Getting report during change of shift

Meriwhen, ASN, BSN, MSN, RN · Jan 12, 2015

Change of shifts...usually when the transfer/admission/discharge/code/AMA decides to happen :) Don't like to deal with it at change-of-shift, but it's going to keep happening no matter what we do, so we just do our best when they happen.

The unwritten policy that our units have is that we don't accept transfers/admits during the last hour of the shift unless it's critical (as in the patient is very psychiatrically unstable where they are). We keep that in mind when we're calling other units about transfers, so we're generally very good to each other. We have to remind intake--frequently--that we're approaching change-of-shift and it isn't the best time to get a patient. With transfers from other facilities...well, neither side always has control over when patients arrive because it's usually whenever BLS transport is able to get the patient from them to us.

If they call right at report time, we tell whoever is calling that we are doing change-of-shift report, that we will not interrupt report, and that we will call them back after report is completed.

If the patient should arrive during the last hour/at shift change anyway, the offgoing shift will do the basics (VS, safety search) and leave the admission for the oncoming shift.

JustKeepSmiling, ADN, BSN, RN · Jan 12, 2015

I have a feeling this will never change. Continuous problem at our hospital. Now charge nurses are forced to take report if district nurse can't. So interrupt my report so I can give report to the nurse when they're done report? Imagine the possibilities with lost in translation there... We're fighting it, but ER fights harder.

Gooselady, BSN, RN · Jan 12, 2015

We also had an 'unspoken' policy, developed in a committee of RNs from the floors and ER, that we would not accept report in the half hour during shift change. This only held true for the 12 hour (7a to 7p) change overs so we who worked 3 - 11 didn't really 'count'. But over time, we were able to beg, plead and send chocolate to the ER and other 12 hour floors to have mercy on us 3-11

ers. Most of the time this was respected, but then there are always irritable bureaucrats who weren't softened by pleading and chocolates

It truly is a problem to have to get report on a new pt while trying to get all your bedside reports inside a 30 minute time frame.

And yes, it drove the ER nuts to have to call back.

So out of respect for ER nurses, we developed another 'unspoken' policy to cover all the other times the primary nurse could not take report from the ER or whatever floor was sending us a patient. Whatever nurse was available, usually the charge, would take the report if the primary couldn't. We developed a 'transfer/admission report sheet' so a good complete report could be taken and then given in writing to the primary nurse. This worked quite well.

Bo,RN · Jan 12, 2015

We can give report at any time, but patient's are not transported 30 minutes before or after shift change.

NurseOnAMotorcycle, ASN, RN · Jan 12, 2015

Here's what you aren't being told:

I work 7p-7a. The med-surg floor charge nurse will often tell us: We have a bed but we don't have enough nurses. Send them at 2300.

Sometimes they say: We just got an admission. Send the next one at 2300.

Or: We got a situation up here. Send them at 2300. It'll be over by then one way or the other.

I ALWAYS write "per floor charge nurse" on my reports that I call and send with the patient. I'm tired of being yelled at by the floor for their own internal conflicts. Need 10 minutes? I'm ok with that. 30 minutes? I'll stall, but my own charge nurse will be breathing down my neck for that bed to open up.

NurseOnAMotorcycle, ASN, RN · Jan 13, 2015

(Also, it is our change of shift. Would you like your entire report to be "I don't know, I just got report 10 min ago and don't know anything about them" or would you rather get report from the nurse who's had them for the last 6 hours and knows the family members by name?)

firstinfamily, RN · Jan 13, 2015

It seems our unit is always getting calls from the ER with urgency in getting a pt up "before our shift ends", meaning the very beginning of my shift. To myself I wonder, why is it always at the end of their shift?? I have just gotten my assignment and usually have just finished getting report when I am told I will be getting a patient from the ER. I feel it is important for me to do my basic assessment on the patients I already have before I get one up from the ER who may take up a lot of my time. They are stable in the ER, so why the rush?? We have not resolved the issues and are usually being told that if we take report that will be acceptable and then ask them to ship the pt up in 15 or so minutes. When I asked the evening supervisor about this, her reply was that the ER has to empty by shift change, I don't get this either!!! A thorn in my side!!

AmeliasAunt · Jan 13, 2015

I'm sure inpatient unit and ED nurses will have different perspectives on this. But it seems to me that if an ED nurse calls me at 7pm to give report but the patient was assigned to the bed 3 hours prior, the ED nurse held onto the patient for whatever reason and he/she needs to wait. And please don't tell me that giving me report at 7pm is now an emergency when you've had 3 hours to do so. Sorry, no empathy from me. Also, I am not blind to the fact that unit nurses purposely postpone admissions because they don't want to do the work. As a charge nurse I've had to deal with it plenty of times.

happyinillinois · Jan 13, 2015

There is no way someone had a bed assigned and sat on the patient for three hours. Generally, once a bed is assigned you have 15-30 minutes to give report and get the person to their room. Unless you work it, you can't understand how you have to keep patients moving, as they never stop coming in. You need to get the patient to the floor to take the next patient. And yes, there is ALWAYS a next patient. We once tried not calling reports in the last half hour of a shift. Know what happened? Instead of no report from 6:30pm-7:00, we found that the nurse wasn't available at 6:20, 6:15 etc. The I'll call you back, when you call at 6:10, resulted in no call backs, unable to take report, and then before you know it, it is 6:30, and they can't take report. You end up sitting on a patient for an hour. It's all about throughput. The giving report to the Charge is supposed to stop this, that is why it is done. Charge can identify repeat offenders. Also, the ER doesn't want to pay incremental overtime to the Er nurse so she can wait 30 minutes to give report. Next time right before your shift, take a walk through the ED waiting room, as well as the unit. You stop receiving patients when your beds Re full, but we never stop.

CTnewgrad826 · Jan 13, 2015

I'm definitely not saying in any sense that the ED isn't twice or three times as busy, just posting to see others opinions on the topic and if/how other facilities handle this.

CTnewgrad826 · Jan 13, 2015

That includes ED nurses, I'd love to hear their opinions on this! I'm sure they feel they get the same attitude back from floor nurses at times.