[GLORIAmunchkin72]

"As soon as you hit the floor, and look in on the people, you have established a care contract"

I'm a little confused. I thought once you took report you cannot turn back even if you're put in a dangerous situation...

[cmo421]

Please,someone enlighten me! Patient care contract? Is that what it is all about today? If u do not have a "pt care contract", u do not have any responsibility? So u r afraid to look at ur pts befor report because u might establish a "pt care contract?
Things have changed so much I guess,or I am getting too old. What happened to us as a profession. I know pts live longer and so r sicker on the floors. But we r still nurses.
OP, talk to your manager and find out what can be done to make ur unit safer. Unless someone gets nurses to come in early and stay late without pay, somethings gotta give. Many hospitals have 8 hr shifts and are not going to pay OT for report. Some nurses actually go into work early to get their assignment and have a few minutes with the off going nurse. Maybe we all need to go back to the overlap of shifts. I do not know the answers for everyone ,I know what I have done.
Maybe an answer is one nurse reports off to only one nurse,assignments stay the same. At night when staffing drops,this might be hard,but it can still work with some fore thought. JACHO wants us to see pts at shift change to avoid all the incidents that happen at that time. No matter what the circumstances r at ur job,with compromise and planning,new things happen. As professionals, we know,or should know ,how to work things out so the pts r safe.
I still have a hard time with the whole pt care contract thing. But thats just me. I work in specialty units now where things r different. But I know that no matter whoses pt it is,report or no report,if they call and I am there I answer and do what I have to do.
In the midwest somewhere there is a purple bracelet thing going on. One wears it to remember not to complain,apparently millions worldwide have been ordered from a small little parish. All started by a minister tired of hearing complaints constantly,it was a challenge to his community and it went wild. I wonder if nurses need purple bracelets,hmmmmmm,,,,I do not think it would work ,,,,


just my thoughts,no more,no less Have a good day all!

[GLORIAmunchkin72]

In a perfect world you wouldn't need a patient care contract but the world has changed drastically; it allows you to decline an assignment if you're going to be the only nurse responsible for 50 residents (just an example), a dangerous situation. You may end up without a license (or worse, sitting in jail).

[abbaking]

This was an issue at the previous hospital I worked at; no RN's/LVN's on the floor during the shift changes. While numerous CNA's had voiced their concerns to the nurse manager about this dangerous practice, not many solutions were immediately implemented. However, as time went on and more and more RN's and LVN's began to notice a recipe for disaster the Nurse Manager and DON came up with a practical solution : Have report inside the nursing station! During this time visitors would be requested to leave the unit, Patient doors would be closed (glass doors so we could still visually monitor the person), and ALL healthcare members (RN/LVN/CNA/Monitor Tech/Ward Clerk) would give reports to the next shift personnel. This enabled all professionals to be at the nurses station and close to the patients in the event of an emergency, better allowed for communication with the team leader, and assured patients that help was close by. IT WORKED!!! Although a bit cramped and noisey, the unit was safer and there was better communication with all the staff.

I now work in a facility that does the same thing the previous hospital used and I must say that the team morale is improved with OPEN floor shift reports. Also, the unit i work on is circular in layout and it is easier to see the patients during shift report.

[Sabby_NC]

When I worked in the hospital setting the nurse gave report to the next staff member in the pts room. None of this all gathering in the same room.
Reports should be concise, only important info (which does not happen all the time) and outta there to allow the next nurse to get on with her work.
Forgot to add that we had a list of all pts and impertinent info but got report only on our patients.

[Rexie68]

The facilities I've worked in...night shift isn't allowed to leave until day shift nurses are on the floor.

Please make sure you're documenting everything.....sending email and saving a copy is a nice "paper trail." Then perhaps if you give your NM a copy of your documentation you'll get somewhere? Of course, there's always going over his/her head....but CYA, 'cause you need to prove that you've brought it to her/his attention.

Heck, it's 7am and you need an RN ASAP....call the operator and ask her to page the NM or DON STAT. She/he will get tired of it after a while and make some changes!

[KristiePDX]

This sounds like management trying to cut costs by eliminating overlap between shifts. They give us 30 minutes to review written and do a brief verbal about any updates ect. No to say that we have not had our problems.

Somtimes dayshift used to take a full 45-50 min in report and we (nocs) would not see the whites of their eyes until 15-20 min after our shift oficially ended. Management DEMANDED that we leave ON TIME to save overtime costs. We were just expected to leave as our noc charge was still there and has a full report on all pts on the unit.
That did not fly to well either. I dont like the idea of anyone being responsible for so many Pts, I dont care if you are super nurse!

What ended up working out better was our written report sheets on each Pt were reviewed by oncoming nurse for 15min, then a 15 min verbal about any extra tips and stuff. Night shift was expected to be in the nurses station and avaliable for dayshift questions ect.

Charges reported to charges, and report is updated by staff RN's a few hours into the shift after they hav seen the Pt with thier own two eyes.

You are assigned a buddy and you give each other a brief nitty gritty befor going on break.

[Starr1966]

I work nights in a hospital and a LTCF, at the hospital when dayshift comes on, the day staff are all in the report room and one night nurse will go give report as the others remain on the floor, then the next one goes back. Our report lasts anywhere from 15-30 minutes depending on the census. Sometimes longer if needed, but rarely longer than 30 mins. We used to do one on one reporting and the charge nurse would update the oncoming CN. Personally, I liked this form of reporting better, but they wanted to do group reporting.

Another hospital that I worked at we did taped report and the oncoming shift would listen to report while the previous shift was on the floor, and if there were any questions they asked when they came out. It worked pretty well for the most part.

At the NH, we now give verbal report to the oncoming nurse et med aides. The CNA's get their report from a sheet that the CN fills out for them of pertinent information they feel the CNA's need to know. I don't like this form of reporting to the CNA's because I don't think that half of them read it. The reasoning for doing report this way was because they felt it took to long and the cna's weren't getting started soon enough. Report still takes as long and the CNA's don't get report other than from that sheet. If they actually read it or not, who knows for sure. I'm betting that a select few don't.
Wanda