Night nurse, AM report

caliotter3 · Nov 11, 2008

If the patient was there the previous day, you might ask them to find out from the PM nurses when they give report today (by that time they should have found out for themselves). They are asking you things that night shift normally does not cover. Night shift might be able to tell them if the patient slept well, or if they are scheduled for early am labs, but not necessarily much more. If they continue to ask you for this info, you might make a habit of asking PM shift when you receive report. If the nurse asks you why you want this info, tell her you want to be able to answer day shift's questions.

rn/writer, RN · Nov 11, 2008

you might make a habit of asking PM shift when you receive report. If the nurse asks you why you want this info, tell her you want to be able to answer day shift's questions.

You should also be able to look some of these things up during your shift. ADLs should be listed in the charting. So should transferring. You might need to know that info on noc shift if you have to help him to the BR.

Here's the thing, though. It's important for you to have an overview of your patient's needs and cares. You may not be addressing some of the issues, but need to know about them so you can catch things that got missed or raise important questions when you spot inconsistencies or new problems.

You should know why your patient is on abx, even if you don't administer any of them on your shift. Why? Because it's up to every shift to evaluate effectiveness and look for side/adverse effects. You can keep an eye on lab values that might indicate a relapse or a new problem. You can note that your patient is having diarrhea and raise a question about whether it is related to the choice of abx. You can spot that his platelets are becoming low and ask whether he should still be getting ibuprofen. This is part of the journey from newbie to more seasoned nurse.

As a noc shift nurse, you are in the best position to be able to speak with residents and early-bird attendings. Most of them really appreciate a heads-up about matters that need their attention.

I'm sure this seems daunting, but as your grow in your career, it will become second nature to you to want to have the "big picture" on all of your patients. You will develop the ability to know when something is out of whack and become proactive on your patient's behalf. It's a great feeling to solve some problems and avoid others because you were alert to some little thing that needed attention.

I wish you well.

MJJFan1, BSN, RN · Nov 11, 2008

I can understand them asking those types of questions: need to know how the feed to be sure there's someone to feed them if the pt doesn't feed themselves. What i hat most is when the AM nurses want to know pt history that's irrelevant for example, what do i care if the patient had a tonsillectomy at age 5 which was about 40 years ago, that has nothing to do with this admission for Altered mental status

Mahage, LPN · Nov 11, 2008

We give a very thorough report. In some cases the day nurse will not give all the minute details unless you ask, but just as sure as you don't the next oncoming nurse will be one of those that wants to know the "color of the patients underwear." I even had one day shift nurse who became belligerent because I didn't tell her which "nare" the ng tube was in. Another was livid because I forgot to tell her the pt had IVs going and at what rate. Now we are on computer and the IV solution and rate pop up. These two both act as if it would kill them to walk in and see for themselves as they are doing their own assessment. And good gosh, one of these gals expects me to be able to recite the exact lab that was done and the outcome. I told her this morning that I always check the lab when it comes up on the computer and if anything is out of line I either notify the doctor or follow electrolyte protocal. Well she thinks I should be able to recite them to her and I told her I don't think in those terms but she can rest assured that I do review my labs and place a rounds sheet in the chart. She was also really po'd because I didn't remember anything about a swallow study being ordered a couple of days previously for today. It wasn't like she had to take the patient either, transport did. I am sure glad she is super nurse...must be nice. I do believe that it is a good idea to be thorough but I get the feeling that these gals just go on and on until they find something they can complain about. We all cringe when we see that either of them are going to relieve us.

Someday I will be super nurse too but I hope to goodness I don't ever purposefully nitpick and offer multiple criticisms rather than education and encouragement to new nurses.

Mahage

emilysmom,RN · Nov 11, 2008

Thank you for all your info. I do go over labs, and we do chart checks but from the point where someone checked the day before. I do go into HandP and see why they are there and the plan. I try to give day nurses what the goal is for the pt. I guess I should look at all meds and figure out reasons for things like ABX and odd meds.

Some nites I don't have that much time. That nite I had a trach pt for the first time and spent over 2 hrs cleaning him and replacing his cannula. And did a great head to toe assessment on him.

Does anyone have any form for a good morning report? I guess I have not had great nite preceptors they just told me what needs to be done and nothing about report. I usually pass on what I got in report and add the things I found and what meds I gave for example pain meds.

Thanks

**canoehead, BSN, RN** · Nov 11, 2008

As you get more experience the day to day tasks will take less time and you'll have more to spend on going over why the patient is there and the reason for each order. Eventually you'll be suggesting things to day staff, and they'll hate you for that instead.

Jules A, MSN · Nov 11, 2008

I usually incorporate information from the evening shift and important things that happened on the previous day shift when I'm reporting off. I try to present the clearest picture of my patient especially if the nurse coming on hasn't had them before.

TX_TeleRN · Nov 17, 2008

I would recommend starting out any change of shift reports with either "Will you be back tomorrow morning/night?" and/or "Have you taken care of this patient before?"

These questions can help you determine how to direct details of your report. If it's brand new to RN, you should give a full report irregardless to whether these are normal tasks to your shift, because you still have to communicate these needs to the next nurse who will be doing those tasks (ie., dressing changes, feeding, etc.).

I'm a day shift nurse. I find that if I open with "I'll be back tomorrow morning," the night RN writes less about daytime tasks and focuses on what she needs for her shift. So when I know I'm not coming back, they actually write down more to pass on to a new day RN. I think that's fair. :uhoh21: HOWEVER, if the census is low and there is a chance for cancellation, I ask the night RN to write down a full report irregardless whether I'm back the next day. It's totally your call...

As for antibiotics, I agree with a previous post. You should know why they are on it, as it may explain certain lab values or pt's symptoms. But then again... That goes the same with many meds we give to pts, right?

Good luck!

TX_TeleRN · Nov 17, 2008

We give a very thorough report. In some cases the day nurse will not give all the minute details unless you ask, but just as sure as you don't the next oncoming nurse will be one of those that wants to know the "color of the patients underwear." I even had one day shift nurse who became belligerent because I didn't tell her which "nare" the ng tube was in. Another was livid because I forgot to tell her the pt had IVs going and at what rate. Now we are on computer and the IV solution and rate pop up.
Someday I will be super nurse too but I hope to goodness I don't ever purposefully nitpick and offer multiple criticisms rather than education and encouragement to new nurses.
Mahage

At our hospital, we use computer charting as well, and we practice giving report in front of the computer screen with pt's chart open for proper handoff. You'll get the hang as to which RNs need/give too much details and which RNs need/give little info. I've learned to adjust my reports according to the different RN styles/personalities.

But... I am one of those RNs who believe it's important to be told which IVF/IVPB/any continuous Rx drip is going on and at what rate so that when I enter the room, I can verify if it's correct to what's ordered.

I've had my share of nitpicking RNs criticisizing this or that... I learn from them though because sometimes it makes a good point. I.e., don't be a witch about it if it's over something silly so that others don't call me a witch. Or i.e., share these learning experiences with student nurses when you precept them so that they know what to expect and how to handle these situations.

We're only human, so there will be mistakes. That's why it's important we communicate pertinent info and check each other to provide safe and quality care to our patients. Good luck!

TX Nurse 2008 · Nov 18, 2008

As a new nurse myself, I simply learn from the questions that are asked when I don't know the answer. For instance, The first dialysis patient I have had (school or professionally) the night nurse asked me where they were accessing him for dialysis... I did not know and I told her so and asked why she was asking. After a little bit of attitude (that happens alot) she explained why she needed to know... well now I know. What I have learned is to not be afraid to ask questions or say I don't know... just make sure you know next time! :nuke:

emilysmom,RN · Nov 19, 2008

Thanks for your advise. We have computer charting too but the AM nurses want the night nurses to tell them everything. And when you have 7 sometimes 8 pts there is no time for researching on all of them. I have been at least looking up H and P and finding out why they were admitted and the plan. And trying to print out a copy of it so I can read it and get past med history off of it. I am there 8 hrs many of the nite nurses are there 12hrs so they have more time to do these things.

Thanks again