Change of shift report

At my facility we use face-to-face. It helps to be able to ask questions, I think. Plus, if there are any questions about medications (ie if a med isn't signed off), the person is right there and you don't have to guess. Also, if there is anything you want to "see for yourself" (ie a wound) you can go in with the offgoing nurse. I will grant that some people get carried away, grilling the offgoing shift on every little thing, but I feel it's my duty to ask if I'm not clear on something. In my first RN job, we used taped report but gave verbal updates if anything had happened since, so the oncoming person was not left in the dark.

Laurie

Hi,

Would anyone be interested in sharing their format and procedure for taped reporting? I work in a small rural hospital where nurses can wear several different hats during their 8-12 hour shift and need to listen to the entire patient load report. Face to face reports are lasting to long and attributing to alot of overtime which of course is being questioned. We do not do walking report due the confidentiality issue. We of course have some jibber jabbers in the group and this is a factor. We would like to try the taped since they would not be able to interrupt or they would not get the story.

Could you help me out?

edrn

Our 15 bed cardiac step down unit currently uses taped report. The hospital is going to all computerized charting eventually and wants us to begin walking rounds. Now four nurses listen to report on 15 patients then divide according to acuity, discharges, who had who the day before, etc. Now they want the charge nurse to come in 15 minutes early to get a brief report on all patients and then have assignments ready when the others come in. Then they can receive report on only their 4 patients from the nurse/nurses on nights. They also want us to have teams of 2 nurses and 2 techs per patient group. We are not really excited about this considering there are certain nurses that you really don't want as a team member as you will be alone. What works for everyone else? Do you think this new system will work? Of course, there is a lot of resistence to overcome from the staff.

The thing about the charge coming in early... hmm. That wouldn't work for us as we don't know who's in charge until we get there and look at staffing.

It sounds to me like we use something similar to your current system, and have very little problem with it. Nurses show up, go to report room, all listen to the taped report from approx. a quarter till the hour, to whenever the tape ends, take a few minutes to decide assignments, and then come out. Count is done either just before or just after listening to the tape. If questions are asked they typically don't take too long. Usually the shift that's offgoing is very close to done with all their work during report so if something happened they would be able to respond to an emergency. There's a "report sheet" that the charge nurse updates during the shift to take notes on from the taped report, copies for the oncoming shift are left in the report room. The only times you'll get verbals are from someone who was too busy to tape, and that's rare. I hate verbal reports; we have people who think that reading the MAR is considered report. grrrrrrrr...

Anyhow what do your charge nurses think of coming in early? And in what format are the individual nurses going to get report? typed? separate tapes? Isn't it somewhat helpful for all the nurses to at least have an idea of what the basic scenario is for all the patients, like who's having surgery, who's post procedure, who's got chest tubes, etc?

We do a verbal report. I work in the ICU- there are 4 nurses assigned to each pod, and eight patients to a pod. We hear verbal report on all eight patients, and then decide amoung ourselves how to divide them up. When I first heard this method, I never thought it would work, but it actually does! A drawback is that sometimes it's long to hear all 8 patients, but then you know a little about everyone.

We do written report. It starts on days, then goes to pm then noc...so you get to read the previous shifts report. I like it because you can still add on extra with a verbal report, but if it's not needed, then you can go home when the shift's done & you already wrote report. Written report also tends to cut down on the extra gabbing...which sometimes happens in face to face report.Plus, in verbal report I hated having to wait and/or track people down to find out about the previous shift. Verbal report seemed to take a lot longer.

We tape report. I like it this way. We can have everything taped by the end of the shift and ready for the oncoming nurse. If anything changes in that time, we add a post it to the kardex. We do not have a shift overlap. When 0700 comes around, I want to go home, since that is quitting time. Once we see the dayshift nurse come off of the elevator we can take off. We don't have to wait for her to get her coffee, breakfast, fix her lipstick, go to the bathroom, take coat off, put purse in locker, etc. until we can give report. Tag, You're it!

If anyone is very sick, anything out of the ordinary going on, or has special tests/being transported we ALSO give a very quick verbal to the oncoming nurse so she has a heads up before listening to the whole tape.

Rarely do we have a question that can not be answered by looking at the chart, kardex or medex. And if we do, we call the nurse at home if it is important.

The only problem is some nurses give a super detailed report, including routine meds, etc. Some things really can be looked up and may make listening to report take too long. These nurses are asked to shorten it and there aren't any problems afterwards.

I find the taped reports to be faster overall, b/c there isn't chit chat between shifts and you don't have to wait for anyone to be "ready" to receive report.

Now they want the charge nurse to come in 15 minutes early to get a brief report on all patients and then have assignments ready when the others come in. Then they can receive report on only their 4 patients from the nurse/nurses on nights.

At both my jobs, charge nurse makes assignment for the next shift. (They take into account who had who the day before and all the other things.) After all, they know the patients better than someone that's gotten there early and gotten a "quick report." Listening to report on everyone and THEN finding out who I had, ack! That would drive me crazy.

Starting next Monday, our unit is doing a one month trial of written report. We have been taping it usually and report is taking almost an hour and sometimes longer and what they have done to try and shorten that has not worked. We will have forms to put the particulars on about each pt, I think each form has space for 4 pts. If there is special details about the pt like family issues etc, we can write...please see me for further details. It will be interesting to see how this works. The forms will then be kept for several days so that the charge nurse can look back at them if need be. The ward clerk is going to run off copies of the reports so the oncoming nurses and charge nurse and supervisor can use them. Like I said, should be interesting. :wink2:

[Anyhow what do your charge nurses think of coming in early? And in what format are the individual nurses going to get report? typed? separate tapes? Isn't it somewhat helpful for all the nurses to at least have an idea of what the basic scenario is for all the patients, like who's having surgery, who's post procedure, who's got chest tubes, etc?[/quote

There are two day shift "patient care coordinators" who work opposite days--12 hours shifts. So there will be days when there is not a PCC to get to work early and make assignments. I am not sure how that will work. Our individual nurses are supposed to get report using the computer and the kardex which will eventually be obsolete and just use the computer. They want us to get rid of our sticky notes and personal report sheets and just use the computer. Dayshift nurse and nightshift nurse would sit down together and look at the computer charts and computerized MAR and make sure all meds are given and tasks are charted. I am having trouble with the concept of not having my report sheet with a synopsis of all 15 patients on it. I like being able to pull it out of my pocket and know a little about the patient. We presently tape report but the previous shift cannot leave until we are out of report which is bad when nurses are late to work and report does not start on time.

I agree that 'walk round' reports frequently breach confidentiality. Also not all aspects of care to be given are appropriate for the patient to hear i.e. tentative medical diagnoses.

My current work area uses face to face handover- this does have the benefit of direct questioning. Also if the nurse knows the patients they will ask for only a brief run down on the changes that day. However i feel that nurse mentors are not putting enough effort into teaching student nurses how to do an accurate but also concise report.

Like most systems of communication we need to assess it's merit in how it helps us look after our patients.' Face to face reports are of extremely good validness when the nurse knows her patient well. Anyone wh has done interviewer research will know the depth of information that can be obtained from face to face communication.

Verbal (25 bed Psych unit). Its good for us. Though, when I first started their were some that just tore me apart.

Its fine, now. Have worked with tapes before, not bad, but I prefer the personal verbal report.

Hi;

I am looking for input on how other hospitals conduct a change of shift report. We currently tape report for the next shift. We are considering going to a walking round or verbal report. What are you doing? What works for you? Any draw backs? Any ideas? Thanks.

Cheers.

CNL