By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Call-ins have always posed a challenge in nursing, but what’s truly alarming is the rapid surge in sick leave, FMLA and PTO usage, often catching nurse managers off guard. 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. A recent webinar featured a manager sharing this story:
As we finished the day, one of my newer staff came to me and said she was not getting enough rest and doubted she could do her next night shift rotation, several days away. She was not asking permission or seeking guidance but warning me that she planned to call in. This is not the first time that this has happened with this nurse. Covering nights has become impossible, and I told her it would impact patient care and her team members. I tried to provide her with some coaching about getting enough rest while working. She did not seem to care or want any advice and told me she needed to worry about her well-being. I have started to see this happen repeatedly with this nurse and others. We have a liberal leave policy, and I have limited ability to hold her accountable. Our staff also knows they are in the driver’s seat and don’t necessarily need a recommendation from their leader or organization to find another job quickly. Building teamwork and esprit de corp is hard when so many focus on their needs.
For this manager and other leaders, practices on managing time and attendance issues are largely driven by your organizational policies and union contract. Some organizations have policies that allow the use of PTO with no questions asked and a call-in window that is very narrow before the start of the shift. Others are stricter about the use of unplanned leave and have a call-in window that might be 2-4 hours before the shift begins.
As I thought about what nurse managers have 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 and make sure that policies and protocols are followed, deviance is normalized around the use of leave.
I recommend to CNOs that the topic of time and attendance should be discussed at least quarterly in nurse manager meetings to assess what is happening with frontline staff. Organization policies should be reviewed and managers should share complex situations for group discussion. It is important that all managers are on the same page about how to handle time and attendance issues as staff readily share any deviations in practices with their colleagues.
There are no easy answers to the questions that managers pose about how they should react to unplanned time usage. Advice on how to manage time and attendance problems is context dependent and there is no one size fits all solution.
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