Shift Report - page 3

by ladytopaz

43,703 Views | 38 Comments

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... Read More


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    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..
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    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.
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    Quote from Daytonite
    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.
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    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
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    My hat goes off to the reply by RNWriter!!!! Very well put and sound advice. As a matter of fact I want to share this with some of my new grads (I have quite a few on my two floors). I have not heard of any complaints from them but silence does not negate feelings. Thanks
    Last edit by jpalmer on Dec 8, '05
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    Oh have touched upon a "sticky" topic. I give report to the oncoming day shift nurses and usually I hear "oh you got your hair cut"; "we did this last night..." who cares??? All I want to do is give my report and get the heck out of dodge after a 12 hour shift especially after a really bad night.

    I still have not found a solution to the rolling eyes or sighs and I have been giving report to these nurses for 3 1/2 years. So I just keep talking and make sure I write everything down on my report sheet which I make a copy of (for my records-which I leave at work in my locker) after whiting out pt names. It is filed in a notebook and goes to our nurse manager once a week. Still it is frustrating to try and pass along vital info.
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    Quote from 2002MissRN
    Oh have touched upon a "sticky" topic. I give report to the oncoming day shift nurses and usually I hear "oh you got your hair cut"; "we did this last night..." who cares??? All I want to do is give my report and get the heck out of dodge after a 12 hour shift especially after a really bad night.
    Hmm, I am definately one that has a little pleasant conversation most of the time as we're walking to the patient's chart. I didn't realize some people were put off by it. It definately isn't the nurse I'm giving report too. Trust me, I want to get out of there too. It can take up to an hour to give report for 8 patients, but it definately is not because I mention to the nurse that I like her hair that day. I feel one reason I don't get the rolling of the eyes by the nurses I give report to is because I get along so well with the other nurses, not to mention getting my stuff done and knowing about the patient before giving report. And if something wasn't done before giving report, it get's done - by me.
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    Quote from 2002MissRN
    So I just keep talking and make sure I write everything down on my report sheet which I make a copy of (for my records-which I leave at work in my locker) after whiting out pt names. It is filed in a notebook and goes to our nurse manager once a week.
    Why do you do this? Is this something required of all the nurses?
  9. 0
    Most nurses keep a copy of their report sheets in their mailboxes or lockers as for a while it was a BIG problem with info that was passed on to be followed up with social workers, admin, MD and such. NOC nurses have a hard time trying to follow up with certain orders as there is no one there and you wind up playing phone or message tag which means sometimes a pt may get d/c before things get done. (Admin :angryfire on any overtime). The nurse mgr required that all reports be turned in once a week so that random checks could be done by her to make things were done in a timely manner.
    For a while that worked fine however it has fallen back to "you didn't pass it along in report" or "you wrote that WHEN??". It is a pitty that grown ups have to be so petty. I've tried waiting out personal conversations, which i don't mind and like to join in but after report, talking over, thru, and around; sometimes just saying it's on the report sheet read it and leave. I still haven't found a solution - maybe they just don't want to hear what I have to say but at least as I attempt to pass along info I feel like that I have done my job.
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    Quote from rn in 3 years
    Why can't some people just GROW UP? You know, I am not afraid of all the gross things nurses have to endure (poop, throw-up, etc) but I am afraid of having to deal with such immaturity with co-workers!
    Love your comment. Straight to the point. Likewise with eveyone. Gee this forum really speaks. I have the same problem.

    One nurse gave me pointers like the MAR/MEDEX. The company has behavioral sheets attach, she told me to write the topics down so when I give report I can mention that. It sounded good at first but when you have more then a dozen resident with multiple problems, it becomes boredom. I only did that once until I was going to give her the shift report. I wrote down it all....and you know what she said after the first resident? "just tell me if there is any changes with the residents." to which my reply was "okay." After that I felt so damn ****** b/c you know how long it took my time just to do that, and when she passes her meds she'll eventually see it.

    Thanks to you all, I learned more....but one thing I notice with nurses and reports......lots of the "no complaints, she/he's fine, nothing to report." are all those terms good to use or should we say a second or two about them like, "slept all night or rested quietly".....that kinda sounds the same....I don't know, any thoughts?

    Just me, just wondering
    Last edit by Just wondering on Dec 14, '05


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