Getting report during change of shift

[CTnewgrad826]

Just curious as to others experience with getting report during change of shift. Where I work, it seems the ED or other units are always calling to giving report on a patient being sent to our unit right at change of shift (7am, 3pm, 7pm, 11pm). Or in other cases we get report at an appropriate time but the patient gets sent up during change of shift. Of course this is going to happen every so often, it's unavoidable and I understand that and staff needs to team together to get the patient comfortable and ensure their stability before finishing their other change of shift duties.

What bothers me is when the nurse reporting off gives a huge attitude about being asked to call back in 10 minutes or so. I understand it's annoying to hold onto a patient for an extra hour because the accepting floor isn't prepared for whatever reason but I think change of shift is an acceptable time to delay the admission/transfer if possible. Change of shift has been shown to be one of the highest risk times for patients since full attention is typically drawn away to get and give report. I think more policies need to be in place regarding this related to what I've experienced so far.

What are your thoughts on getting report/accepting new admits during change of shift?

[PACUpleeze]

I work at 3 different hospitals in PACU and ER, it is an act of congress at all 3 to give report to a Floor nurse during or even kind of near 30 minutes of shift change. It's just not done. I can't even tell you. And I did my time on the floor, so spare me I don't understand.

You are either accused of "holding" the patient too long (which meant the floor was pulling the "it's not clean" scam) or you are "too fast" to give report (Geez, I JUST found out about this patient, I can't take report "yet"). Unreal.

When I was on the floor you better get your behind to that phone fast for ER because they would dump that patient prontissimo in the room and you would know NOTHING about them. And your charge would shrug her shoulder and say "I told you you better take report!".

[NickiLaughs, ADN, BSN, RN]

IToday I had two pts assigned beds on different floors at the same time.

sicker pt: attempt to call report.

Charge nurse: we don't have a nurse assigned yet, callback in 10...ok

I call back in 5 because I got a new pt no I needed to set eyes on, start IV, send labs. I sit on hold 5 minutes, so I hang up. Go to discharge a pt . call report on the less sick one. Nurse is in isolation room. So I say I'll call back in 5

call the floor again regarding first patient. They hang up when I call. Call again, same thing happens again.

Finally give up and cal, report on the other patient. My one empty room now has a screaming lady holding her back. I go get her started, assessment in. Go back to call report on my guy for the 5th attempt and I've already notified my charge nurse of the issues reaching the floor. The nurse is available, I sit on hold again for. Few minutes, she tells me she's with a pt and she'll call me back. At this point I've wasted easily 30 minutes on the phone of my last hour. I have a lot of orders to catch up on and my sick pt has a k of 7. I just don't have time for the phone. I then focus on all the tasks I really need to knock out.

The nurse is calling me back but I now have my hands in the middle of a sterile field while placing a foley. So I call her after I'm done with the foley.

So finally over an hour after this report was originally supposed to take place it happens. This is why I'm actually in favor of a written report. It's more concise, I don't have to repeat myself and i know everything I need to ensure the nurse knows is on that report note I place in the EMR. The nurse can look at it when she is not in an isolation room and it would have probably saved us all a significant amount of time.

this had nothing to do with change of shift. Just a vent of how inefficient report calling is in general in the world of nursing and how there has to be better ways....I'm frequently asked by the oncoming RN to call report to the floor because I know the patient better. Which is true, my report will be better than hers. Sometimes it works out and sometimes it doesn't.

[NickiLaughs, ADN, BSN, RN]

Yes, but to talk to most ED nurses, you'd think they were the only ones who ever have emergencies, sick patients, or people waiting. Let me be clear, I have no issue with taking report on the patient during shift change; I do have an issue with a patient rolling up at 1905.

I do believe my opinion right now is colored by a very unsafe admission situation that my unit recently experienced from the ED (it was not change of shift). It just reinforced my already extremely low opinion of their consideration for patient safety outside the ED.

We aren't the only ones who have emergencies, but we should have them the most. Our job is to stabilize our patients and then if we have correct knowledge and advocate well, the patient should arrive to the floors (except possibly ICU) in more stable condition than when they arrived at our ER. That's if we are doing our job correctly and I'm aware that not every nurse is a good nurse as well as a pt that is stable at one time may have a condition change a short time later.

dont assume that every ER nurse doesn't care about or safety, most of us do. I know that my pt who is "stabilized" will likely see their nurse upstairs much sooner than I will be able to for a while when I have a code 3 roll in. This is often the reality. I also try to call report if I can to the oncoming RN on the floor because I would hope they would appreciate a report from a nurse who knows the pt, versus the nurse who just cumin. The pt may not be sent up until the floor is ready depending on the rules etc. but I do try to give that nurse the chance of a more detailed proficient report.

[gemmi999]

As an ED nurse, I try hard not to send pt's up during COS, but at times it happens. There are a couple reasons for this:

1) we're told no RN is available until COS when short staffing will be fixed; then, we need to call new RN to give report on the pt. we've had for past 6 hours prior to us going home, otherwise the report will be: "Um, dx: CP" and "check EMAR for meds given last shift". Which is worse?

2) I tried calling report before COS, at 6:00 and then at 6:15; RN and Charge "busy"; it's now 6:40 and they won't accept pt., it's too close to COS.

I've had nights where I show up and my ENTIRE run gets beds assigned within twenty minutes of me arriving; I spend the next two hours trying to assess my pts so I know who they are, give report, chart and get them up x 4 pts, while receiving new ones in the beds I just emptied. It sucks but it happens, a lot of time because floor nurses won't take pt. before COS because it's too close to COS.

[Karou]

IToday I had two pts assigned beds on different floors at the same time.

sicker pt: attempt to call report.

Charge nurse: we don't have a nurse assigned yet, callback in 10...ok

I call back in 5 because I got a new pt no I needed to set eyes on, start IV, send labs. I sit on hold 5 minutes, so I hang up. Go to discharge a pt . call report on the less sick one. Nurse is in isolation room. So I say I'll call back in 5

call the floor again regarding first patient. They hang up when I call. Call again, same thing happens again.

Finally give up and cal, report on the other patient. My one empty room now has a screaming lady holding her back. I go get her started, assessment in. Go back to call report on my guy for the 5th attempt and I've already notified my charge nurse of the issues reaching the floor. The nurse is available, I sit on hold again for. Few minutes, she tells me she's with a pt and she'll call me back. At this point I've wasted easily 30 minutes on the phone of my last hour. I have a lot of orders to catch up on and my sick pt has a k of 7. I just don't have time for the phone. I then focus on all the tasks I really need to knock out.

The nurse is calling me back but I now have my hands in the middle of a sterile field while placing a foley. So I call her after I'm done with the foley.

So finally over an hour after this report was originally supposed to take place it happens. This is why I'm actually in favor of a written report. It's more concise, I don't have to repeat myself and i know everything I need to ensure the nurse knows is on that report note I place in the EMR. The nurse can look at it when she is not in an isolation room and it would have probably saved us all a significant amount of time.

this had nothing to do with change of shift. Just a vent of how inefficient report calling is in general in the world of nursing and how there has to be better ways....I'm frequently asked by the oncoming RN to call report to the floor because I know the patient better. Which is true, my report will be better than hers. Sometimes it works out and sometimes it doesn't.

I am a floor nurse, medsurg. Could the charge nurse not take report either? That's just ridiculous how long they put it off. If I am charge I often take report while the primary is busy, and other charge nurses will do the same. I have taken report for my hallway partner or another nurse when I am not charge either.

Can you document each attempt to call in the chart? I am sorry, that sounds really frustrating.

[NickiLaughs, ADN, BSN, RN]

I am a floor nurse, medsurg. Could the charge nurse not take report either? That's just ridiculous how long they put it off. If I am charge I often take report while the primary is busy, and other charge nurses will do the same. I have taken report for my hallway partner or another nurse when I am not charge either.

Can you document each attempt to call in the chart? I am sorry, that sounds really frustrating.

I documented every attempt and we put it in some log because it's an outlier as the pt didn't go up within the hour. I also arranged after contacting the hospitality for urology to see this pt and when I finally got to give report the nurse kept asking me why the pt didn't have a foley when I explained that after three attempts including using a size 12 French due to his large inguinal hernia only a urologist should attempt placement. I kept telling the nurse he should not attempt a foley but he seemed more concerned that the order wasn't complete....sigh. We all need to have each other's back more and realize if we United together and fought for safer ratios and methods of getting patients to the correct floor safely all of us would have better work environments.

management loves the bickering of day vs night and floor vs ED. It keeps us from focusing on the real issues.