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Presented by: Emily Carlton BS, CCLS & Beth Phillips MS, CCLS. Evening Coverage. Struggles, Strategies & Solutions!. Objectives. Share the personal and professional benefits of evening coverage Discuss the differences between daytime and evening positions

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Presentation Transcript
  • 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
what s the difference
What’s the difference?



Frequent independent work

Higher patient volume (ER)

Reduced team presence

Evening multidisciplinary team structure

Increased presence of visitors (siblings)

  • Greater team presence
  • Administration & multidisciplinary team available
  • “In the loop”

“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
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
potential struggles
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.

How we make it work!

  • Phone calls & e-mail
  • Charting
  • Phones Vs. Pagers
  • When to call....
  • Supervisory Support
clearly defined prioritization
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
  • #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
time management
Time Management
  • Snowball effect
  • Meetings
  • There is always “one more thing”
  • Additional responsibilities
    • Evening volunteer supervision
    • Department-wide program coordination
    • Misc.
what works
What Works?
  • Including evening hospital staff
  • Starting small
  • Follow through
  • Staggered shifts
    • No delineation
  • Having patience

Diversion Task Force

one step at a time
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
the continuing journey
The Continuing Journey



Balancing areas of work

Reaching out to the community, barriers in communication

Deciding when to flex

Work/life balance

Thinking outside of the box

  • 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
resources and final thoughts
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

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


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