What’s with “researching” patients before clocking in?! Is this a standard?

[NurseOrBust13]

Hi all,

I’m a baby nurse (new grad) going into day 3 of orientation with my preceptor. She mentioned that she lives close (within 5 mins) to the hospital so she usually gets there early [at a time that places her 40 minutes earlier than the start of her shift] so that she can get her day started ahead of clocking in. When our shift was coming to an end, I hadn’t looked at the time so I thought it was time to go because I saw night shift staff all over... but no, we had at least 45 minutes to even give handoff. One person (still in her coat, who I realized was a nurse) was even there more than an hour before shift start. So I realized this was a majority thing.

But why? Is this a common trend? When my professors in nursing school mentioned this, most scoffed at the idea of working for free. Yes I’m a new nurse but I’m not fresh out of school entering the workforce for the first time. It just feels weird that the notion is - in order to be successful and get home on time we have to work off the clock. I do understand being there in time to get settled (lunch purse away lol, snack eaten, coffee refill, non-patient chit chat, etc.) and getting your ducks in a row, mentally, to begin your shift. I’m not really an early riser but I do get in early enough to be on the unit at an appropriate time. I just feel like I can’t compete with the nurse who’s there an hour early. It’s like I’ll look ill-prepared being on the unit only 15 minutes prior to starting.

I just figure - I’m here for 12 hours and of course I’m still learning time management as an RN but gooooodness! Isn’t half of a day enough?? And if not, why? Do you do this? Is it so that you are able to be ahead or question the nurse who’s giving you report? Is it a reflection of management that it’s allowed or even required in order to feel comfortable with your patients?

I hope this doesn’t come off as offensive or snooty but I am really curious and kinda nervous at the same time.

[RNperdiem, RN]

Every unit has a different culture. Apparently where you are now working, this is a tactic nurses use to survive.

Coming in early to look up patients, leaving late to chart, missing lunch regularly are symptoms of a unit with a crushing workload, lack of ancillary staff, or low quality ancillary staff ( CNAs who are always in the cafeteria or on smoke break).

Do the best you can.

[Tweety, BSN, RN]

It's not common where I work to arrive that early. Only one nurse on day shift arrives about 45 minutes early to look up her assignment and organize herself. She's quite anal retentive and gets anxious often when her plan goes askew. But several people arrive about 15 minutes early to get situated, get their assignment and get organized prior to clocking in. This is not a bad habit.

Myself, I barely arrive on time but I don't hold anyone up researching, I am ready for report right away.

[caliotter3]

I used to come in ten to fifteen minutes early. At one place, I sat on a couch in the foyer, near the time clock. I was the only one who did this. The offgoing shift expressed their resentment. The CNAs thought I was there to spy on them as they gathered round the time clock, not finishing their assignments or answering call lights. Although I managed to see and notice plenty, even from just the foyer, that was not the deal. I sat on the couch to calm myself from getting off the highway. Call it attempting to achieve peace of mind if you will.

[JKL33]

These are people who are simply accustomed to having the time to get a better handle on patient information than what there is usually time to obtain.

I never arrived very early (now I don't have to worry about it anyway d/t working in an area where it wouldn't be useful). But I did used to have time to read charts during my shift when I worked the floors - probably an hour of time all put together during night shift. And it was useful. As a new grad I was on a floor where patients might stay for awhile and I really learned a lot about their diseases and treatment processes by understanding the bigger picture of the course of their hospital stay.

Times are different now. That kind of thing isn't expected, it isn't as relevant and there wouldn't be time for even if it were.

On 2/21/2020 at 6:36 AM, NurseOrBust13 said:

When my professors in nursing school mentioned this, most scoffed at the idea of working for free. Yes I’m a new nurse but I’m not fresh out of school entering the workforce for the first time. It just feels weird that the notion is - in order to be successful and get home on time we have to work off the clock.

There was a time (maybe it's regional, I have no idea) when people didn't worry as much about ^ that; they weren't nitpicked and treated with the kind of begrudging disdain that has become common. Employer-nurse relationships were completely different. In some places there weren't even restrictions about punching in 7, 3, or 1 minutes before the shift, either, so some nurses could actually punch in if they arrived early and wanted to get prepared. A historical view is useful: Arriving 15-20 early might have been common and yes, at one time might have been a way to go above and beyond. Now it is considered low-value and stupid, but people are willing to go above and beyond by sitting on committees where they have very little say in anything and doing projects that may or may not ever help a patient. ??‍♀️.

On 2/21/2020 at 6:36 AM, NurseOrBust13 said:

I just feel like I can’t compete with the nurse who’s there an hour early. It’s like I’ll look ill-prepared being on the unit only 15 minutes prior to starting.

You don't need to compete.

On 2/21/2020 at 6:36 AM, NurseOrBust13 said:

Do you do this? Is it so that you are able to be ahead or question the nurse who’s giving you report?

No, although that might be a result of actually knowing the basic information before-hand and not having to blindly rely on whatever someone else chooses to share.

On 2/21/2020 at 6:36 AM, NurseOrBust13 said:

Is it a reflection of management that it’s allowed or even required in order to feel comfortable with your patients?

No. If anything it's more a reflection of individuals' personalities. Some people it just makes them feel like they have a better handle on the information. I fully expect the reverse of this will be argued in this thread, but I will tell you right now: Both views are going to be somewhat correct because they'll be talking about what they find useful or not useful. Some people feel more prepared with the kind of practice you're reporting.

I don't think you really need to worry about it much, but if it seems to be fairly common practice where you are, I would avoid the scoffing of your professors and focus on learning all you need to learn and upon creating a routine that makes you feel comfortable.

[Floor_Nurse]

It's kind-of like getting a head start for multitasking a busy day. But personally, I wouldn't do it for two reasons: if you start working and something happens (like a code or a death) what is your responsibility? Are you going to be called in for questioning because you're involved with something when it's not actually your shift? Years ago, I came toward my unit very early when the the fire alarm went off. Probably just ask drill, but it's a big deal and ALL people must be evacuated and accounted for. The drill was not intended for me or my shift, so why in the world am I involved in this? The second reason I do not come in 45 minutes early is that I'm not getting paid for it.

[NightNerd, MSN, RN]

This was common practice on my former unit, so I rolled with it until we were told not to clock in that early. Nope, nope, nope. This nurse is not working for free. At the unit where I work now, we're honestly lucky if the assignment is even done by 645. ?

I found it useful to take those extra 10 minutes when I was brand new to the hospital, but it was more a way to assuage my own anxiety by developing a plan before my shift. Now I feel like I am more comfortable getting report, doing my own assessment, and putting together the rest of the details from the EMR. That said, if it's helpful to you to get a headstart on looking up your patients, there's nothing wrong with that. I don't think you should expect yourself to be there 40 minutes early, though; I'm sure there's stuff you'd rather be doing before spending 12-13 hours at work.

[AnLe, ASN, RN]

I have a coworker who goes in 1.5 hrs before her shift. I'm not sure of she clocks on or not, but she calls the doctor to clarify orders or for anything extra the patient needs. She says she needs to get there early to get out on time.

I go on 15-20 minutes early. I work on a med-surg/tele floor and our ratio is 6:1. Our turnover has been better lately, but we still get new people every few months. I just find it helpful to see what meds I need to give and what labs/vitals have been abnormal. A few people of the dayshift staff give a very short report or forget to do things.

For example, I had a patient with stat ABGs ordered at 1430 that had never been done. When I questioned her, she said lab hadn't come up yet. I had to mention that lab doesn't draw ABGs, RT does. I had her call the RT that was on, they weren't happy about it.

Besides us, everyone else either gets there 10 minutes before or right on time.

[verene, MSN]

I think this can be unit dependent and also personality dependent. As CNA and RN I may have arrived 15-20 minutes early to work - but I usually just hung out in the break room, got my stuff put away, maybe had a mug of tea or checked e-mail. Arriving early was a buffer to a long commute and potentially unpredictable traffic. If I arrived on time it was fine. Most of the other employees were similar - maybe arrive a little early but report almost never started until time (we weren't really supposed to clock in early) and we usually got on out time unless something really crazy happened on shift.

As an NP I do try to come in ~30 minutes early on my "Monday" just to get settled, catch up on my e-mail, and try to prioritize my day and my week. This is pretty typical of my colleagues in the department as well, but is not mandated by anyone.

[klone, MSN, RN]

I'm not going to fault them if that's what they feel they need to do to have a successful shift. But IMO, it points to lack of support from leadership. I would wonder what is going on that the nurses feel so overwhelmed that they have to come in 45 minutes early and work off the clock in order to be successful.

[Daisy4RN]

I noticed this happening in the last few years I worked in the hospital. It was annoying to me because the oncoming nurses would plop down and take over the computers. I would not come in early in order to work because 1) 12 hrs is already a long day and I dont want to, 2) not being paid, 3) things can get sketchy due to emergencies, HIPAA, and it just being a waste of time if floated or list change etc. I figure I will accomplish whatever I can with the 12hr time frame, doing the best I can with what the facility allows for, including time.

[nursej22, MSN, RN]

As a former charge nurse who had to make the assignments for the oncoming staff this used to drive me crazy. The staffing would often change up until the last minute, and I might revise the assignments multiple times: trying to give someone the same patients, unless someone was staying over, don't over load the newbies, don't assign open hearts to float staff, don't give too many isolation patients to one nurse, try to keep them in the same geographic area, etc. And then try to make good assignments when someone is hopping foot to foot asking for their patients.