Research patient or see patient first?

[RNingBSNing]

Hello,

A novice RN here asking mostly for professional opinions.

I've noticed that older and more experienced nurses will get report in the morning, take down notes from the night shift on their patients and point any questions directly to the night shift nurse. Then, without looking in the EMR, they automatically start their day by seeing their patients, doing their assessment and getting vitals.

Newer and younger nurses I've noticed tend to come in earlier, spend endless time in the EMR looking things up and then get report and either spend more time in EMR or see their patients. I can't really discern if either system works better or not.

The newer nurses I've talked to feel like they're catching things they might otherwise miss (low blood glucose on AM labs, Med not given, etc.) but the older nurses seem to think that if any of that really mattered then they would see it on assessment. For instance, a patients blood glucose or potassium could be really low, but does seeing that on a computer screen do you any more good then actually having already assessed the patient?

[LouBean]

I'm with most of the other folks here. I take report, go see my patients and say: "Howdy, I'm LouBean, I'm going to be your nurse today, let me write my name up on the board so we can both remember it. How are you feeling? Are you hurting anywhere? CP/SOA/N/V/D? Can you locate the call light on your bed for me? Okay, let's see if that works. Great. Do you have any questions or concerns you want to address today?"

It takes literally 2 minutes for even the chattiest of patients, and lets me eyeball everyone toute suite, before the day goes to ****.

[ThatBigGuy]

I don't think it really matters if you want to check the EMR before you get report.

However, once you receive report and assume care, you need to lay eyes on your patients before you start/continue your chart check.

Never delay your first visit.

[SouthpawRN]

As a student just listening in on shift reports I don't get to do this, but from an EMS background, I always want to touch my patient. A simple check of the radial pulse while I introduce myself gives me a lot of info. This will also guide if i feel i need to assess the patient further or ask more questions of the previous nurse or patient before proceeding.

[gemmi999]

I'm in the ER, so it's a little different. There's such fast patient turnover and there are always new orders. Depending on who I'm getting report from and if they're busy giving report to another RN or not, I'll look at chief complaint, age, medical hx, VS, and orders pending. That way if I have a new patient with chest pain, for instance, with no IV or blood drawn, I'll know to bring the IV tray into the room with me and assess them while starting the IV. I can also delegate tasks such as having a tech get a patient on the monitor while I"m getting report so I'll have solid new vitals when I go into to see the patient.

To be honest, though, I always look at chief complaint before I go into a room. That way I can get a urine speciman cup, IV tray, etc, before I go in. I'd rather spend 20 minutes all at once with a patient, get them settled and waiting on lab results then piecemeal it and walk back and forth. I'll spend the first hour of my shift running around getting all my patient's settled and then sit down and do my own charting.

[audreysmagic, RN]

That depends, almost entirely, on who I'm getting report from.

Truer words were never spoken...

[audreysmagic, RN]

I work in adolescent psych, so I don't have an acutely (medically) ill population. When I did the medical side of things, though, as soon as I got report, I wanted to lay eyes on the patient and then use the record for research. It's basically what I still do, except my unit is a little less "conventional" than medical units are. My patients are up and about, and since I've been at this facility and am also a supervisor on the weekends, most of the kids who have been there for more than a few days know me. (And we're not a long-term facility, but we do have a few long-term patients because they're waiting on placement for discharge.)

My coming in to work usually goes like this...

Me, coming off the elevator...

Three patients: HI, MISS AUDREYSMAGIC. (I use caps because they ARE shouting.)

Me: Hi, guys.

Patient: Are you our nurse tonight or are you supervising?

Me: I'm on the unit tonight - I'll check in with you after I get report, okay?

Patient: I could tell you what happened.

Me: I'm sure you could, but let me get the official report anyway...

(If I'm working night shift - which starts at 11pm at my facility - I usually throw in a playful, "Go to bed!" if it's a patient I have a good enough rapport with. Because lights out on the unit is 10pm, but I also try to keep things light and not making it a power struggle for stragglers...they're teenagers. And some of them have clinical issues that have them delaying going to sleep. etc... )

Also, my facility is still paper-charting, so I especially tend to ask questions/see the patient first and use the chart to follow up later, because that takes more time and I like to hit the ground running at the start of my shift.

[Rebel Nurse]

I like to pour over the EMAR, orders, vitals, and labs before I start my day. Yes, that means I usually come in early! When I first started that meant 30 minutes, now that is anywhere between 20 and 5 minutes. If I have no time to do it before getting report, I do it after. That said, we do pseudo bedside report, meaning report in the hall and then popping in to say hi and do a safety check, so I do lay eyes on each person early. I just don't feel confident about planning my day if I haven't taken note of when meds are due (including frequently requested PRN meds), how frequent vital signs need to be taken and when they are due, if there are time-sensitive labs or treatments that need to be on my radar. It may seem a little crazy, but new orders are being placed constantly and the previous nurse is sometimes not aware of a change. Also, some patients take up a lot of your time, especially on your first trip in, so I like to have an idea of where I want to be first, second, third, etc. If possible, I like to plan to be in the room when PRN pain meds are due, for example, to avoid an angry patient later who had to wait because I was with someone who needed a good chunk of time to get cleaned up, take a million pills one at a time, asks a lot of questions, etc. Maybe when I'm more experienced I won't feel the need to plan so far ahead, but for now taking the time to look at as much as I can before I start has made a big difference in improving my work flow!

[Swellz]

At my old job, the assignment was made ahead of time, so I would come in 10-15min early to look up my patients - labs, test results, H&P, orders, etc. I liked being able to leisurely look that all up before verbal report. Unfortunately, where I am now, the assignment usually isn't done until 15min into my shift, so I rely on verbal report and my own assessment until I can research my patients. And frequently I don't have the luxury to do that at all because it's busy, or I can't do it until after the dayshift docs leave, so I'm dealing with on-call docs who don't want to make changes. I just think it simplifies things to have that background information, but I'd rather come in early to do it so I'm ready to roll, as opposed to trying to do it while the call bells are going off.

[JerseyTomatoMDCrab, BSN]

When I worked bedside, I always got to work a few minutes earlier to look up when my meds were due. Something about knowing how much I had to give and when helped structure my day. If I had time, I also looked up labs, diet and any orders I may be responsible for during my shift. Anything I was confused about would get jotted down and I would ask the nurse giving report about it once we started handoff.

After report was over, however, I always assessed my patient first. If report went fast enough, it would be too early to give 0900/2100 meds anyway. I would do an assessment, document, and head off to the next patient. I would lay eyes on them during bedside report and however they looked/what the outgoing nurse told me would determine who I saw first. Once all my morning meds were given and my assessments were charter I would start looking at the chart, reading notes (if I had the time!)

[peachypurple]

for me it depends on 1. the status of the patient and 2. the offgoing nurse and what they're doing at shift change. If they're still trying to get caught up on a patient I'll go in the room with them and ask if there's a way I can help. That way you lay eyes on the patient and can see if they are in any sort of distress or if the nurse is just tidying up things. If the offgoing nurse is someone who I know I can trust and he/she says "I just checked on the patient, no needs at this time, resting quietly" I'll scan over the chart before I go in to see the patient. If it's a nurse who is known to leave you a mess (and we all know it happens unfortunately) I'll head in the room right after report. We don't do bedside report so I'm gonna really try to get in the habit of having the offgoing shift help me turn and resposition the patient before they leave, that way I can glance at the patient/drips/vent settings and clarify anything if need be.

[CardiacDork, MSN, RN]

Just because the patient is okay doesn't mean you can ignore a potassium of 2.2 ...! Because soon it won't be okay. I'm not saying what should come first, in reality it doesn't really make a huge huge difference.

I'm a nurse with almost 4 years experience and to me ... the first thing I do is I review my labs and vital signs. It seriously doesn't take that long. I then go ahead and start assessing and medicating and I'll ask for any replacement electrolytes from our resident MDs along the way.

[SaltySarcasticSally, LPN, RN]

We do bedside report as well so that's my initial look at the patient. I was digging into the chart before starting my med pass but it was taking way too much time.

Plus we aren't allowed to access Epic w/o being clocked in so coming in early doesn't help. I have certain alerts set in epic so if there are new results, new orders, or overdue meds I will check that out. Other than that, while doing my head to toe, I will go through the chart as much as possible. Our unit Secretary posts daily on our assignment sheets anyone scheduled for a procedure that day and possible discharges.

Afternoon is a bit slower so then I will research further if needed. I'd love to know every thing in and out first thing in the AM but I can't do seem.to do that and not fall really behind.