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Evening Coverage

Struggles, Strategies & Solutions!

Presented by: Emily Carlton BS, CCLS & Beth Phillips MS, CCLS

Objectives

• Share the personal and professional benefits of evening coverage

• Discuss the differences between daytime and evening positions

• Identify the struggles that and evening CLS might encounter

• Impart strategies for successful evening practice and our methods for developing those strategies

• Acknowledge that evening coverage is a continuing journey

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What’s the difference?

Daytime

• Greater team presence• Administration &

multidisciplinary team available

• “In the loop”

Evening

• Frequent independent work• Higher patient volume (ER)• Reduced team presence• Evening multidisciplinary

team structure• Increased presence of

visitors (siblings)

“There was an increased number of patients triaged as either urgent or emergent on evening shift when compared to day shift, reflecting an increased acuity on evening shift” (Krebel, Clayton, Graham, 1996).

Benefits of a Non-Traditional Shift

• Increased independence• Opportunities to work across several diverse areas• Close relationships with multidisciplinary team

members• Flexibility with personal time• A calm atmosphere• Increased opportunity for in-depth patient interactions• Unique perspective

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Potential Struggles

• Diminished personal time during traditional off hours• Additional effort is necessary to remain connected to

day shift employees• Meetings and communication during daytime hours

can be difficult• Flexibility is key!• Working throughout the hospital • High-acuity situations: traumas, withdrawals from

care, etc.• THE BUCK STOPS HERE

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StrategiesHow we make it work!

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Communication

• Phone calls & e-mail• Charting• Phones Vs. Pagers• When to call....• Supervisory Support

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Clearly Defined Prioritization

• When to contact your CLS• A heightened sense of the

“normal” CLS priorities• We are responsible for

representing the evening staff– Holidays– Meetings/Task Forces– Committees

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Teamwork

• #1: Know your team• It could represent more of a struggle• ½ Day, ½ Night• Less coverage means you may be spread

thin• Trust• Support• Examples

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Time Management

• Snowball effect

• Meetings

• There is always “one more thing”

• Additional responsibilities– Evening volunteer supervision– Department-wide program coordination– Misc.

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What Works?

• Including evening hospital staff

• Starting small• Follow through• Staggered shifts

– No delineation

• Having patience

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Diversion Task Force

One Step at a Time…

• Struggle: we were receiving calls/pages to offer diversion items and activities to patients multiple times each night

• Strategy: along with an inpatient CCLS we presented this struggle to our co-workers at a shared governance meeting, and from that a task force was formed, which we joined and had a vital role in.

• Solution: the task force recommended that each unit/area (inpatient, ER, and Radiology) have a consistent, clearly identified area in which these items would be available to nursing staff 24/7

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The Continuing Journey

Emily

• The ER is an ever-changing environment that will continue to require immense flexibility

• Growing with experience• Looking to the future:

balancing work with personal life

Beth

• Balancing areas of work• Reaching out to the

community, barriers in communication

• Deciding when to flex• Work/life balance• Thinking outside of the

box

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Resources and Final Thoughts…

• Importance of brain-dumping

• “Shift Work” – further readings

• Know yourself

• Support your colleagues

• Strengthen your time management skills– Check out Getting Things Done by David

Allen

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Questions?

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References

Chetty, M. (2006). Working the Night Shift: Preparation, Survival and Recovery. A

Guide For Junior Doctors. Occupational Medicine, 57(1), 75-76.

 

Krebel, M. S., Clayton, C., & Graham, C. (1996). Child Life Programs in the Pediatric

Emergency Department. Pediatric Emergency Care, 12(1), 13-15.

 

Nicholson, P. J. (2011). Shift Work and Chronic Disease: The Epidemiological

Evidence. Occupational Medicine, 61(6), 443-444.

 

Texas Nurses Association: AdvocDirectCareNurse Shiftwork. (n.d.). Texas Nurses

Association. Retrieved May 31, 2013, from

http://www.texasnurses.org/displaycommon.cfm?an=1&subarticlenbr=235

 

Thompson, R. H. (2009). Program Administration and Supervision. The Handbook of

Child Life: A Guide for Pediatric Psychosocial Care (pp. 203-205). Springfield, Ill.:

Charles C. Thomas

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