importance of getting report before seeing the patient

nursej22, MSN, RN · Feb 16, 2010

I am sorry that you got in trouble, although if there is no specific school policy about report before seeing the patient I am not sure what your instructor is after. As a student we charged with meeting the patient and asking permission before obtaining any information on them. And our nursing assistants gather vital signs before getting report.

(Vent Alert) That being said, about a year ago our hospital changed report from oncoming nurses gathering from the computer and chart for 20 minutes with 10 minutes left for face to face between nurses to entering each pts room first to introduce oncoming and then gathering info. IMO this creates chaos as the 2 shifts are verifying high risk gtts like heparin when you have no idea why the pt is on it. The patients and/or families have questions but the oncoming RN knows nothing about their status or plan of care. Plus even though this meet and greet is only supposed to take 1-2 minutes per patient with the rest time for gathering info, the offgoing shift will take 5-15 minutes describing each pts complete course of stay, labs, imaging, and their shift in excruciating detail. But this is for 4-5 patients. And admits, transfers and report from other departments starts at 15 minutes into report. Did I mention chaos?(end of vent :))

The patient deserves care from someone who is familiar with their diagnosis(es), plan of care, restrictions, and any outstanding or critical issues. As a nurse when you have report first you are able to formulate a plan of care, critically analyze the clinical picture and be prepared for unforeseen occurrences. You have a chance to evaluate and prepare any educational or cultural needs and organize and prioritize your work. Unfortunately many codes occur at shift change and you won't have time to dig through the chart for info for the code team. They will need history, labs, meds, etc. immediately to provide the best chance of survival.

Best of luck!

roser13, ASN, RN · Feb 16, 2010

How about the possibility that after you introduce yourself as the patient's nurse, the patient asks you a question about their treatment or condition....not exactly harmful to the patient to say "I don't know" but not exactly confidence-inspiring for the patient.

"Gee, she's my nurse and she doesn't know a thing about me!"

Then there's the always the possibility that something could be going wrong with the patient when you walk in the room. Say a code was called (extreme example, I realize) and you would be called upon to relate the patients condition/history/meds and you wouldn't have a clue.

DirtyBlackSocks · Feb 16, 2010

Aggressive pts, risk of infection to yourself or the pt due to conditions, impersonal experience between yourself and the pt due to lack of background on them...

How unprofessional would it look if you walked in to care for some one and did not know a thing about why they're in there? There are tons of questions you cannot answer without prior knowledge.

blessings2nurses · Feb 16, 2010

Another issue to consider is that once you go into the room and introduce yourself you have established a patient relationship which you are now accountable. Nine times out of ten (or more) this would not be a problem however, say you would need to opt out of providing care for moral reasons. For example, a Jehovah witness is not required to care for a patient receiving a blood transfusion, etc. If you have not established a relationship, it is easier to opt out following your organizations policy in how to have your assignment changed.

Good luck!

rn4ever? · Feb 16, 2010

Getting report is essential for the reasons that were already mentioned here, but apart from that, let's say in the Psych unit for instance, it will give you a clear picture of what to expect, what to watch out for, what to be careful of, and how to handle and respond to patients appropriately. Sometimes we hear in report that a patient prefers a staff member of the same gender because his/her history/experience as a child warrants it. Or, the Charge RN doesn't assign a male staff to a certain female patient because she is being inappropriate and has a history of false accusations on male staff members. Or it could be as simple as the patient is going for testing and was on NPO and since you didn't know that piece of information and she asked for some crackers because she was hungry, you hurriedly and gladly gave it to her. Those are just some examples. You can think of some more instances that could be observed during your clinicals. Maybe your professor wanted specific scenarios. Also, she most probably asked you to write about that topic so that you don't forget the lesson from that incident. But then, people make mistakes and the important thing is that you learned.

ukstudent · Feb 16, 2010

Don't forget that as a student you have been given permission to follow a certain nurse for the day, she/he has agreed to have you be with them. The night nurse has NOT. Whether it is save for either the patient or yourself to go into the room, LEGALLY you have no right to walk into that room.

Think of it this way, you have a patient or set of patients that are your responsibility during your clinical. You are not allowed to just go in and start being the student nurse with other patients. Until report is given, even if you are going to have this patient, it is not yours yet.

By going into that room prior to report you put at risk the night nurses license and your clinical instructors license. This might be the MORE your instructor wants you to acknowledge and write about.

CoffeeRTC, BSN, RN · Feb 17, 2010

Different world in LTC, but sometimes I walk in after being off for a while and might answer a call bell if I see if going off for a while and I'm waiting for report.

I just explain that I haven't got report yet, but can I help you. Simple and then I go get help if it is something else.

ONCRN84 · Feb 17, 2010

I'd suggest if you find yourself in this situation, start looking through the chart before you pop in on the patients. Check out labs, history, code status, plan, etc. Then you have at least have some background on the patient even before you get report.

Sometimes in the ICU we assume patients during an emergency and don't get a complete report. I always do some research before I ever go see patients and ideally I'd get a face to face report, even if it's brief.

jjjoy, LPN · Feb 17, 2010

I'm not sure how your instructor gave you feedback on this but I would've congratulated you on wanting to get going and not just looking at waiting for report as an excuse to do nothing. Then I'd point out that in actuality it's not a good idea. Perhaps I'd ask you to think about why it's generally not a good idea & write that out as a short essay. I'd also likely ask what you could do instead of heading straight into patient rooms when waiting for report. And I'd likely discuss the issue with the whole clinical group, addressing issues such as how long is too long to wait and what one could do if the wait becomes too long.

It seems like perhaps the assignment sounds too simple to write an essay on. Can't it be summed up pretty quickly as in your example above "by not listening to report from the last nurse we are not only missing an important piece of patient care, but we are also putting the patient at risk ( since we might be missing a vital piece of information that can affect the patients life)"? In that case provide examples. And reviewing other nursing learning materials may help you figure out how you might better express the thoughts. Notice that most use pretty simple sentence structures. Avoid sentences that go on and on and check your spelling and grammar. This is a formal written assignment, not free flow thoughts. You may not need that reminder, but since your note is written very informally with many mistakes I thought I'd mention that just in case.

In case you're not aware, charge nurses usually should be at least minimally familiar with all of the patients on the floor and aware of problems such as a nurse who is too busy finishing up to give report on time.

Tait, MSN, RN · Feb 17, 2010

I have had the rare occurence where I have stopped to silence a pump, realized it was my patient, introduced myself and then got bombarded with questions about thier care, status and meds.

Rather than stumble about and say "umm I haven't actually gotten report on you yet" I just keep my mouth shut.

I would probably discuss the importance of building confidence with the patient by having all your ducks in a row before heading into the room. I often even look up when the patient can have their next pain pill if I am waiting for report in case they ask me.

Best of luck!

Tait

mappers · Feb 17, 2010

I'm not sure what the big deal is. There would be certain situations where going in first before knowing about the patient is a problem, but the majority of the time, I don't see how it is. (I'm in med/surg). If I'm waiting on the night nurse to get report, I will sometimes go into a room and introduce myself. I simply say, "I'll be your nurse today. I will be getting report from (night shift nurse) in a few minutes and then I'll be back to see what needs to be done. Is there anything I can get for you right now??" If they ask for coffee and I think they might be NPO, etc, I'll say, "Let me check to see what your diet status is first, then I'll see what I can do." Usually we have signs up if a pt is NPO or on a fluid restriction or in isolation, etc. I have a kardex with that info, I've already looked them up in the computer. It really isn't a big deal the way our unit is set up.

And it is NEVER a problem to say, "I don't know, but let me check on that for you and I'll be right back." NEVER. That instills more confidence than making promises you can't keep or lying.