I have been feeling an increasing level of frustration lately with regards to giving reports to the floor, be it ICU, med-surg, or OB. Yesterday I had one intubated patient who I had just finished titrating to keep him down. I was working diligently to get the versed and propofol to the correct doses to keep him comfortable, and to bring his fever down to stop him from shaking.
I had another patient - she was much less critical, though still important. 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. To be honest, I am not an expert in preeclampsia. I am also a new nurse with just over one year of experience.
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.
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.
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.
I am a fairly new nurse also. When I began encountering this I ended up figuring out what each department was filling out during the report call. each one had a report sheet they were filling out. So I had each one send me one so I can know what they were really looking for. Most don't know I have it when giving report so that negativity is decreased. but even sometimes no matter what some people will be grumpy and cut you off when giving report. You have to politely-yet firmly let them know you will get with that and ask any further questions at the end of my report.
In the interest of trying to give better report, I would like to intentionally adopt the SBAR format. I am going to make every effort to give report in SBAR. In light of this, where do I put medication administration? As an ER nurse, I usually start my report with chief complaint and how the patient arrived (by ambulance or through the front door). I then tell tests we ran and orders that were received due to chief complaint. Sometimes those are med orders, sometimes radiology ...
This last report that I gave seemed to get so fouled up because the nurse was asking for specific times (and doing a lot of interrupting). I can generally say that I gave the med about 2 hours ago - but I have to switch screens to get exact times of med administration. I gave her blood pressure of the pt in triage and what the BP was at the time of report - but she wanted blood pressure BEFORE med administration, and what times had I given the med and these sorts of things.
I appreciate her being so fastidious, but I had a patient on a vent whom I was titrating, so I didn't have the bandwidth to get to the nitty gritty (and I'm not sure those details make a difference to her interventions going forward)??? Why does she care what the BP was exactly BEFORE I gave the med? She knows the BP was high at triage and that after giving mag and labetalol it is in a more manageable range - so what is the deal with that?
I need a better script (a diplomatic yet assertive script) to be able to move quickly past the minutiae.
In the interest of trying to give better report, I would like to intentionally adopt the SBAR format. I am going to make every effort to give report in SBAR. In light of this, where do I put medication administration? As an ER nurse, I usually start my report with chief complaint and how the patient arrived (by ambulance or through the front door). I then tell tests we ran and orders that were received due to chief complaint. Sometimes those are med orders, sometimes radiology ...
This last report that I gave seemed to get so fouled up because the nurse was asking for specific times (and doing a lot of interrupting). I can generally say that I gave the med about 2 hours ago - but I have to switch screens to get exact times of med administration. I gave her blood pressure of the pt in triage and what the BP was at the time of report - but she wanted blood pressure BEFORE med administration, and what times had I given the med and these sorts of things.
I appreciate her being so fastidious, but I had a patient on a vent whom I was titrating, so I didn't have the bandwidth to get to the nitty gritty (and I'm not sure those details make a difference to her interventions going forward)??? Why does she care what the BP was exactly BEFORE I gave the med? She knows the BP was high at triage and that after giving mag and labetalol it is in a more manageable range - so what is the deal with that?
I need a better script (a diplomatic yet assertive script) to be able to move quickly past the minutiae.
She cares because she's a good nurse & is establishing for her patient's history a baseline. She wants to know how elevated it was at presentation, what meds & when and the response to those interventions.
I would want to know what it was at triage. It would help me to know if the patient later had another elevated BP if it was about the same or even more elevated.
Our ER faxes an SBAR to the floor, usually about 15 min before pt arrives. Really it's the ER summary report so it includes pt complaint, pt hx, labs, meds given, interventions etc. There's not much left to report once the pt hits the floor, usually comments re behaviors/family.
Our ER faxes an SBAR to the floor usually about 15 min before pt arrives. Really it's the ER summary report so it includes pt complaint, pt hx, labs, meds given, interventions etc. There's not much left to report once the pt hits the floor, usually comments re behaviors/family.[/quote']
Ours is similar. We have a comment section at the bottom to write any extra "need to knows" on top of history, recent meds, iv fluids, labs. We are told within an hour of when the bed is ready on the floor, so we fax up report and then send the patient soon afterwards.
Thank you for all of the replies. I appreciate the discussion.
In which part of SBAR do you include medication administration?
You're actually looking for ADPIE (the Nursing process). SBAR has been so trendy lately that we try to use for all sorts of things it wasn't meant for and isn't appropriate for. SBAR for is for communicating a single change in status. ADPIE is the overall process of patient care and provides a much better structure for capturing and organizing information on a patient. Typically when someone is using SBAR for report, they're actually just using ADPIE, it's just cooler to call it SBAR.
I stick to SBAR reporting. When the questions start flying about skin integrity, A&O, ambulatory or not, I just say 'you are going to do your own assessment.' No, I don't know the diet, so don't ask. It is not relevant to my job unless I am holding. Look at the orders yourself, I do not have to read them aloud to you.
I absolutely HATE when I get interrupted while giving report. Maybe if you actually listened, you would know the IV site with which fluids are running in, and not have to ask me 4 times. If I get interrupted more than twice, I say "if you have any questions my extension is ....." and hang up. Obviously they were not focused enough to listen to my report. We also have to get patients upstairs within 30 minutes of receiving bed assignment.
Inpatient nursing and outpatient nursing is completely different, and working both sides, I have little sympathy for upstairs. You have an empty bed, you know you are going to get a patient. I don't get angry as I receive 2 EMS back-to-back, it is the nature of the beast. I'm at work to earn a paycheck, not to complain.
I stick to SBAR reporting. When the questions start flying about skin integrity, A&O, ambulatory or not, I just say 'you are going to do your own assessment.' No, I don't know the diet, so don't ask. It is not relevant to my job unless I am holding. Look at the orders yourself, I do not have to read them aloud to you.
I absolutely HATE when I get interrupted while giving report. Maybe if you actually listened, you would know the IV site with which fluids are running in, and not have to ask me 4 times. If I get interrupted more than twice, I say "if you have any questions my extension is ....." and hang up. Obviously they were not focused enough to listen to my report. We also have to get patients upstairs within 30 minutes of receiving bed assignment.
Inpatient nursing and outpatient nursing is completely different, and working both sides, I have little sympathy for upstairs. You have an empty bed, you know you are going to get a patient. I don't get angry as I receive 2 EMS back-to-back, it is the nature of the beast. I'm at work to earn a paycheck, not to complain.
You don't think whether or not the patient is A&O in the ED is worth giving in report? A patient who's A&O and then suddenly not is worth knowing.
You hang up the receiving Nurse if they ask questions?
You're actually looking for ADPIE (the Nursing process). SBAR has been so trendy lately that we try to use for all sorts of things it wasn't meant for and isn't appropriate for. SBAR for is for communicating a single change in status. ADPIE is the overall process of patient care and provides a much better structure for capturing and organizing information on a patient. Typically when someone is using SBAR for report, they're actually just using ADPIE, it's just cooler to call it SBAR.
Actually, when I say I'm using SBAR, it's because I'm using SBAR.
Thank you for all of the replies. I appreciate the discussion.
In which part of SBAR do you include medication administration?
For meds given prior to arrival, I'd include it in the Background section. For meds given in the ED, I'd include it in the Assessment section followed by the most recent vitals and pertinent lab results.
nurseEnurse
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I am a fairly new nurse also. When I began encountering this I ended up figuring out what each department was filling out during the report call. each one had a report sheet they were filling out. So I had each one send me one so I can know what they were really looking for. Most don't know I have it when giving report so that negativity is decreased. but even sometimes no matter what some people will be grumpy and cut you off when giving report. You have to politely-yet firmly let them know you will get with that and ask any further questions at the end of my report.