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Stop keeping nightshift nurses in the dark


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Removing communication barriers helps the nightshift staff stay up to date

Communication between nurses on day- and nightshifts is often limited to patient reports, leaving nightshift staff members in the dark when new policies and procedures are implemented, forms are changed, and activities take place. But that all changed for AtlantiCare Regional Medical Center in Atlantic City, NJ, when Catherine Clark, RN, nightshift liaison, was working as a nightshift nurse in the pediatric department and saw promotional material for the hospital’s clinical ladder program.

Clark was looking for professional development opportunities but swiftly realized that for her to partake in the clinical ladder program at AtlantiCare—an ANCC Magnet Recognition Program® recipient in 2004—she needed to attend and participate in daytime committee meetings. “I couldn’t qualify for the clinical ladder program because I was too exhausted during the day to come in for committee meetings, participate, and have my voice heard, and I didn’t think that was fair,” says Clark.

Clark thought she discovered her solution when she found minutes from a staff meeting posted in the nursing lounge that talked about an unresolved problem, so she e-mailed her manager with a solution. “My manager replied, saying my solution was an excellent idea,” says Clark. “I asked, since I read the minutes and resolved one of the issues that couldn’t be resolved at the staff meeting, if that counted for attendance. My manager said no—that was the icebreaker for me.”

Opening the communication door

Clark wrote an e-mail to the vice president (VP) of nursing detailing her complaints about the communication barriers between day- and nightshift employees and how to fix them. “The VP of nursing wrote back the next morning and said, ‘You’re right, come in and meet me,’ ” says Clark. “I thought I was coming in to be fired in person.” But the VP told Clark she understood her frustrations and explained how she could implement her e-mail solutions. She says the VP told her, ‘If you can make this work, then you and I will do this, but you don’t have a budget.’ ”

Without a budget to work with, Clark began examining creative ways to solve her problems. She started with a literature search in hopes of adapting other hospitals’ strategies that had eliminated communication barriers between day- and nightshift workers, but she came up empty-handed. Clark had to find another way to solve the problem, so she started a nightshift committee to help her design a communication system.

At first, interest was limited. The committee began in December 2004 with only six members, but Clark kept going, and, eventually, more nurses became interested.

Step one: Validating participation

The first item Clark had approved by the VP of nursing was that nightshift staff members could participate in committees through a variety of formats (e.g., answer an issue via e-mail). This opportunity allowed nightshift staff members to participate in the clinical ladder program.

Clark created binders for nightshift staff members that provided guidance on the clinical ladder program and how they could participate. She says the response from nightshift staff members about new committees or programs was, “I don’t understand it, but if you will guide me, I will participate.”

Step two: Identifying a communication system

Clark opened a line of communication with dayshift personnel and began receiving daytime committee meeting minutes, attending daytime committee meetings, and obtaining access to every department head—a significant task accomplished with help from the VP of nursing. She would then communicate the information obtained from dayshift to nightshift staff members through e-mail, person-to-person conversations, or the phone:

E-mail. Clark joined the document review committee that discusses any revision to an existing form or updates on new forms that are being introduced. To inform nightshift staff members about these changes before they are implemented, Clark designed a project to encourage nightshift staff members to participate, and those that do are called communication champs and can earn points for the clinical ladder program.

When changes are made to a form, Clark receives an e-mail from the committee with the new form attached, which she then e-mails to the communication champs notifying them of particular changes to the form. She also attaches a sign-in sheet with details in the e-mail explaining how they can verify their participation to attain five clinical ladder points. Communication champs do the following to validate participation:

In-service five of their peers about the changes to the form and click the Read Receipt button when they reply to Clark. “The reply is notifying me that they received my e-mail and that there were no problems with the e-mail. I then go back to my book and check them off for that date that they participated,” Clark says.

In-service peers with at least 50% of the forms that are sent out (e.g., if 16 forms are e-mailed in one year, they must in-service eight nurses) and include sign-in sheets.

“We have been so proficient with this system that I even have nightshift staff in-servicing dayshift staff with updated changes to forms,” says Clark.

Person-to-person. Clark has a contact in HR who she meets with once per month to address any concerns nightshift staff members have and to receive updates. HR updates Clark on the following items:

Town meeting times. The meetings are held during the day with representation from leadership who listen to employee concerns and provide facility updates.

Organizationwide initiatives. HR showed Clark the hospital’s revised intranet site before it was launched so she could educate nightshift staff members on how to access policies and procedures.

Phone. A conference system was recently designed that allows nightshift staff members to listen to and participate in a dayshift committee while in the comfort of their home.

Increasing numbers

By 2006, the nightshift committee’s attendance increased to 22 members, says Clark. “And in 2007, I had over 100 members,” she adds.

Clark says designing a nightshift communication system is a lot of trial and error because not all initiatives are going to work. “My biggest encouragement to people is to try what you already know works, because if you can [provide] leadership with one successful [communication tool], then they will tolerate your failures and let you keep redesigning the system,” she says.

Tip: At St. Vincent Indianapolis Hospital—an organization pursuing ANCC Magnet Recognition Program® (MRP) designation—MRP champions are selected from the day- and nightshift. These selected champions keep the communication line between both shifts strong by having monthly meetings, which are held at 8 a.m. to accommodate the nightshift and at noon for the dayshift, says Sallie Latty, MA, BSN, RN, MRP coordinator.

Editor’s note: To contact Clark for further information, e-mail her at Catherine.Clark@atlanticare.org.