Hand off

  1. Please help me. I am a new nurse (2 months) and I suck at giving report. Its is the most stressful part of the job for me. All someone has to do is ask me one question I dont know the answer to and the rest of by he report goes down the tubes. I feel as though if I am not reading my SBAR I can't remember the info. It gets so bad with me stumbling cos some nurse had intimidated me, you would think I never spent 12 hours with these patients. I am in desperate need of how to prepare a solid sbar. I get physically sick to my stomach at the mere tight of giving report. Most of the times its okay but those times when its bad, its real bad.
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  2. 16 Comments

  3. by   Dr.Naija_Queen
    Sounds like the new nurse jitters. I can relate because it was hard for me to give report when I was a new nurse. After 2 months, you are still a fairly new nurse and still learning of course. It can seem intimidating when you're asked a question, but just know that the nurse wants more info. You spent the whole shift caring for the patient and I'm sure you know the patient.

    It's okay to read from you SBAR. You need to communicate the main thing about the patient. You're not telling their whole life story.

    Patient name
    Diagnosis (what the pt is admitted for)
    Treatment plan- Be brief, just the main idea
    Equipment (IV, Chest-tube, etc)
    Mental status
    Diet:
    Activity level
    Labs (significant or note worthy)
    Any changes in status
    Communicate responses to new meds or treatments
  4. by   Yorker
    It is hard for everyone in the beginning, don't panic and don't be harsh on yourself. Although everything is on SBAR I still like to write stuff down in that way its repeated twice, one while seeing on the EMR and second in my report.
    When I started new I use to get confused between the diagnosis between 6-7 pts, so writing helped me.
    Rest I agree with the previous post, those are major things that needs to be included.
    Even if you don't know the answer to the question , don't be nervous include the nurse and tell her lets see in the EMR.
    Always , always talk to the physicians , some don't like to but I would haunt them down and ask them , what is your plan?

    PS: It always helps to come a little early on your shift and dig in the pt's chart.
  5. by   b747girl5
    Like I said most of the times its not horrible but there have been occasion, like today that I was so nervous I was unable to answer the questions the nurse had. Not only am I knew but I am also a float which makes thinks harder. Today I felt as though I never spent a day in nursing school. Can only imagine what was thought of me. It just really sucks. I know its all a learning experience and I know am aware of what I need to have prepared for next week.
  6. by   RNperdiem
    Giving report is a skill. Different nurses also like different reports.
    One thing I like to do is use the patient summary screen on the computer for a 'visual aid'. I begin with who the patient is, why they are here and how long they have been there and past medical history. It is all there on the screen. If the nurse asks about a particular lab, you are already on the computer, so click on labs and answer the question using that.
    I don't even try to memorize every last detail. Let your resources help you.
  7. by   Yorker
    Quote from b747girl5
    Like I said most of the times its not horrible but there have been occasion, like today that I was so nervous I was unable to answer the questions the nurse had. Not only am I knew but I am also a float which makes thinks harder. Today I felt as though I never spent a day in nursing school. Can only imagine what was thought of me. It just really sucks. I know its all a learning experience and I know am aware of what I need to have prepared for next week.
    First things first, when we are nervous we tend to forget even the things that we know, take a deep breath before you start report. As much as I want to ask you which questions do you get stumbled on??? but I don't want to get personal. Maybe there is a pattern ??? Maybe you are missing that area?
    Some nurses are not that great in report taking either , some of them want to know everything and anything.
  8. by   NightNerd
    Take a deep breath. Giving report is a skill that gets easier with practice, like so much of nursing. It will get easier!

    Do you have a brain sheet that works well for you? I have one that keeps me organized duringv the shift, and using it to jot down any pertinent details and events gives me a headstart on a good report. Start there if you don't have one; there are many available online and even on this site.

    Remember, you are just trying to give the oncoming nurse a picture of where the patient has been, what you're doing for them, and where they expect to go afterward. Also, think of the things you would like to know. Probably something like this:

    -Name, age, diagnosis and PMH
    -Code status, major allergies, diet, how pt takes meds
    -Restraints or sitters, if applicable, why they have them, when they need to be renewed
    -Current situation (where did they come from and why are they in the hospital?)
    -What the patient is like (mental status, ADL ability, continent or not, any skin issues, are their heart and lungs normal, whatever stands out. If everything is okay except for their lungs being diminished or something, say that and that their assessment is otherwise benign)
    -Any relevant PRNs and when last given, if the patient is likely to need it
    -Any outrageous lab values, vitals, etc., and what is being done to correct them
    -Potential discharge plans or patient goals, if you know them

    It takes a little time to get this right, and if someone asks a question, just breathe and answer it the best you can. Sometimes there are shifts so busy that the info falls right out of your head. That's okay; apologize and look it up together if possible. Always go into report with the goal of setting up the next nurse with the information they need to hit the ground running.
  9. by   JKL33
    Two things that come to mind -

    1) Hopefully you haven't been off orientation long. Did this come up during orientation and if so did your preceptor have any insights or observations about your struggle in this area? Don't feel like you have to answer, but think about it for personal reflection and review his/her suggestions in your own mind if there were any

    2) You may have to help set expectations for the people to whom you are giving report. I know that may sound weird and I also acknowledge that it's not an easy task to negotiate as a new nurse. But what I mean by this is that if any part of this has to do with someone wanting to know what the patient's K+ was last Tuesday, or their full list of allergies and meds (from your memory), you are going to have to nip that in the bud. Report is not a sport where we try to one-up the reporting nurse by asking questions until we finally ask one they can't answer. Prepare your report, have the EHR open. Give your report and refer to the chart as necessary. I suspect that projecting a pleasant but kind of no-nonsense persona may help you here.

    Good luck!
  10. by   chacha82
    Use a facesheet organized by systems or whatever graphic organizer your floor uses. As the oncoming nurse, I want to know:
    - What they're here for, post-op day, whatever
    - Plan (from what you know) and if they have to be NPO today or anything like that
    - PRNs given during your shift, any special communication or parameters from the MD during your shift
    - Events on the monitor (if you are on a tele floor) or something out of the ordinary
    - How do they get around, take their meds, etc.
    - Psych social, anything sensitive about pt or family I need to know.

    Other than that I am usually OK. History and allergies I can look up, etc. I try to go easy on new grads giving report, as I know it's a learning curve. Try not to get flustered. Even if you only have a few minutes, spend some time reading the chart to help you fill out your face sheet.
  11. by   FineAgain
    Please remember that some nurses will ask you ridiculous questions that have no real bearing on patient condition. I personally give an eye roll but that is somehow frowned upon by management. Seriously though, it is perfectly ok to say you don't know the answer to something. If it is important to the patient, offer to look it up together. If it isn't, they can figure the answer out for themselves. I personally just want to hit the high points like chief complaint, what you did, what you may not have had time for. I have 12 hours to do the rest!
  12. by   ILUVERNSG
    I find this disturbing...

    In our hospital system new grads get 10 weeks on orientation. New grad float nurses get 12 weeks orientation.

    You're flying solo as a float nurse with two months under your belt...You've barely left the nest my dear! Don't be so hard on yourself!

    Keep your chin up and create a worksheet to keep yourself organized for report, etc.

    I personally think SBAR is useless, but then every hospital uses it and seems to think it's great.

    You'll gain more and more confidence and competence as time goes by.
    Just remember some day when you are getting report from a new grad to give her a break!
  13. by   RNrhythm
    As others have said, giving report is a skill and you will improve with practice. I always do the same thing: Who they are, where they came from (home, SNF, ICU), and why they are here. I then start from the head and work down, which helps me visualize the patient in an orderly manner. Then I talk about other stuff, like pending procedures, lab results, etc.

    I also practice during my shift for end of shift report.
  14. by   bellini
    To add to what others have said, a systematic body systems approach is helpful so that nothing is missed...I like the mnemonic Could an RN Want to GUess What's GoIng on for Circulatory, Respiratory, Neuro, GU, GI. Then finish up with a review of the labs and meds, and orders for your shift.

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