GIVING REPORT!!!!!

Esme12, ASN, BSN, RN · Aug 9, 2013

Sometimes...sadly......It is the nature of the beast...you sound on top of it to me. It is passive aggressive behavior....most of the time. I have witnessed floor nurses have the admission paper work in front of them and fill it out as you talk. See if that is the problem. Are other ED nurses also complaining? Is this a system issue?

Sassy5d · Aug 9, 2013

Same problem at my place. Roll it off. I actually just talk. Tell em why they are there, what meds, iv, vs, dx admit doc and history. I don't let them ask 500 questions

Aurora77 · Aug 9, 2013

If it helps, we floor nurses are driven crazy by those same coworkers during our shift report. Some people want to go on and on about the minutiae. Find a way to politely cut them off. We only need the pertinent facts not a whole life's story about a patient.

Guests · Aug 9, 2013

I had another patient - she was much less critical, though still important.

Important but neither critical nor urgent.

I'm a big fan of the quadrilateral: x-axis = urgency, y-axis = importance... start in the upper, right-hand corner and take things off from urgent to less urgent and then important to unimportant.

She was admitted for postpartum hypertension. Her blood pressure was around 140/77 when I called report. We had treated her with magnesium to prevent seizure, placed a foley catheter, and given labetalol PO. The doctor had also ordered a labetalol drip. Additionally, he had ordered 24-hour urine collection.
I am an ER nurse, and I did not put the foley catheter bag on ice.

Unless I expected her to board with us in the ED, that would be about x=0.25, y=0.5... meaning it probably wouldn't get done by me anytime soon, especially if I'm flipping my beds.

I am feeling SO FRUSTRATED as a new nurse while giving report. I am doing the very best I can to keep up with orders - and I feel like the floor nurses are never happy with what gets done in the ER.

Usually, they're not. There's an acronym that they use for us: FERN... The F is the present progressive of a word that rhymes with luck or duck and the rest is emergency room nurses... you get the point.

Especially in the ICU, many of them fail to understand the difference between "getting" a patient with the art line and CVP and peripherals x3 and the foley and the OG and the tube and... and managing the same.

I just honestly feel like there needs to be a larger discussion around how to give and receive report. Do you think there should be a time limit on how long we can give report on one patient. There are certain details that I sometimes wonder ... among the zillion things I have done for the patient in the ER ... why do the floor nurses ask 300 questions during report? Also, I just feel like I am getting the 3rd degree for everything I did or didn't do while in the ER.

I give them the big-ticket items and often say things like, "that's in the EMR, you can look it up just as easily as I can" and the truth is, often they're reading the EMR while we're talking.

The one that makes me chuckle is when they start asking about what access they have. Geez, a 10-second assessment answers the question... and it's charted.

How do you layout your report? What details do you offer? When an ER gives report to another ER nurse, it takes 3 minutes MAX - but giving report to the nurses on the floor seems to take an ETERNITY! What is the deal with that? When I get a patient ... I figure it out! I would really like to get better at giving report, but I hate feeling like I am getting asked for details that are minutiae. And I am really struggling with the attitude of many of the ICU nurses to whom I give report. Perhaps it is only at my hospital, but I don't think it is necessary to be condescending.

Nope, not just at your hospital.

Fortunately, it's a minority of the nurses IMO. Mostly, I refuse to play the game and refer them back to the EMR.

Sometimes I'll say, "I'm sure neither of us has the time to go into the less-critical details so let's just hit the high points - you can take a quick look at the EMR while I'm bringing them up and then we can cover anything that's unclear at that point."

ChristineN, BSN, RN · Aug 10, 2013

I agree it can be frustrating trying to give report. Does your ER have a handoff report sheet they use for calling report? My ER does, and I think it helps some, but you still do get the nurse that wants to go through and ask you questions when the answers are right there on the sheet

1Cor1313 · Aug 10, 2013

Unfortunately, this happens in many hospitals. When I'm calling report, I know what to expect so I try to disarm the nurse from the beginning of the call. Before I even say I'm calling report on Mr. ABC, I ask them how their day is going. Sometimes its nice to just take a moment out of the chaos and connect on a human level. Most of the time I get a negative answer, "it's horrible" "we are soooo busy" "this day can't be over fast enough". I genuinely try to empathize and let them know its not pretty down in the ER either. By now (the majority of the time) we have connected enough to realize this isn't a battle between floors. It's not my personal choice to give the floor nurses "more work" by sending them another pt. I don't have a choice when I have to triage my 6th ambulance in the last 4 hrs (and I certainly would not take it out on EMS). This is the path we all have chosen (for better or for worse). There have been times when no matter how I try to ease the situation I can still hear the overwhelming frustration in the nurse's voice. At that point, I'll acknowledge it and say "how about I give you report now and not send the pt up for 10 minutes". That usually works and the nurse sees that I am not enemy number one. And what's another 10 minutes anyway? It gives me just enough time to triage the ambulance coming in to the hall bed...lol! There have been rare occurrences when nothing works...that's when it's just a personality problem and I have no issues being all business at that point.

As for report, I try to be thorough but not go overboard. Name, DOB, Allergies, PMH, where the pt is from, CC, my interventions and re-evaluations, VS, admit dx and any safety concerns, everything else is in my notes. If it was a code I'll include pre-ER circumstances. Our computer system allows the receiving RN to view labs and radiology reports, but I will still report any criticals. I always ask if there are any questions and most of the time I get a "no"...and sometimes I even get "have a nice day" :)

One other note, don't ever be intimidated to call the floors for advise. How often do we initiate 24hr urines in the ER? Whatever the question, I call the related floor...just like they rely on us for rapid response, difficult IV's or hard to place foleys. I'm always calling the lab or pharmacy for questions too. I work with nurses that have been in the field for 30+ years and they still wouldn't consider themselves an expert. The only constant in nursing is change...we are always changing and learning. And lastly, you seem like an amazing ER nurse...be confident in what you know, be confident in what you don't know...and NEVER let anyone take your joy

dansamy · Aug 10, 2013

Here lately, our er has been wanting to just read us the patient's dx & admit orders. Thanks. I can read. I want to know what YOU did for them. Initial presentation, interventions, response, etc.

Anna Flaxis, BSN, RN · Aug 10, 2013

I use the SBAR format:

Situation: Mr. Smith is a 60yo male who presented to the ED for a chief complaint of chest discomfort, onset at about 2pm today while mowing the lawn.

Background: Mr. Smith has a previous cardiac history including MI with stents. When his chest pain started today, he took 3 NTG 5 minutes apart, and when the pain didn't stop, he dialed 911.

Assessment: EKG and initial trops are WNL. He is currently pain free after 2mg of morphine. He is A&O x 4, and no other complaints at this time. An 18g was started in his RAC en route and it is patent.

Recommendation: Mr. Smith is being admitted for observation to rule out MI. He will be on telemetry and serial cardiac enzymes are ordered. Mr. Smith's wife is present and will accompany him to his room. He was hungry, so I gave him a sandwich, but he's still hoping for something more substantial when he gets to the floor.

That's it. Short and sweet.

DayDreamin ER CRNP · Aug 11, 2013

I use the SBAR format:
Situation: Mr. Smith is a 60yo male who presented to the ED for a chief complaint of chest discomfort, onset at about 2pm today while mowing the lawn.
Background: Mr. Smith has a previous cardiac history including MI with stents. When his chest pain started today, he took 3 NTG 5 minutes apart, and when the pain didn't stop, he dialed 911.
Assessment: EKG and initial trops are WNL. He is currently pain free after 2mg of morphine. He is A&O x 4, and no other complaints at this time. An 18g was started in his RAC en route and it is patent.
Recommendation: Mr. Smith is being admitted for observation to rule out MI. He will be on telemetry and serial cardiac enzymes are ordered. Mr. Smith's wife is present and will accompany him to his room. He was hungry, so I gave him a sandwich, but he's still hoping for something more substantial when he gets to the floor.
That's it. Short and sweet.

That's pretty much how I do it. It is also kind of how our charting goes.

I really hate it when the floor nurse I'm reporting to starts asking me questions right in the middle of what I'm saying. I especially hate it when they start getting ahead of what I'm trying to say. I usually get to everything you need to know about this patient and if they would just be a tad more patient I wouldn't have to jump around the chart to find the answer.

I had a horrible experience the other day with a nurse and ended up telling her that if she would stop interrupting me I would cover what she needed to know. It was also about 6:20pm and I just needed to get this pt GONE.

Me: Mr. Joe Blow came to us earlier this morning ar..

Her: What time?

Me: around 0730. He came to us from the nur....

Her: did he come by ambulance? Where did he come from?

Me: He came from the nursing home c/o of SOB. He has a his....

Her: does he have COPD or asthma?

Me: If you could just let me finish I will cover it all for you and if you have any questions I'll be happy to answer them.

friendlylark · Aug 11, 2013

YES - that is exactly the THING - it's the questioning in the middle of the report that drives me nuts - and then I have to skip around the chart to get everything answered!!! OH m'gosh :-) Well, thank you so much for letting me vent. Part of it is that I lack confidence and don't know how to push back a bit ... but I am learning!!! :-)

pandabear2185 · Aug 11, 2013

It depends on the ER. I work in the ICU and get may Pts from the ER with almost no info in the EMR. Forget about lines, you're lucky if they were entered. And most of the time the RN giving report has only had the pt for 5 min so they know nothing.