How detailed is your change of shift report? - page 3
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... Read More
Apr 12, '12Less is more for me. I only want the highlights. Not everything you think is important is important to another nurse or physician. I can read the progress notes quickly and learn more than what is told in report usually. Ever read a H&p and it's totally different than what you were told in report? I have no problems ending report early if you're long winded and talking about things that aren't necessarily relevant to the next 12 hours.
Apr 12, '12I have noticed the same thing. I actually went down in acuity and the nurses here are so much more detailed. Everyone comes in early to look up patient information off the clock and thus you don't really need to give an excessively thorough report, but I find myself doing it habitually. I have really enjoyed these habits I've picked up here.
I did want to warn you to try not to compare this place with the old place at work. I made that mistake of making a lot of comparisons and it was taken the wrong way as if I was being critical of their hospital. I don't know though. The culture here is quite hostile and gossipy though so that could just be it.
Good luck to you. I saw your other post and I am feeling the same way. I hope we both get in
Apr 12, '12Quote from VespertinasI want you to be my colleague! It would be a perfect match - professional wise ^^That's my problem. I DO care that the oncoming and offgoing RN have and will take good care of the patient. Sometimes I work really hard to stabilize someone (or straighten out their little but many issues) and it feels like such a blasted waste when it gets handed over to an RN who is going to let all the nuts and bolts go loose. After 12 hours and especially after 3 straight, I start to feel a little possessive over my patients.
i.e. I worked REALLY hard on pulmonary toileting, please don't let that go down the drain. I TOLD you you need to flush the rectal tube every 4h on this pt or it gets clogged. So why am I changing the whole bed and inserting a new tube at the start of my shift? (and no, I'm not assuming why) etc etc etc
I'm sounding grumpy, I'm sorry
Apr 14, '12I work at a teaching hospital, and I know everything pertinent about my patient, PMH, dates of surgeries, trends of labs/ABGs, recent tests, assessments, change in status (or system change, neuro, cardio or otherwise) social situation of patient (live with family, alone, nursing home; do we need a social service consult? etc), plan of care, what still needs to be done or if they have serial labs to draw etc. I don't think this should be a teaching hospital vs community hospital issue. I was surprised to hear that. Isn't this something every nurse should know? Granted, it's much harder for m/s nurses to know as much just because of their patient ratios, but every ICU nurse should know their patients very well, and give a good report to the next shift.
A detailed report of important info does not take long at all. If they're really critical, it might take maybe 10 mins to give report for that 1 patient? That's not too bad considering we rely on it, though
I write up a report sheet as I get report, but I don't write things down as I go. I chart as I go, and as far as labs go, I have a really good memory, so I pretty much have them memorized and look things up on the computer to get more info throughout the shift.
Apr 14, '12I think it depends on the nurse. I always give a detailed report; sometimes I didn't have time to really dig into the physician's progress notes so I feel like during those times my reports are lacking information. Some nurses want to know EVERYTHING while others just want to know the basics and they can look up everything else in the computer.
I always tell them the admitting dx, PMH, code status, labs (and anything that needs to be collected, like a UA, guiac stools, sputum, etc), IV sites, gtts, neuro status (A&O or not), highlights of their stay so far and the plan. I also include any procedures or tests the patient will be going for that day if any.
I tend to write things down on my "brain" sheet. Without it, I would be lost lol.
Apr 14, '12Rcon, I am a lot like you and could have written your post with the only difference being I switched from a teaching hospital to a community one. I also need to have a big picture so I can put together things on my own. I am new to ICU and not as good with pathophys as the more experienced nurses are so having all the details helps me put the picture together better. I also come from a unit where report was VERY detailed (med-surg unit). We gave all the details because it was entirely possible we would not get to look at the charts for the whole shift! I have found that some of my new co-workers like a very detailed report whereas others don't want to know anything! Some of them write things down, others of them write nothing down.
I try to adjust my report to the style of the person I am giving it to. Many times coworkers will just say leave me your sheet because they know I write down date of admission,history, consults and why, labs, and a complete systems review with my findings. I also include dates of important things like surgeries or culture results etc. When I get report if they are a highlights only kinda nurse, I take what they tell me and then go straight to the chart and put together the pieces for myself.
Sometimes I get angry when people leave out things like the neuro pt. who has a non-reactive right pupil as baseline, even though everyone has charted equal and reactive bilaterally and its not mentioned anywhere in the H&P and the neuro surgeon is just thrilled to hear from you at 8 p.m. on Easter sunday and more than happy to inform you it is the pt.s baseline. lol. Such is nursing and it really does not do any good to get angry about it. You still have to figure it out for yourself.
It is really hard to adjust to the new culture a new unit often presents especially when things are vastly different from your previous unit. I still have difficulty with shift report. I find it helpful to say "I am a little obsessive compulsive do you want all the details or are you a highlights only kinda nurse?" I actually find myself looking forward to reporting off to the highlights only nurses its about the only time I leave on time!
Apr 15, '12Name, DOB, Attenting & Consults, Admit. Dx. & date, relevant med Hx, Allergies, code statues, Rhythym, O2 (room air etc), Activity/voiding,Diet, IV lines with drips, accuchecks, labs due & any unusual lab trends, and any skin issues. Also of course a general plan of care, and any dates of previous procedures.
This report is pretty par for the course on my unit (ICU), and people are more thankful for a good report than they are annoyed (seriously who gets annoyed?).
Though I will add this, we have nurses who I would just rather not get a report from and go figure it out for myself.
Apr 15, '12Does your unit use a kardex that is not apart of the medical record but stays with the patient while in the unit? We have one that is different than other ICU's and the intermediate level units, specific for our patient population. It normally speeds up report, but keeps it thorough.
Apr 17, '12I am with you on details!!!!! i have worked in a large 950 bed teaching hospital where I did my ICU training and also now at smaller hospitals, both types of hosp we give details, and you better know the dates for surgeries, labs, meds, dates of lines, etc. Don't give up your good habits to fit in, encourage them to rise higher!!!!
Apr 17, '12OMG you are my doppleganger!!!!!! smiles, you sound like an ICU nurse !!! this site is great , why i dint join it sooner i have no idea, finally a great place to read posts that are right up my alley! ty ty ty
Apr 19, '12Mr. Blah, 70 y/o M, NKA, full code, pt of Dr. Sues.
Came in for blah, what's going on now that he is here. surgeries. complications. etc..
PMH is blah
that's my report. I'm quick but detailed. I prefer the physician's daily progress note over most nursing reports to be honest.
ICU versus floor is totally different. When I'm floated to the floor I want only basics and abnormals.
Teaching versus community hospitals. In general it really depends on the particular hospital. I've been a travel nurse for awhile so have worked both. I'm kind of in a similiar situation, the last place I worked we presented the patients to the attending md, the pharmacist, the charge nurse, social worker, case mgr, etc.... so you had to know everything. And presenting the patient and being really involved in their care makes your job more enjoyable. The current place I work I'm a little disappointed in how little the nurses seem to know about their patients. The resident presents the patient, the nurse isn't really included or even acknowledged in rounds and yea...it's just not as good nursing IMO (and it's a magnet hospital which is funny).
Apr 19, '12That is exactly how I feel! I used to give a report pretty much exactly how you detailed...but now when I do...the nurses just look at me and then cut me off...like what I am saying is not important. They do not even want to know when the patient was admitted to the ICU...I mean if the patient is 1 day post surgery or 6 days post surgery makes a big difference! They do not write down any past medical history, and when it comes time for them to give report...they do not know any of it!
At my old job we would present the patient in rounds the way you described...but at this new hospital the nurse is not even included in the process. Nurses never know the plan or why things are being done...it is almost like nurses are not supposed to think. Of course this is not true, but this is just how I feel.