CHAPTER 4 WHEN? STARTING, SCHEDULING, STOPPING
“On your mark, get set, go!” It’s easier to win the race if you have a head start, so get started early on: where, who, how care will be given.
The hospital will likely give you a specialist to aid in the transition to home, but you will quickly be on your own unless you hire a nursing agency, which would simplify your tasks but at higher costs and give you less control than you would have if you were managing the care yourself. We started with an agency, learned from them, saw how to do better, and started hiring our own nurses. Without an agency, you’d quickly have to advertise for, interview, and orient your new nurses, and you might not have your systems in place to demonstrate the requirements of the job.
Advertise in local publications and on the Internet.
Ask people who might have employed nurses before.
Interview in the home: name, address, training, experience, availability, references, extra capabilities. Would they be allergic to your pet? Rule out smoking on the job. In case of emergency, can they help evacuate the patient? Do they have any physical disabilities that would keep them from moving the patient in bed and transferring the patient to and from the bed? Keep your questions task-related. Do not ask questions that might suggest you would discriminate unfairly or illegally. As you converse, try to determine whether they are sufficiently intelligent and articulate and pleasant to make you comfortable having them in your home. After they leave, write your comments on your home-made form, so you don’t forget, and give them a tentative grade (A down to F). Don’t write down something that might embarrass you later, if it came to light.
Call references, unless you have ruled the candidate out. If a majority of the references for a candidate don’t respond or are Luke-warm, rule that nurse out. You are looking for “wonderful,” ”great,” ”outstanding,” etc. from people she/he worked for. Ask how long they were employed, doing, what, and would they hire the person again. Do not ask questions that might suggest you would discriminate unfairly or illegally. Friends of the candidate can be expected to be enthusiastic. Consider using a detective agency to do a background check.
Ask what nursing credential the candidate has, RN or LPN. Registered Nurses (RNs) have more training than Licensed Practical Nurses (LPNs), and they typically get about 50% more per hour. An LPN with many years of experience is probably equivalent to a new RN, although the latter will have more “book learning.” We had a mix, but paid all the same (to forestall rivalry or jealousy), attracting LPNs from much farther away than RNs.
In the rest of this chapter, we will show the different forms, the “charts,” we created for scheduling shifts, treatments, medications, assessments, etc.
SHIFT SCHEDULE, Exhibit 1
First is an example, Exhibit 1, of the schedule we posted for our nurses, usually at least a month in advance. The shifts varied in starting and ending times to accommodate certain nurses. The initials identified the nurses, whose names are not given in the sample.
This one’s title indicates the schedule was posted over a month in advance and was considered tentative, but probable. The August schedule was posted May 31. The first column is the work date. Next is the first shift, usually 8 a.m. to 4 p.m., followed by an afternoon-evening shift (e.g., 4 p.m. to 10 p.m.) and an overnight shift (usually 10 p.m. to 8 a.m.). We did not give these nurses an overnight pay-rate differential, but the longer hours and the relative lack of activity on the overnight shift made it adequately attractive to keep it staffed.
If a nurse worked a shift routinely for a prolonged period, she essentially “owned” it, so she could plan her life outside the job easily. If she could not work a shift, she had to get a substitute from the staff of about ten nurses. They could exchange hours or money or both, and they did so freely and reliably. Once in agreement, they would cross out
TENTATIVE SCHEDULE [partial shown here]
FOR AUGUST 2015 [POSTED MAY 31]
DATE DAY DAYTIME EVENING OVERNIGHT
01 SAT 8A-4P EP 4P-10P MB SC
02 SUN 8A-4P BT 4P-10P CP DO
03 MON 8A-4P MW 4P-10P CP AP
04 TUE 8A-2P DO 2P-10P MB BT
05 WED 8A-4P MW 4P-10P CP AP
06 THU 8A-1P DO 1P-6P KK 6P-11P BT AP(11)
07 FRI 8A-1P DO 1P-10P KK BT
08 SAT 8A-4P DB 4P-10P HG AP
09 SUN 8A-4P BT 4P-10P CP DO
DB = Diane Beggin (xxx) xxx-xxxx
MB = Melissa xxxx etc.
the initials originally on the schedule and replace them with their own. We paid the nurses before they actually worked for the coming week, so they had to work out their settlement if they made it after we made the payroll. In one or two instances, we lost money due to a nurse’s failure to work the pre-paid shifts. One such loss was about $1400, however.
Soon after arriving, the oncoming nurse would discuss with the nurse being relieved what significant activities had occurred. She would also read the communications book and then look at the comprehensive charting book.
Bound composition notebooks were used and eventually stored when full. Notifications of the nurses, requests for supplies or substitutes, comments on nursing practice were entered by management and staff at will. This did not replace the more formal nursing assessment forms, however.
[TO BE CONTINUED]