Shift Change

KelRN215, BSN, RN · Jan 13, 2012

What kind of things do they "need"? Often the things people call for can wait a few minutes despite the fact that they make it seem like it's an emergency. We have tried to get our AAs to ask "what do you need?" when patients/families call. If they just want to tell me that they urinated and have a specimen for me, that can wait until I go into the room which I will be doing for bedside report in a few minutes anyway.

MN-Nurse, ASN, RN · Jan 13, 2012

Hi everyone, I am a ward clerk/tele tech and I have a question that I hope someone could answer. At the hospital I work at, we have some issues during shift change. One of the main issues is that during shift report, when a patient calls up and needs something from the CNA or the RN, it's like pulling teeth to get them to help that patient. I would like to know what your hospitals do to fix that issue. Any suggestions would be appreciated. Thank you

It depends on what they need. If they want another soda or a blanket, that's gonna have to wait.

I suggest the ward clerk/tele techs answer call lights during report.

AggieNurse99, BSN, RN · Jan 13, 2012

I always round if I have the time prior to report, and tell the pt. "We're about to start report/shift change and I just wanted to make sure there was nothing you needed" about 1820-1840. It really does help.

**LaurelRN, MSN · Jan 13, 2012

though there still may be times when no one can get there- my hospital went to cna's coming in 15 minutes earlier (and they get off 15 minutes earlier)..that way report is staggered to free up the cna when nurses are giving report and vice- versa

turnforthenurse, MSN, NP · Jan 14, 2012

Our CNA's start at 06:45/18:45 to help answer call lights while the RNs are getting report. We have a phone for call lights and the monitor techs/secretaries (or anyone at the desk for that matter) can answer them. All of us are in the habit of asking what the patient the needs or if the patient is asking for the nurse, "is there something that they can bring for you?" - really helps. For example, a patient calls, asks for their nurse. If the person answering the call light phone asks what they need and the patient says they want pain medicine, well there, the nurse can just bring it in instead of making two trips :) Unless the patient isn't due at that time or something.

I also always do 06:00-06:30 rounds to make sure all of my patients are okay and medicate them for pain/nausea if needed (and if they are due) that way the on-coming shift doesn't have to worry about it.

KelRN215, BSN, RN · Jan 14, 2012

Our CNA's start at 06:45/18:45 to help answer call lights while the RNs are getting report. We have a phone for call lights and the monitor techs/secretaries (or anyone at the desk for that matter) can answer them. All of us are in the habit of asking what the patient the needs or if the patient is asking for the nurse, "is there something that they can bring for you?" - really helps. For example, a patient calls, asks for their nurse. If the person answering the call light phone asks what they need and the patient says they want pain medicine, well there, the nurse can just bring it in instead of making two trips :) Unless the patient isn't due at that time or something.
I also always do 06:00-06:30 rounds to make sure all of my patients are okay and medicate them for pain/nausea if needed (and if they are due) that way the on-coming shift doesn't have to worry about it.

And, on the other hand, if all the patient wants is to know the address to the hospital, the secretary on the other end of the call light can answer that question. No lie, this happened to me today as I'm running around dealing with real issues the secretary comes to me and says "your patient in 10 needs you" and I go in and I get "what's the address to the hospital?" Really?

whitecotton87 · Jan 14, 2012

Well a lot of times, the patient needs to use the bathroom so I tell the CNA. But there are also times that the IV's are beeping, or they need medication. I notify the RN, but they would rather give report so they can go home. I just don't like to see the patients suffer.

whitecotton87 · Jan 14, 2012

I like the thought of the CNA's coming in 15 min early. I will also try to enforce my coworkers to ask what the patients need when they answer the call light.

dudette10, MSN, RN · Jan 14, 2012

I don't have an answer for you, but having experienced shift change for every shift, noc/am change is the worst. The patients are waking up all at once, and all of us are busy.

We have two CNAs on night shift, and I've often wondered if, after they've both done AM care, daily weights, blood sugars, and collected I/Os from their assigned patients, we should have one of them be responsible for charting this info, while the other is responsible only for call lights.

KelRN215, BSN, RN · Jan 14, 2012

Well a lot of times, the patient needs to use the bathroom so I tell the CNA. But there are also times that the IV's are beeping, or they need medication. I notify the RN, but they would rather give report so they can go home. I just don't like to see the patients suffer.

From the RN's side- a beeping IV can wait. It can mean anything from the patient bent his arm to the pump needs to be plugged in to a medication is finished and the pump needs to be turned off. A beeping IV is not an emergency and by no means is a patient going to suffer because his IV pump is beeping.

Waiting 10 minutes for medication is also something that isn't going to kill a patient. Most patients can also wait 10 minutes to use the bathroom.

These are actually good examples of why bedside report works. I hated bedside report when we started doing it at my facility but we've been doing it for several years now and I like that at 10 past 7, my patients know that I am their nurse and I can assess if they need anything. If they want their am medication, I can get it for them as soon as I have gotten report on all my patients. Many patients who call at 7 "needing" medication just woke up and want to take their typical morning medication because they take it when they wake up every day. Taking it now or in 10 minutes makes no difference. And there may be reasons why they can't have medication now-- they're not due for pain meds or they need to have drug levels drawn, for example.

Anna Flaxis, BSN, RN · Jan 14, 2012

I like some of the ideas so far.

Also, I agree it drives me absolutely nuts when someone (x-ray tech, registration clerk, housekeeper) comes to me and says "The patient in 10 is asking for you", and I go in there and they just want to know what time the cafeteria closes or some other question that it doesn't take a nursing license to answer!

Finding out what the request is and routing it to the appropriate personnel will go a long way in eliminating unnecessary interruptions of report, which means the nurses will be able to finish report sooner and address patient needs that only they can address that much sooner.