Staying late to complete your work

Plagueis · Dec 18, 2009

Yes, I do stay late sometimes to finish charting, or some other type of paperwork. I'm a newer LPN, and I work in LTC. I don't stay late because of a lack of time management. I stay late sometimes because, at my facility, the nurses have to everything.

I pass meds, do treatments, take off orders, deal with labs, and do dining room duty (an hour) on most days. On those days, I can leave on time. However, if a resident falls, or has to be sent out to the hospital, then I'm going to be clocking out late, since I am the one who has to do all of the paperwork (I hate those college-term-paper-sized incident reports!), as there is no supervisor or manager on my shift to help out.

Plus, if there's an admission to do on top of my regular duties, there is no way I can clock out on time. Even the nurses who have more experience than I do cannot clock out on time if they have an admission or incident report to fill out, along with their regular duties. Plus, at the end of each month, we are expected to do recaps, on top of everything else. (They don't bring in extra nurses to do this.)

I do stay on the clock to finish my work. Considering all of the things that us nurses are expected to do in an 8-hour shift, management shouldn't be surprised that us nurses sometimes have to accumulate overtime.

910hope · Dec 18, 2009

I'm a new grad (with no prior experience) in a SNF...assigned to 30 patients...about 12 of them recent admits from the hospital with more pain, breathing Txs, etc. than the others. I was on orientation for about a dozen days during the last month and now I'm on my own. Today I finished so late that I was just starting to chart as the 3:00 shift was arriving.

I don't like the fact that I clocked out and then spent another 2 and a half hours charting. But I've been lectured about the overtime and I knew the ADON would give me grief if she knew I was still on the clock. But when I had to do the monthly med recap and stocking at the end of my shift on my 1st day on the cart last week I told myself there's no way you're not gonna get paid for this extra work, so I didn't clock out and I brought my overtime approval slip to the DON.

The SNF world...I like getting to know the residents and seeing them again, but the management/ownership makes me hope I can find another job in the New Year.

Virgo_RN, BSN, RN · Dec 18, 2009

How many of you have to stay past the official end of shift to complete your work? I ask because I would say that 75% of the time, I do. It is always doing my shift summaries and/or a PIE note or two. But, I look around and most of my co-workers are waving good-bye.

Are you able to chart as you go at the bedside?

sunnycalifRN · Dec 18, 2009

Are you able to chart as you go at the bedside?

The hourly charting of vitals, events, etc is no problem . . . the PIE notes and shift summary is what I often get behind on because I usually wait until 10 hrs out of 12 are past. Even though I know what my primary concerns are with each patient, I don't like "cookie cutter" notes, so I wait until I can document my actual interventions/concerns for the shift. And, often when I'm wanting to enter the notes and summary, things are busy. But, I've got some ideas for how to deal with this.

CaLLaCoDe, BSN, RN · Dec 18, 2009

I'm pretty good with leaving in time. Every once in a while I stay late. Management is really on our case, I even have to leave work an hour early on saturday to save the facility money.

This sounds a lot like the last place I worked, a not for profit, nonunion, profit machine. :smokin:

meandragonbrett · Dec 18, 2009

The hourly charting of vitals, events, etc is no problem . . . the PIE notes and shift summary is what I often get behind on because I usually wait until 10 hrs out of 12 are past. Even though I know what my primary concerns are with each patient, I don't like "cookie cutter" notes, so I wait until I can document my actual interventions/concerns for the shift. And, often when I'm wanting to enter the notes and summary, things are busy. But, I've got some ideas for how to deal with this.

Why don't you assess your most critical patient first, then immediately start charting your narrative and assessment (do you have computers at bedside?). Once you do that then go to your other patient and do the same thing. Then you've got it done and out of the way for the night.

I do absolutely everything in my power to be 100% caught up (meds and charting) by the 2100 visitation then the rest of the night is smooth sailing for me. On the other hand...all of the other nurses are just finishing their coffee and chit chat by 2100. I don't stay late. I clock out on time every day unless a patient starts dying at 0530.

SoundofMusic · Dec 18, 2009

I work on a busy med surg type unit and am rarely if EVER out on the dot at quitting time. Most of us are there at least 30 mins past, and my "average" is about 45 mins past. There is just no way w/ all the paperwork -- and we probably have the worst paperwork of any unit in our hospital -- or so we've been told by many float nurses.

I can't help it when I'm discharging 3 out of 4 patients (w/ an hour of work per discharge) admitting another, and taking care of yet another who is more critical usually than anyone. It just always seems to go this way. If I take a lunch, stop to take some breaks -- that's it -- I'm there late.

But I honestly don't care. They are working us short usually -- sending home techs, saving money in all sorts of ways. If they can't pay me an extra 3/4 hour's worth to get it done right, to keep patients alive, to do a proper admission and not pass on too much to night shift, well, so be it. I just really don't care.

We have had one nurse, however, who will hang around until 10 p.m. or 10 a.m., repeatedly. She REALLY caught flak from management because it was chronic.

If I just keep my head down, don't take breaks, don't talk, just move,move,move, maybe I can get done in time -- but I'll always get thrown a new admit about 5 p.m. which will kill it for me -- if I'm busy w/ other patients as well -- forget it.

I don't see how ANYONE could ever get out on time w/ these type of assignments. If they complain to me, I'm going to ask them to SHOW ME how to do it, then. So far, no takers.

kimmie4476, ASN, RN · Dec 19, 2009

I don't know how your day goes, but maybe you could start your summaries and PIE's in the am when you first come on shift, even if all you are doing is writing them down on a piece of paper and filling in the blanks or adding to them as the day goes on, then all you have to do later is type them in.

I will occasionally stay over to finish charting, but that is usually because it has been an extremely busy day and the boss knows this (usually we have her transcribing orders and things, so she is expecting it, ALL of our charting is on paper) But there is someone I work with who I (and others) think is padding her check by regularly staying late to chart (no new nurse excuse for her, she has been at this hospital for like 14 years). This practice is what makes the bosses come down on US for staying over occasionally, but my response to them is that if you are going to require all this redundant paperwork be done, get me help to actually take care of the patients and I'll just focus on the paperwork. Until then, my number one priority is taking care of the patient, then I'll finish the paperwork after someone has relieved me and is able to care for the patient. Never once has my OT been denied.

Mudwoman · Dec 19, 2009

We are staffed via our "grid" on the pt count at shift change, regardless of whether we are getting admits or discharges. Then at 1400, we have to call staffing with the number of pts we have and 99% of the time, we loose a tech or nurse or both at 1500. Then starting at 1600, they start emptying ER onto our floor. It is not unusual to get 7-8 admits between 1600 and 1800. Most nights I clock out at 1915 and stay to finish charting. I was there last night until 2100. It is a nightmare situation. Our facility seems to think that if you can't get it done on your shift that is your problem, and should it be a continuing problem, they can find someone that CAN get it done. So, we clock out and then finish.

Healthcare is getting ugly out there. There is another grid we have that is some type of percentage/ratio they use for staffing purposes in addition to the pt count. Our's used to be 10.5. It has been adjusted over the last 2 years down to 7.8. The higher the number the better the patient/nurse ratio is. Obviously we are having to do more with less people at 7.8

Jules A, MSN · Dec 19, 2009

I rarely have to stay late unless there is an incident around shift change that bogs us all down but I also don't take a break on day or evening shift. At my job staying late is really frowned upon by management. FWIW those that punch out to avoid scrutiny aren't immune either so I think finding ways to speed things up is the best strategy.

sparketteinok · Dec 20, 2009

I work on a busy med surg type unit and am rarely if EVER out on the dot at quitting time. Most of us are there at least 30 mins past, and my "average" is about 45 mins past. There is just no way w/ all the paperwork -- and we probably have the worst paperwork of any unit in our hospital -- or so we've been told by many float nurses.
I can't help it when I'm discharging 3 out of 4 patients (w/ an hour of work per discharge) admitting another, and taking care of yet another who is more critical usually than anyone. It just always seems to go this way. If I take a lunch, stop to take some breaks -- that's it -- I'm there late.
But I honestly don't care. They are working us short usually -- sending home techs, saving money in all sorts of ways. If they can't pay me an extra 3/4 hour's worth to get it done right, to keep patients alive, to do a proper admission and not pass on too much to night shift, well, so be it. I just really don't care.
We have had one nurse, however, who will hang around until 10 p.m. or 10 a.m., repeatedly. She REALLY caught flak from management because it was chronic.
If I just keep my head down, don't take breaks, don't talk, just move,move,move, maybe I can get done in time -- but I'll always get thrown a new admit about 5 p.m. which will kill it for me -- if I'm busy w/ other patients as well -- forget it.
I don't see how ANYONE could ever get out on time w/ these type of assignments. If they complain to me, I'm going to ask them to SHOW ME how to do it, then. So far, no takers.

This is usually how my day goes on a busy tele medsurg unit. I haven't ever been lectured about OT, but I would love to get out on time. Our problem is that report ALWAYS runs 30-45 minutes late, and we can't leave til the other nurses are out even if we are done. Even still, I know I could get better with time mgmt. However, I do feel like someone else said, toileting, call lights, pt/visitor requests, etc. (stuff that CNAs can do, but never do see them, so it's easier to do it myself), that kind of stuff is always interrupting my charting and thoughts. I work 7A-7P with 4 nurses and one CNA for 23 patients (at capacity). Isn't that too little staff? Shouldn't we at least have one more CNA? Oh, and a unit secretary that is worthless at doing anything other than entering orders (supposed to answer call lights, etc. but won't)....

sigh....does feel really hopeless some days...just hope I never go before naughty nurses court.....

Cinqly, BSN, RN · Dec 20, 2009

It's important to remember that even if you do stay late, that it is YOUR license on the line. Yes, you have to take care of your patients. Yes you have to chart. No, you didn't have enough time to chart it all during your shift. But you have to document care that you gave and the required paperwork, or it looks like you didn't do it/were not there. In order to document that care you have to be on the clock. I would NEVER chart on a patient off the clock. How would that look in court? First and foremost you have to protect your licencse and your ability to practice nursing. You can't help patients without that!

If management is giving you a hard time I would look at the reasons why. Am I late after every shift? Do I chronically forget to chart certain items? Is it the schedule of events on the units? Is it patient assignments/acuity/nurse-patient ratios? Is there a lack of teamwork on the unit? Am I delegating correctly the the UAP?

At the beginning of each shift I look at each patient, develop a plan for the day, and try to stay on top of things as much as possible.

I try to chart ASAP, because you never know what might come.

I also try to chart in the room (unless it's isolation, and even then I'll sometimes move the computer up and chart standing) - that way if I 'forget' something I am right there with the patient to ask or look.

With discharges/admits/transfers/etc if I can't chart right away I keep VERY detailed notes (who I called, when, what happened, new orders, etc) so that I can chart quickly, as well as pass on unfinished orders to the next shift.

Teamwork is essential, and although there are a few bad eggs on my unit for the most part people have the attitude of "nursing is a 24/7/365 job; if you can't finish it all in one shift there is always someone coming after you".

Oh, and remember that if you work a 36 hour work week you have 4 hours each week to play with. (They take out 30 minutes for lunch if we work 6 or more hours). Managers usually only start to care when you go into OT.

Some other things to think about:

-Are you delegating tasks appropriately to your UAP or trying to do it all yourself? If you delegate, do the UAP actually do what they are supposed to?

-Create your own, personalized brain. Make lots of copies and put them in your bag. Use a different color paper for each patient. I can't tell you how much this helped my organiztion and time management. It saves time because you are not writing from scratch on blank computer paper every am, and it tells me what is important for me to remember each shift.

-Don't be afraid to ask for help.

-Ask your manager if they can hire/staff a "discharge nurse" that only works on discharge papers in the afternoon.

-Remember to breathe. :-)