I Suck at Giving Handoff Report

[Kp1]

Hello, I'm a new grad nurse of 3 months and my handoff reports I feel suck. I work Night Shift so you would think I have plenty of time to relax and look up more info on my patients.

Something always happens to where my plans to sit down and look up more info/updates on my patients fails. Either a patients IV blows, I get a new admission from ER, which btw at my hospital, you don't get report, most of the time you get a txt from transport telling you that the new admission is coming to your room. Other times the patient needs you to turn them or assist them in going to the bathroom, which btw I know I can delegate to the CNA but sometimes they can't be found or they won't reply back and you feel bad telling the patient to wait and no one ever shows up.

I've tried to prioritize who to assess first, give meds to first as well but small things as mentioned occur sometimes all at once. Sometimes I get multiple patient calls on my mobile at once. Not to mention I get calls from drs or lab which I feel delays my time management.

I'm really trying to better myself each day but I feel I fail and I look so bad giving report to the oncoming nurse, I feel I look neglectful as a nurse or don't really know my patients and it looks so bad. IDK what to do, I feel I'm not getting better at report and multi tasking. Am I doomed to suck or is it something I'll get better at?

[JBMmom, MSN, NP]

You will TOTALLY get better at it, it's all about time and organization. It starts with getting report in an organized fashion so that when it's time for you to GIVE report, there's no need for looking stuff up, because as you have found, you will rarely have time. When I was on the med surg floor I made myself a template, it had a lot of check boxes, but it minimized writing. Foley? check box, IV access? That was a line where I wrote PIV LFA, for example. Get a patient sticker instead of writing name, room and admission date. If you're not allowed patient stickers, find a quick shorthand for yourself. There are many examples of "brainsheets" on the internet, you can find one and use it or personalize it to your style.

Have you gotten feedback that your reports aren't good, or is it just your perception that you're having trouble. You may be doing perfectly fine in the opinion of other people, you're just being hard on yourself. ALL of nursing improves with time. The muscle memory on procedures and tasks will take over, you will develop a better understanding of certain interventions or medications go with what diagnoses and then things will get clearer.

I always gave report in the same order so it became routine to me. Name, date of admission. RELEVANT medical history (Don't care if they had their appendix out at age 11), presenting symptoms and diagnosis. Then, what are the most important things that have happened so far, and what should the oncoming nurse expect to happen on their time. Then the little stuff, oxygen needs, diet, OOB orders, IV access, other things like foley, fistula, dialysis catheter, antibiotics, etc. And on med surg everyone wants to know when they last pooped. And if someone asked me something I didn't know, I would just straight up answer "that didn't come up on my shift, but I'm sure it's in the chart". Don't start apologizing for not knowing nitpicky things. You can't know everything and giving report to some nurses is just a pain in the rear. 

Give yourself some grace. You're new, it's busy and it takes time. You'll get there!

[Been there,done that, ASN, RN]

It appears that you are on a very busy unit. Three months of experience  is not enough to excel any where. Use SBAR to provide a concise report.

 Hang in there... it will get better.

[toomuchbaloney]

Thank you for reaching out.  You've clearly started on a busy unit, you can do this.  Keep your head down.  If you don't have mentor relationships ask your unit manager. Work on developing good work habits. In 3 months you'll likely feel much better.  You might have moments of confidence and comfort by this time next year.  Really work on SBAR.

If this were a poker game, I'd bet on you. 

[Amanda Styron, ASN]

Hang in there. It does get better. I started on an extremely busy unit and felt the same way. Eventually things got better. This is not to say that sometimes even now when I'm giving report I think to myself, "wow this is a crappy report".  Don't give up. You've got this!!

[JKL33]

Excellent advice above. A few more things to think about:

• Awareness of one's weaknesses (in this case directly related to being new) is a good thing but can be a double-edged sword. Please don't get down on yourself for where you are in the learning process--we have all been there. Having decidedly negative/self-deprecatory internal dialogue about it is overall harmful. Trust that you're going to be okay and just keep learning. The other thing about areas where we feel weak is that they tend to get more "air time" in our own heads. Make a point to reflect briefly on the things you learned that day or the things that you executed well. In this way you balance your own thoughts/feelings about yourself in a healthier way.

Kp1 said:

Not to mention I get calls from drs or lab which I feel delays my time management.

• These are not really interruptions--they're very much a part of what the job is. They're a direct part of taking care of patients. This example presents another opportunity to change one's internal dialogue. When you think of these as interruptions the natural reaction is to feel "behind" after handling them and put them into some negative category where they can only become increasingly frustrating as the days go by. While you need a very general game plan for each shift, it is also imperative to (choose to) handle what is immediately in front of you, then move on--rather than becoming internally more and more anxious at each "interruption," not doing a great job of handling any of it, and then feeling bad about it after the fact.
• Becoming completely jaded is never good, but being REALISTIC is good and is not "being jaded." So with that I say that as you grow into your new role, it isn't a bad idea to remember that: If society and our monstrous healthcare corporations wanted you to be able to handle this insane and 100% unrealistic amount of multi-tasking with nary a bead of sweat and no one ever having to wait for anything, staffing would be much, MUCH different than what it is. You will never be able to right all wrongs. PERIOD. You are not an angel or a saint or a magician; you cannot accomplish every silly directive handed down nor meet every need every day.
• So focus on learning to be efficient at doing your best; that is all you can do and also all that can be rightfully asked of any nurse. It would make my heart so happy to see a new generation of nurses who balances conscientiousness and hard work with refusing to (figuratively) kill themselves by trying to take responsibility for (or make good on) the consequences of others' poor choices.

 

[Music in My Heart]

I personally believe that verbal report is grossly overrated... and a lot of nurses seem to take great joy in asking numerous detailed questions that are beyond the scope of a basic SBAR handoff... Once I got comfortable saying, "I don't know...," the whole process became a lot easier.... some nurses expect you to recite the the whole chart...

My view is that anything that is charted and easily accessible is beyond the point of report...

It does become much easier as you build confidence and begin to form mental pictures of your patients. Still, don't worry too much about it... hit the big items and let them find the rest for themselves...

Just because another nurse isn't skilled in culling information from EMR doesn't mean that it's on you to recite every detail on every patient.

[Tweety, BSN, RN]

Don't beat yourself up.  Most likely the person handing off to you didn't have time to dig into the chart, so don't expect that of yourself if you don't have that kind of time.  Patient care comes first.

I usually report diagnosis, history,  head to toe, pertinent labs on my time, abnormal vitals, IV access, discharge plan etc.  My template is organized with this stuff on it and if I start at the top and go to the bottom, they have what they need to take care of the patient.  If I get "one of those nurses" that ask detailed questions I'll just say "I don't know" and not feel bad.  If they want to know what their Creatinine was two days ago, they can look it up.

It gets better.

[upt0wntruths, BSN, MSN, RN, CNS]

OK so it sounds like many nurses have already given you some great advice so to limit redundancy... 

Here's what I did as a new grad in ICU. Once I started practicing, even the internist on rounds gave me a compliment! 
 

-I went back to the basics (made sure I understood my meds, diagnoses, & equipment settings like IV pump rates & vent settings. When you truly take the time to understand you patient's illnesses, it will start clicking why you're treating them with this & that... and you'll be able to give a general summary, or go into detail as needed to balance out your time/report 

-after each work day, I either kept my report and scratched out patient identifiers or wrote down things I didn't understand and looked it up when I got home. I knew it before my next shift. 

-YouTube. I looked up the expectations for MD & RN reports. What is the oncoming nurse wanting to know? What would be helpful? 
 

-I started taking notes and giving report in this format to myself in the mirror... and then to teddy bears... and then to my boyfriend at the time. Over and over again. I pretended I was in rounds, or I was in front of my preceptor (these moments gave me the most anxiety) 

- SBAR format. I came in earlier (this is controversial depending on where you work) to look up my patient assignment and get a real good understanding of my cases before hell broke loose at 7:00am. I knew what needed to be done and compared that to the report I got to the nurse I was relieving

-throughout my shift, I did things early when possible and planned out my day, things don't always go as planned so don't fret! But typically we have some time to do things before they're actually do which helps with time management. Limit side conversations, look at what the resource nurses do to get done quick and ask for help when needed. Cross out what you finished and keep your head up high when when you have to tell your relief that couldn't get everything done. Just make sure you prioritize stuff like insulin & other meds, changing an IV site although annoying can be done by the next shift.

you'll find your sweet spot. Keep going, you're doing great. Pressure makes diamonds. If you haven't given up, you haven't failed. Keep that confidence alive