How to get report without chasing call lights???

[NYNurseRN]

I work on a 32 Bed Cardiology floor, very high acuity, we are usually full and have 5-7 nurses, and 2 techs (sometimes one or none!) The problem I am having is getting started in the morning, I mean, we come in to take report (Which is written in SBAR form) and check the labs, charts, etc, but the call lights are needing to be answered and pts are needing care, the techs are taking AM vitals (We do vitals Q4H), and arent able to attend to all the lights! Some mornings, I cant even start meds and assessments until 9am (We start shift at 7am). I thought about asking my manager to have the night shift do the AM vitals so the techs can tend to the pts while we take report, but that prob wont happen....... ANY suggestions?

[qt2168]

In my unit patients needs come before getting vital signs. If a tech is getting routine vital signs and a call light goes off they are supposed to stop what they are doing and go answer the bell.

[NYNurseRN]

Ofcourse they do that, the issue is, not enough techs to answer all those needs, thus we must quit taking report and assist the pt, delaying medications, etc. (Reread the original post)

[proudnurseRN]

Are vitals 00-04-08-12-16-20? If so, I assume night shift is getting 0400 vitals? Are you wanting night shift to get 0800 vitals? Does your night shift start giving report at 0700?

Maybe a change of vital times.... 0200, 0600, 1000, 1400, 1800, 2200?

Or more techs? Our floor would have at least 4 techs for 32 pts, and maybe even 5.

[NYNurseRN]

vitals start @ 0700. More techs would be great, but isnt going to happen.

[Ahhphoey]

I think your floor is understaffed with techs! For a floor that size, my hospital would allow up to 4 techs. Of course getting additional staff is likely not gonna happen:uhoh3:

But, my hospital's answer to this problem was to stagger the shifts for nurses and techs to allow for safer handoff. The nurses shifts remained 7-3/7-7 while the techs went to a 6-2 or 6-6. This way there is staff on the unit at all times who are not in the process of changing shifts. This change was made several years ago to address just such a problem along with increased falls and issues that arose during that change of shift period.

[TiffyRN, BSN, PhD]

When I used to work a general telemetry floor, the way it was supposed to work was that the nurses paired up for report which was given person to person. The way it was supposed to work was that on-coming techs would go off to take vitals while the off-going techs would sit by the call bell and answer lights, trying to put out little fires until the nurses got out of report. That was the way it was supposed to work but in reality the off-going techs disappeared (to sit in a waiting area until time to clock out) so the nurses had to answer the lights or they just didn't get answered. Drove me nuts.

One suggestion would be to do things that way, but actually enforce that the off-going techs monitor the call-lights.

One suggestion might be for all of the techs to watch the lights during report, relieve them of those initial vital signs duty. Nurses do their own initial vital signs, I am willing to bet that even with the additional 2-3 minutes you add to your assessment time to do vitals you will come out ahead compared to how it's happening now. It would require each nurse to have their own vital sign machine or at least their own BP cuff & thermometer. One place I worked each room had a blood pressure cuff so if I could just get my hands on a thermometer I was golden.

I used to do my own vitals (and everything else techs were supposed to be doing) because I always seemed to be working at places that tolerated really shoddy standards from the techs. One place it took the regular tech 2 hours to get vitals & pass ice to half the floor (28 bed unit). I have worked some places with wonderful techs but have worked enough places with not so great ones to learn how to just do everything myself.

[3kidmama]

Can you have night shift tape record the main portion of report on the patient, so the night nurses can help answer lights while you listen to report on your patients, then follow up with a quick face-to-face "hand-off" with the night RN to ask/answer questions and get last minute updates? Figure out a way to limit the time where you are pulling ALL the RNs from both shifts off the floor.

Change the times for vital signs. I'm a heart patient myself and in and out of ICU a lot - and while I detest the 2am vital signs, I have already been awakened for early lab draws so a 6am vital check fits there nicely in terms of patient comfort. Several of my meds NEED to be given on time (within the correct hour) so med passes being that behind wouldn't be good.

[proudnurseRN]

vitals start @ 0700. More techs would be great, but isnt going to happen.

Let me re-phrase the question, what times are your scheduled vitals? I understand we (because I do my own vitals often) start vitals early, because logistics say not every single patient can be done at exactly 0800, but if 0800 is the scheduled time, then wanting night shift to start them at 0600 (which is what would have to be done for them to be able to give report at 0700) is too far off.

Essentially we have a 1 hr window, 0400 vitals can be done between 0300-0500, but we can't take 0400 vitals at 0200, or they aren't every 4 hours.

The previous poster had a good idea about having techs come in early also.

[rn/writer, RN]

Where I work, we have a folder for each patient that contains written shift-to-shift reports starting with admission and continuing until discharge. That report contains prn meds and times, IV status, I&O totals, labs and any other pertinent data. It takes no longer to write this out than it does to record it, and it can actually be quicker than getting bogged down in the needless chatter of a spoken hand-off..

One of the advantages is that you can, in a single glance, get the overview for this patient over the last several shifts/days. Another is that it frees the off-going crew to answer call lights and telephone. If there are any questions, you can take a moment to clarify with the nurse from the previous shift, but you don't have to get stuck in the quagmire of endless rambling.

We have found this written report system to be tremendously effective.

One other suggestion is that you communicate with patients to let them know that they should certainly call with requests for pain meds or assistance to the bathroom or other essentials, but that it would be of benefit to everyone if they could call before 0700 or after 0730 (or, realistically, 0745) with matters that are not so urgent. We do that, and most patients can understand that it's to their benefit to avoid report time with requests that can wait a bit.

I have worked at places with recorded report and spoken report and I prefer this written system hands down. It's so much more organized. The report is there should I need to refer back to it. And many times, as I'm writing my report for the next shift, I think of something I need to chart, look up, or complete. It's the best report system I have ever participated in.

[juliaann]

I used to be a CNA on a unit that sounds very similar to the OP's: cardiac tele floor, 5-6 nurses, qualify for 1 CNA for every 14 patients, so we usually only had two CNAs. We did q4 vitals at 10, 2, and 6. From 7-10a we did FSBS, linen changes and baths, and breakfast. Then we did our first round of vitals that usually took us until time for lunch FSBS, with 14 patients. While doing our morning vitals at 10 should give us time to be "free" to get call lights in the morning, I often was pressured to do them earlier because the nurses wanted fresh vitals for passing meds at 8. While I understand the importance of that, sometimes our patients would go 6-8 hours without a set of vitals due to taking the 10a set early and then something coming up in the afternoon and getting started on my 2:00s late. It is really hard to balance call lights and getting vitals done on time. The answer is definitely better staff-to-patient ratios, but like the OP, my hospital won't be making that change any time soon.

[sashamay]

I've been a CNA for 5 years at a variety of hospitals (mostly agency per diem work). (gunna be a nurse now in about 3 months tho! =)

Wish i had a good solution to this problem but unfortunately it seems to be a bit universal. Shift-Change sucks. lol One place i worked as staff, tracked how long call lights went un-answered (it was all electronic) and sometimes it was up to 45+min in the morning!!

The places that seem to run the smoothest that I've seen, are the ones where the nurses do their own first set of vital signs. At my last primary hosp, we had 2 blood pressure machines that worked w/out being chronically plugged in, and 1 you had to always plug in.. and also *usually* had enough pulse ox's and thermometers to go around for the nurses and/or iso rooms (usually...some would randomly disappear at times..) , and we had the BP cuff on the walls (which i thought was universal till i moved up 4 hrs north for nursing school...and work at a place that doesn't have a manual cuff anywhere!).

The nurses could get their morning BP's while they did their assessments, not only would they have them for the meds, but it virtually eliminated any back-tracking-double VS taking, med problems, timing issues, and second guessing for accurate VS (a couple nurses wanted to do their own manual BP if it was abnormal, even if i had already gotten a man. reading for them to cross reference the machine) -

Anyway, after the dayshift CNA's (and RNs) read the written report in the break room and copied what they needed, night shift would be answering lights. Then theyd hit the floor, and nights would give a brief verbal report, adding important stuff not listed. - usually quick, sometimes took a lil while when i had 15patients or so..

We'd often answer lights together during this brief time if needed, and some nurses even would answer lights together as well, cuz they were suppose to do a face-off dealy so if their patients were callin, theyd kinda kill 2 birds w/ one stone. (depending on the nurse....)

Tho inevitably, a couple certain CNA's would run off the floor the second verbal report was given..and hang out in the breakroom, even if we had 15min left till we could leave.... I was usually the one getting extra 15min of overtime here and there cuz I'm pretty anal about call-lights Lol. But that way..the nurses got their VS when they needed them, they had to go in and meet every patient anyway for their assessments...as someone else said, it takes just a couple extra min per each patients.. - and the day shift cna's can get a better handle on AM care, baths, breakfast, and call lights get answered. =)