Tale of two shifts

By Michael C. LaFerney | 01/21/2015

Same unit, different time of day. What makes the difference?

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 Kate, a nurse who works the evening shift on the long-term care unit of a local nursing home, dreads reporting to work. Melissa, who works on the same unit but during the day shift, loves coming to work. Why the disconnect? Can the same unit really be that different from shift to shift? And, if so, what factors make it that way?
 
LaFerney_Michael_embed2_SFWDay shift
Nurses on the day shift have worked together a long time. They know each other’s routine and work together in a team fashion. They start off each morning with an inclusive report where all staff members have input. Problem areas on the unit, such as lack of supplies or behavioral issues of certain patients, are addressed, so everyone is on the same page. Jill, the charge nurse, deals fairly with employees and is willing to discuss posting of assignments, and there is a professional atmosphere. Problems at home are left there, but if an issue does arise that causes an employee distress, support is given.
 
The first shift has also adopted the “two-an-hour rule.” This means that twice hourly, at a minimum, staff members will compliment or say something positive to a patient or fellow staff person. This simple practice sets a positive tone for the unit. “You did a great job in rehab today, Mrs. Jones,” “Love your hair, Sally,” and “Thanks for doing my dressing change for me” create good feelings among co-workers and patients, resulting in a more pleasant atmosphere. Staff members enjoy learning, and the charge nurse arranges coverage so nurses can take turns attending in-service staff-development offerings. To allow for their attendance, Jill will even cover their assignments herself!
 
To manage conflicts that arise between staff members, a policy of quick arbitration has been adopted to resolve differences immediately, so negative feelings don’t fester. Jill, who has an authoritative style, listens to both sides in a dispute and uses evidence-based research to determine outcomes. This earns her the respect of team members and, even when ruled against, they tend to go along with the decision because they know it was decided fairly. Jill also takes the time to explain the rationale behind her decisions. She consistently enforces the nursing home’s policy of no cellphones during work hours, so staff can focus on their responsibilities without distraction.
 
Evening shift
The evening-shift nurses, where Kate works, have not worked together much. Several times a week, the unit is staffed with nurses floated from other units who are often unhappy about the situation and voice their feelings openly. When patients hear this grumbling from their caregivers, their morale is also negatively affected.
 
There is no beginning-of-shift report, because short staffing and staggered schedules don’t allow for it. No plans are made in advance to deal with problematic behaviors, and patients with these issues can create division and disharmony among staff members. Because staffing is so inadequate, attendance at in-service training is not possible. As Peg, the evening nurse in charge states, “We don’t have enough staff to let anyone leave the unit.”
 
Peg’s management style is authoritarian (much different from authoritative), and she is viewed as a bully. She is often critical of nursing staff and uses a “write them up” approach to problems. She is harsh with Robin, who has permission to come in a half hour late because of child-care issues. When Robin asks for a quick update of her patients, Peg scolds her, “If you were on time like the rest of us, you’d know what’s going on!”
 
There is no two-an-hour rule in place or any conscious attempt to make a more positive environment. As a result, there is frequent staff turnover. Nurses often spend time on their cellphones dealing with family issues, which distracts their attention from patients. This behavior is reinforced by Peg—who, herself, is often seen playing games on her phone.
 
Kate, a conscientious nurse, has worked an occasional day shift on this unit and can’t believe it is the same place she works in the evening. She would like to see the environment change on the evening shift, but doesn’t know what to do.
 
Action plan
Nursing facilities can conduct staff-satisfaction surveys to gain input from staff members on how they view working there. A survey at this facility might point out the difference in working environments and even suggest ways to improve. One way to implement positive change is to use the first shift as a model. First-shift employees are happy. What can the evening shift do to emulate the first shift?
  • Change the mood on the unit from a complaining atmosphere to a positive one by adopting the two-an-hour rule.
  • To address issues and plan proactively, start the shift with a brief report with all staff members present.
  • Show nurses who have later starting times that they are valued members of the team by providing adequate updates when they arrive.
  • To provide training for evening-shift nurses, arrange for members of the staff development department to give on-the-unit training during that shift.
  • Focus on patient care by not allowing distractions such as cellphone calls.
  • Offer support for staff members with family issues by referring them to human resources or employee-assistance programs, so they can address those concerns during nonworking hours.
  • Most importantly, assess the leadership of the unit.

The leader sets the tone. Peg’s style is not consistent with good management practice. It’s time for a change. This might create a good opportunity for Kate, who is ready to implement practices she has seen used so effectively on the day shift! 

Michael C. LaFerney, PhD, RN, PMHCNS-BC, is a psychiatric clinical nurse specialist at Arbour SeniorCare in Haverhill, Massachusetts, USA.
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