Shift Report

TypicalFish · Nov 23, 2005

This is a very common problem. The nurse with the rolling eyes is just being dramatic and nasty. What she should be doing is giving you some constructive feedback and helping you streamline your report. So much for helpful co-workers. Isn't that so sad? Next best thing would be to just ask this dumbbell for feedback. "Help me out here, won't you? What information am I not giving you that you want? What information am I giving you that you don't need?" Then brace yourself because if she's so dramatic and nasty she's probably going to blast you. You have to look beyond her behavior though and consider the salient points she does make.
Other advice. . .don't look at her during report so you can't see her physical behavior. . .tape report if possible.

That's good advice, as is listening to how other nurses give report. I use my "brain"; I take report in one color, and then I use my black ink throughout the day. That way, I know at a glance what has changed/been done throughout the day. The brain that I used starts with name, age, admit date; then it goes to chief dx; then History; then I go by systems and what happened during the day. It also helps to know if the nurse has had the pt before; we work 12's and they try and give the same nurses. That way, the nurse I got report from at 0700 is the nurse Igive reprot to at 1900.

Don't worry about thr eye rolling nurse-really, just stop and ask her "I'm sorry, am I doing something wrong?" She's rude, and there's no excues for that. Giving shift report can be hard, but don't worry, after doing it awhile, it will become second nature, and you'll get the hang of it. You'll also get to know the other nurses; some on my unit take down everything you say, others barely pay attention to you, because they are reading your flow sheet and so forth. You'll get it-you will-I did! Best wishes.....

xokelly2 · Nov 25, 2005

THANK YOU!! I am so happy to see someone recently started this thread because thus far in my nursing career it has been my #1 concern!

I have been interning for three months as a new grad (7 months since grad.) and just recently started the night shift on my own. I've begun leaving every morning feeling like I there were things I had forgotten in my charting, lab values I had forgotten to look up, etc... I keep second guessing myself and stressing about stuff all day. So needless to say, I try my darn hardest to do as good of a job as I can.

Lately what has been playing into my insecurities has been giving change of shift report in the am to a few select nurses. Now granted there are the few who ask a million questions and keep me there an hour.Thats fine, I have no problem saying I don't know, but i'd be happy to look it up! But...

What bothers me are the snide remarks, exasperated sighs, and rolling of the eyes. I have tons of respect for RN's on my unit who have 20, 30+ years experience,(I know, any amount of experience can lead to this, but just in my personal case....) but at the same time, it sucks being obviously/blantantly looked down upon because I do not have the same logocal thinking they do. They questiong my critical thinking/rationale/interventions of everything, nit pick my charting, get upset when I don't have time to start discharge paperwork, etc...

It really brings me down, it adds to my fustration and I drive home in tears. I wish there were some kind way to let them know I just feel feel really beat up, there is no intentional slacking involved. I do try my hardest. and I don't think some of them realize how much it can affect someone. (i.e: me) I offer to stay late and finish d/c paperwork, check off with consults, call dr's etc..... that makes them sigh even harder. I understand from thier point of view it has to be very fusterating.... but I feel stupid apologizing.

I love the work, love the pts, and the staff.... but this is really getting to me, I also do not want to complain to anyone, because I think it is just personal quirks and, I hope nothing intentional. I even rationalize to myself that they must be having a rough day, but I still feel like total crap.....

Thanks for letting me vent......any advice on how to tactfully let them know I am waving my white flag, and please no more beration????

rn/writer, RN · Nov 26, 2005

thank you!! i am so happy to see someone recently started this thread because thus far in my nursing career it has been my #1 concern!
i have been interning for three months as a new grad (7 months since grad.) and just recently started the night shift on my own. i've begun leaving every morning feeling like i there were things i had forgotten in my charting, lab values i had forgotten to look up, etc... i keep second guessing myself and stressing about stuff all day. so needless to say, i try my darn hardest to do as good of a job as i can.
lately what has been playing into my insecurities has been giving change of shift report in the am to a few select nurses. now granted there are the few who ask a million questions and keep me there an hour.thats fine, i have no problem saying i don't know, but i'd be happy to look it up! but...
what bothers me are the snide remarks, exasperated sighs, and rolling of the eyes. i have tons of respect for rn's on my unit who have 20, 30+ years experience,(i know, any amount of experience can lead to this, but just in my personal case....) but at the same time, it sucks being obviously/blantantly looked down upon because i do not have the same logocal thinking they do. they questiong my critical thinking/rationale/interventions of everything, nit pick my charting, get upset when i don't have time to start discharge paperwork, etc...
it really brings me down, it adds to my fustration and i drive home in tears. i wish there were some kind way to let them know i just feel feel really beat up, there is no intentional slacking involved. i do try my hardest. and i don't think some of them realize how much it can affect someone. (i.e: me) i offer to stay late and finish d/c paperwork, check off with consults, call dr's etc..... that makes them sigh even harder. i understand from thier point of view it has to be very fusterating.... but i feel stupid apologizing.
i love the work, love the pts, and the staff.... but this is really getting to me, i also do not want to complain to anyone, because i think it is just personal quirks and, i hope nothing intentional. i even rationalize to myself that they must be having a rough day, but i still feel like total crap.....
thanks for letting me vent......any advice on how to tactfully let them know i am waving my white flag, and please no more beration????

poor beat up girl. they do this because they can.

i'm not blaming you. just pointing out that they are pushing your buttons because you wear them for all to see. you do that because you're an earnest, caring, dedicated newbie who is trying her guts out to belong. you do it because you haven't yet developed a sense of who you are as a nurse and you're asking the wrong people for permission to try your wings.

one of the things you will learn as you grow in your career is how to set good boundaries. either that, or you will burn out (chronic and slow) or flame out (quick and dramatic) along the way.

you need to set personal boundaries. you will forget things. you will misinterpret things. you will wake up from a sound sleep and think, "oh crud, i didn't chart such and such." you will commit or omit various items because you're human and because, no matter how well you do, there is always something you could have done better. that's the nature of the beast. setting personal boundaries in this area means you look at each one of these lapses, and, instead of beating yourself up, you make a mental note to catch it next time. you acknowledge your own humanity and in humility, balance your sense of failure with an awareness that demanding perfection from yourself or anyone else is really an unhealthy form of pride.

if you or someone else catches you in an error, correct it, learn from it, make whatever peace you need to with it, and let it go. if you don't, you can end up so preoccupied and paranoid and wired that you miss what's happening in the moment, opening yourself up to further mistakes. i'm not suggesting that you should dismiss or diminish problems. just don't use them as evidence to indict yourself as unworthy on a personal or a professional level. separate yourself as a human being from your actions. what you do can be held up to an examining light. what you are never should be called into question that way.

until you stop beating yourself up, you won't be able to set the limits that keep others from going after you. we take readings on each other all the time, and those who project insecurity and inferiority are in for a rough ride.

you said, "it sucks being obviously/blantantly looked down upon because i do not have the same logocal thinking they do." it does suck that some nurses forget their early years. but what hurts you far more than their disapproval is your own lack of self worth. they're just stepping on already tender toes.

how do you change this? by becoming aware that you are asking them to validate you as a nurse and withdrawing your request. don't we need affirmation and encouragement from our peers and our betters? of course, we do. but that doesn't mean you put yourself at the mercy of people who have shown you they don't have your best interest at heart. you hear them out (if they actually tell you something--eyerolling doesn't count) and consider the merits of what they have to say, but you do not make yourself emotionally vulnerable to them. you do not ask for their approval. you do not worry about whether or not they like you. you do your job as well as you can and then, in your spirit and in your demeanor, you say, "it is what it is."

you said, "it really brings me down, it adds to my fustration and i drive home in tears. i wish there were some kind way to let them know i just feel feel really beat up, there is no intentional slacking involved. i do try my hardest. and i don't think some of them realize how much it can affect someone."

it's unlikely that these nurses are trolls. the greater possibility is that they're unhappy--with themselves, with the job, with other parts of their lives, with the fact that they were once as young and idealistic as you are now and the years somehow got away from them. it doesn't matter. what does matter is that you are giving them waaay too much say-so over how you feel. don't try to find a way to communicate your anguish. on some level, they already know they're beating you up. the problem is that they don't see you as a person, but rather as a symbol of everything that ticks them off. that's childish and mean-spirited, but common. they probably don't know how much you're agonizing. but even if they did, there's no guarantee that would make them stop.

so how do you get through this awkward growing stage?

choose to set aside the urge to court their approval (which unhappy people withhold to control insecure people), resist the temptation to feel apologetic and deficient (the smell of blood to sharks), grant yourself the grace to be where you are (seven months into your nursing career, three months into a new job). soon, you will find yourself far less needy and anxious. and you will take away their power to bring you to tears.

the truth is that they will never be able to offer you respect they haven't given themselves.

the irony is that, the less you need their approval, the more likely you are to get it. the bonus is that if you can do this with them, you can carry the same skill forward and deal far more confidently with skanky patients and snarky docs, twisted family members and warped "friends." you will project strength and maturity and be a good example to the newbies who follow you down the path.

i wish you all the best.

giada23 · Nov 26, 2005

Very well said rn/writer, you just helped me very much in my own problem that is similar to this post!!!!!

xokelly2 · Nov 26, 2005

Thank you so much for that RN/Writer!

It really made me feel better and so very true....

Thanks!!!!

xokell

GoldenFire5 · Nov 26, 2005

That's such good advice... for nursing and for life in general!

RN5000 · Nov 26, 2005

You may also want to consider if it is actually the shift report that is the problem. Speaking as a newer nurse, I dont always get every little thing done simply because there is still much I dont know. I try to ask, and to get assistance for the important things, but sometimes I just cannot attend to every thing, especially when I have too many pts to care for. Some nurses make a big deal about the little stuff. I just let it roll off my back and try to learn and do better next time.

The advice here is great tho. Give a little less, hit the big stuff and ask in the end if the nurse you are reporting to has any questions. Also good point about being bold and assertive. When you give report, before hand give your self a good affirmation. " I am a good nurse who took good care of my pts last night, I have valuable information to give." Think of some compliments you have received in the past prior to report and just go for it. Use humor when you can to lighten the load. You never know what others are dealing with when they come to work, and some just arent as good at leaving their personal stuff at the door. Good Luck!!

pie123 · Nov 28, 2005

I am a first year nurse, graduated in June of 2005. I am having one heck of a time being able to give report off to the next shift without the oncoming nurse making rude comments, rolling of the eyes and what not. What the heck am I doing wrong? I spoke with my mentor and she told me that each nurse wants different things. Some only want what has happened to that patient just during your shift, others want 'everything'. Shouldn't everything be the same?
This is a second career for me, I am 48, used to work in management and am by no means a 'dummy' but I am really getting to feel inferior as to my skills and am starting to question as to whether I really made the right decision to go into nursing.
I am on the verge of going to our unit manager and having a talk with her it has gotten so bad. (As in my mentor getting complaints about how I give report. That's when she told me about how some want report and some don't)
Has anyone else run into this type of problem? If so, how did you handle it?
Thank you in advance for all your suggestions/ help.

I am a new grad also, and sweat about giving report to some nurses. My report sheet is set up from head to toe (Dx, Hx, Neuro, Resp, CV, GI, GU, Skin, IVF, Labs/Tests). My preceptor has told me the same about different nurses wanting different things. I just try to make sure it's structured, and that I'm not jumping all over the place. I have noticed that when I'm giving report to others, they are writing all over the place: sometimes at the top of their report sheet, then at the bottom, then back to the top again. That's just the way they have organized their report sheet. That would drive me crazy though. Also, at the end of my report, I ask if they have any questions. Good luck.

ladytopaz · Dec 1, 2005

I finally started using our computerized Kardex's on each patient. Writing down labs, new meds, VS, tests that have been ordered, etc. If I havn't written it down and it's not on the Kardex...they can look it up. Some of the things they were asking me were so anal and did not pertain to what happened on my shift or important things that they needed to know.

Thanks for all of your suggestions. I give report in the order of the Kardex, don't jump around all over either and it's working a lot better.. :)

Daytonite, BSN, RN · Dec 2, 2005

I've been following the posts on this thread with interest. For those of you youngsters who did not know this, let me explain to you how report was done 30 years ago. We actually had something called a Kardex. It was a rand into which we placed a heavy bond paper card that was folded in half. It contained most of the information that the computerized Kardex does today. However, during report or throughout the shift we could add or remove things from a patient's Kardex. It was done in a blink of an eye because it was available to us. Today you must actually sit at a terminal to do this. Do you give report while you are sitting at a terminal so these changes can be made as you are having a pow-wow during report? No, at least we don't where I work. The Kardex was kept in pencil. All us nurses either had a pencil in our pocket or they were in abundance at the nursing station. That Kardex contained every doctor's order, including all tests, x-rays, labwork, medications and treatments! And, somewhere on it there was one small side reserved for the care plan. The left side of the care plan was a column for "Problem". If a patient was having diarrhea or vomiting, we wrote it there and so anyone checking the Kardex would know the patient was having this problem. We didn't do nursing diagnoses in those days. The Kardex was kept at the desk and if you answered a call light and that particular patient, lets say, was vomiting and wanted somthing for nausea, you merely flipped to his card in the Kardex and you could see instantaneouly that this was not a new problem and there was already a prn med ordered for it. Your choice, then, was to medicate the patient yourself, tell the medication nurse to medicate him, or tell the team leader assigned to him. As you gave report you had this rand in front of you and you flipped through it so you were looking at each patient's card as you were reporting on them. In an instantaneous glance you could see what labwork needed to be drawn tomorrow, what the patient's diet was, whether or not he was getting potassium to cover a low potassium level. There were not many bad feelings during report because the information to answer someone's question, no matter how obscure, was very likely right at your fingertips on the Kardex in front of you. A simple pencil slash through today's labwork let those coming after you know that it had been done. Nothing was erased unless it was good and gone forever. So, we could see a small list of all the labwork, x-rays and other tests that had been done on each patient in the last few days. When an IV was D/C'd, a slash was placed across it or it was erased off the Kardex by the unit secretary or the nurse could just erase it off during report, "oh, yeah, his IV was d/c'd today." It was a good system. It was a kind of point of service tool for us. It was designed to work within a functional team nursing approach to patient care. The nursing informatics people, I know, have worked hard on re-creating the usefullness of this old tool, but so far I haven't worked with one that comes close to what we once had. PDAs may be getting close. Wireless technology may be a big help as well. The computerized Kardexes I've worked with don't even compare to what these older ones were in terms of an informational tool UNLESS people take the time to go to a terminal and update some things on them. So, I see electronic Kardexes showing a patient still has an IV long after it's been D/C'd, or shows a daily dressing change that is no longer necessary. I always take the time to update these on patients I am caring for, but we all have to make the effort to do this. Otherwise, we each have to create our own brains to include information that was once on those old penciled in versions of Kardexes just to have current up-to-date information on our patients for report. I'm not an old fuddy duddy by any means, and I love working with computers (I had an Apple II when a lot of you were babies!), but there are some things that just can't be done with them yet.

SandraJean · Dec 4, 2005

I've been following the posts on this thread with interest. For those of you youngsters who did not know this, let me explain to you how report was done 30 years ago. We actually had something called a Kardex. It was a rand into which we placed a heavy bond paper card that was folded in half. It contained most of the information that the computerized Kardex does today. However, during report or throughout the shift we could add or remove things from a patient's Kardex. It was done in a blink of an eye because it was available to us. Today you must actually sit at a terminal to do this. Do you give report while you are sitting at a terminal so these changes can be made as you are having a pow-wow during report? No, at least we don't where I work. The Kardex was kept in pencil. All us nurses either had a pencil in our pocket or they were in abundance at the nursing station. That Kardex contained every doctor's order, including all tests, x-rays, labwork, medications and treatments! And, somewhere on it there was one small side reserved for the care plan. The left side of the care plan was a column for "Problem". If a patient was having diarrhea or vomiting, we wrote it there and so anyone checking the Kardex would know the patient was having this problem. We didn't do nursing diagnoses in those days. The Kardex was kept at the desk and if you answered a call light and that particular patient, lets say, was vomiting and wanted somthing for nausea, you merely flipped to his card in the Kardex and you could see instantaneouly that this was not a new problem and there was already a prn med ordered for it. Your choice, then, was to medicate the patient yourself, tell the medication nurse to medicate him, or tell the team leader assigned to him. As you gave report you had this rand in front of you and you flipped through it so you were looking at each patient's card as you were reporting on them. In an instantaneous glance you could see what labwork needed to be drawn tomorrow, what the patient's diet was, whether or not he was getting potassium to cover a low potassium level. There were not many bad feelings during report because the information to answer someone's question, no matter how obscure, was very likely right at your fingertips on the Kardex in front of you. A simple pencil slash through today's labwork let those coming after you know that it had been done. Nothing was erased unless it was good and gone forever. So, we could see a small list of all the labwork, x-rays and other tests that had been done on each patient in the last few days. When an IV was D/C'd, a slash was placed across it or it was erased off the Kardex by the unit secretary or the nurse could just erase it off during report, "oh, yeah, his IV was d/c'd today." It was a good system. It was a kind of point of service tool for us. It was designed to work within a functional team nursing approach to patient care. The nursing informatics people, I know, have worked hard on re-creating the usefullness of this old tool, but so far I haven't worked with one that comes close to what we once had. PDAs may be getting close. Wireless technology may be a big help as well. The computerized Kardexes I've worked with don't even compare to what these older ones were in terms of an informational tool UNLESS people take the time to go to a terminal and update some things on them. So, I see electronic Kardexes showing a patient still has an IV long after it's been D/C'd, or shows a daily dressing change that is no longer necessary. I always take the time to update these on patients I am caring for, but we all have to make the effort to do this. Otherwise, we each have to create our own brains to include information that was once on those old penciled in versions of Kardexes just to have current up-to-date information on our patients for report. I'm not an old fuddy duddy by any means, and I love working with computers (I had an Apple II when a lot of you were babies!), but there are some things that just can't be done with them yet.

I agree! The old Kardex system was great.

SaderNurse05, BSN, RN · Dec 5, 2005

I had this problem as well. There was one nurse that I just hated to give report to- she would interrupt me, asking questions and rolling her eyes if I didn't know, etc. To top it off if she found something that was ordered on my shift (even 15 minutes before I got off) she would hunt me down while I was finishing my charts and tell me to be sure and do it. I tried really hard for a while with her but one night I just lost it, ccried (major frustration) and told her I was doing the best I could and that I was not stupid, just new. Well lo and behold about 2 months later this nurse transferred to days with me (7-7). On the first day she hunted me down and apologized. She said she had never done so much in 12 hours in her life. :chuckle