Okay, if anyone I work with reads this thread, they'll know it's me in a heartbeat, because I've been complaining about this to anyone that'll listen, picking their brains, & generally trying to get others' input on this.
I'm five weeks into orientation, and I really need some advice on giving report. Not unclear on SBAR, and I've *heard* report given many times before. I think I have a pretty good grasp of exactly what goes into the thing, and the reasons why all the different components are in place. Ideally, a continuity should come of it, that would to the patient's perspective be as though no handoff had happened, right? So, the oncoming nurse needs to have as good a perspective on the pt's history, history of present stay, demographic data including allergies, code status, any abnormal labs & vitals, any pending ones, any "to-do" items, and the overall plan for the immediate future if not the remainder of his stay. Is this a fair, albeit cumbersome, summary of what's needed?
What I feel I'm falling down on is in gathering some of these items (especially the 'plan', though I'm getting familiar w/ the residents and being able to grab them and ask) throughout the course of a busy day, and keeping some previously-reported items stored for reporting (his history of present stay, for instance). I feel a lot like a pinball being shot from task to task, to phone call, to this, to that, etc. I can't see where I'm wasting any time at any point, though I'm sure my ability to cluster activity could stand improvement. I've tried various strategies I've found on this site involving organizing data throughout the day, and some of them involve a little more graphic design-time than my day will allow me! :behindpc:
My preceptor tells me I'm doing well, and tells me not to get too preoccupied with this. Reviews from peers, clinical specialist, manager, patients, all have been positive, but this aspect of nursing is really bothering me. Some of it is that I blank when put on the spot about a patient, and come across as knowing considerably less than I actually do! :angryfire:
Has anyone dealt with this and worked through it, or is anyone currently going through it? Questions, comments, suggestions, curses?
Are there days where you just physically *can't* pull it all together by change of shift, and if so, how does that play out?
If you've read this far, thank you. Have a cookie, it's on me!
Sep 27, '07
first of all... relax... listen to your preceptors. sounds like you're doing great.
now report comes in many styles/qualities. my own report varies depending on the type of night i had and why the patient is in the hospital.
i work trauma med/surg so many of my patients have no hx, many have substance abuse hx, many have hx of violence, many stay in the hospital for weeks/months, while others are on a 23h obs.
this is how i do report on a perfect day with an average pt (not super sick, but sicker than a 23h obs)...
john smith 32m, dr. smith (trauma) admitted 9/25
s/p mva car vs. tree, restr. passenger, +airbag
conc w/ +loc
r rib fxs 6-10, r hemothorax, ct to 20cm pleurovac suction
r acetab fx (orif'd 9/25)
r open tib/fib fx (x-fix & woundvac 9/25)
no hx, no allergies (i don't always remember to say this)
neuro checks q4h
neurovasc checks q4h
telemetry 24h (d/c'd 9/26) don't always remember to mention routine tele that's been d/c'd.
tolerating regular diet
bedrest hob 30 degrees
neuro pupils 3=brisk
good strength all extremeties with exc rle.
lungs clear decreased b/l bases, r more decreased.
uses incentive but needs encouragement.
good pedal pulse on left. right difficult to palpate. strong doppler pulse.
assessment otherwise benign.
lbm 9/26/07, small hard. gave mom/warm prune juice last night.
morphine pca & percocets for pain. pca 2mg q6mins/ lockout 10 attempts. put new bag up at 2000. pain well controlled.
plan (if i know it).
go over new orders.
abnormal labs & what we're doing about it.
if have labs in a.m.
so that's an example. now after a hairy night or when i'm really tired... this isn't automatic. sometimes oncoming nurse has to ask me labs or ask me re: pain control. i've given report and not told my assessment until asked. i don't always give lab values, just the highlights.
i like face to face report, because if i forget to mention something, the oncoming nurse usually remembers to ask.
it i give an take. no one is perfect at giving report. and some ppl love tons of details, i just want the hightlights. i also adjust my report for who i am giving it to. if they like a lot of details, i give a lot of details. if they like just the highlights i give just the highlights.
really, you'll get comfortable in time. only time. all the advice in the world won't replace the time it takes to just feel comfortable in your own nursing skin. some ppl like to use report sheets. if you see someone with one, ask for a copy.
Last edit by CarVsTree on Sep 27, '07
: Reason: To add something to my report that I forgot... See (I put it in red)
Oct 5, '07
Actually what you wrote is very similar to what one of my preceptors just wrote out for me a couple nights ago, basically an outline of what the "flow" of report will involve. I've been on nights this past week and next week, and thus have had a few spare minutes (literally) to compile a solid report on _most_ of my patients, barring of course the late admissions, which are nobody's favorite. Most nurses report from their printout of the kardex, but for this nervous newbie that's a jumble of print and my handwriting to try and sort through while giving report, so having the list has helped move things along.
I just need to organize the data I collect through the day a little better, and I should be alright. I can't help but wonder how I'll end up getting _more_ done in a shift. I can't see where I really waste any time, and I don't want to skimp on time talking with the patient - I try to make it a point to have an actual conversation w/ each patient, if they're able, in addition to the "strictly medical", to build rapport/trust/their comfort/etc. Not a long conversation, just a check-in.
I guess I'll get better at making my work more efficient through the day, in order to squeeze everything in, but at this point it looks like a steep climb!
Last edit by David's Harp on Oct 5, '07
: Reason: re-wording