Good vs Bad Handoff Report

[PeachTea7]

I have been a registered nurse for over 4 years now in Med-Surg. I have given and received hand off report countless of times at this point in my nursing career.

The other day, I was just thinking about the types of hand off report I get from Night Shift nurses and I am often left with quick reports. 

Is anyone else experiencing this? 

I come to the floor… and most nights nurses are ready to go home… when I approach them to relieve them from their shift. They provide a quick report, so quick that they jump around and  don’t provide details such as patient’s ambulating status, skin problems, IV sites, last BM. When I inquired, they say: they don’t know, or they forgot to ask. 

On the other hand, when I am giving hand off report to evening nurses, I am the one looking for them in the floor. I feel disrespected because I am looking for them! Sometimes, they go into their assigned patients rooms to do their assessments and I have to kindly remind them that I need to give them report so I can go home. 

I get a long pretty well with my co-workers but I am wondering if I am being passive or not assertive at all. Because quietly frankly, I feel disrespected by both shifts in different ways. 

[Davey Do]

There's a lot of people out there who will work hard at avoiding work and are entitled.

Even if we can only be the strongest link in the chain, it's difficult when we're linked with wet noodles.

I was not liked by all my coworkers because I called them out on their duties and responsibilities. I would have not won a popularity contest, but I assured those I served received appropriate attention and I slept relatively well with myself.

[Emergent, RN]

Are the other day nurses also experiencing this? If they are, maybe you can bring the issue up to the manager. 

If they aren't, there's a possibility that the night nurses are dodging you in particular. Do you tend to be nitpicky during report? Do you put people on the spot? Some nurses are unpleasant to give report to because they turn it into 20 questions, as if they are trying to catch you on one they can't answer. 

For instance, you mentioned that they don't tell you about the IV site. I got over that after a couple of years of Nursing. It's pretty easy to find the IV site when you go in the room to see the patient.

A lot of people are passive aggressive when dealing with something that annoys them. I don't know the truth in this particular case, but it is something to consider.

[JBMmom, MSN, NP]

It's very unprofessional to be going in and doing an assessment while someone is waiting to give you report! As someone else said, if it appears to be a whole shift doing so, maybe it should be addressed at change of shift huddle. We've all had something come up at change of shift that delays us at times, but you shouldn't have to chase anyone to give or get report. 

I tend to ask very little in report, especially if it's a floor with large patient assignments, because I know that it can just be hard to keep track of everything. I check the LDA chart for my lines and tubes because sometimes nurses forget whether the patient has a catheter, rectal tube, where the IV access is, etc. As for last BM? I'll come across that in my charting as well, I don't have address it in the first 30 minutes of my shift either way. I'm not saying it's unreasonable for you to want basic information in a report, but I find that if I spend a couple minutes looking up the detail stuff, I can listen to stuff that's not in the chart. 

[PeachTea7]

8 hours ago, Davey Do said:

There's a lot of people out there who will work hard at avoiding work and are entitled.

Even if we can only be the strongest link in the chain, it's difficult when we're linked with wet noodles.

I was not liked by all my coworkers because I called them out on their duties and responsibilities. I would have not won a popularity contest, but I assured those I served received appropriate attention and I slept relatively well with myself.

Thank you so much Davey Do!

As a young nurse, I don’t think I have the right to tell other nurses how to adequately do their job or being professional… I don’t want to be the one telling others how to work and have principles. I find that people usually show who they really are through their work performance and the things they do anyway. So teaching an old dog new tricks, it’s not my cup of tea since they could be lazy. 

 

[PeachTea7]

On 10/5/2022 at 10:28 AM, Emergent said:

Are the other day nurses also experiencing this? If they are, maybe you can bring the issue up to the manager. 

If they aren't, there's a possibility that the night nurses are dodging you in particular. Do you tend to be nitpicky during report? Do you put people on the spot? Some nurses are unpleasant to give report to because they turn it into 20 questions, as if they are trying to catch you on one they can't answer. 

For instance, you mentioned that they don't tell you about the IV site. I got over that after a couple of years of Nursing. It's pretty easy to find the IV site when you go in the room to see the patient.

A lot of people are passive aggressive when dealing with something that annoys them. I don't know the truth in this particular case, but it is something to consider.

Hi Emergent! 
I haven’t asked other nurses yet. 

but sometimes* when the charge nurses hears the hand off report that I get. She usually tells me: log into the computer and make sure that the night nurses completed the Labs/orders. Sometimes, I have noticed that they forget to complete the 6AM Labs ordered. But by the time, I noticed…they are far gone. 

But, even the charge nurse has mentioned to me that I am Zero confrontational. 

I am not nitpicky at all during report. 
I am more of the type of nurse that says “I had so and so for the past 2-3 days, can I just get an update?”. 

I think you really pointed out things that by common sense I could get out of the patient’s electronic medical chart. But sometimes, just knowing ahead of time if a patient has a Mediport, central line, IV is infiltrated or patient had over 3 BMs last night goes along way and help you prepare what needs to get done first in your shift. 

I usually only asked if the patient had pain/BM/ambulating status. 
if I get a “I don’t know” answer. I usually follow by saying “it’s okay, I will look it up or ask the patient”. 

But, I just can’t help but wonder why they give me report so quick. I have worked evenings and days so I can’t blame one particular set of night nurses since I have received a really quick report from day nurses when I worked evenings. 

[PeachTea7]

6 hours ago, JBMmom said:

It's very unprofessional to be going in and doing an assessment while someone is waiting to give you report! As someone else said, if it appears to be a whole shift doing so, maybe it should be addressed at change of shift huddle. We've all had something come up at change of shift that delays us at times, but you shouldn't have to chase anyone to give or get report. 

I tend to ask very little in report, especially if it's a floor with large patient assignments, because I know that it can just be hard to keep track of everything. I check the LDA chart for my lines and tubes because sometimes nurses forget whether the patient has a catheter, rectal tube, where the IV access is, etc. As for last BM? I'll come across that in my charting as well, I don't have address it in the first 30 minutes of my shift either way. I'm not saying it's unreasonable for you to want basic information in a report, but I find that if I spend a couple minutes looking up the detail stuff, I can listen to stuff that's not in the chart. 

Thank you so much JBMmom, 

I really try hard not to ask stupid questions at all. I usually stick to only asking basic questions: pain? Last BM, skin issues? IV? Did this patient walked?

I can’t tell you enough how that small piece of quick information helps you prepare for the day.  Was the patient too heavy with severe back pain that could only use a bedpan? 
has the patient had over 3 loose stools last night? Now I need to collect a sample next time it happens! 
It really sets your day off… but if a nurse doesn’t know/remember…. I usually say “it’s okay, I can look it up or ask the patient”. 

There had been other occasions where I wasn’t told about any skin problems but when I do my assessment. I find a bad wound! 
 

On The other hand, I have been asked by a seasoned-almost retired nurse: what type of Pacemaker my patient has, or what is my patient EF in a Med surgical floor. 
those questions always embarrassed me because I honestly don’t know and she ask me when we have nursing students on the floor. 
 

[JBMmom, MSN, NP]

1 hour ago, PeachTea7 said:

On The other hand, I have been asked by a seasoned-almost retired nurse: what type of Pacemaker my patient has, or what is my patient EF in a Med surgical floor. 
those questions always embarrassed me because I honestly don’t know and she ask me when we have nursing students on the floor. 

If the person asking you was just trying to make you look bad, that's a jerk move. If the type of pacemaker or the patient's EF was a very vital piece of information, that patient should probably be on a cardiology floor or stepdown, not med-surg. And if you said the EF is 20%, how was that going to change how they manage their next eight hours? People RARELY know the type of pacer a patient has, unless it's been implanted on that admission. Some people just like to show off for students, or, they're just jerks. 

It certainly doesn't sound like you're asking for anything unreasonable. And the instances you mention highlight when "small things" aren't really small things. A nurse should be telling you about wounds automatically, if a stool sample needs to be collected that's more than just reporting last bowel movement. I hope that things will improve for you, and if you do find something like a wound that wasn't passed in report, I would circle back with that nurse and ask them about it the next time you see them. 

[JKL33]

2 hours ago, PeachTea7 said:

I usually stick to only asking basic questions: pain? Last BM, skin issues? IV? Did this patient walked?

Devil's advocate and a bit of technicality here for a minute: Last BM is not really basic information, and anyway you aren't actually asking the info in a way that would elicit an answer to the question you claim to have. "Last BM" means you're calling on the person to recite whether Joe Blow, who may not  have any GI issues, might have had a BM at 0200 or was it 0430; you're asking the person to tell you when it was. And--if what you really want to know is whether the person is pooping their brains out, "when was their last BM" doesn't answer that question, either. I maintain that this info is no more "basic" than any of hundred other questions you could want to know. For example: Don't you want to know if per chance they vomited during the night? Or happen to be having any urinary symptoms? Have they coughed up any blood? Are both of their feet warm and of their usual color? Etc., etc.

IV site: It's nice to get basic information about the type. Exact location is not report-worthy info.

Overall, what you want is the short synopsis of the admission story and where we are in the general plan of care. 

A lot of the other stuff would be nice to know. Does the IV tubing need to get changed with next bag--and millions of other things that would help your day go easier--allllll of that info would be nice. But I think you'll also find that if you just take the day as it comes to you and do your best, you can do okay. And you will be sparing yourself a LOT of angst in the end.

If you find out that a.m. labs were not drawn, you'll do that.  This is a 24-hr job and unless someone is a habitual offender who often forgets or is unable to draw their labs, we all need to just pick up where the previous nurse left off.

If the patient has a loose BM and has 3 more during your shift, you'll know what to do. If you walk in the room and the IV is infiltrated, the patient is going to need new access established. If come across a wound in your assessment, document it properly and provide the appropriate care for it. Carry on. These things are not reflections upon you and if you accept that some of this stuff is just part of providing inpatient nursing care, you'll feel better. Often these things aren't really reflections on anyone or anything other than the fact that this job is complicated. ?

3 hours ago, PeachTea7 said:

On The other hand, I have been asked by a seasoned-almost retired nurse: what type of Pacemaker my patient has, or what is my patient EF in a Med surgical floor. 
those questions always embarrassed me

Agree this is a jerk move as JBMmom already said. There is no need to feel embarrassed; the nurse who did that should feel embarrassed about needing to stoke his/her fragile ego by trying to impress a student. Seriously. When you are asked questions like this quickly say "no idea" without making eye contact and keep right on going with your report. Don't give that behavior any more attention than it is due (which is zero).

I get where you're coming from, we all wish some people would be more astute, more professional, more organized, etc., etc. But you will eat yourself alive as the years pass if you let your day be about these things. Just tell yourself you will handle what you encounter and get out there and get things done.

21 hours ago, PeachTea7 said:

On the other hand, when I am giving hand off report to evening nurses, I am the one looking for them in the floor. I feel disrespected because I am looking for them! Sometimes, they go into their assigned patients rooms to do their assessments and I have to kindly remind them that I need to give them report so I can go home. 
 

Yes, this does sound rude. If it's a habitual problem it's worth discussing. If it's once in awhile and you were busy with something else or giving report to someone else, it's reasonable for them to duck in a room to get started on a few things rather than stand and wait. Just pop your head in and say "ready for report."

I would really emphasize not looking for reasons to feel slighted. Life's too short.

It sounds like you care about patients and the quality of your work, and like you are doing well overall. So keep it up. ??

 

[Davey Do]

16 hours ago, PeachTea7 said:

Thank you so much Davey Do!

As a young nurse, I don’t think I have the right to tell other nurses how to adequately do their job or being professional… I don’t want to be the one telling others how to work and have principles. I find that people usually show who they really are through their work performance and the things they do anyway. So teaching an old dog new tricks, it’s not my cup of tea since they could be lazy. 

 

There are certain constants and truisms in life, no matter our age or experience, apply to everybody.

Being on time increases productivity and will gain respect from those who matter.

Being polite and considerate will prevail over being self-involved and entitled.

Principles should always prevail over personalities- personalities are written in water and principles are carved in concrete.

We cannot change another, but we can manipulate them to a therapeutic end. 

[PeachTea7]

On 10/5/2022 at 9:07 PM, JKL33 said:

Devil's advocate and a bit of technicality here for a minute: Last BM is not really basic information, and anyway you aren't actually asking the info in a way that would elicit an answer to the question you claim to have. "Last BM" means you're calling on the person to recite whether Joe Blow, who may not  have any GI issues, might have had a BM at 0200 or was it 0430; you're asking the person to tell you when it was. And--if what you really want to know is whether the person is pooping their brains out, "when was their last BM" doesn't answer that question, either. I maintain that this info is no more "basic" than any of hundred other questions you could want to know. For example: Don't you want to know if per chance they vomited during the night? Or happen to be having any urinary symptoms? Have they coughed up any blood? Are both of their feet warm and of their usual color? Etc., etc.

IV site: It's nice to get basic information about the type. Exact location is not report-worthy info.

Overall, what you want is the short synopsis of the admission story and where we are in the general plan of care. 

A lot of the other stuff would be nice to know. Does the IV tubing need to get changed with next bag--and millions of other things that would help your day go easier--allllll of that info would be nice. But I think you'll also find that if you just take the day as it comes to you and do your best, you can do okay. And you will be sparing yourself a LOT of angst in the end.

If you find out that a.m. labs were not drawn, you'll do that.  This is a 24-hr job and unless someone is a habitual offender who often forgets or is unable to draw their labs, we all need to just pick up where the previous nurse left off.

If the patient has a loose BM and has 3 more during your shift, you'll know what to do. If you walk in the room and the IV is infiltrated, the patient is going to need new access established. If come across a wound in your assessment, document it properly and provide the appropriate care for it. Carry on. These things are not reflections upon you and if you accept that some of this stuff is just part of providing inpatient nursing care, you'll feel better. Often these things aren't really reflections on anyone or anything other than the fact that this job is complicated. ?

Agree this is a jerk move as JBMmom already said. There is no need to feel embarrassed; the nurse who did that should feel embarrassed about needing to stoke his/her fragile ego by trying to impress a student. Seriously. When you are asked questions like this quickly say "no idea" without making eye contact and keep right on going with your report. Don't give that behavior any more attention than it is due (which is zero).

I get where you're coming from, we all wish some people would be more astute, more professional, more organized, etc., etc. But you will eat yourself alive as the years pass if you let your day be about these things. Just tell yourself you will handle what you encounter and get out there and get things done.

Yes, this does sound rude. If it's a habitual problem it's worth discussing. If it's once in awhile and you were busy with something else or giving report to someone else, it's reasonable for them to duck in a room to get started on a few things rather than stand and wait. Just pop your head in and say "ready for report."

I would really emphasize not looking for reasons to feel slighted. Life's too short.

It sounds like you care about patients and the quality of your work, and like you are doing well overall. So keep it up. ??

 

Thanks! 

[FiremedicMike, RN, EMT-P]

Man.  I would hate my life on the floor.

ER handoff report - “patient in 3 has back pain, waiting on toradol and discharge, patient in 4 had a bad COPD flare, on bipap, sats are good, waiting on a bed”