giving report to a SNF

[psu_213, BSN, RN]

Recently had an elderly female pt who was living at home...she fell out of her w/c and broke her wrist. The ER doc did not feel it safe for her to return home and a SNF admission was arranged for rehab. Our case manager gives me the # for the nurse at the SNF to whom I'm supposed to give report. I call her, she transfers me to someone else, this second person says I should be talking to (insert name of the first nurse) and gives me her number. I tell her that this first nurse had tranferred me to her. She says "Ok then" and hangs up. Frustrating, very busy day, I'm falling way behind.

So I call the first nurse back, she was going to transfer me again until I finally 'convince' her that I need to speak with her to give report. Anyway, this is just the annoying background story.

I'm telling her about the pt, why she is here, what we did for her, etc. I go into the vitals. "On arrival her heart rate was 72, her blood pressure 128/52, her resp..." She cuts me off "52 is her blood pressure? Isn't that really low? Did you notify the doctor about that?" I tell her that is a totally acceptable BP for us, and, yes, the doctor knows about it. Then I go on and finally get to the discharge VS "...and her blood pressure was 99/56." Uh oh, I know what is coming. "And that is her blood pressure?? And she is going to leave there with that?" (actually, thanks to the little phone tag game earlier, medics had just picked up the pt and she was already on her way to the SNF)

I am not try to criticize SNF nurses and I am not angry, per se, with this nurse. She was probably busy too, and perhaps she just had a pt last week whose BP went downhill very quickly and she did not want a repeat performance. It was very frustrating in the course of a busy day to face this line of questions when I was just trying to get things done and get caught up.

Any suggestions on how to make this process a bit smoother?

[CoffeeRTC, BSN, RN]

Gosh...this is what gives the rest of of LTC nurses a bad name.

I would go with the speak to the supervisor route. Sounds like it was a bigger LTC center and you got bounced around to a bunch of units/ nurses, but they were rude and she was a bit ??? Yeah, I might have my concerns about a "lower" bp but would probably ask or phrase my questions differently when getting a report. I would rather ask the questions then and prevent a return to the hospital. Yes, technically we can do IVs and labs and a bunch of different meds, but we don't have them on hand for stats (might take 3-4 hrs to get them delivered)

If you are getting bounced around like that, I would ask to speak to the admissions director, unit manager or even the DON, heavens knows you don't have the time to be making calls. I know I don't.

Sorry.

[psu_213, BSN, RN]

Gosh...this is what gives the rest of of LTC nurses a bad name.

I would go with the speak to the supervisor route. Sounds like it was a bigger LTC center and you got bounced around to a bunch of units/ nurses, but they were rude and she was a bit ??? Yeah, I might have my concerns about a "lower" bp but would probably ask or phrase my questions differently when getting a report. I would rather ask the questions then and prevent a return to the hospital. Yes, technically we can do IVs and labs and a bunch of different meds, but we don't have them on hand for stats (might take 3-4 hrs to get them delivered)

If you are getting bounced around like that, I would ask to speak to the admissions director, unit manager or even the DON, heavens knows you don't have the time to be making calls. I know I don't.

Sorry.

Nothing for you to be sorry about. I was given the unit/nurse # by our case manager. Didn't really have time to go the supervisor route when I was already behind and the pt was on their way to the facility.

[LPNnowRN]

Ask for the social worker or the DON on a calmer day and find out who they would prefer you to give report to. Tell them about being bounced around. Kudos to you for giving report, LOL! Sometimes we have to call and find someone in the ER/hospital to get report. At my facility, the charge nurse does all the admissions, so you could always ask for them. You may have called at shift change in the gray area when the outgoing doesn't want the call and the incoming hasn't had report yet. It probably was a busy day (usually is), and I personally have had to send patients back to the hospital after we admit them for unstable V/S--you may be correct in thinking that she may have been thinking the BP trend was troubling. Maybe more discussion as to why the V/S are considered stable? Hope that helps.

[CT Pixie, BSN, RN]

Ask for the social worker.

Our social worker would transfer the call to the nurse on the unit the patient will be assigned to.

As an LTC nurse I feel bad that you were bounced around on the phone like that.

I don't think any info from me would have made your experience with that nurse any smoother. She sounds a bit rude. If I had any questions about the vitals I would have let you finish with them and asked my question, I never cut anyone off while they are speaking. Honestly I probably would have questioned the lower BP also but not in the way she did. I probably would have asked if any meds were given prior to the lower BP just for my own info.

I've had reports for new admits/readmits where the nurse would literally give me a minute by minute on what the patient did, said, ate, every lab and result etc from the time they were admitted until the time of discharge..and others gave me so little info I'd have to pull teeth to get it. Give me middle of the road. Luckily our local hospital is very small so you get to know (if you aren't related already..yeah..its that small) the nurses who work the same shift you do. We know them, they know us and what our facility would like to know..flows very smoothly when he/she is discharging to us.

My apologies from all us LTC nurses who appreaciate your report, that you were treated in that way.

[vampiregirl, BSN, RN]

Gee, I'll bet that gave you a great impression of the LTC...

The patient may have initially been assigned to one room and then reassigned, I know that's happened at our facility. Still, it's no excuse for what you went through to give report. I appreciate that you considered that maybe the nurse was just a little frazzled. I know sometimes my mouth gets ahead of my brain sometimes. Maybe she really meant to ask if that was normal for the patient.

As for streamlining the process, I know I've taken report for another nurse on an incoming patient - especially if room assignments are not finalized yet. In this case though, I always get the name/ phone # for the person giving the report in case of questions. Or if giving report seems to be an ongoing issue, could report be faxed w/ contact info. Often times nurses on both sides of the transfer are busy...

[Forever Sunshine, ASN, RN]

For a LTC facility we like their blood pressures to be a little higher than that. Although some of our residents thats where they live at but we keep a close eye on them. I would have ran that B/P by the RN supervisor and let the MD know, just to be on the safe side but I wouldn't freak out about it.

As for who to talk to.. maybe next time ask for the nurse whos going to be taking care of "John Smith"

I thank you for taking the time to call and give report. I would jump through the phone and give you a giant hug if you called me to give report. It would make the admissions process so much easier knowing what we are dealing with before we go into that room. Sometimes the EMT will give us a report. We usually just get a 3 inch thick pile of paper and have to find all that information from there.

[iceprincess492]

I thank you for taking the time to call and give report. I would jump through the phone and give you a giant hug if you called me to give report. It would make the admissions process so much easier knowing what we are dealing with before we go into that room. Sometimes the EMT will give us a report. We usually just get a 3 inch thick pile of paper and have to find all that information from there.

Agreed. Report is greatly appreciated. Can't tell you how many weekends I have worked and had patients show up from hospital without us even knowing they are coming :)

[NurseKatie08, MSN]

Agreed. Report is greatly appreciated. Can't tell you how many weekends I have worked and had patients show up from hospital without us even knowing they are coming :)

I agree as well. When I am getting admissions to my rehab unit I almost never get report. Usually just a chart from medical records with copies of the hospital MAR & the screen from our admissions nurse. Not always the most up to date info, but something just that gives me a sense of what I'm getting. It would be a real treat to actually get report, as I've gotten an admission here and there that should've never left the hospital.

[JenniferSews]

Hopefully you understand this is just one nurse and one report. Just like I understand that it is just one nurse when I hear "last bm was 7 days ago so you might have to give them "something" when they get there."

If you really have the energy and time I would say yes, please call the DON. There needs to be some training. When we get report there isn't any transferring around and arguement. But we are also used to multiple admissions nightly. The LTC half of our facility rarely get admissions so they and can sometimes be a little questioning when someone is trying to give report and try and send them to the skilled units. They also aren't used to patients who aren't stable enough for ltc, where they are not going to have their vitals taken several times a day.`

[miss81, BSN, RN]

Ask for the social worker or the DON on a calmer day and find out who they would prefer you to give report to.

Social worker?

Social workers here would tell me that this is a nursing issue. What in the world does social work have to do with this situation?

[NurseLoveJoy88, ASN, RN]

Sorry you went through this, not all SNF nurses react like that.

Now let me vent.... Please don't transfer my patient back to SNF knowing when he is unstable ! Now that he has a MASSIVE GI bleed, guess what he's coming back to your ER !