New grad nurse needs help giving report

MamaBeaRN · May 9, 2019

Use a brain and organize it in the order you want to give report, then you just go down the row of info. I use SBAR with the "A" being my head to toe.

Guest219794 · May 9, 2019

Unfortunately, you work in an environment in which you aren't comfortable getting this coaching, which is a shame. It is in the interest of experienced nurses to help you learn this skill. Have you asked?

Also- how did you get report? Was it concise and allow you to do your job? Imitate the good ones.

When giving report to an experienced nurse comfortable in the mentoring/teaching role, tell them you are working on the skill and want feedback. There has to be some approachable competent nurses their.

If the documentation is good, I can easily take a patient with no report at all. It is what I would do if you ended up 1-1 with a critical PT, and I had to take your other PTs.

I am not suggesting no report, but boil it down.

Why are they here?

What did you do?

What needs to happen to get them out of here.

Room 22 is a 55f COPD exacerbation. Labs and X-ray were negative, she got a neb and steroids. She needs another neb and a road test- if she maintains > 90%, she goes home. If not, good luck getting a room. ABX were PO, so no line.

That would take 15-20 seconds, and would be plenty for me. And for many ER nurses. If there is something else I want to know, I can probably find it and read it faster than you can tell me. If there are other factors not charted, that might be helpful- "she rang and asked for a bedpan. She drove herself here, uses the toilet at home. I told her where the bathroom is, and she did just fine". That took 10 seconds, but helped me understand a bit about the PT.

Thoughts on other stuff that might or might not help with this report.

Medical history unrelated to chief complaint. I trust you- if it was relevant, you would have told me. If I don't trust you, I am going to look it up anyway. It seriously takes seconds if I am curious. If her chem showed a sugar of 50 and you gave her a tray, let me know.
Allergies- They are right there on the chart. In red. If she has an allergy related to something I am going to do, then it could be helpful. We often give ABX to COPD, so if she is allergic to PCN or whatever, a verbal reminder probably adds some safety.
Assessment findings unrelated to the chief complaint. "She was super tight when she got here, and the first neb opened her up enough to hear wheezes". That helps paint a picture, but if you left it out, I would still be fine. Everything else? you shouldn't have spent much time on everything else, but if you found something that is related to her ER course, feel free to include it.
IV- I don't care what it is or where it is. If it a patient who would typically have an IV, but does not, let me know.

Remember, all you are trying to do is paint a picture. Minor details that are either not relevant or charted don't need to be included.

Nurse8988 · May 9, 2019

I say come up with a system to give report. The more you follow it the easier it will get. For example what works for me is following my report sheet which starts with name, age, code status, admit date, allergies, reason there, backstory, history, events on shift, then a pertinent head to toe going in head to toe order so that it has a systematic approach ie neuro(head), diet(mouth), airway rhythm o2(chest), bm continence urine output, then finish off with iv, gtts, skin, fs, and drains. The more you follow whatever method of report that works for you the easier it will be as time goes on. Try avoiding giving info thats not necessary. Example: giving detailed info on normal bowel sounds on a patient thats admitted for say resp problems. Stating last bm is sufficient if gi assessment is normal is an example of something to exclude in report. Also give yourself time to figure it all out and find what works for you. Be gentle and kind to yourself!

Forest2 · May 9, 2019

On 5/5/2019 at 9:21 PM, JKL33 said:
Agree. ^
Complaining about a new ED nurse's report instead of coaching is unacceptable.
**Get on the assertive, pronto.**
Go to the educator and let him/her know that you are looking to improve in this area and ask for some coaching. This should involve not just discussion with made-up examples, but some help from someone who can evaluate what you are leaving out, and what you are including that is truly extraneous. In other words, someone who knows the patient a little (or can also review the chart) and then listen to your report in real time.
Do not mention that you have heard through the grapevine that people have been complaining about you. Approach the educator (or your manager or whomever is overseeing your orientation - - [speaking of which, please tell me that you still have a preceptor working with you...] - - in an upbeat/positive and proactive manner about this.

I think the staff nurses could use some education, if they don't like the report then they should help her understand what they need to know. Like when she starts onto something, just say, "ok, skip that and tell me about such and such".

Forest2 · May 9, 2019

It sounds to me like a lack of focus, because there can be a lot of things going on that side track you. Make a cheat sheet, Imagine giving report like a medic gives to nurses when they bring someone in, like on TV. Simple and straight to the point.

Male, 38, fell at home off house roof, A & O, peripheral in right upper arm, works good, NS at 100, what meds on board and why, awaiting Xray of hip, VS, that should about do it.

but that is just me, I like it sweet and short. Think about what you would want to know to be able to take care of the patient. When you get report what has bothered you that someone might have left off, or what has the previous nurse told you that you really didn't need to know?

Last week I had a patient that had multiple comorbidities, I counted how many, I named the pertinent ones and told the next nurse he has 30 different diagnosis what do you expect for 94. LOL

Don't worry , you will get better.

CanIcallmymom, BSN, RN · May 9, 2019

As a previous ED nurse, I loved a short and sweet report at the bedside. I like to know:

1. Name of pt and presenting problem/allergies
2. Brief overview of what's been done ("We've drawn labs and pt had CXR, looks like pneumonia, etc. or even "patient was just placed in this room, haven't even finished my assessment yet, they've only had triage").
3. If there are orders I need to complete if the previous shift is leaving me ("They're being admitted, but I haven't had a chance to do UA, I haven't hung abx yet, they are just waiting on the doc to write up discharge orders, etc").
4. Has report been called to floor (if necessary)?
5. Pt's general well-being--are they completely independent, do they need some assistance, or should I be calling Tom, Ben, and Jerry to come help me move pt.
6. Any abnormal assessment findings or critical lab abnormalities, also pertinent medical history to the problem.

ED Nurse to ED Nurse that has worked well for me. When I first started, what helped me was using a report sheet for my patients at change of shift. I would physically give the other nurse a copy as well, so if I forgot to mention something out loud, it is written on there.

Ruby Vee, BSN · May 9, 2019

On 5/5/2019 at 7:56 PM, Orion81RN said:
Why can't people be grown ups and state their issues directly with one another instead of resorting to gossip? If someone were giving me report and went into detail I didn't know, I would recognize they are new and tell them in a helpful educational way. I am so glad I found that there really are places where everyone isn't immature.

The issue these days is that if you try to tell new people in a helpful, educational way, they often don't see it as helpful or educational. Then they run to management and complain that they're being bullied. People don't know how to take negative feedback . . . so they just conclude that any interaction that they don't like must be bullying. We see it on this forum all the time.

Ruby Vee, BSN · May 9, 2019

Brain sheet! (And don't use a paper towel unless you're OK with sometimes using it to dry your hands. Ask me how I know this!)

There are examples of brain sheets somewhere on this forum -- maybe someone here remembers where. Start with something that goes by systems -- when you've had some practice with that, you'll be able to put it into SBAR formula. And then ask your preceptor to spend a few minutes with you toward the end of shift to help you pick out the most important things to pass on.

ER nurses don't care about the spouse's pudding choice, but if you ever transfer to ICU that does get passed on. Sadly.

Orion81RN · May 12, 2019

On 5/9/2019 at 6:04 PM, Ruby Vee said:
The issue these days is that if you try to tell new people in a helpful, educational way, they often don't see it as helpful or educational. Then they run to management and complain that they're being bullied. People don't know how to take negative feedback . . . so they just conclude that any interaction that they don't like must be bullying. We see it on this forum all the time.

Not receiving feedback well is an issue but it is not THIS issue. There is no excuse to assume someone can't take constructive feedback so instead gossip. "They might act unprofessionally so I'm going to do it first." Yeah, no.

Ruby Vee, BSN · May 12, 2019

1 hour ago, Orion81RN said:
Not receiving feedback well is an issue but it is not THIS issue. There is no excuse to assume someone can't take constructive feedback so instead gossip. "They might act unprofessionally so I'm going to do it first." Yeah, no.

Whether someone takes constructive feedback well or not, they are entitled to the chance to take it well, or to learn to do so. I'm with you there. But I know and awful lot of people IRL who have been burned by orientees getting much-needed feedback who then go crying to the manager calling the preceptor a mean old bully who made them cry. Some managers see through this feces. Others, unfortunately, do not.

EllaBella1, BSN · May 12, 2019

My one tip in addition to what has been mentioned here is to always make sure you start with name, age, code status and allergies. To me those are the 4 most important things in report. Name and age to make sure it's the right patient, and my absolute biggest pet peeve is when a nurse can't tell me a patient's code status and allergies. If someone is giving me report and has no clue, I'll stop report and log in to the computer in the room to check. I've had patients code during bedside report before- it's not worth taking the chance.

Other things you absolutely should know: What the patient's current drips are, any testing/labs that are pending or will need to be drawn, current oxygen/IV access. And a personal pet peeve as an ICU nurse- if the patient is intubated I want to know their tube size, and what marking it's at and at what landmark. Bonus points if you're able to say what the last ABG was and what(if anything) had been changed since then. This saves me the trouble of having to get a stat chest X-ray on a patient who shows up from the ER with an ETT at 19 at the lip, or having to dig through the chart to see if an ABG with a huge negative base excess had ever been addressed.

I want to be able to take over where you left off, not have to piece together what you did already as I go. I will say I'm saying all of this as a nurse that would get report from the ED, not an ED to ED report.