giving report

noregrets · Jan 11, 2011

On our floor we do bedside report and the floor decided on a format.

Everybody follows the same format in the same order so nothing is missed.

This might be a project for your Unit Council if you have one, or for your educator.

Christen, ANP · Jan 11, 2011

I disagree with pretty much everyone but the above poster (LOL). Report is one of the most important parts of your job. If you leave things out consistently, you're putting the nurse you give report to at risk for not knowing important things. I've followed nurses like you who I have to pick out each piece of information and it can be frustrating, because what if I forgot to ask a specific question (like - hey, what's that about a 2d echo on your report sheet?") and you forgot to mention it, and the patient has a bad outcome because of the poor report you gave. Sure, not knowing about an echo isn't going to kill someone (well, it could maybe), but not knowing about serial H&H's, or a STAT test, or something else could.

We all go through this, but after a year you should really have your report giving skills down a bit better. You know what information is important and what isn't at this point. What it sounds like to me is you have an issue with organization and keeping all the new information and changes that comes throughout the shift straight. A good report tool would help you immensely. It would make you more consistent, which is what it sounds like you need. What kind of floor / unit do you work on? Does your facility have a standardized report tool like Joint Commission requires?

melisgood · Jan 11, 2011

A good report tool would help you immensely. It would make you more consistent, which is what it sounds like you need. What kind of floor / unit do you work on? Does your facility have a standardized report tool like Joint Commission requires?

I work on a telemetry floor (step down unit). It's one of the busiest floors in the hospital. We have 3 patients if we're assigned to trach/vent and 4 if regular tele patients. During the day shift it can be a struggle just keeping up with new orders and interacting with the patient's families. The majority of our patients are total care. Rarely would I have the time to write out report at the end of my shift for all of my patients. I do not know of any standardized form on our floor...if there is one, no one uses it that I know of. Everyone has their own method of taking and giving report. Some write down hardly anything, others (like the nurse I was giving report to yesterday) have a separate form for each patient divided by system. I made a form like that and I found it difficult to have each patient on a separate sheet of paper.

I take report on a single sheet of paper with all 3 or 4 of my patients listed. It's a printout that we are given at the start of shift that has the patient's name, age, gender, Dx. I take report and write the info down in catagories such as Hx, allergy, tele (HR, rhythm and rate), and IV. On the left I write skin issues or anything else pertinent to the patient such as abnormal labs or test results. On the right side I leave a section for things I need to do during my shift: Rx times, IVPB, pain meds (with frequency and times given) and any tests or procedures being done during my shift: EKG, 2Decho, CT scan, UA or stool I need to collect, etc. At the very bottom of the page I make another column for each patient and I use that for notes during my shift....I put the time and what I did...such as 0920: called Dr Smith about BP=188/96 or 1230: dressing changed. I feel like I am doing things in an organized manner? I highlight anything major that happened during my shift, such as 0920: called Dr Smith about BP=188/96 or any abnormal labs (which I also write down in the notes section). I do seem to write a lot more down than other nurses, but I'm not sure if that's a good or bad thing? We are still stuck with all paper charting and I hardly ever have time to chart as things are actually happening...I go back a couple hours later and look over my "notes" and document off of that. Should I be doing this all different? Any tips? I know this guy was being a ****, but I'm also willing to change how I do things.

Thanks!!!

Christen, ANP · Jan 11, 2011

I worked in a step down ICU when I was a new grad, which sounds pretty similar to what you're working with. A lot of total cares, trachs, stable vents, 3 to 1 ratio.

We used EMR, but it took me a while before I could chart as I went. Even at the end of my bedside career in the ICUs, I still would have days where I'd chart...eventually. That's where good note taking comes in handy, which it sounds like you've got down. Sadly, charting is way down the line after patient care and new orders.

One thing that helped me was my report tool - I had a single page for each patient so I could keep everyone straight. It was also very thorough and laid out in the way that I gave report. So during report, I would basically read from my report sheet and the chart. Start with Dx, Hx, head to toe assessment, and end with any changes that occurred during the shift.

Consistency is the key here, giving report the same way every time, writing down changes the same way every time, giving report with the chart the same way every time. This is what keeps you from missing things.

It can be challenging and confusing having a single page on each patient, but that helps you keep everyone separate in your head (ya know?). Having everything on one page might be too distracting. I used a sheet like this when I was prn on the floors because the patients aren't as sick, so I didn't have to write as much, but the ICUs I used a longer, more thorough tool.

Has anyone else ever given you feedback on your report (positive or negative)? Maybe ask some of the other nurses, or even ask the a-hole nurse what it is about your report style that isn't working for him.

Freedom42 · Jan 11, 2011

Question #2: How should I handle a co-worker being rude to me in front of a patient/family in a situation such as this?
TIA!

If that nurse is exhibiting this behavior toward you in front of a patient and/or family, you need to nip it in the bud. The next time he does it, I suggest you calmly give your report, ask if he has any questions, then ask if you can speak with him privately once report is finished. Tell him ever so calmly that you are working hard to give a complete report and that you do not appreciate his unprofessional behavior toward you, especially in front of patients. Tell him that you expect the eye-rolling and the attitude to stop, then leave. If it continues, you need to go to your supervisor and explain that, despite your attempting to resolve the problem directly, the rude behavior persists. That kind of behavior is completely unacceptable.

Of course, that's hard to do when you're a new nurse. I went through this myself about a year ago, when an ICU nurse to whom I gave report complained about me to a tech in another department. The tech then repeated the gossip to another nurse right in front of me, unaware that it was me she was talking about. I didn't miss a beat; with the charge nurse standing right there, I picked up the phone, called the ICU and very pleasantly asked to speak with the other nurse. I told her that I understood she'd expressed some frustration about something I'd done, apologized for the problem, explained that I was new, and said I wanted to make sure that she understood I needed and appreciated her direct feedback. Tech was speechless, charge nurse beamed, and the ICU nurse got the message that I will not be bullied. That's what the other nuse is doing to you, OP; he's testing you to see how much you'll let him get away with.

How about finding a colleague and practicing how you will stand up for yourself the next time it happens? It'll make it easier.

Christen, ANP · Jan 11, 2011

Wow, I didn't even remember to go after that! If a TM or nurse acts unprofessionally in front of a patient, as hard as it is this is not something you let go. Unprofessional behavior and criticism is not something you do in front of a patient. They are already scared enough for whatever reason they're there, they don't need to doubt your competency as well, even though it's unjustified!

Altra, BSN, RN · Jan 11, 2011

If that nurse is exhibiting this behavior toward you in front of a patient and/or family, you need to nip it in the bud. The next time he does it, I suggest you calmly give your report, ask if he has any questions, then ask if you can speak with him privately once report is finished. Tell him ever so calmly that you are working hard to give a complete report and that you do not appreciate his unprofessional behavior toward you, especially in front of patients. Tell him that you expect the eye-rolling and the attitude to stop, then leave. If it continues, you need to go to your supervisor and explain that, despite your attempting to resolve the problem directly, the rude behavior persists. That kind of behavior is completely unacceptable.
Of course, that's hard to do when you're a new nurse. I went through this myself about a year ago, when an ICU nurse to whom I gave report complained about me to a tech in another department. The tech then repeated the gossip to another nurse right in front of me, unaware that it was me she was talking about. I didn't miss a beat; with the charge nurse standing right there, I picked up the phone, called the ICU and very pleasantly asked to speak with the other nurse. I told her that I understood she'd expressed some frustration about something I'd done, apologized for the problem, explained that I was new, and said I wanted to make sure that she understood I needed and appreciated her direct feedback. Tech was speechless, charge nurse beamed, and the ICU nurse got the message that I will not be bullied. That's what the other nuse is doing to you, OP; he's testing you to see how much you'll let him get away with.
How about finding a colleague and practicing how you will stand up for yourself the next time it happens? It'll make it easier.

I wish I could give this post 10 Kudos. :yeah:

I detest nurses who need to be spoon fed every last freaking detail in report. Do they not check over orders or read the chart a little here & there, when there's time? Do they not look at the patient? Because if they did, they would not need to stop me in the middle of report when I've said, (a real life example) that the patient sustained a small lac on their forehead when they fell and it's sutured, to ask me which freaking side of the forehead the lac is on so that they can write it down on their piece of paper ... :rolleyes: ( ... it's on the patient's FOREHEAD, dear ... I'm confident that you won't miss it if you actually look at the patient)

OK, sorry, got a little sidetracked with my own vent there ...

OP - your coworker's behavior is about his being a jackalope, not necessarily your poor report-giving skill, unless you've consistently gotten feedback that this is an area in which you need to improve. You may want to consider practicing saying something like, "I've verbally given you the information you need to start caring for the patient. You have all night to read the chart & look up labs & test results. Have a good night."

NurseLatteDNP, MSN, DNP, RN · Jan 12, 2011

Don't be intimidated by a bully. I always tell my new grads, you have to find your inner shark. You are doing great, just believe in yourself.

ckh23, BSN, RN · Jan 12, 2011

Tell him to stop being such a ****. He can look up his own stuff.

I second that.

RNJoInMI · Jan 12, 2011

"I've verbally given you the information you need to start caring for the patient. You have all night to read the chart & look up labs & test results. Have a good night."

I love this!!!!!

meandragonbrett · Jan 12, 2011

I have no problem telling people "I don't know. Look it up. The more you interrupt me the shorter your report is going to get because I WILL leave on time."

noelia23RN · Jan 12, 2011

Ok he's being an *** because he probably feels superior than you because he has more experience and wants to belittle you. Don't worry about it just ignore him but do not back down to him, tell him to freaking look it up himself. As far as report goes my biggest pet peeve that I've come across with people given me report is when they don't even know if the pt is still alive. You' ll ask him/her does she have any iv access answer, don't know, is the pt npo answer don't know, dnr answer don't know any lab results, don't know and this goes on throughout the whole report which is really not a report. I just say to myself thanks a lot!!!!!"