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.
Specializes in Psych (25 years), Medical (15 years).
Wow. Just: wow.
A new nurse at Wrongway once said, "You do your job here and you're a rock star nurse!"
If a staff member is chronically 10 minutes late, they're "fashionably late". Those of us who arrive on the unit on time are revered. But: "early"?
Maybe it's the difference between medical and psych. Belinda, my medical nurse wife, is typically 30-45 minutes early for her shift.
I can get or give a report in 10-15 minutes on the geriatric psych unit and there are comorbidities! Nurses on child and adolescent take 30 minutes to get and give report! What's there to report? Bad kid, bad kid, bad kid!
I think they like to discuss the drama of the family dynamics.
I usually arrive 5-10 minutes until the clock in time ( 0653 ). Due to dropping off my daughter at the daycare, I allow extra time for travel ( 10 min to daycare, 5 min to the hospital) and any potential "blow-out-on the way to daycare". This gives me enough time to look up vitals and due meds. There are some (anxious) RNs that are already there at 0620.
You don't have to come in early, it's your choice.
What I don't allow is when someone comes in at or after 7, looks at their assignment and starts questioning the charge why they have this assignment, want it changed. Not at my expense, usually I politely tell them that it's after 7, and I already looked up my patients. I never question charge nurse's assignment because I know it's a hard work.
I work outpatient so I know it’s not relevant. But one of my coworkers had gotten in the habit of working off the clock. (Our workload really is too much to accomplish in each shift, so she felt like her choices were either leave stuff undone or stay late, and we aren’t allowed to have overtime.). The manager found out and told her she had to go home on time. It eventually escalated until she was told that if she’s working off the clock, security will be called to take her out! They don’t want the liability of someone in there messing around with drugs and patient charts, but not officially being at work.
We used to have staff come in early but admin put a stop to it. Looking at patient charts when you’re not on the clock was considered a HIPPA violation.
Oh yes, the huge grey area that is HIPAA; can't forget that. Certainly accessing charts when you're not clocked in, despite having an expectation of care for the patient, can very easily be considered a HIPAA violation.
The expectation of care is the important thing; at least as my current facility. If we have an expectation of care for a patient (say, they are being assigned to us and are in the ED) we are allowed to access their medical information. In the event we don't end up caring for that patient (they are downgraded to med/surg, upgraded to ICU, or given to someone else), we are not penalized for having been in their chart. The limit to this, is we have to be 1) clocked in, and 2) assigned the patient by either the charge nurse, supervisor, or patient flow (day shift only, which is a weird concept to me, they just call you like "hey! There's an admission in the ED I'm gonna give you, like... WOW!, who are you!? call my charge nurse! ahem, anyway).
So yeah, super grey area when it comes to HIPAA, if your employer doesn't like you and you're non-union... you leave yourself really open there.
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.
How has she survived nursing becoming anxious when things don’t go as planned?
Thats like all of healthcare? Even outpatient. Like, things happen.
In fact, this is the world in general. I’m guessing she’s just learned to cope.
Accessing the pt chart before your shift starts and on the clock is legally a HIPAA violation. You are not caring for that patient and have no need to be in their chart at that time. Don't do it.
There you go, Kyrshamarks! Researching patients off the clock when the nurse hasn't accepted a patient or received report is a HIPAA violation, especially if assignments get changed and you find yourself not caring for that patient after all. We don't allow that on our unit.
Accessing the pt chart before your shift starts and on the clock is legally a HIPAA violation. You are not caring for that patient and have no need to be in their chart at that time. Don't do it.
1 hour ago, sevensonnets said:
There you go, Kyrshamarks! Researching patients off the clock when the nurse hasn't accepted a patient or received report is a HIPAA violation, especially if assignments get changed and you find yourself not caring for that patient after all. We don't allow that on our unit.
It's not a HIPAA violation since it is clearly related to providing care to the patients, even if your assignment gets changed. I'm not sure what you mean by "researching patients off the clock when the nurse hasn't accepted a patient or received report is a HIPAA violation", how does a patient receive report without being told any information about the patient? And are you under the impression that if you're getting an admit from the ED that you can't know anything about the patient until they are already under your care?
Working off the clock in general is problematic, aside from employment laws there can also be insurance liability issues for the employer, but it's not a HIPAA violation since that isn't dependent on any sort of payment arrangements, it's purely based on whether accessing the patient's information is for the purpose of providing care to the patient.
This is fascinating to me, I do this too, more so when I first started, but I’m sitting down 20 minutes before shift and do a quick lookup to prepare for the day. However can’t punch in til 7 of. That’s a hippa violation ? Oh boy. I’ve never been spoken to about it, but I think I’ll trade that possibility for 15 more minutes of sleep.. good deal.
If you have been given your pt list for the day then there is no problem with HIPAA even if it changes, the problem comes when nurses come in early and peek at the list and assume it is finalized when it is not. When I did charge I got to the point that I couldn't leave my draft at the desk bc of nurses routinely coming early, assuming the list was finalized, doing the research/giving themselves report, and then getting mad when the list changed. So if they were off the clock, and were not assigned the pt then it was a HIPAA violation.
Davey Do
10,666 Posts
Wow. Just: wow.
A new nurse at Wrongway once said, "You do your job here and you're a rock star nurse!"
If a staff member is chronically 10 minutes late, they're "fashionably late". Those of us who arrive on the unit on time are revered. But: "early"?
Maybe it's the difference between medical and psych. Belinda, my medical nurse wife, is typically 30-45 minutes early for her shift.
I can get or give a report in 10-15 minutes on the geriatric psych unit and there are comorbidities! Nurses on child and adolescent take 30 minutes to get and give report! What's there to report? Bad kid, bad kid, bad kid!
I think they like to discuss the drama of the family dynamics.
Working psych is definitely not rocket science.