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.
assuming the list was finalized, doing the research/giving themselves report, and then getting mad when the list changed.
I don't get mad when that happens. The board can change any moment for balance. Secondly, it helps to get a 2nd pair of eyes on the board, like when people get 2 stroke patients or patients with the same last name and gender, which happens a lot.
I used to look up my patients 15-20 minutes early, but they put a stop to it saying it was a HIPAA violation. They also used to let us clock in 20 minutes early. Now- only 8 minutes. Admin says its a HIPAA violation to look up your patients before you're on the clock so I assume their legal department has looked into this.
I used to look up my patients 15-20 minutes early, but they put a stop to it saying it was a HIPAA violation. They also used to let us clock in 20 minutes early. Now- only 8 minutes. Admin says its a HIPAA violation to look up your patients before you're on the clock so I assume their legal department has looked into this.
It's certainly not an unusual myth and typically an easier explanation to give than the more complicated insurance and labor law reasons, so it's a story many nurses have heard.
As an example, the CT surgery PAs where I work get paid hourly, but take call without getting paid, is it a HIPAA violation when they look up related information on a patient when you call with an issue (of course it isn't). What is and isn't a HIPAA violation isn't stipulated based on how you get paid, it's based on the purpose of obtaining the information.
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.
I know what you mean and ^ that's certainly a PITA...but it doesn't become a HIPAA violation based on the fact that it was otherwise problematic. That's a situation of your employer's twisting and underhanded interpretation using a technicality in order to curb a problematic behavior. (Their [disingenuous] assertion: You can't be said to have a "need to know" when you aren't on duty. Sure...except that you are on the premises and on the unit for the express purpose of caring for patients and are in fact minutes away from being responsible for the patient whose information you are reviewing...). The fact that the employer has decided that they don't wish to pay for such preparation or the fact that the law does not allow you to perform work-related activities without being paid does not mean that you have accessed PHI for an illegitimate purpose, it means that they have you by disingenuous application of the need-to-know concept. Also, the fact that assignments might not be finalized until 06:59:30 really has nothing to do with the intent of the access or the legitimacy of it.
Same reason that if you are in the middle of getting report and your assignment changes, no HIPAA violation has occurred. Same reason that salaried employees who might be working any hours depending on how they might flex their time are not violating HIPAA if they have a legitimate need to access PHI outside the 7-3, 8-4, 9-5 or whatever window of usual business hours.
Specializes in LTC, TCU, Drug Rehab, Med/Surg, ICU Stepdown.
A large percentage of my co-workers live more than 30 miles from the hospital. This means they are commuting 40 mins plus to get to work. Those nurses are the ones he arrive consistently 30-45 mins early. If they leave later they will hit traffic and be late so it is either arrive early or be stuck in traffic. Since they are here early they feel they might as well get to work to help ensure they leave on time. In addition to the other reasons mentioned this might be why some folks arrive so early.
This practice was forbidden by management on the last unit I worked so it was definitely not part of the culture. We were told if you wanted to look your patients up and access their chart, you had to clock in (but not before 7 til) and be back in the break room for huddle at 0700 or 1900. There was only one nurse who would do this “research” for 7 minutes.
This was also a unit though, that had tremendous support for management and a streamlined, consistent way to give report. As charge, I would typically be able to look through all of the charts to check on appropriate orders before end of shift and follow up with our physicians if anything looked wonky. We also had a very consistent and standardized way of giving report. Off going and oncoming nurse would look together at orders, labs, patient history, and go through the systems together. And then end of report consisted of those nurses actually putting eyes on the patient, their lines, drips, and the monitor. I believe if report is done this way every time, there truly is no need for you to come in and do this extensive research on your patients.
I haven't worked inpatient hospital nursing since 1980, and I realize that things are completely different now. Nowadays, nurses take report only on their assigned patients. However - back in the day - we took report on the entire unit, as we might need to answer call lights at any time, on any of the patients. So HIPAA (which we didn't have back then) would not have been a problem.
All of them were our (shared) patients.
Are nurses today expected to answer call lights on patients that they don't know from Adam?
I get there in time to put my purse away and do the narcotic count with off going nurses, and restock anything on the med cart that might need restocking . each shift was supposed to do that at the end off their shift, and empty the trash, and put on new trash bag . but I like to see that everything I'm going to need is there. Water pitchers filled, fresh pudding cup, etc. I get there on time to let offgoing nurses time to count and wrap up their shift. I expect my relief to be on time as well. 8 hrs was enough thank you .
This practice was forbidden by management on the last unit I worked so it was definitely not part of the culture. We were told if you wanted to look your patients up and access their chart, you had to clock in (but not before 7 til) and be back in the break room for huddle at 0700 or 1900. There was only one nurse who would do this “research” for 7 minutes.
This was also a unit though, that had tremendous support for management and a streamlined, consistent way to give report. As charge, I would typically be able to look through all of the charts to check on appropriate orders before end of shift and follow up with our physicians if anything looked wonky. We also had a very consistent and standardized way of giving report. Off going and oncoming nurse would look together at orders, labs, patient history, and go through the systems together. And then end of report consisted of those nurses actually putting eyes on the patient, their lines, drips, and the monitor. I believe if report is done this way every time, there truly is no need for you to come in and do this extensive research on your patients.
This would be great if it could be done in 30 minutes on 5 pts. It could be done if we didn't need to do bedside report. But not with pts needing to go to the bathroom or wanting to talk a lot. Yes, we can try to take care of those needs before report, but it rarely works- they still find something to need during report.
This would be great if it could be done in 30 minutes on 5 pts. It could be done if we didn't need to do bedside report. But not with pts needing to go to the bathroom or wanting to talk a lot. Yes, we can try to take care of those needs before report, but it rarely works- they still find something to need during report.
Completely agree. This kind of report would typically take 30-45 minutes on 2 ICU patients. I think a condensed version would be more feasible for 5-6 med/surg patients. Some sort of consistency in report and accountability of the off going nurse goes a long way.
Too bad the theory of “nursing is a 24/7 job” is used as an excuse to not follow up or check on things and that this attitude wins out over setting your peers (and patients!) up for success.
I don’t believe it should be the expectation that you look your patients up before you start your shift unless you can clock in and get paid for that time. If nurses feel this is absolutely necessary and the only way to be successful on their unit, I believe an alternative solution needs to be offered by management.
As a new nurse I went in early to research my patients, but I clocked in for it. I don't do my job without getting paid.
Now as an experienced nurse, I don't need to do that. Also experienced nurses know what to hand off that you need to know so you only look up what you need to know. Generally it takes me 5 minutes to look up my 3 patients and the most important details. We really need to know our patient's though due to them being critically ill, but with time management and experience you are able to do it far more quickly.
AnLe, ASN, RN
44 Posts
I don't get mad when that happens. The board can change any moment for balance. Secondly, it helps to get a 2nd pair of eyes on the board, like when people get 2 stroke patients or patients with the same last name and gender, which happens a lot.