Some night shift registrars face not only a crowded waiting room of patients upon arrival at work, but also a mess from the day shift’s pizza party.

“Nothing can kill morale like coming in and finding all the leftovers that the day shift had — and you get to clean it up as well,” says Mike M. Harkins.

For years, Harkins, now director of registration at Sentara Healthcare in Norfolk, VA, worked the night shift and found leftover pizza many times. However, Harkins’ staff do not have to worry about this. “You must consciously have the same ‘fun’ for all shifts. It is only fair,” Harkins says.

If the day shift eats pizza, fresh pizza is offered to evening and night shifts, too. “We order and pay for it in advance with places that are open late,” Harkins explains. The same is true of communication. Day shifts sometimes gather in daily “huddles” to learn what is going on in the department. Meanwhile, night shift registrars have to settle for impersonal emails. Sentara Healthcare’s registrars all receive information the same way regardless of what shift they work, whether it is in by email, bulletin boards, or in-person.

Another well-known morale-killer for the night shift: Staff meetings inflexibly held only on day shifts. Harkins makes sure meetings are held multiple times during the day. “Every employee has an equal chance to attend,” Harkins notes.

Suddenly spotting a well-meaning but rarely-seen supervisor in the middle of the night has an unintended negative effect. “Employees become suspicious that you are checking up on them if you just show up randomly,” Harkins says. Instead of surprise visits, all patient access supervisors put themselves on the schedule every other Thursday night. “This sends a consistent message to staff that they are in the building to work a normal shift,” Harkins explains.

On alternate Thursdays, supervisors work a 7:00 p.m. to 7:00 a.m. shift. “They catch all three shifts, and it gives the supervisor off on Friday,” Harkins says.

Employees who have small issues know that they can wait for the Thursday the supervisor is working to be heard. “People just want to vent sometimes, and we need to listen,” Harkins says.

One supervisor recently noticed that computers and printers were not used because night shift registrars worked in a different location than the day shift. New equipment was added in a more convenient spot. Another supervisor saw ED registrars constantly struggling with patient volume and added an additional registrar to the overloaded shift.

Even grabbing something to eat was once a problem; soda and chips in snack machines were the only option for off-shifts. “There was nowhere for the night shift to get a meal,” Harkins says. To fix this, new snack machines were added, offering soups and sandwiches.

Savvy supervisors noted that day shift registrars tended to avoid restocking and cleaning.

“The attitude was, ‘Leave it for the night shift, because they don’t have enough to do,’” Harkins says. Supervisors made it clear that day shift registrars needed to do their part. On the other hand, supervisors also noticed some bad habits cropping up during late shifts, which were not scrutinized as closely. “Uniforms, food rules, and phone rules start to relax,” Harkins notes. Requirements are reinforced consistently.

Most of the issues brought up by the night shift are no different than any other shift. “But if there is no avenue for night employees to be heard on a regular basis, things can grow out of proportion, causing bigger problems,” Harkins cautions.

If morale is not the best, supervisors pick up on it before it gets out of hand. “Sometimes, it is great to bring in some ice cream and just spoil them a little bit,” Harkins says.

Keeping up morale for night shift registrars is not an easy task. “We all know 24/7 operations can be a challenge,” says Pamela Konowall, CHAM, assistant director of healthcare access at the Cooper Health System in Camden, NJ.

All levels of the patient access management team visit employees at all shifts consistently. Supervisors are scheduled for each shift, and monthly rounding is conducted with every employee. Konowall stays late or arrives early to hear what is going on during off-shifts. Recently, registrars complained that when they entered a patient’s room to obtain demographic information, they would find out a colleague had already collected that information. It was frustrating both staff and patients, but a simple fix was found. “The resolution was to assign staff members to specific areas so it’s clear which registrar is responsible for which room,” Konowall says.

With supervisors physically present, off-shifts can let them know right away if scanners or computers are malfunctioning. If so, the equipment is immediately serviced and then tagged to indicate that it has been repaired.

Whenever managers reward staff in any way, they do not ignore the night shift. Recently, the ED registration team achieved a 20% increase in collections for the first quarter.

“All shifts played a part in meeting the goal, so all shifts were rewarded,” Konowall reports.

Everyone earned a free takeout meal, which they ordered themselves from a restaurant of their choice.

“Third-shift employees have restrictions due to operational hours of fast food delivery options, but they do have a favorite food spot that delivers until 1:00 a.m.,” Konowall notes.

Likewise, when personal notes written by supervisors are offered, managers make sure to do it for all shifts.

“One can see thank you cards proudly displayed by employees,” Konowall says.