How detailed is your change of shift report?

  1. 2 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.
  2. Visit  rcon profile page

    About rcon

    Joined Jan '12; Posts: 16; Likes: 16.

    24 Comments so far...

  3. Visit  Always_Learning profile page
    3
    I used to be kind of panicky about asking the off-going nurse EVERYTHING - it was a way (in my mind) of making sure I didn't miss anything. However, now I am a little better at just getting the basics in report and not dwelling on things that I can research on my own (I can look up labs, review orders, read H&Ps/notes, op notes, etc.). Don't get me wrong; if there is something I feel is pertinent, I will ask it ("Hey, did you get these blood cultures or do I need to?"), but sometimes our nurses don't go over every bit of history, because it is in the computer. I know they want to go home (just as I do at change of shift), so as a rule, I don't ask about things that I can look up. I routinely tell patients, "Hi, my name is Always_Learning, and I'll be your nurse tonight. I am going to take a few minutes to look at your heart monitor and your labs, and then I will be back to assess you." I just build in a little time at the beginning of the shift to write down labs/history and glance at notes, and then I will generally read the notes in more depth after assessment/med pass.

    Also, not all nurses are "write it all down" kind of people. Now me? If I lose my "cheat sheet", I would be lost - LOL. But I have also received report from nurses who don't write a thing down and I have felt that it was very complete. I chalk it up to their experience; I'm not quite there yet.
  4. Visit  gallllatea profile page
    1
    I think it's called prioritization. Writing it down doesn't mean it'll be your focus either. I get critiqued by my clinical instructors for writing all the same kinds of details down. They make fun of me as the paperwork queen. The trend just seems to be "less is more." There is just no time to write a novel about every pt. and memorize it. But knowing the most important things and writing them down is important. I find that no matter the floor - cardiac, neuro, surgical, medical, NICU - same thing, sometimes vague, always quick reports. What I have found is that it's about liability too. You can't really trust what that nurse before you did or reported. You have to double check it all anyway because ultimately your ass is on the line. I've been told time and again, "yeah, we have to look it up again anyway"..Often they are totally right too. I think report is just a guide into a shift, but in the end you have to create your own research log due to time constraints, and it needs to be prioritized and brief. In the NICU, boy those women always double checked everything - no one trusted the nurse that was there beforehand - and I don't think it was always personal, it's just that they are so busy, mistakes are just far too common, so if that new nurse coming didn't see something on the computer as true (or see it happen in person), it didn't happen.
    fiveofpeep likes this.
  5. Visit  gallllatea profile page
    0
    I'm not sure experience has anything to do with it either. I've seen nurses with 30 years on the job write down a lot (because their memory is starting to fade, and yeah, it starts at 40), and vice versa. It's just an individual thing and a photographic memory sure would help!
  6. Visit  Esme12 profile page
    1
    Quote from rcon
    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.
    I'm a gimme the highlights kind of girl but I look up the other stuff on every patient and had my own w/u sheets. I don't write down alot but I have a really good memory (even thigu I've been at it for 34 years....) What you talk about is one of the reasons I never did like academic centers (with the exception of trauma flight/critical transport) and stayed to a high level community hospital.
    tewdles likes this.
  7. Visit  joanna73 profile page
    3
    The highlights and that's it. Need to know information only. If anyone requires more detail, they can read the Kardex or the chart.
    wooh, loriangel14, and Aurora77 like this.
  8. Visit  MLB55 profile page
    0
    Relevant history, plan for the day, detailed neuro exam (in neuroICU), pertinent lab values, access and GTTs. Keep it simple. Don't go off on tangents about non clinical information. I don't write anything down anymore; everything you need to know is on the computer.
  9. Visit  sistasoul profile page
    1
    The only nurses I know of that can give a great detailed report are ICU nurses. They need to know every little detail because their patient's are so critical and they have one or two patients. I would love to have all of that information but with 5-6 patients, admits and discharges there just isn't time. I usually write down labs, tests, diet and activity orders plus any random orders like guaic stools, collect stool or urine specimen, etc. In report I get more information hopefully. I wish I had time to read charts but I don't.
    fiveofpeep likes this.
  10. Visit  OnlybyHisgraceRN profile page
    0
    I would love to hear more from ICU nurses. Obviously report details will differ depending on specialty. For example there is no report on some residents in LTC ( who gives report on 30 residents?).

    I'll be starting ICU soon so I would love to hear how report should be in ICU. I would imagine it to be like how the OP described since these patients are so sick.
  11. Visit  Creamsoda profile page
    2
    Keep doing as your doing. Im relatively experienced in the grand scheme ( if you count 7 years ), ive worked numerous places. Most places the ICU's are as you wrote of your past experientce. Very detailed, thorough and we are expected to "know all". doesnt matter where I am, i write a summary of events, pertinent dates, history, meds, labs (pertinant trends of abnormals/improvements). Most of the info I need is in the computer, so I just write down the stuff ill need to remember to pass on in report and to plan my day and to make it easier and consise when I give report. My paper is my brain sheet. If i dont write it down, I worry ill forget to pass something on to the intensivest and if they have a question I usually have the important stuff written down.

    I guess think of it this way, even if your coworkers dont do it, you should continue to do it. Your going to look better in the longrun and the intensivests will know you are on top of things because you will never be caught off guard " er um, I dont know" is a really terrible thing to have to say when you should know the answer.


    And even though I am fairly thorough in my report, its a "pertinent thorough". My report never goes over, usually ends early because its concise, to the point, but all relevant info is included. Trust me I hate irrelevant stuff. I hate when people focus on stuff like "they have a such and such IV, # bla bla bla in the left cephalic vein", and they completley fortget to mention they had a PEA arrest a few days prior because of a mucus plug.
    fiveofpeep and OnlybyHisgraceRN like this.
  12. Visit  Vespertinas profile page
    3
    I am a chronically long-winded report-giver. I can't help it and I don't see where I can improve. I think EVERYTHING's important! Sure, you'll read the chart but maybe you WON'T notice that he didn't recieve his dose of metop this morning bc of a borderline VS. So instead of me coming back tomorrow to see an order for double his regular dose bc he went into rapid afib overnight it would behoove you to know that maybe he just needs a 1x additional dose that night rather than bumping him up overall. Or maybe you SHOULD care to know every colorful detail of the wound because charting is inadequate to describe what I'm seeing and you KNOW these things change over time. Tomorrow there may be more necrosis than yesterday but you wouldn't know that if you were rolling your eyes because you think it's unnecessary.

    I also don't trust everyone to read the chart like I would like. Especially for those RNs who seem like they couldn't care less, I am certain to tell them even basic orders because when I receive report from them, there are big holes that make me question their awareness. Like.. why is this patient on neurochecks? Umm I don't know. I guess because of the old stroke? Huh... upon investigation maybe it's bc of a recent GSW to the head with cognitive deficits including L sided neglect!
  13. Visit  joanna73 profile page
    2
    While I want to ensure my coworkers have the information they need to take the patients, it's still highlights only for me. Everywhere I've worked, report is brief. I don't work ICU though. Also, we are all individually responsible for our practice. I'm not going to worry about, or question whether or not the oncoming RN is going to read the chart, or how he/she does their job. Everyone is different.
    wooh and Aurora77 like this.
  14. Visit  Vespertinas profile page
    5
    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


Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top
close
close