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.

[morte, LPN, LVN]

On 2/22/2020 at 2:54 PM, TriciaJ said:

Till you get an employer who wants his bum wiped. Then you'll wish you'd saved the fifteen grand.

That would be a valet, not butler,...

[TriciaJ, RN]

5 hours ago, morte said:

That would be a valet, not butler,...

As long as you get a written job description. The Downton Abbey crowd have been known to demote butlers to footmen.

[MunoRN, RN]

On 2/24/2020 at 7:50 PM, Lorie Brown RN, MN, JD said:

This sets a bad precedent. If something happens to you, you are not covered by worker's comp. Also, if you access charts and you are not on the clock, legally it is a HIPAA violation although your hospital would probably never do anything about it. I suggest you contact a labor law attorney or find a job that is a better fit for you. If you have to show up early to survive, there are better options elsewhere.

As an example; https://www.nurse.com/blog/2015/02/23/is-it-a-HIPAA-violation-to-chart-while-youre-technically-off-the-clock/

Quote

. Likewise, reviewing documentation in the record on your assigned patient before your shift starts in order to get up to speed prior to your shift, or to add documentation for the patient (following facility policy) charts before you begin to provide care for that patient would not be a PrivacyRule violation.

Of course HHS is the most reliable source, and they used to have this same answer on their FAQ page which has now rolled off due to newer questions, we've also asked HHS directly as this question came up in a much more extreme example; nursing students who are expected to look up their patients a full day before caring for them, the response from HHS was that this was not a violation is the access of the PHI was for a purpose allowed by HIPAA.

There seems to be an incorrect assumption that to access PHI you have to be the one actively caring for the patient, which isn't correct. It just needs to be related to the care of the patient rather than idle curiosity, etc (or related to quality assurance, education, etc.)

[BSN-to-MSN, ADN, BSN, RN]

On 2/23/2020 at 5:54 PM, MunoRN said:

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?

Yeah, really!

[caliotter3]

On 2/24/2020 at 5:18 PM, casa_bella said:

I don't do a minute of work off the clock.

My hero!

[CardiacRNLA, BSN]

At the end of the day who cares. Not all nurses are created equal. Whatever one has to go to make his or her shift go well, I say for it. On my first day, I’d come in 30 min early. After that I did not. But it put me at ease and make my shift easier.

if it isn’t illegal, jeopardizes patient safety and if it works for you, do what you can.

[SweetSouthernLove, ASN, BSN]

I would say this is appropriate to do as a new nurse until you grasp your own rhythm and time management. Then come in when it is time to clock in. Think of it as accelerated self-study. All nurses are different but we all have licenses to protect. The more you know about the life that you are responsible for in that half of your day the better everything runs and this is just my experience.

I am not sure what unit you are working on or how much autonomy you have from your preceptor right now but taking time solo to look up all the unknowns of the day can put you at a great advantage. Usually there isn't much time between unit huddle, shift report/hand off before you are off to do your initial assessments and grab meds. If someone has a complicated pathological process going on you need to know it. Not through RN report but know the concept of the disease process and what is normal vs. abnormal. This is learning and gaining experience. Some nurses may know how much time they need to wrap their head around things, others may be super quick and are masters at their craft.

If you can find the time to do this ON the clock, well by all means DO these things ON the clock. If not, and you find that you clock in and can't "research" adequately then you should find out how much time you do actually need to know things about your patients. This is important not only for you but the entire team caring for that patient on that day. During rounds you should be speaking for your patient as the bedside nurse, at least where I come from this is what occurs.

A good thing you can practice with your preceptor is having he/she ask you what is going on with your patients for that day. So you both start off on the same page. Being a relatively new nurse would be the only reason I would agree with this situation. Things will happen during your shift where you may have to know a lot of information in just a short amount of time. Basically, this is a skill, like other nursing skills, and you are new so you can perfect it as you gain more experience.

[wsunurse14, BSN]

I show up about 15 mins early. Put my stuff away, grab a water or coffee, and spend about 5 mins looking up my pts. Just basic stuff like name, allergies, diagnosis, meds for the night. We are allowed to clock in 5 mins early at my facility.

[caliotter3]

On 2/23/2020 at 2:20 AM, Davey Do said:

I think they like to discuss the drama of the family dynamics.

All nurses love to discuss the drama of family dynamics.

I have taken as long as 45 minutes doing so with my relief, (but we work in extended care with one patient, usually a more relaxed atmosphere). Just have to make certain one is clocked out if using electronic EMR and everything in report is not crucial enough to warrant being paid to discuss it.

[CPLibra, ADN, BSN, RN]

For me, it really depends on the day that I am having and how I am feeling.

If it is my first shift on and my patient assignment will be new to me, I sometimes like to come about 15 to 20 minutes early to look things up on the EMR and take my time perusing through the paper charts.... as not all documents/information are automatically uploaded onto the EMR. Sometimes I just like to go in early and chit-chat with my coworkers while I am looking up information to just get a head start so that I can catch up with my coworkers and somewhat anticipate what kind of report I might be getting.

My unit has a high turn-over rate. I often get report from various different new-grads and from registry nurses at least 5 out of my 6 required shifts... I like to look things up prior so that I can ensure that things do not get left out and that the nurse that is endorsing to me would be on the same page. If I came right on time and did not have enough time to look things up, I would research concurrently at the same time that the nurse is endorsing and giving report to me AKA multitasking! However, I only do that if I know that the nurse has a reputation of leaving a lot of things out, if they are registry, or if they are new and I am not sure regarding their level of nursing... (notice I say level and not years of experience haha).

Some may think of this as being rude or being anxious, but I have learned that it's best to be prepared. Like another poster here, I have also experienced at my current place of employment that there are many times that the relieving nurse leave out way too much information and leave way too many tasks in-completed. Looking things up ahead of time prior to clocking in helps me to prioritize my shift better on what needs to be done first and for which patient first as well.

Going a little off topic, but.... As of lately with the whole COVID-19 pandemic and increasing admits of COVID-19 patients onto my unit, I come in about 30 minutes early on my first shift on to mentally prepare myself while gathering my much needed PPEs because there is a long line needed to grab PPE's... (and to mentally prepare myself for the dreaded reusing of PPE's ???, but that's another story for another thread haha).

My experiences and place of employment may be different from yours, but that is the current culture at my work place. There are a couple of my coworkers on both day and night shift who also come in early to look up labs, meds, and progress notes from Dr's to ensure that they have a planned shift ahead of them so they know what to expect...

During nursing school, my instructors would frequently make us come 1 hour ahead of the oncoming shift's nurses to look up information so that we could get a better grasp of patient information. A previous poster mentioned that, and I think that is a great idea.

If you are already on your own, I would say to come in on time and just go with the flow... you will eventually get a feel for it and see whether you feel like you want or feel the need to come in early to research or not.

I have seen two sides, in which very experienced nurses can come in late every shift and are able to still grasp nursing concepts quick without research... I have seen very experienced nurses who like to do research AND get report 20 minutes before clocking in because they want to quickly get their day started with assessments and med passes. You will learn your style.

[CPLibra, ADN, BSN, RN]

On 2/24/2020 at 8:01 AM, Mavnurse17 said:

When I worked bedside, it was a personal preference of mine. It gave me time to look ahead at my orders, especially if I had a complex patient (multiple drips, pumps, an LVAD, tubes & drains, tube feed, lots of skin issues, etc). Perhaps it was because I was a new nurse, but I found that once report was over at 1930 I had very limited time to get my assessments done, meds passed, and nightly care finished. Sometimes I had an early admission and god knows those took forever and would put me wayyyy behind. If it was a particularly busy night, I wouldn't have time to sit down and read recent progress notes. I personally felt better going into my shift with more background on my patient than the day shift nurse was likely to give me.

*Editing to add that I've caught a few med/order errors upon walking into bedside report with the day shift nurse because I'd already looked up my patient beforehand.

This. This is the reason why I also come in early haha. Not to mention, an early admission, a discharge/transfer, and an unstable patient all in one..... Yeah... Granted not all shifts are like that, but sometimes coming in early to read all about it in advance puts my mind at ease.

On top of that, catching med errors was a big thing... I would ask the relieving nurse why wasn't a certain medication given and they would look at me perplexed... and they would say that they did administer the medication, but that the scanner did not scan it... ?

[Elaken]

Never ever do this. First of all it is most likely illegal because it probably counts as working off the clock. Secondly you are accessing patient’s information off the clock and that would be a HIPAA violation. What if something changes last minute and they don’t go to you. It is one thing to have been looking while on the clock and they are provisionally assigned to you. Quite different to be in a chart 20 minutes before you work for a patient you never get. And thirdly do not give the company free time. Then they turn a blind eye and say our staffing is appropriate because everyone got out on time.