giving report

Virgo_RN, BSN, RN · Oct 27, 2007

I have dreams like that too. I think it's normal.

First, I always read or at least skim the H&P at the beginning of my shift, before I even walk into that room. I want to know a little about the person I'm working with.

Next, I skim the progress notes so that I know the general direction the doctor is going in with treatment, and I note any lab results that might come on my shift that I will need to know and possibly report. Then I check the MAR to see if there are any medications that absolutely must be given at a specific time.

When I give report, I like to do so right next to the patient's chart, or with a computer right there, so if the oncoming nurse has a question that I don't know the answer to, I can say "Let's look that up". Usually they just say not to worry about it, they'll look it up when they get a chance, or they're happy to look it up with me and get an answer right then.

I know the feeling of thinking that I should know every detail of the patient's life since birth, but the truth is that my shift is spent putting out fires, and I just can't know everything. But by being willing to look up the information for the next shift at the time of report, I've found it really helps both them to feel like they're getting the info they need, and me to feel like I'm doing a better job caring for the patient.

pedsmariposa · Oct 27, 2007

Hi Ya!

I worked Adult Onc as a new grad..OVERWHELMING...oh yeah!!

First off -you CANNOT know everything.nobody does..you know that saying "nurses eat their young"?? That could be a little bit of what's going on...I DO think it happens..even w/the nicest nurses..Maybe they feel like they're helping..who knows?!

Anyway - some (perhaps) helpful hints - when YOU get report ask this: 1) Plan?? 2) D/C goals?? 3) I & O's?? VERY IMP!!! You should definitely know this and you WILL be asked..even if you have an AID etc. 4) know the PMD, the Onc (or specialist, surgeon, etc.) 5) know the labs that were drawn and the results (esp bld cx, urine cx)..Check your MAR right after report...The nurse going off and giving you report IS responsible for keeping YOU up to date also!!!

I went home (several times) in tears bcs of an evening shift nursing coming on and me not knowing the answers to her questions..or (worse yet) a pt going sour on nights and me coming in the next day and feeling like I was blamed..You HAVE to be confident (even if you don't always feel that way) and if you are doing all of your duties and monitoring your patients take heart and chin up when you give report. If you don't know the answer to a question..don't make excuses (they're RN's after all - they DO get it - even if they don't let on)..simply say "I don't know". They're adults - they can also look it up..DO know the basics (above) and DO ask for them when you GET report!!

Good luck!!!!

abundantjoy07, RN · Oct 27, 2007

Giving report...I hate giving report. I always feel like it's not "good" enough.

However, in listening to other nurses, I get the feeling that all my report lacks is the non-essential gossip surrounding patients that many nurses like to include in their report.

Report for me includes:

Patient, room number, treating physician.

Diagnosis/primary complaint

History

Locations and presence of ports/drains/IV's etc.

When last PRN meds were given on shift, why, and pt response.

Pending treatments/procedures/labs to be done, etc.

And any other pertient information such as new orders or stat orders.

David's Harp · Oct 27, 2007

Well, at least I'm not the only one! I tend to get some stage-fright, feeling like I'm defending a Master's thesis with each report I give. Some nurses are better than others, and ironically I'm finding that the real tough ones are the ones who leave the most gaps in their reports when I get their patients.

There are some great suggestions in this thread, which I'm going to try next time I'm in (H&P, more attention to progress notes than I've been giving). Check back in and let us know how you progress with this.

Thanks,

Kevin

Virgo_RN, BSN, RN · Oct 27, 2007

Another thing that might help is to find out if your agency has a standard for what should be included in report. Is there a format that should be followed? Are you giving a systems report, or an SBAR type of report?

At my agency, it seems as if each nurse has different expectations as to what should be included in report. I try to get a sense of that when I'm giving report. I'll just a basic rundown on the patient, then ask them if they have any questions.

An observation that I've made is that a lot of the nurses who have been nursing for a long time seem to want a systems assessment type of report. They basically want me to give a picture of what my head to toe assessment revealed. And when they give me report, this is the type of report that they give. They tell me about the patient's neuro status, their cardiovascular status, their respiratory status, etc., from head to toe, system by system. A lot of the more recent grads tend to do the general overview type of report, including anything pertinent, rather than system by system. I'm not sure why this is.

NurseNayin07 · Oct 28, 2007

hello--i'm a new nurse--off orientation end of september, working nights. i am on a busy post-surgical/oncology floor with overflow from other services. i usually have 7 patients overnight, and as you night nurses know, someone always spikes a fever, gets a little loopy, cannot sleep because of pain, or needs narcan because they aren't handling the anesthesia well. whatever. people think and say that nights are easy because the pts are just sleeping--which is just not true. anyway, i'm doing well dealing with all the unknowns, giving meds, keeping people comfortable, getting the piles of documentation done, labs drawn, etc. all night--i do not sit down for 12 hours. then i get into report and get a barrage of questions about a patient's long term history, why is the medical plan for this and not that, what is the discharge plan for the patient, etc. i know i should know all of this, and sometimes i do, but sometimes i've just been focused on handling the pts immediate concerns like pain or nausea or fever or respiratory status or urine output for the 12 hours (with six other pts). i don't get this information at report when i come on, so am i supposed to read everyone's entire charts when i come on so i can get their entire history? anyway, then i leave report feeling like a bad nurse. i know i'll get better at knowing my pts' total histories (which usually you can only do by reading a 100 pages of notes in the chart, because no patient wants to tell you their whole story at 11 pm) but my questions are these:
1) does anyone else feel utterly stupid when it is time to give report even though you did a good job taking care of the pt for your shift?
2) if any experienced nurses are reading this, how long before i should expect to get better at this? i'm tired of leaving work feeling defeated and stupid, even though i took care of a lot of patients and got them through the night more comfortable, safer, and handled all complications that arose.
3) when do the bad dreams that i have when i go home and sleep stop? i dream of iv pumps beeping, people going septic, forgetting patients altogether and leaving them in their own xxxx.
thanks for any input.

I've been in orientation since the beginning of August and I'm going on my own in November. ahhhh!! scary! Giving report has been a big challenge for me as well. I'm starting to get much better at it through (or at least I'd like to think so, haha!). Even though I'm with a preceptor still, I'm pretty much taking all the patients and reporting on all of them. Sometimes I really do feel like a mumbling idiot! I mean, I've been with the patients 12 + hours.. you'd think I'd know a thing or two about them! Anyway, I find what works for me is using my "brain sheet" that I used to get report from the beginning of shift. I make changes on that same sheet of what "new" has come up during my shift, cross things out so i dont get confused, etc.... I like to keep copies of my orders throughout the day on each patient. Here is a list of stuff I usually tell: Name, Age, DX, Dr., Allergies, History (at some point during my shift i regroup and look at H & P, *IF* I have time, if not then i usually report on the history that i got about the patient at the beginning of my shift), IV site/fluids, Blood sugars/coverage during my shift, activity status, voiding or foley, dressing changes, drains, oxygen, important VS changes, crucial labs, pain level/last time medicated for pain, and any other crucial patient needs or changes, as well as family concerns. Is the patient oriented? Diet? how are they eating and drinking? how is their output? I think its important to point out the abnormals than the normals. Its so easy for a nurse to go and look at the normals... ya know. Hope this helps a little bit... :) Oh yeah and I can relate to the whole dreaming thing! I usually dream the night before I go into work... usually my dreams are about getting fired and losing my license for killing a patient. Crazines :lol2:

cardiacRN2006, ADN, RN · Oct 28, 2007

I'll give you the short answer. It's because you're new, or have less experience than the other nurse who's asking.

Sometimes, nurses like to point out what they know, by asking you things that they know that you don't know.

So while you are busy getting the job done-which is very hard to do as a new nurse, they are asking things that they can find out on their own, but they like to see you squirm.

I remember this time vividly when I was brand new. I despised report. I worried about report. I drove home in tears about report.

What happened is that I would say, "I don't know, but I'm sure you can find that tonight", or "I was too busy dealing with XYZ to care about looking that info up..."

And then move on with report. Don't stop and let them see you sweat. Be confident, and know that you are doing a good job at work!

RainDreamer, BSN, RN · Oct 28, 2007

I agree with the above post. I was the same way when I first started. I used to really dread giving report!

After a while you'll get a nice flow going and give report without much thought. There's things now that people ask me and I don't have a comprehensive answer. For example, if they ask me what the echo showed, I usually look up the report and just get the important basics ..... "well it showed a small PDA and some other stuff, you'll just have to look it up on the computer to get all the details". And people are totally fine with that. If they don't see you sweat and don't see that you're that concerned about it, then they won't be either.

I used to always think afterwards about forgetting this or forgetting that. But it was always minor stuff that the next shift could look up with no problem. There will always be people that want every last minute detail about the entire history, and that's just not feasible, especially if it's a patient that's been there forever!

If you have time to look up reports and other details, then great ..... you can make some notes and pass it on in report. But if not, then don't sweat it!

It'll get better :)

pedsmariposa · Oct 28, 2007

Hey!!

Thank you to EVERYONE who has posted!! I'm getting back into bedside nursing after being away since 2000.. I'd forgotten about the report anxiety!!

Speaking from an older (I am 48 yo) perspective...You are all RIGHT ON TRACK!!! Really - the key is that you ARE doing your job..Don't let these other nurses intimidate you. Keep in your mind and heart that we are all on the same side..i.e., getting that patient well and D/C'd..meeting their needs, their families' needs..I DO think older nurses try to intimidate the "younger" aka newer nurses...not out of meanness perhaps (benefit of the doubt)...maybe this is their way of "teaching".

Also - I STILL have dreams..even if I haven't worked in a while...not giving meds..not charting..not knowing..not knowing..not knowing..YIKES!!!! I think if you are a conscientious person you just cannot get around this..and come on!! We ARE caregivers...pleasers..and WANT to fix it!!! This is something that you just cannot escape!!!

Take a deep breath....give yourself a break.....you do the best you can..and go on from there!!!

Remember that nursing is an art AND a science..it is a PRACTICE..THAT means you don't know everything from day one (hint hint..NOBODY does!!!!!) even after MANY years of nursing!! Trust yourself...listen to your inner voice and be confident!!!

XO

elizabells, BSN, RN · Oct 28, 2007

Ditto what cardiac said about nurses wanting to show how much they know... we've got a doozy on my unit. Reamed me out for not calculating the UOP for the shift BEFORE mine, which happened to be (drumroll) her shift! So duh, she should have known that, and if she didn't she has no place getting snippy with me for not knowing it either. And did you ever notice it's these same nurses who give the two second "Everything's stable, kay byeeeeee" while flying out the door before you've even sat down? It got so's I'd start having an anxiety attack every morning at 0645.

On a practical note, though, here's what I learned after giving report to the aforementioned beast every day for my first month off orientation: I write EVERYTHING down. We do verbal report only, but I pretend I'm giving a written report. When I'm checking my orders at the start of shift, on the back of my "brain" sheet I start an outline for my report. Review of systems, IVF, IV access, labs, meds, other tests, any events overnight, etc. Even on my primary I put in a short blurb with dx, day of life, weight, etc. Obviously you won't always have time for this on those busy shifts, but it really does help. That way when your brain is fried at the end of a shift you have a cheat sheet.