I have been an ICU nurse for a little over a year and I recently made a switch from a 450 bed community hospital to a SICU in a large teaching hospital. At the community hospital, I felt like change of shift report was very detailed, explaining when and why the patient was admitted and the main occurances through the patient's hospital stay. I would thoroughly check the orders, write down all my meds, and read the doctors notes from admission and the most recent ICU note to get an idea of the main diagnoses and plan of treatment. I would write down all the results and from days prior to critically think about trends and why certain labs would be altered. At my old hospital, nurses gave the intensivists detailed rounds explaining everything about their patients, and the doctors relied on the nurses to tell them pertinent information and critically think about what should be done for the patients. The patient population was mostly medical with some surgeries (mostly severe sepsis, stroke, GI bleed, respiratory failure...etc, some GI surgeries, cranis...). At this job I felt competent and I was used to knowing EVERYTHING about my patient, including all PMH and pre-admission medications (even when the last BM was, how fluid positive or negative, and when centrals were placed). I enjoyed putting all the pieces together and working with the doctors to ensure the patients got the care that was needed.
At my new job, the nurses give report with almost no detail, leaving out dates of surgeries. They never go over PMH, they write practically nothing down, and they just glance over labs and tests. There is no way of really knowing the plan of care for the patient. I mean shouldn't the nurse know when the patients GI surgery took place to track progress?
I guess it is just a very different atmosphere. Coming from a hospital where I wrote everything down and critically thought about the plan of care and pathophysiology of my patient's condition, I am having a hard time adapting. It is almost like the nurses don't think about their patients. It makes me really nervous and I start to feel overwhelmed and panicky. I feel stupid. I just wish report was more detailed. I don't know how the nurses care for such sick patients and not write anything down. Report is short and SOOO much pertinent information is left out. Sure, you can read the doctor's notes, but at this new hospital they do not go over a plan of care.
I have been told at this new hospital that when I get more experience, I won't have to write things down. But that is just not how I operate. At my old hospital all nurses wrote detailed reports, even the nurses who had been there for 20 plus years. Are my feelings crazy? Maybe I am just not cut out for the teaching hospital atmosphere. Any thoughts would be greatly appreciated. Sorry for my super long rant.
