Charge Nurses and Shift Report

[DisneyNurseGal, BSN, RN]

Hello all!

I have been a charge nurse on a 36 bed medical oncology unit for about 3 months, and my manager has asked me to investigate ways to streamline our charge nurse shift report process.

Currently, we have a form, and the charge nurse will walk around to each floor nurse and get a quick report on each of the 36 patients. We just ask significant things like oxygen need, pain control, significant changes this shift, barriers to discharge and other needs.

The problem is these, (1) it take too long. I would rather be helping nurses than spending the hour getting report (2) it is a cumbersome form with too much information, and (3), I think we trying to get too much information. Then, at shift change, we go over all of the patients with the oncoming charge nurse.

My question to everyone is this. How do your charge nurses get a status update on all patients? Do you have a form? Does the charge nurse fill it out? does the staff nurse fill it out and turn it in?

Thanks everyone

[NOADLS]

Where I work (LTC), only the major stuff is covered at shift report (palliative, new infection, significant decline). We get report from the floor nurses sometime during the last hour of the shift. If the floor nurse is new or a slow learner, we'll check in on them at the start of shift.

I don't see the reason to get the small details. Nurses on the floor should be competent enough to plan and intervene appropriately to things like pain management and oxygen.

[Gooselady, BSN, RN]

Our medical oncology floor had 26 patients. Someone made a spreadsheet that was updated by each nurse by a certain time during the shift (a five minute or less task). The charge nurse or the primary nurse would make sure to enter in the new admits or delete the discharges, make sure room changes were noted.

It didn't work perfectly, but it did provide a single (2 page) Charge Nurse report that was roughly updated every shift and mostly had all the correct information.

Our spreadsheet was SO detailed that keeping every little bit of it updated was not gonna happen, so I'd suggest keeping the details to the essentials -- who's on comfort care, who's getting chemo/Rituxan/IGG or something needing closer observation, pre and post ops, potential discharges, and so on.

On our unit, we'd print off 8 or 9 Charge nurse reports to give to the oncoming charge, and the staff would receive them and use them as a report sheet if that's what they wanted to do.

Before I left, someone was going to do something with a function in EPIC where a single sheet about every patient could be printed out at the change of every shift. I wondered how that would work because it too that nice consolidated Charge nurse report and turned it into 26 pages, one patient per page (if we were full).

I think deciding upon WHAT, exactly, is the most important things a charge nurse needs to know to make assignments and field discharges, admissions, procedures and acuity can be streamlined and simplified beyond how my old unit did it, but the level of detail is a personal preference thing.

[ArmaniX, MSN, APRN]

In my icu info pertains to

1. Reason admit/isolation?

2. Intubated?

3. Central lines/Foley / drips

4. Possible transfer?

[TheCommuter, BSN, RN]

How do your charge nurses get a status update on all patients?

I'm a charge nurse at a freestanding acute rehab hospital. I don't want or need a status update on all patients, and neither do any of the other charge nurses at my workplace.

I receive report from the offgoing charge nurse which consists of updates on patients with actual issues (changes in condition, family dynamic problems, new admissions, pending discharges, scheduled surgeries, etc).

[turnforthenurse, MSN, NP]

We have a charge nurse shift report where I work that we have to turn in, but instead it deals with how many patients are in the ED, percentage of higher acuities (level 1's and 2's), etc. As for an actual patient report, we just get down to the nitty gritty unless there is something pertinent going on with a particular patient.

[dirtyhippiegirl, BSN, RN]

Are you doing this to help make assignments? I precepted on a large heme/onc floor that had a matrix that the nurse filled out for each patient they were taking care of. Each item has a point value and higher points meant a more difficult patient. The charge nurse could then look at the points and make assignments accordingly. I do think they ran into some issues with the matrix not always accurately reflecting how busy a patient would be for the next shift because it recorded what was done during the nurse's shift.

[DisneyNurseGal, BSN, RN]

Thanks everyone for posting.

We mostly use the information for what we call care coordination. Which is a meeting that is held daily with all disciplines (nutrition, respiratory, PT and OT, Social Workers, etc.) to work on discharge for patient. Oxygen when they go home? Home health??? Are they strong enough??

We inquire about pain as charge nurses because our unit is working on our Pain control HCHAP score.

We also like to know a little about each patient so we have somewhat of a clue when nurses ask us questions.

[sistrmoon, BSN, RN]

Charges don't get much report, especially not on each patient. Just any situation with narc count, if there are sits or restraints anywhere and any situation with a patient or family member that might need to be handled. Oh and any staffing issue. I'm on an Onc floor.

[loriangel14, RN]

We have a preprinted report sheet with a space for each patient. The name,age, MD, diagnosis and code status are already printed on it. Each nurse adds whatever needs to be passed on to the next shift and the charge nurse reads the sheet at report and adds their own stuff as well.