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 love how my ER gives report. We fax our charts to the floor, call the charge nurse to let them know it has been faxed, and that is that. We still call report to the units, but overall the faxing thing is AWESOME.
I am really trying to pay attention to what I am saying in report and how it is received. ANOTHER BAD ONE last night! It's like I can just plan on my report being crappy :-( I feel like the nurses on the floor are just out to ding me for this, that, and the other. Last night I held the patient for 5 hours. I gave Zosyn and Tobramycin, but had not yet given the Vanco. The nurse asked me THREE TIMES why I hadn't given the Vanco yet. I told her I had only gotten the meds from the pharmacy a few hours prior and had worked as quickly as I could. She kept insisting Vanco was in my pyxis - why did I have to wait for it from the pharmacy? VANCO IS NOT IN MY PYXIS!!!
Oh m'gosh I am so flabbergasted. This is like the other day when I ran a code chill and put the pt on the jelly roll cooler but did not put the patient on the blanket or with the cap. The ICU nurse looked at me laughing and said, "No one taught you that?" NO!!! No one taught me that!!! Actually, our protocol in the ER is to get the patient on the jelly roll and get the patient on the floor. The cap and top blanket go on when the patient gets to the FLOOR!
I am just starting to feel flabbergasted. These nurses on the floor have NO CLUE what goes on in the ER, but are completely condescending! I am glad they are so psychic that they know exactly what meds are and are not in my Pyxis!!! ???
Nurses do eat their young, and they do it in report. I cannot wait until I am a more seasoned nurse and I can stand up for myself better. There is no reason for the high-and-mighty attitude. Why do more seasoned nurses forget what it is like to be figuring it out. I feel like I am panicking constantly about what I may have forgotten to do or missed. I am juggling 20 things, but I seem to not be able to keep up with the expectations!
One thing is ... I will NEVER be a jerk to a new nurse like these nurses are. I would like to be an educator and a leader, and I can tell you I will never treat a new nurse the way I have been treated. I have very little respect for these nurses, and I hope they never end up in a leadership role.
When I'm getting report from anyone, ED, another hospital or nursing home, I go down my report sheet and ask the questions that I need to know and need to pass on to the next shift. I also ask pertinent past medical history and any other information that is needed for me to care for the pt. At times I will ask (of a drunk non-compliant pt) why the hell is he coming to the floor lol.
You don't have to wait until you're more experienced to stand up for yourself. Do it now. If your pyxis in your er doesn't stock xyx, you can tell them that. "YOUR floor pyxis MIGHT stock 1gm of Vanc, but the ER pyxis does NOT."
I know different units stock different meds. In my facility, peds and oncology are the only 2 floor units to stock 2mg dilaudid syringes.
You don't have to wait until you're more experienced to stand up for yourself. Do it now. If your pyxis in your er doesn't stock xyx, you can tell them that.
Very true.
Don't get emotional or personalize things -- stick to facts, and don't take on anyone else's perceived "feelings" that are not yours. There's no Vanco in the Pyxis? ... then there's no Vanco in the Pyxis. It's not an emotional issue. What is the nurse from another unit going to do -- *insist* that it is in your Pyxis? Make it magically appear?
There certainly can be issues giving reports to different units, and not all nurses play nicely in the sandbox ... but whether or not you react emotionally to this is entirely up to you.
Can you listen to a co-worker giving report and mold your own style off of it? That is what I did as a nursing student precepting in the ER I now work in. I have learned to tweak it based on different floor's expectations (focusing on rhythm for a tele admit or neural status for a stroke pt) but I still use basically the same outline I originally learned.
If you use ISBAR you should have no problem at handover. Also only cover critical info, what orders are outstanding, obs times etc. the rest should be on the patient chart which should be checked each time obs are done incase the doctor has added orders....just like a care plan in an aged care facility should be checked each time.
Yesterday at work ... I admitted 3 patients - and I gave 3 WONDERFUL reports :-) The nurses who received the reports were wonderful :-) THANK GOODNESS! I definitely needed a break from crabby co-workers. I am currently finishing my BSN through Grand Canyon University ... and I am reading portions of a book called "Radical Loving Care" by Erie Chapman. The concept of the book is a discussion on how we can provide loving care to our patients, and also to each other :-) Emphasis on the "each other." Let's build each other up and look out for each other.
Namaste, peace, and light.
"There is a power in me to grasp and give shape to my world." - Rainer Maria Rilke
Hi it's Armygirl from the ER to give report on Pt Smith- who am I speaking to? Hi Suzanne - how's it going up there tonight? Cuckoo? Yeah here too, hang in there.
This is Mr. Smith 75 yo male AOX3 arrived from home via ambulance, 4 hours ago c/o chest pain radiating to left arm. He's admitted to TELE for r/o ACS, 1st troponin at 15:45 was negative second one ordered for 23:45, no CP, no SOB at this time, sinus rhythm @85 bpm on the monitor, skin intact, walks to bathroom with assist, his wife's at the bedside, she's normal!
He's got a history of CABG in 2005, he's got 2 stents, Hx of diabetes and HTN, no known allergies, he's got a 20 gauge in the left AC. Vital signs: 158/78, HR 85, temp 98.2, O2 100% on room air, RR 18, finger stick one hour ago 121.
We gave him ASA 325 PO at 1600, lopressor 25 PO at 1600 and that's all we did for him. He can travel by wheelchair (our floors order the transpo).
If Suzanne starts asking me stuff like "What was his potassium?" or "Does he have orders?" I say I'd have to look up the K (just like she would) and "No stat orders at this time." If the pt's a PIA I try to make light of it but let the RN know, and if the Pt is a dreamboat I also let them know - I think we all benefit from knowing what's coming our way!
I agree ICU report is more stressful, because naturally the Pt is very sick and potentially had a boatload of interventions in the ER, drips running, intubated, resuscitated, etc. And generally the ICU pt (ideally!) moves quicker to the unit than Mr. Smith whom you would already have a handle on his overall status before giving report. With the ICU Pt you have less time to process all that you did for the Pt before giving report. I always just try to gather myself for a minute prior to giving report so I have everything at my fingertips, but sometimes transpo happens so fast my report sounds a bit disombobulated - what can I do, I'm not a machine!
All stat orders written in the ER have to be accounted for so if I have a pt who is getting abx therapy and I haven't hung the vanc yet because something else is running I just let the RN know and I pull the vanc (or whatever med if we have it) from our pyxis and put a Pt label on it and send it up with the Pt. Our floor RNs always appreciate that because otherwise they are waiting on pharmacy to deliver. Drips I always get started in the ER, even if it means I hold the Pt a bit longer - I might call and give report and say I'm hanging the heparin drip as soon as we hang up as ordered at X units/hr if there's any problem I'll call you back. And they will see all the documentation anyway.
My favorite report is to the OR - those RNs cut right to the chase! They don't want a single superfluous detail, they don't care how the Pt arrived in the ER or from where etc! They want last PO intake, current status, VS, allergies, labs drawn (wow they know how to look up their own results!!!) access, consent, and make sure that Pt is stripped naked under the gown before wheeling him over! That's it "click!"
I'm a relatively new nurse too and like all things giving report gets easier. Try not to take anyone else's attitude personally. I give people the benefit of the doubt, they may be as stressed out/tired/hungry/new/unsupported/ overwhelmed as I am at times.
Sounds like you are doing just fine...and you'll get better shift by shift!
Anna Flaxis, BSN, RN
1 Article; 2,816 Posts
I've never forgotten a lesson I learned as a new nurse: You should be able to take your own assessment to the bank. Period.
I don't care what the ED told you.
I don't care what Cath Prep & Recovery told you. I don't care what the ICU told you.
I don't care what the previous nurse told you.
What did you observe with your own eyes/ears/touch? THAT's what counts. PERIOD.