Shift-to-Shift Animosity

[Eschell2971, BSN]

"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."

Shift-to-Shift Animosity

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).

References

"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

[Daisy4RN]

This has unfortunately been going on for years but I agree that it is getting worse with increased patient acuity etc. I have always taken that stance that if the pervious shift nurse giving me report says "I didn't get this/that done because..." I take s/he at their word and move on, no big deal. If it continues all the time then maybe I might question it (you can usually tell when someone is lazy etc). I usually have received the same responses back, no problems. But, there are those who would get mad, expect you to run around and complete "all your work", and I would just remind that nursing is 24/7 and now I am off. (Of course, there are times you need to stay r/t emergencies etc.) Even before OT was a bid deal I never wanted to stay, 12hrs is enough! A also think problems arise during report when some nurses want too much info, every little detail, that not only is annoying but can cause OT as well. You can read the chart and/or do your assessment after I give you report.

[johsonmichelle]

People need to understand that this a 24 hour job. Everything cannot be done in 12 hours. Also sometimes its not the staff fault , if the doctor is ordering things that close to shift change. I'm also not excusing lazy behaviors either certain people have track records of getting things especially critical interventions that need to be done in a timely manner. Instead of backbiting, people should confront the situation at hand. As adults, one should be able to voice their concerns to that individual in a professional manner and if that issue is not resolved after that THEN it can be brought up to management.

[pwtruby]

This frequently happened where I used to work. Most admissions happened at night on weekends when we were short staffed at night with no C N A. All total care. Caring for existing patients and getting 2 admits with no help was a joke. Dayshift always had more help and less admissions.

[pikachu715]

This is a major problem at my old hospital. The morning RNs always pick on the night RNs. There's always comments like "nights staff just sleep during their shift" or "If I [morning RN] do your work then i might as well get your pay." This shift to shift animosity is more profound when it comes to the topic of which shift should give pt bedbaths.

Sometimes work can be difficult due to pts decompensating, the challenging nature of pt's conditions, demanding pts, and trying to meet pt's needs at night when there is no CNA. If you add day to day work stress that a floor RN handles with rude doctors, shift to shift animosity, and demanding patients a floor RN can easily burn out. I believe that all these factors can cause floor RNs to have PTSDs. It is in the best interest of the pts and the floor RNs to all work together to reduce stress. I love it when a co- worker help me pull up a pt, start an IV, or hang a new bag of IVF; and I will gladly return the favor any day. At the start of my shift, I always thank the co- worker who gives me shift report. We, RNs, don't get recognize for the work we do and a small "thank you" goes a long way for our emotional well being.

Patient care is 24 hours. If last shift didn't get their stuff done I don't mind picking up their work. Because there will be times when I rely on the next shift to help me too. I always keep that in mind.

[TruvyNurse]

I feel like this is bad with 12 hour shifts but even WORSE with 8 hour shifts. "Dayshift is accused of being entitled, 2nds get dumped on all the time, night shift is lazy and doesnt do a thing." It's always SOMEONE'S fault. I try not to leave work for my incoming shift if I can absolutely help it. Teamwork! However you will always have a lazy bum or 2 on ANY shift

[pixierose, BSN, RN]

TruvyNurse said:

I feel like this is bad with 12 hour shifts but even WORSE with 8 hour shifts. "Dayshift is accused of being entitled, 2nds get dumped on all the time, night shift is lazy and doesnt do a thing." It's always SOMEONE'S fault. I try not to leave work for my incoming shift if I can absolutely help it. Teamwork! However you will always have a lazy bum or 2 on ANY shift

I noticed this too.

I've been rotating days/eves lately due to short staffing and oh my gracious, the trash talking! Day staff complains that evening staff doesn't understand how bad they have it ("its just busier during days"), evening staff thinks that day staff are ridiculous and spoiled, saving the work for 3-11 ("sure, save xyz for after 3")... and night staff thinks everyone is entitled and doesn't understand what they go through. It seems worse than the 12's at my other job.

And you can't talk common sense into anyone; the people who want to complain, they'll complain. It's better just to save your breath, focus on your tasks and patient care, and keep out of their way.

But I always say a heartfelt "thank you" to the off going shift and a sincere "have a good ___" to the ongoing shift. It's still about teamwork.

[Neats, BSN]

I call this bad culture. This type of behavior can be solved with careful thought and consideration. Everyone says nursing is 24/7 and yes this is true. What I have done in the past to correct this type of environment is this I ask nurses on each shift what their top 10 daily tasks are and how long it takes them to do each task. We have a similar list on each shift and then I throw in the assigned tasks as needed and the time it takes. I hang those lists up for all to see. I also have designated a responsible position each shift for any unusual occurrences and it is surprising that day/evening shift can be a different position but NOC shift it is always the same position. Who knew?? I also mandate each licensed staff must review the 24 hour report. I am bringing this up because by showing the task list, by showing what is occurring or being assigned on each shift, shows the burden of cares are being distributed in a firm, fair way. Lastly I ask staff to bring suggestions to meetings to making our floor run better.

This culture has been allowed to develop and fester. It should be fixed and you maybe surprised to find it is just a few who are causing the most issues. Once a problem comes to me I always mandate the person have at least one suggestive solution this way they are part of the solving process.

[Chrispy11, ASN, RN]

TruvyNurse said:

I feel like this is bad with 12 hour shifts but even WORSE with 8 hour shifts. "Dayshift is accused of being entitled, 2nds get dumped on all the time, night shift is lazy and doesnt do a thing." It's always SOMEONE'S fault. I try not to leave work for my incoming shift if I can absolutely help it. Teamwork! However you will always have a lazy bum or 2 on ANY shift

I worked the dumped 2nd shift. The day aides would go to the DON early morning then there would be a memo about extra responsibilities evening now had to do. It got so bad, the place voted for a union and out went the DON. At nights only one aide was scheduled. Their job was to answer calls only and do monthly maintenance on different things. Teamwork was out the window. I just accepted it. Left it at the door when I went home. Got another job, same stuff all over again. Was in nursing school at the time. Chose not to work. I learned many lessons and will carry them to the new career. I refuse to buy into negativity. It makes for a toxic environment.