Managing Time and Attendance Challenges

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Much of the nursing workforce continues to report feelings of exhaustion and burnout. Nurse well-being is a high priority for health systems and the nurses working in them. Due to the turbulence in healthcare environments, managing staff time and attendance issues has never been more challenging for nurse leaders. Nurses are in the driver’s seat when it comes to choosing employers. They know it, as do their managers, who vacillate between wanting to be empathetic and ensuring their unit is staffed. Consider some of the following observations that I have recently heard from frontline nurse leaders:

• I recently looked at PTO usage on my unit – it was shocking how many staff have no accrued days and use it as they receive it.
• FMLA is now a huge challenge in my unit – I am constrained about what I can ask, but the abuse level is a growing concern.
• I have nurses who call in 20 minutes after the shift has started – this would never have happened in the past.
• Our unit is very short-staffed – on a Friday afternoon, one of our RNs called in to say she was stressed and anxious and was taking a mental health weekend off.
• I was counseling a nurse about her time and attendance, and she looked me in the eye and said that our hospital was consistently short-staffed and that maybe I should focus my time on that instead of hassling her.
• One of my staff who just started in June told me she would take two weeks’ vacation in August. She never discussed this during the interview. I explained that the vacation schedules for August had already been developed. She responded that she would seek employment elsewhere if I could not give her the time off. Her conversation was to inform me and not ask permission.

As I thought about what these managers told me, I reflected on my leadership experience. Throughout my career, I had many conversations about time and attendance, but these problems generally only happened with the non-professional staff on the units I led. We are now in a different place and time. Holding professional staff accountable for their actions has become more complex. When leaders don’t take action, deviance is normalized around the use of leave. If I, as a new nurse, watch others call in frequently, fail to provide adequate notice, or misuse leave with no follow-up – it becomes okay to do it.

When staff know that a leader will do follow-up and take action, the dynamic can change.  Let’s use the following case example to illustrate how to coach around accountability for time and attendance:

Cheryl is a new nurse working on your team. She has good clinical skills but needs help taking feedback. You have begun to see a pattern of behavior where she arrives late for her shift without calling the charge nurse. When the charge nurse questions her about arriving late – she gets very angry and upset. Today, you are bedside rounding with the night staff, and Cheryl still has not arrived on the unit by 7:20 AM – the charge nurse takes the report on her patients. Patient care is delayed because the charge nurse must give her a report when she arrives. She becomes defensive with the charge nurse when questioned about her lateness.

I recommend using the Situation – Behavior – Impact – Way Forward approach to this coaching conversation recommended by the Center for Creative Leadership.

Situation – I was with the team this morning on bedside shift report and noted you were 20 minutes late for the shift and had not called to let anyone know.

Behavior –  You became defensive with our charge nurse when asked about your late arrival.

Impact – It may not be your intent, but arriving late on the unit negatively impacts the team and the start of patient care. It is a patient safety issue for the team.

Way Forward –  I need your commitment to arrive on time for your shift. If you have issues or challenges getting to work on time, then you and I need to discuss this, as this is a professional expectation. You are an excellent clinician, and I know you can improve in this area.

I think it’s essential to address the behavior right away. Cheryl will probably tell me she doesn’t remember the incident if I wait a few days. Nurse leaders should make their comments behavior-focused (late to work) versus personality-focused (you need to be more reliable). Even if you may feel that Cheryl intended to be late to work, start by assuming good intentions. Stay focused on the desired outcome – Cheryl comes to work on time and contributes as a highly-skilled nurse to the team.

Time and attendance issues are among the greatest challenges nurse leaders face today. These conversations are rarely pleasant but very important to get things back on track.

© emergingrnleader.com 2023

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