Economic Costs; Medicare Policy Implications of Chronic Wounds. Retrieved from American Professional Wound Care Association - New Study Demonstrates the Economic Costs; Medicare Policy Implications of Chronic Wounds .
Shift-to-shift animosity Lampert, L. (2016)
Nurses can't afford to ignore healthcare costs