Continuity of Care vs. Nurse to nurse Report!

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Just a little background first...I work on a 25 bed Cardiac stepdown unit with a 5:1 ratio. I charge on the 7p weekend shift. My dilemma is that my manager is insisting on report being nurse to nurse, which is wonderful if it is possible to keep the same patients. The obstacles we face on our floor are:

  • Day shift tends to staff 1 more nurse than nights...especially on the weekends.
  • Admits at night can pile up fast and aren't convenient to the oncoming nurse and get reassigned to a nurse who is closer. (i.e.-we try to keep nurses from having to be spread down 3 halls)
  • Our open heart ratio is supposed to be 4:1....but when nights is short a nurse we have to have them take 5.
  • Any RN in who has a patient that is post open heart cannot take ANY isolation patients. (this makes assignments tricky when we have a lot of iso's and totals and have to split them up between the RN's who do not have them.
  • Float nurses/Agency nurses are not allowed to take certain patients (ie open heart/service recovery patients)...making the assignment change completely if we have either.
  • There is not a "set schedule" and different nurses work different days, which makes it difficult to make it nurse to nurse when the only RN who wasn't there the day before take all the admissions from the previous night because everyone else had the other patients...
  • The previous shift makes the next shift assignments....ehhh...i just think the charge nurse for that shift should make the assignment...Plus day shift always comes in a changes it....
  • The charge nurse cannot be in the back hallway, which is the designated open heart area (rooms 1-10)...(adding to difficulty because of newer inexperienced nurses shouldn't be isolated w/ open hearts.)
  • Chart checks with patients is a must (at least for me) and my first night I really like to go over my orders thoroughly and if I have time my entire chart....(when it is nurse to nurse I end up losing my patients every night and have to start over again, which is more time consuming than reviewing the last 12 hours orders and getting any changes)

My manager is insisting that it is more time effective to stay nurse to nurse rather than practice a continuum of care. I personally feel that the continuity helps maintain patient safety by allowing RN's to really know what is going on with the patients, know the meds that are given, how they respond to PRN's, the condition from previous shift worked and be better able to spot changes quickly, help build patient rapport by seeing same nurses, and many other advantages for patients. Not to mention the time I would save by just getting an updated report/chart check on a patient I already know, even if I have to talk to 3 other nurses.

Only 3 day weekend nurses and 4 weekend night nurses have "set days" and the rest of our nurses have random days. We are constantly having to fill in with nurses who may work one or two days and be off for one day, then back.

Please if you have any suggestions please let me hear them...about anything. I am trying to find any evidence based studies regarding continuity of care rather than nurse to nurse assignments, as proof to my manager that it is a better way to go so if you have any sources I would love to have them.

Thanks in Advance...Ashley

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Where I work, the charge nurses from day and night shift sit down together 20 minutes before the beginning of the next shift and work out the upcoming shift's assignments together. The list of nurses coming on shift is present, they know who worked the day before and would want their patients back.

They manage to work appropriate assignments for new grads, floaters and nurses on orientation.

At 0700, the charge nurse gives us a brief listing of patients, gives nurses their assignments, and we are ready to begin. Charge nurses here do not have an assignment.

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Specializes in ER, Infusion therapy, Oncology.

I guess I am confused by your post. :confused: It seems like the main point is you want to keep the same patients. You started out saying you don't want nurse to nurse report because you can not have continuity of care, ( I am not sure what one has to do with the other)but then you say it is ok as long as you get the same patients. I do not think nurse to nurse report is the problem.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

my unit...which is a med/surge tele..and I float down the hall to tele does things this way...and it seems to work well!

We recently switched from scattered 8 and 12 hour shifts to strictly 12 hour shifts (yes, we lost a lot of great nurses that had been there forever...that was a very bad thing, but I love the continuity of 12's!). The charge nurses try very hard to keep oncomming nurses with the same patient's as before to keep the continunity...but some days it just isn't possible with the influx of new admits...but they do a great job of it for the most part...

We tape report, and oncoming shift comes in 30 minutes before shift and listens to report. We stay until we have spoken to each nurse we are handing care to to make sure there are no updates and questions. So a bit of nurse to nurse if necessary (sometimes if it is the same two nurses over time, we know the patient well enough a long formal report is not necessary...just the changes in a patient we know well is suffient and saves time).

I wait till they open the kardex and check the MAR's for the patients so in case I forgot to sign something or there is a question that might be remembered by seeing the MAR (those constant "oh yeah..." moments...LOL!).

The trick to this is making sure you not only manage your patient care well...but get that charting done effectively and throughout the day, and complete your charting and your shift tasks by shift end! I am able to do this easily because of my prior experience (worked ALF with 150 patients to one nurse, talk about lots of charting and tasks...but I learned to write fast, just the facts, and don't write the same things on my nursing notes that I have charted elsewhere...no need to write copies of things...and boy did that save time!!!).

I like this style of report...

However, we are going computerized soon...not sure what type of reporting that will result in at this point...but I am sure I will make the best of it...

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I guess I am confused by your post. :confused: It seems like the main point is you want to keep the same patients. You started out saying you don't want nurse to nurse report because you can not have continuity of care, ( I am not sure what one has to do with the other)but then you say it is ok as long as you get the same patients. I do not think nurse to nurse report is the problem.

Sorry about the misunderstanding...When i say nurse to nurse I mean that my manager wants us to give/take report from only one nurse. I can see her point that it would save time not to have to wait for the others to get out of report, but what ends up usually ends up happening is with all the factors I posted in the original post, we end up losing patients that are still admitted to have only one nurse to talk to. This weekend, for example, even though all 5 of my original patients were still there all 3 days, I ended up actually having 8 patients over the course of the weekend due to the nurse to nurse report. Does that make sense?

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Specializes in Med/Surge, Psych, LTC, Home Health.

Hmmm... on the unit that I work, we really don't do it either way. Basically, the charge nurse comes in and assigns everyone to a certain part of the hall. So I might have rooms 1 and 2 (semi private rooms, so I have four patients), Suzy has rooms 3 and 4, Jane has rooms 5-8, and so on. If I work all weekend, I will probably have rooms 1 and 2 all weekend, but if patients get discharged out of those rooms and don't get readmitted, then I might have patients in rooms 1, 2, and 3, just to make the assigments fair.

So, in a three day stretch I will BASICALLY have the same group of patients but my group may change a bit. Doesn't really bother me too much. Making assignments fairly and in a way that makes everyone happy must be so frustrating. I'm glad I'm not a charge nurse! :)

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