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

Nurses   (6,979 Views | 68 Replies)
by NurseOrBust13 NurseOrBust13 (New) New

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You are reading page 6 of What’s with “researching” patients before clocking in?! Is this a standard?. If you want to start from the beginning Go to First Page.

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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,...

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TriciaJ has 39 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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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.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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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/

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. 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.)

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RN-to- BSN has 6 years experience as a ADN, RN and specializes in SCRN.

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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!

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

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

My hero!

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CardiacRNLA has 5 years experience as a BSN and specializes in Tele/Interventional/Non-Invasive Cardiology.

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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. 

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SweetSouthernLove has 3 years experience as a ASN, BSN and specializes in Operating Room.

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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. 

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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. 

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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.

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