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Getting patient information before shift

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AikoRN AikoRN (New) New

My hospital just started strongly enforcing nurses to not login to a patient's chart unless you have clocked in (7 min before start of shift). It hasn't been a big problem for me since I usually come into work around 6:50 or so. However, a lot of other nurses are having a difficult time with this and are trying to go around it (e.g. gathering the patient's info from the previous shift's logged in computer). We also just started bedside shift report and the oncoming shift doesn't know much about the patient before report and it can get pretty lengthy if you have to explain pmh, h&p, assessment, etc. The nurses have gotten pretty frustrated with it lately and bedside report isn't consistent anymore. I was wondering what other hospitals have implemented for nurses to gather information before the start of the shift without clocking in or have it considered "working off the clock." I have read that some hospitals record the report on a tape or have a kardex. Any other suggestions?? Thanks!

Aurora77

Specializes in Med Surg. Has 4 years experience.

I think it's working off the clock. I get to work about 1820, then get my assignment and get report. I don't see the point of giving free labor--anything I'm doing as part of my job, I'm getting paid for.

I'll get report then check labs and orders. It works for me. Our reports include the things you mention and can usually be done in about 20 minutes for 5-7 patients. Of course there is the one nurse who gives such a detailed report, you could do your initial assessment off of it alone. :). Her reports take forever.

Bec7074

Specializes in Trauma, Critical Care. Has 3 years experience.

I think it depends on where you work and how you get your assignment. I work in an ICU. We are split into teams. Each team gets a group report and hears the basics of each patient on their team. We get a small spreadsheet of information on all the patients that includes their docs, what they were admitted for, drips, vital sign info, and frequency of some labs. From there, a team leader makes the assignments and we pick or are assigned by the team leader. Then, we go and get report from the previous shift for our patients. Combined, it rarely takes longer than 30 minutes, but we also have 1-2 patients. At the end of our shift, we update the spreadsheet for the oncoming shift. Here's an example of info on the spreadsheet:

J. Smith, 35M

Full Code

Truma-Dr. Ortho

11/12-to ICU L pneumo/rib 3-8fx's, open pelvis fx, OR-ex fix on pelvis, intubated 11/13 BLE dopplers (-), 10 beats VT 11/14 trach'd at bedside, start feeds

HR: ST 110s Temp: afeb BP: Keep MAP>60 Resp: Vent

Foley

OG to LIS

IV: Fentanyl, Precedex, Levophed, MIV

q4h H&H, q4CVPs

History: hyperlipidemia, OSA (CPAP)

Then say at the end of my shift, my patient had a temp and went for a CT, I would change the sheet to reflect that. I really think the sheet is great and makes going through report much faster. The sheet is saved on one computer so everyone can always see it. Then you never lose the medical history or what the patient has had done during their course of stay. Makes things SO easy!!! :)

My mum is an RN at a private hospital and handover for them is they dictate it and the next shift listens to the dictation. They are now implementing bedside hand overs but they don't have a nurse:patient ratio so for a med/surg ward with a 3 bed HDU as well and the average number of patients is 1:6-7 and they're all old 10mins to do a full handover isn't enough

RNperdiem, RN

Has 14 years experience.

No advice, but I am impressed at how ready to start the day these nurses are! I would love to be the shift reporting off to a nurse who has already gathered some information.

I just read a post about nurses taking breaks first thing in the day and cruising the internet. What a difference in unit culture.

i think time should be alotted to look things up. report takes 20-30mins without interuptions (rare). many reports are less than useful. i like to read latest md notes, look at orders, meds and charting before i see that patient.

I like having information down on a patient before report. Work hasn't given anyone any problem that I know of for nurses coming in early to get such information.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

From what I understand they do not want you to log into a patient's chart BEFORE you clock in. That is because you are not officially on the clock and as we all know the computer leaves a trail. So,legally you should not have access to the chart and protected health information until you are working with that patient or have a reason to be in the cart. That is why you never want to clock out and then give a prn med or even continue charting for that matter.

You should never use anothers log in either unless that person is physically there. So if nurse A is giving report to nurse B and you are scrolling through the cart together that is OK

So now the problem...you will all have to adjust and those that want to get a little jump start can clock in at the 7 min cutoff. I think by the time you waste keeping up a Kardex that can easily be incorrect you could have got report. We have the same system and I never log in to a patient's chart until I have signed in . On a few occasions I have had to provide patient care after I have logged out and then had to log in. I also never log in during my lunch break

So many nurses come in early pouring through charts, and clock out only to return to charting. I am thankful to be blessed with time management skills, also growing up in a union home I learned never ever work for free at work.

RainMom

Has 7 years experience.

We have pt care summaries which automatically print about an hour before shift change. They show name, DOB, admission date, dx, attending/consulting MDs, most recent VS, activity, diet, upcoming labs or testing, list of orders since admission date, & current meds with the most recent administration time. I rarely feel it necessary to log into the chart until after I've received report; it usually only happens if report gets delayed because RNs trying to finish up with pts. Also, most of us don't show up until about clock-in time anyway. Much earlier than that & pt assignments probably won't be up yet.

nursie_nursie_415

Has 8 years experience.

If you are not officially "clocked-in", not only is being in a patient's chart equivalent to working for free, it is quite possibly a violation of HIPAA.

KitkatPRN

Specializes in LTC, Rehab. Has 5 years experience.

If you are not officially "clocked-in", not only is being in a patient's chart equivalent to working for free, it is quite possibly a violation of HIPAA.

AND... in 10 minutes you are ACTUALLY assigned to the patient ?? Ugh ... sometimes I feel like all I do is waste time to CMA & keep updated with the ever changing policies the facility makes to CTA.

I'm amazed at people that WANT to work for free. Hospital doesn't pay me to prepare for my shift? Then I won't be prepared.

We have pt care summaries which automatically print about an hour before shift change. They show name, DOB, admission date, dx, attending/consulting MDs, most recent VS, activity, diet, upcoming labs or testing, list of orders since admission date, & current meds with the most recent administration time. I rarely feel it necessary to log into the chart until after I've received report; it usually only happens if report gets delayed because RNs trying to finish up with pts. Also, most of us don't show up until about clock-in time anyway. Much earlier than that & pt assignments probably won't

be up yet.

Have been asking for such a report but no one has seen it as important enough to address yet. If I had that wouldn't have to get there early.

Aurora77

Specializes in Med Surg. Has 4 years experience.

I'm amazed at people that WANT to work for free. Hospital doesn't pay me to prepare for my shift? Then I won't be prepared.

Ditto. Maybe I'm old and cynical, but I got burned by my old (non nursing) job. I'm fully prepared to give my 100% in return for my wage, but no way in the world am I giving more for free. If my job wants me to do something they'll pay me for it or it's not happening.

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

Like someone else said, they can get you on a HIPAA violation if you log in off the clock. You should never do anything off the clock.

I'm amazed at people that WANT to work for free. Hospital doesn't pay me to prepare for my shift? Then I won't be prepared.

Agreed. No wonder so many facilities unofficially expect this from nurses.

RNperdiem, RN

Has 14 years experience.

With my first job, I always came in a few minutes to start gathering info for my "brains" sheet. With 6 patients the morning workload could be crushing sometimes and anything extra would help.

I also quickly realized that starting early, leaving late and skipping lunch most days to stay caught up was not a sustainable long-term strategy.

I don't work there anymore. I hear my old workplace is hiring right now. They are always hiring. Wonder why?