End of shift report

[jekajoy]

I work on a 32 bed telemetry unit. Up until November we were general medical/surgical. Now 16 of our beds are for cardiac monitoring. We also changed from recorded reports to verbal reports at the beginning of our shift. It is taking me on average 45-60 minutes to receive report from the 4-6 nurses that I need. The quality of the report is SO much worse than when it was recorded. I kind of feel like if it wasn't broke don't fix it.

Management wants us not only to do verbal reports, but also go in to each room with the oncoming nurse and do report at the bedside. By the time I find all of the nurses, wait in line for her to give report to me, and go into each room to do report my 1830 shift doesn't actually get started until ATLEAST 1945...and that's not including getting pertinent information off the electronic charts.

Does anyone have any suggestions on how to organize this process? It's taking too much time, we are all frustrated, and any suggestion would be very appreciated! thanks in advance!

[MunoRN, RN]

Why in the world is this happening on a regular basis? What is going on with patient assignments that it is necessary to break up an assignment to that extent? I could see flipping a patient or 2 ... but 6? No reason for it, unless I am missing something major.

I've also had to give report to 6 nurses when working tele, which certainly isn't ideal, but believe it or not it is sometimes the best option.

By far my least favorite thing about relief NTL is making assignments. Every nurse wants an assignment that is no heavier than any other nurse's, they want all their patients back (except for the ones they don't want back, which we are just supposed to know who those are), they don't want to walk too far, and they want to get report from only 1 nurse. For the most part, this can't all be done, not even close.

It may be easier on floors with more long term patients, but the average stay on our tele floor was 26 hours, making it pretty unlikely that yours or anyone else's assignment would not have changed when you come back for the next shift.

We could guarantee reporting to only 1 or 2 nurses by defining assignments in terms of room numbers. We do have an NTL that just assigns by room numbers (Nurse A gets the first 5 rooms, Nurse B gets the next 5, etc). Of all the varying preferences people have for how their patients are assigned, this method is universally despised, mainly because we put all of our open hearts on the same hall and our heaviest (non-OHS) patients on another, meaning you could end up with all 5 open hearts or the 5 heaviest patients on the floor.

My first goal is to even out the acuity, second is to give nurses back the patients that they know, third is keep them reasonably grouped together, leaving the number of nurses they report to last on the list; it's a consideration, but not my first, second or even third. (I could go either way with grouping the patients together vs number of nurses to get report from, but if day shift had their choice most would rank the proximity of their rooms to be at least the second highest priority).

[enigmaticorange]

I am on a 33 bed tele unit, and we are expected to give bedside report always. It is always a PIA to change, but really, bedside reporting can be great when 1: staff is properly trained in reporting off, and 2: Staff is scheduled to match groups as closely as possible. Night/day take diff # of patients on my floor so I have at least 2 people to report to, but hopefully if a nurse is coming back I only need to give updates! A bedside report should be by exception and goes something like this:

"Hello Mrs Jones, This is Anne and she will be your nurse this (evening/morning). I am just going to give her some information to let her know how to best care for you."

(Situation/Background:)

Mrs Jones is a 81 yo pt of Dr. Smith. She arrived in the ED after experiencing CP at home. Pain was relieved by 2 nitro and 2mg morphine. enzymes were positive on arrival and is set for a cath today. she has been NPO since midnight and the cath sheet is in her chart. She has a HX of CAD, arthritis, and Diabetes, and is ACHS finger sticks. (assessment:)

As you can see, Mrs. Jones is A/O x4 and is able to walk with 1 assist.

Lungs clear upper lobes with crackles in bases. O2 2L sats WNL, CXR showed mild bilat infiltrates.

Pressure fine, Sinus Rhythm, mild edema to pedals pitting +1. Cath is today. No CP since arrival.

LBM yesterday, voids in BR

Skin WNL

No pain

IV #20 L A/C INT

(exit:)

Thank you for allowing me to care for you, Mrs. Jones. I hope you have a great day today, and Anne will return shortly for your assessment."

It takes 5 minutes, and if patient has fluids, foley, skin issues, etc., these can be looked at while giving report.

Only report what is NOT WNL. I still have nurses I report to asking about random labs and asking, "Positive pulses?" No. The have no pulses and I forgot to tell you that their feet and hands fell off during the night. No, I cant tell you the exact last blood sugar, look it up if it is important to you. I told you they are a finger stick/diabetic. If the sugar was >300, I would find it noteworthy.

Just remember, it is not the time to chit chat with the patient about sports or take care of non-essential requests by the patient. If the patient suddenly needs a new water pitcher or use the BR, etc., I let them know we are rounding and we will have an assistant come right in and care for their needs. If the issue is pain, we grab it quickly while still talking or ask the charge to assist.

I am rarely not finished by 7:30. The longest I have ever taken was the day I gave report to 3 nurses, one of which who was both talking sports with patients and does not know how to take a hint.

In a completely separate issue- Why are glucose checks being done at 0600?? Do your patients eat at 0630? Why can a CNA not take blood pressures on a tele floor? I have all vitals taken at beginning of shift so when I give my first round of meds they are already in the computer for me to check.

[gcupid]

I am on a 33 bed tele unit, and we are expected to give bedside report always. It is always a PIA to change, but really, bedside reporting can be great when 1: staff is properly trained in reporting off, and 2: Staff is scheduled to match groups as closely as possible. Night/day take diff # of patients on my floor so I have at least 2 people to report to, but hopefully if a nurse is coming back I only need to give updates! A bedside report should be by exception and goes something like this:

"Hello Mrs Jones, This is Anne and she will be your nurse this (evening/morning). I am just going to give her some information to let her know how to best care for you."

(Situation/Background:)

Mrs Jones is a 81 yo pt of Dr. Smith. She arrived in the ED after experiencing CP at home. Pain was relieved by 2 nitro and 2mg morphine. enzymes were positive on arrival and is set for a cath today. she has been NPO since midnight and the cath sheet is in her chart. She has a HX of CAD, arthritis, and Diabetes, and is ACHS finger sticks. (assessment:)

As you can see, Mrs. Jones is A/O x4 and is able to walk with 1 assist.

Lungs clear upper lobes with crackles in bases. O2 2L sats WNL, CXR showed mild bilat infiltrates.

Pressure fine, Sinus Rhythm, mild edema to pedals pitting +1. Cath is today. No CP since arrival.

LBM yesterday, voids in BR

Skin WNL

No pain

IV #20 L A/C INT

(exit:)

Thank you for allowing me to care for you, Mrs. Jones. I hope you have a great day today, and Anne will return shortly for your assessment."

It takes 5 minutes, and if patient has fluids, foley, skin issues, etc., these can be looked at while giving report.

Only report what is NOT WNL. I still have nurses I report to asking about random labs and asking, "Positive pulses?" No. The have no pulses and I forgot to tell you that their feet and hands fell off during the night. No, I cant tell you the exact last blood sugar, look it up if it is important to you. I told you they are a finger stick/diabetic. If the sugar was >300, I would find it noteworthy.

Just remember, it is not the time to chit chat with the patient about sports or take care of non-essential requests by the patient. If the patient suddenly needs a new water pitcher or use the BR, etc., I let them know we are rounding and we will have an assistant come right in and care for their needs. If the issue is pain, we grab it quickly while still talking or ask the charge to assist.

I am rarely not finished by 7:30. The longest I have ever taken was the day I gave report to 3 nurses, one of which who was both talking sports with patients and does not know how to take a hint.

In a completely separate issue- Why are glucose checks being done at 0600?? Do your patients eat at 0630? Why can a CNA not take blood pressures on a tele floor? I have all vitals taken at beginning of shift so when I give my first round of meds they are already in the computer for me to check.

I have worked at several facilities and the truth of the matter is that this type of report works in ideal situations, with ideal nurses, and ideal patients...I have to address this

" If the patient suddenly needs a new water pitcher or use the BR, etc., I let them know we are rounding and we will have an assistant come right in and care for their needs. If the issue is pain, we grab it quickly while still talking or ask the charge to assist."

Have you worked on a floor when the CNA's are completely done by 6:30 and if everything is not done by that time it's just not getting done and that's only if you have a CNA to begin with... Plus, I couldn't imagine being in a patient's room and they ask to go to the bathroom and I tell them we will have an assistant come right in and care for your needs.

(That statement would cause so much drama....1rst If there is an aid, he or she is going to be wondering with so many patients I have, you mean to tell me two nurses in the room could not help this lady to the bathroom. #2. Good customer service does not make you wait, especially as it will appear in the patient's mind that the nurses are doing nothing...check press gainey scores on a few patients with diarrhea or the sort who all happened to ask multiple times around shift report for issues to be addressed and you may be surprised.)

I have worked at a facility where it seems like there were more drug abusers and the tone of the facility also condoned for more abuse to be handled by the nurse with bullying and acts of hostility and manipulation with management/doctors (the people with the real power to change things b/c nurses won't stick together) that I also could see it as draining for the off going and on coming nurse to have handle these difficult patients during the report process. (statements like just give me anything I can have ...give me phenergan cause its around the time...I'm sorry ma'am, are you nauseated? I am feeling however you think I need to feel in order for you to go draw me up some medicine,)

You better use the charge nurse for when you really need him/her to do you a favor. I wouldn't waste one of my limited request for giving pain medicine to one of my patient's that I could do for myself. At one facility most charge nurses stopped at 6:15 unless of an emergency....they'd be the first to leave. I seen a particular charge nurse walking to the time clock and I literally ran in front of her and clocked out. I told her this is the first time in a year I have ever beat you to the clock to punch out. (It was 7:20. She just started laughing b/c she knows it doesn't matter what's going on when it hits a certain time, your just a**ed out. (anything short of a code, of course)

Verbal report is good but bedside report can be challenging. I have walked in on some irritable things but for the most part I'd rather give my licensed peers the benefit of the doubt. We are a team and need to be able to have some type of faith in each other's work ethic. With the statements you've given, I'd just like to ask is your place of employment currently accepting applications for your unit.

[MTRN13]

We actually started a new system at my hospital. We have kardex, written report, and bedside report. I know it sounds like a lot. The evening shift has a form we fill out for each of our patients for pertient information like tests that were ordered, IV sites, Diet, Drains, Foley Catheters, etc.... There is also a large section were we write on what needs to be done on the next shift to be carried out. There is also a comment section for any other info. The day shift then writes what needs to be carried out the next shift on a minimized version on the backside. We all used to be there until 0800-0830 after a shift, and management made our whole hospital switch over. We all get out on time now. If we do not clock out by 0735 we get written up unless there is an emergency, or something crazy has happened on your shift to keep you over. I personally like getting home a little earlier especially if I have to be back the next night. We had some day shift nurses that would put everyone through the ringer, and make you seem like you were on trial. Mostly stupid stuff, and now if it gets out of control I can write them up as being the reason for clocking out late and they are the ones getting into trouble. We had a few notorious people everyone hated to give report to because it was like you were on trial, and they would always start out attacking even if everything was done correctly up to the point of report. I am thorough on my written report, and even have open check boxes I make next to the things that need to be done. It saves me a lot of time at report, and I know it is an excellent report. I spent my time on it when I have a bit of down time in our shift.