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Giving report/day shift probs

Posted

Has 1 years experience.

Night shift nurse here!

I just wanted some advice and all of your opinions on this. I feel like giving report is a HUGE emotional hurdle sometimes when I'm coming off shift. Some of the nurses I give report to want to know EVERY MINUTE DETAIL about the patient including non relevant stuff (how many pregnancies did they have in the 1980's, what is the exact name of chemo they get five years ago, what's their favorite Beatles song), basically things they can easily LOOK UP IN THE CHART. I work in oncology FYI and in my opinion what matters in report is diagnosis, pertinent PMHx, mobility, code status, vitals frequency and how they've looked, mental/cardiac/respiratory status, skin issues, relevant meds, IV access and general plan for hospitalization and DC. THAT'S IT! If they're hemodynamically stable, medicated for pain and otherwise comfortable move on with your day and stop asking me stupid questions!!!

Now, if that isn't irritating enough these nurses that haggle me for every tiny detail not only berate and bully the night shift nurses for not memorizing the last 500 doctors notes.. OH NO, when we get report from them at night and ask them EXTREMELY important questions (Did the ultrasound show a clot?, what is the rate of the PCA?, what was the last hemoglobin?, how are they getting out of bed?), they brush it off or say they didn't have time to check!!! AND it seems like once management leaves at 3 PM all responsibilities get thrown out the window. I come on to do bedside report and these patients are screaming in pain from not getting pain meds since noon, actively vomiting or have had an IV beeping for the last hour.

Look, I understand day shift is more busy and maybe they don't have time to read every detail of a note, but when it comes to daily assessment and events of the day, the day shift nurse needs to be completely on his/her game! ESPECIALLY with high risk drugs given. Ugh! The fact that these same nurses who harass me for not knowing about the tonsillectomy a patient had in 1996 are unaware of extremely important current medical events is seriously messed up.

Ok, end rant. So what I'm asking this community is what should I do about this? A lot of my other night shift coworkers feel the same way and we've talked to management before and they haven't done anything. It's two nurses in particular here and they have seniority. I've been working about two years so I feel like a jerk telling them what to do but since they're compromising patient safety I feel the need to do something. Should I go to HR? The union? What are my resources?

Been there,done that, ASN, RN

Has 33 years experience.

Is your main concern report issues, or the fact that the day shift is making errors?

scooterscamp123

Has 1 years experience.

making errors is the big concern. But the report is frustrating too. All in all just a lack of cohesiveness and teamwork in a stressful environment that snowballs into patient errors

Edited by scooterscamp123
more info

Without apology, you say "I don't know," and you continue right along with your relevant and concise report. Keep calm. If they are more aggressive you can use the phrase, "I don't know, that isn't at all relevant to the care I provided last night."

A good many times this behavior is displayed as an attempt to make others feel "lesser." If you choose not to feel "lesser" because you don't know some stupid fact from 10 years ago, then this ceases to be an issue. Giving report should not be an emotional undertaking. You're letting this report thing become "worse" by the fact that you're also upset about something else. Stop letting it "harass" you. Develop assertiveness, prepare for report, be concise, and refuse to become rankled with the "50 questions" antics. It's hard to hear, but to some extent (with things like this) we train others how to treat us, based on what we expect and what we tolerate.

As to the rest of it, if there are consistent/repeated issues, you will have to decide whether to report them or discuss with your manager about how to handle. Remember, though, nursing is always a 24hr-ATC job. Both shifts will have things that need to be passed on or need to be tidied up or taken care of when the next shift comes on. That is the nature of providing acute care to very sick patients. If the issues are deeper, you will have to seek advice from your manager.

Good luck with all of this!

brownbook

Has 36 years experience.

I completely agree with JKL33, smile sweetly and politely say, "I don't know," maybe you can add, "you can look it up in their chart."

Without apology, you say "I don't know," and you continue right along with your relevant and concise report. Keep calm. If they are more aggressive you can use the phrase, "I don't know, that isn't at all relevant to the care I provided last night."

A good many times this behavior is displayed as an attempt to make others feel "lesser." If you choose not to feel "lesser" because you don't know some stupid fact from 10 years ago, then this ceases to be an issue. Giving report should not be an emotional undertaking. You're letting this report thing become "worse" by the fact that you're also upset about something else. Stop letting it "harass" you. Develop assertiveness, prepare for report, be concise, and refuse to become rankled with the "50 questions" antics. It's hard to hear, but to some extent (with things like this) we train others how to treat us, based on what we expect and what we tolerate.

As to the rest of it, if there are consistent/repeated issues, you will have to decide whether to report them or discuss with your manager about how to handle. Remember, though, nursing is always a 24hr-ATC job. Both shifts will have things that need to be passed on or need to be tidied up or taken care of when the next shift comes on. That is the nature of providing acute care to very sick patients. If the issues are deeper, you will have to seek advice from your manager.

Good luck with all of this!

^All of this.

I worked night shift until two months ago. Night shift had issues with day shift (and some things were legitimately annoying). However, I'm now seeing it from the other side and have realized that my former night shift co-workers are far from perfect themselves. Most of us are pretty good nurses but none of us are perfect. It really is a 24 hour job.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

You could bring it up in a staff meeting, see if everyone can agree on a standardized report. Or even agree to keep it as brief as possible and look up info instead of reporting every detail. You'll get an idea of where everyone stands (they might all agree with you during the meeting). Or maybe your coworkers will bring up the same issues you've been having. In any case, your manager will probably put out a memo on what everyone agreed on that you can refer to when you get quizzed intensely, and you're off the hook.

kaylee.

Specializes in Stepdown . Telemetry. Has 8 years experience.

Uggh! I hate the quizzer types!

Sometimes what i do, is when giving less relevant hx i eliminate the window of questioning myself by saying:

"they had chemo in 2006 for xyz, not sure which drugs they were."

They often end up letting me move on...Its a way of not letting them ask by preemptively answering.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

I'd advise staying on track with your clear, concise report and asking them to defer questions until the end. They'll be less likely to nitpick that way.

For patient safety issues and important tasks being ignored or left undone, ask your coworkers politely to address them please before they leave. You won't make friends, but you're an RN, not a Registered Friend. For serious patient safety issues, you might have to use whatever incident reporting system you have at your hospital. Once serious patient safety issues get in front of risk management, even entrenched senior employees get dealt with as needed.

As for report issues, don't make a mountain out of a molehill. Are two nurses in particular asking pointed yet pointless questions to seem smart? Tell them you don't know or that you'll look up answers with them after the rest of report, keep your cool, and keep right on giving report. Is EVERYONE from day shift asking questions you don't know the answers to? If so, then they probably have to know the answers even if you don't think it's important - maybe the docs ask them or its a part of some routine quality insurance checks they have to fill out or something. Just roll with it, it's not a trench that's worth dying in.

I frequently find that the things other nurses ask me in report aren't things I find important while other nurses often don't know things I think are important. A lot of it has to do with nurses giving reports from pre-made report sheets with fill-in-the-blank spots for different sections - I don't care what the pupil size and reactivity is on my A&Ox4 STEMI patient, but heaven forbid half of our staff bother to figure out which vessel occluded and where, or anything the echocardiogram found besides the EF... but I digress. Just keep a computer with the medical record handy during report and look up any questions at the end. Or maybe while the other nurse is describing those pupils.

hawaiicarl, BSN, RN

Specializes in Critical care. Has 28 years experience.

Try sarcasm .... not advised if you are a novice at it. Something like "their last chemo was lot #23-b16e, expired 1/16/12, given through the port-a-cath with a 22 gauge access over a time of 87 minutes, there were scattered showers outside, and a robin flew by the window as it was spring." They should get the point that they are asking inane questions. If they still don't get it, ask them to repeat it back to you .... I find they are usually just not paying attention, and fill time with ridiculous questions.

My personal pet peeve is when they wander in 10 minutes after the shift started with a plate of food and coffee .... then they ask stupid questions while stuffing their face, which they don't hear the answers to because of the noxious cow chewing sounds.

Cheers

decembergrad2011, BSN, RN

Specializes in Oncology. Has 12 years experience.

Make sure you have a report sheet that reflects your patient care area.

As a general rule, chief complaint and primary diagnosis, along with current treatment plan, is what I start with when I give report. Example: Mr. S is a 56 year old man with newly diagnosed AML on day 3 of 7+3 induction. That tells so much about everything and is important for EVERY oncology nurse to know. I'm not perfect but I have not had a good day if I do not know that information about my patient! IV access, mobility, toileting, cognitive, and VS that are not normal should be discussed as well. On my unit, we report the labs to each other because we give blood and electrolyte replacements based on those values. History is important but nitpicking is not helpful. I assume things were normal if they were not discussed. I do my own assessment so it doesn't seem important to tell me everything was normal. :)

I will ask a question at the end of report sometimes but I move on if the person does not know. However, if I ask a question and you hem and haw about how you don't know and how you had the busiest night ever and blah blah blah, then you are the one making more out of it. I can only speak for myself, but I move on and look it up if I need to know. I also don't make a big deal about it if a nurse asks me a question at the end of report or if I am being disorganized in my report - I either answer or admit I do not know the answer and we move forward.

I remember this feeling a lot more hostile when I was a brand new nurse. Likely because there were times that I did not know things that I was expected to know by people who had been there longer. I find myself having a subconscious list of things I expect my peers to know now that are much more natural to me.

Good luck! Try to look at it as a learning experience. You could also try this line - "I'm not sure - is that something we usually pass along in report?" It is also important, very important, to remember that day shift and night shift can be two different beasts depending on the unit. You typically do have much more time to organize your thoughts on night shift. I have worked both on the same unit within the same week on a regular basis so I know that on my unit, night shift usually gives more time to read through notes and catch small details. Day shift may not have that same opportunity. It might not apply to your situation, but look at ways to collaborate with your coworkers rather than fight with them. I like the idea of a standardized report - in general we give reports similar to each other on our unit.

scooterscamp123

Has 1 years experience.

hawaiicarl, This is fantastic! Thanks for making me laugh :)

scooterscamp123

Has 1 years experience.

A sense of humor is definitely a requirement in this field!

vintage_RN, BSN, RN

Specializes in NICU. Has 7 years experience.

I get this a lot of the time In the NICU. Oftentimes we have babies born at 25 weeks who stay with us until they are 40+ weeks and have multiple complex issues. When I'm giving report on an "old chronic" baby as we call them, please don't ask me why apgars were 2 and 5, why the baby switched from CPAP to NIPPV 3 months ago and what the results of their head ultrasound 6 weeks ago was. You can read the kardex for the extensive history....I'm only telling you the pertinent, CURRENT issues.

Been there,done that, ASN, RN

Has 33 years experience.

Management is aware, and will not deal.... so you must do it. When asked about tonsillectomies in 1961, respond with " I did not have time to delve into the history, feel free to do that, when you have time".

If you are not getting pertinent information in report, make them accountable each and every time. PCA rate? Go to the bedside , make them look at it with you. The change to bedside report could be your answer,and you can make that happen.

Try sarcasm .... not advised if you are a novice at it. Something like "their last chemo was lot #23-b16e, expired 1/16/12, given through the port-a-cath with a 22 gauge access over a time of 87 minutes, there were scattered showers outside, and a robin flew by the window as it was spring." They should get the point that they are asking inane questions. If they still don't get it, ask them to repeat it back to you .... I find they are usually just not paying attention, and fill time with ridiculous questions.

My personal pet peeve is when they wander in 10 minutes after the shift started with a plate of food and coffee .... then they ask stupid questions while stuffing their face, which they don't hear the answers to because of the noxious cow chewing sounds.

Cheers

American Robin, or White Throated Robin?

I think that in this era of electronic information the lengthy verbal report is a dangerous and outdated vestige of the past. AFAIK, nursing is the only field in which this is done. After spending the whole night awake, one nurse takes a piece of information that has been electronically recorded and is easily accessible. That nurse verbalizes the information to another nurse, who then writes it down on paper. Is there a method more likely to cause mistakes? I hope to hell the guys over at the nuclear power plant have a better system.

Of course there is plenty of information not well recorded in the chart, and that is a great use of verbal report.

caffeinatednurse, BSN, RN

Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF. Has 5 years experience.

One thing that helps, is to do a bedside report. You don't have to do the full report at the bedside. But you can walk in the room with the other nurse. This gives you the opportunity to check the IV fluids (and tubing!) right then. That's also when you get to lay eyes on the patient. If they're yelling that they've been without their PRN pain meds for hours, then that gives both of you the opportunity to fix the issue right then and there. When the problem nurses realize how thorough you are, they're more likely to make an effort to not leave their patients in a mess for you to clean up.

As for report, do your best and move on. If they give you too much lip about it, say that the information they're inquiring about wasn't relevant to your shift. Invite them to look it up on the EMR.