New grad struggling with receiving/giving report

[dann023]

I am a old 'new grad' graduated last year May. Recently started on a stepdown med/resp floor. lots of unstable/critical patient. I get 3 weeks of orientation, and I am really struggling right now.

one big problem I having trouble is remembering reports and getting a big picture together after receiving reports. I feel after received report, I should be able to retell the report to another nurse right after or give the CNA a brief report but I can't!

often I feel I am barely having time to writing down report, and after report is done I still don't really know why the patient is here, what has happened, etc. All I can remember is the not-so-important things such as pt has a PIV at left hand, family was at bedside..uggh! but the big picture - why was the patient first admitted, why is pt still here? what are we treating? what's the plan of care? I can't remember them!!!! I am so frustrated with myself. And after getting report I actually feel MORE anxious & panic. I know I can read up H&P, but I really want to be able to just get a big grasp of patient during report, and use the H&P to fill in more detail information.. not the other way around. I know you can ask the nurse to repeat, but I feel I literally need them to regive the whole report.

The inability to put a big picture of my patient together stop me from prioritizing things I need to do for the rest of the day. I am really worried and wonder if I really gone through nursing school at all..

I tried to communicate this problem to preceptor a few time, but she doesn't seem to understand what I mean, I guess no one else had the problem before..

I was mostly an A student in nursing school, I have struggled with report before in school, but never this bad. I could at least give a little bit of the story after getting report. I wonder if it's because I just need to adjust to the clinical more? Even though I graduated last year, my last actual Adult med surg was 3.5 years ago.. Because I did my preceptorship in Pediatric and my last 1.5 year of school we were doing community health and Ped/OB, etc. many terms, dx, medication, treatment are all so new to me.

I feel so overwhelmed, and out of place. Any tips/advice?

[Double-Helix, BSN, RN]

You need to write down what you are hearing in report. Use your computer to make a brain sheet template with spots for all the important information that you need to know during report. There are several examples of brain sheets on AN. Before each shift, print off enough brain sheets for each patient. When you are getting report, fill out the information. If, at the end of report, you are missing information, ask the nurse to repeat that section. When you give report at the end of your shift use the same sheet so you don't leave out any information during your report.

For example, your sheet should include:

Name/Initials

Diagnosis

Doctor's name/number

Significant symptoms

Ambulation status (independent, total care, etc)

Labs/Tests due

IV's

Wounds/Drains/Tubes, etc.

If you come up with a system to organize yourself and to concisely write down the patient information during report, you'll be able to refer to the brain sheet if you forget something. You don't need to remember everything about the patient off the top of your head. You do need to be organized and have a way to quickly access important patient information throughout your shift.

[amoLucia]

Are you using some kind of a cheat sheet??? There's several references floating around here on AN. I used my own 'daily' sheet in LTC and I worked off that (which was built off my updated 'master' sheet). Seemed to work well for me and every one who borrrowed my

'master' for report. Had the stuff that I thought was important to follow & communicate.

[elprup, BSN, RN]

Research shows it takes upwards of a year of experience to "get the big picture" and stop being so task orientated. Everybody says it will come with time...but it is so frustrating that a new/old grad is just expected to know.

[SarcasticLVN]

Whenever I get a new admission I always take a few min to scan the chart just for the basics.. I work ltc so most of my residents are permanent there.. I am lucky if I get in a report on a N/A if they are ambulatory or whole/crushed pills, always end up looking things up. After a while you will get used to it. There are a lot tasks you are learning and with you being new it's just going to take time.

[RNRAC]

Hey...I am a new grad, still looking for a job so I cant say I really know what you are going through...but I do remember a nursing mentor telling me that I should try to give and take report as much as possible while i was on preceptorship, because in her experience, that is one of the things that new nurses really really struggle with. And I tried to do it as much as possible, and I always messed up. Im no dummy either, it just is a very difficult skill to learn. I think a cheat sheet is a great idea for when I start working, so thanks to all that posted them!

Im sorry you didnt get any good feedback from your preceptor but please know that you are not alone in this area.

Best of luck!

[amoLucia]

Another thought - try to tell them what YOU want to know so you can do your shift.

I classify information into 3 groups .... first = absolutely NEED TO KNOW and can't do my job without info

second =NICE to know about interesting, semi- important stuff but not critical and I can manage if I didn't know about it

third = TMI, who cares, yeah ok ...keep moving, yada yada yada, wahwah, wahwah...

Tell them what you'd like to know & PRIORITORIZE

I work 11-7, get report from 3-11 and report off to 7-3. Example - pt's pink eyeglasses missing = #2 info. Safety risk but so is everybody and she doesn't get out of bed NOC; I'll let CNAs know.

Activities had a bingo and she won a pair of knitted booties = #3 info. OK

She fell about 11 am = #1 info. Post incident, wonder why. Communicate to CNAs & double check safety alarm.

Hs fingerstick was 70; info = #1. Maybe earlier fall cause, not eyeglasses. Did she get hs snack? did she eat dinner well? what's her meds? I just might do an early fingerstick as a baseline when I check her post-incident..

Off my master sheet, I know this pt and what I to want to hear in report. I know I'll repeat her status post incident and her sugars 3-11 & 11-7; she's moving, turning in bed without problem, no pain, no bruising etc. Safety alarm on. No eyeglasses found. And I repeat the admission data as nec

[tigerlogic]

I'm currently a float CNA who often changes floors after the first 4 hours (and a nursing student), and I recently started taking control of the handoff and just asking the questions that I needed answers for and kinda cutting off the offgoing CNA when it was info I didn't need. Granted, it's a different position and different information, but the change for me was directing the hand off rather than receiving the hand off. Try it. You might be surprised what happens when you ask the questions you need to know rather than just listening to everything they tell you.

[Esme12, ASN, BSN, RN]

You need a good brain sheet.....here are a few.

Feel free to change/adapt them for your needs hey are not all mine they are a mixture of many contributors especially Daytonite....

mtpmedsurg.doc] 1 patient float.doc‎]

5 pt. shift.doc‎]

finalgraduateshiftreport.doc‎]

horshiftsheet.doc‎]

report sheet.doc‎]

day sheet 2 doc.doc]

critical thinking flow sheet for nursing students]

student clinical report sheet for one patient]

[Guest343211]

You need a good brain sheet.....here are a few.

Feel free to change/adapt them for your needs hey are not all mine they are a mixture of many contributors especially Daytonite....

mtpmedsurg.doc] 1 patient float.doc‎]

5 pt. shift.doc‎]

finalgraduateshiftreport.doc‎]

horshiftsheet.doc‎]

report sheet.doc‎]

day sheet 2 doc.doc]

critical thinking flow sheet for nursing students]

student clinical report sheet for one patient]

^This. Good stuff. You have to develop a system. Also, you might want to figure out what the typical admits are for your floor--or break it down to those clients that are most regularly admitted--cardiac players, renal players, etc. On your off time, use your patients (keep the names and such off of the information--HIPPAA--you know) as case studies and read up on these kinds of illnesses, the typical labs, treatments, meds, extremes--chronic versus worst case scenarios. It is on YOU to continue to learn. School will only teach you so much, and so will orientation and precepting. So you have to go the extra mile if you want to be excellent at what you do. As you learn, you will become more comfortable with the various pathophysiologies and treatments and complications, lab data, meds, etc. It will take time, while you are working, and after you are done working. This to me is part of how I can detect someone that will be excellent versus someone that just gets by or is OK.

Decide for yourself to be excellent, but know that it will take time and vigilance. So you will also have to be patient.

Talk to experienced nurses, docs, RT's etc on the particular kinds of patients, but also read and learn about them on your own. As you are new and/or learning, you have to figure in more time to do everything. Yes, it's a pain to look up meds and not just give them; but go the extra step and look them up. If time is an issue for say a patient that may be going down the tubes, or someone you are worried about, don't be afraid to get help and support.

When you take report, prioritize. Ask questions and don't worry about what others think. You are trying to put the patients first.

When you get time, try to go through the charts, not just chart checks--these are important, stuff gets missed--but look through history, lab values, EKGs, etc, any pertinent data, and what the physicians plans for the patient are.

You will get it. Hang in there.

[ADN2B]

Thank you sooooo much. I had some difficulty saving them because it said, "read only."

[dann023]

thank you all sooooo much. Today, I used and modified one of the brain sheet and it helped more! I will definitely try to ask more question - and thank you for reminding me, it's about the patient, not me. I have to admit I was intimidated and often worry more about how other nurse will perceive me instead of think patient first. and I will definitely be doing my homework.. I use to hate careplan so much, but now I wish I have the opportunity do preplan.. ha... anyway, thank you all so much again :) they are great tips/info and thank you for all your encouragements and being supportive!!