Shift change/report problems (long)

dinkymouse · Aug 30, 2005

I work in LTC but have done med/surg. Where I work now has about the same problem. Stuff left for the next shift, not getting told important things about pt., Like they have vomited everyday for over a week and nothing was reported or done. Pt having diarrhea for over a month with order for Lomitol that wasn't given because no one person knew of all the times she had it. We use CNA's and getting report from them sometimes is futile. They know if some one is vomitting, not eating, etc. but they don't tell us. We have about 40 pts. per unit now but 1 nurse cannot assess them all. Our report sheets have a box for each shift, nothing gets dated, so it may or may not be pertinent. It has helped some when I have written a note to our DON about not getting a good report, but in a few weeks they will all go back to the old ways. If you are night charge, when it is time for report and taped bring the tape recorder to them and say, "I am sorry you haven't had time to tape so do it now or come in and give an oral." After you shoving the recorder in their face for a few days maybe they will get the message. I "*****" when I don't get told important things. Not intimidating but assertive that I have things that need done and need to find out what is left over.

trudlebug · Aug 30, 2005

I work in LTC but have done med/surg. Where I work now has about the same problem. Stuff left for the next shift, not getting told important things about pt., Like they have vomited everyday for over a week and nothing was reported or done. Pt having diarrhea for over a month with order for Lomitol that wasn't given because no one person knew of all the times she had it. We use CNA's and getting report from them sometimes is futile. They know if some one is vomitting, not eating, etc. but they don't tell us. We have about 40 pts. per unit now but 1 nurse cannot assess them all. Our report sheets have a box for each shift, nothing gets dated, so it may or may not be pertinent. It has helped some when I have written a note to our DON about not getting a good report, but in a few weeks they will all go back to the old ways. If you are night charge, when it is time for report and taped bring the tape recorder to them and say, "I am sorry you haven't had time to tape so do it now or come in and give an oral." After you shoving the recorder in their face for a few days maybe they will get the message. I "*****" when I don't get told important things. Not intimidating but assertive that I have things that need done and need to find out what is left over.

Thanks for the response. I guess my problem is that I am one of the "newbies" on the floor, and I don't want to go over my ANM and NM head, but I have stated that something needs to be done, or I'm outta there...(promised a promotion/raise 2 months ago...paperwork still "waiting":uhoh3: plus a 40 mile drive each way and then dealing with this BS....gotta save my sanity...or at least some gas!) Too bad, because I really like working with the night shift crew, but something's gotta give.

BETSRN · Aug 30, 2005

I could use some advice...
I'm a RN on a med/surg floor where we tape report for the next shift. I work 11-7, and the problem we are having is the 3-11 shift not getting their reports taped. We are to start report at 2245 and end at 2315 (30 min overlap of shifts). However, we rarely get out of report until 2330 or later because we are waiting for a verbal, (usually missing important details, like IV fluids/site etc. and when asked, the usual response is a blank stare :stone). The evening shift workers stay until 0100 or later to finish their charting, and this causes us to have to wait at least 1-2 hours to begin our charting. (Paper charting...for now, start computers this fall...will this help?)
It is also a frequent problem that they do not finish tasks that should be completed during their shift (for example, the pt is to receive blood, no IV site, order was written at 1600 or something like that). Now I know that nursing is a 24 hour a day job, and sometimes leaving things for the next shift is necessary, but this is an every day occurrence. The assistant nurse manager/charge nurse for the shift is the worst offender, and frequently places blame on either the CNA or the Unit Clerk for problems.
Some on the staff are new nurses, and I am afraid they are getting bad habits, and not developing any time-management skills. The assistant NM for our shift has discussed this with the nurse manager, and she reminded her that nursing needs a "continuum of care" and that we all have to cover for the other shifts, but I have noticed a definite morale drop on our shift because of the evening shift "dropping the ball".
I do not know how to approach this problem that will get results. When I ask a question, the ANM from evening shift just blames others for the problem, or states "you should come and work evenings, because they won't listen to me."
Also, our NM doesn't come in to work until 0900, almost 2 hours after our shift ends, so it makes it difficult for us to talk to her. I was thinking of writing a letter to her, but am not sure how to approach the subject without sounding like I am b*tching.
Sorry this has gotten so long...guess I needed a bit of a vent, too.
(just a bit about me...been nursing just over a year, but have management experience and have done relief charge for about 3 months. Also, the unit has 15 beds, 3 licensed, so the ratio is 5:1 with some on tele...not bad, charge takes full pt load, 3-11 has one aide, none on 11-7)

It sounds as if you are pretty critical of another shift. I would wager that if one spoke to the day girls, they might have complaints about you all as well. It really irks me to hear one shift "blame" another, as you are doing here in this post. As a 20 year veteran of evenings, I can tell you that things do not slow down on the off shifts and as a night nurse, you should know that.

I would suggest that you ask to form some sort of task force with nurses from all your shifts (and all your managers) to start working on this problem. I have to say if I were one of those people on evenings and I had to work with the criticisms and the attitude that you have presented here, I wouldn't be too happy. Just because an order was written at 1600 does not mean it is going to get done in a timely manner (depending on the order and the acuity of the patient, of course).

I see you have been an RN for a whopping 12 months, yet you criticize newer nurses because they might be developing "bad habits?" You have hardly had time to develop any habits (good or bad) yourself! Maybe it is time for you to learn to "think outside the box" and realize that things do not always go as they should, even under the best of circumstances. Maybe your shift needs an attitude adjustment as you seem to have such a morale problem. That issue belongs to you people on nights, NOT the evening people.

I am sorry to sound so harsh, but your critical and judgemental manner will not get you too far in this profession. You have quite the nerve, placing blame on every staff member and nurse manager when you seem to take no responsibility for any of the problems yourself.

Now, to add a bit about me (as you did), I am a RN with 20 years at the bedside, with several advanced certifications after my name. I am also a regular charge nurse as well as a preceptor for new staff and students. Now, doesn't that sound silly? Please get a grip.........

trudlebug · Aug 30, 2005

It sounds as if you are pretty critical of another shift. I would wager that if one spoke to the day girls, they might have complaints about you all as well. It really irks me to hear one shift "blame" another, as you are doing here in this post. As a 20 year veteran of evenings, I can tell you that things do not slow down on the off shifts and as a night nurse, you should know that.
I would suggest that you ask to form some sort of task force with nurses from all your shifts (and all your managers) to start working on this problem. I have to say if I were one of those people on evenings and I had to work with the criticisms and the attitude that you have presented here, I wouldn't be too happy. Just because an order was written at 1600 does not mean it is going to get done in a timely manner (depending on the order and the acuity of the patient, of course).
I see you have been an RN for a whopping 12 months, yet you criticize newer nurses because they might be developing "bad habits?" You have hardly had time to develop any habits (good or bad) yourself! Maybe it is time for you to learn to "think outside the box" and realize that things do not always go as they should, even under the best of circumstances. Maybe your shift needs an attitude adjustment as you seem to have such a morale problem. That issue belongs to you people on nights, NOT the evening people.
I am sorry to sound so harsh, but your critical and judgemental manner will not get you too far in this profession. You have quite the nerve, placing blame on every staff member and nurse manager when you seem to take no responsibility for any of the problems yourself.
Now, to add a bit about me (as you did), I am a RN with 20 years at the bedside, with several advanced certifications after my name. I am also a regular charge nurse as well as a preceptor for new staff and students. Now, doesn't that sound silly? Please get a grip.........

Thanks for your input...if it was only my opinion, I would never have posted, but all nurses on our unit have the same concern. I just wanted some advise as to how to we could approach them and/or management to voice the concerns. It really has nothing to do with whether or not I like the staff, as a matter of fact, I do like all of them. My concern is that the patients may not be getting the best care from ALL of us because of this situation. I want to HELP them, not argue/fight with them. I want to be part of a team! I am sorry that I gave such a bad impression, because that is the farthest from the truth, and why I put my info at the bottom was to let you know where I am coming from, not to brag. Lord knows I have a lot to learn, and that is why I come here to allnurses.:imbar

allele, LPN · Aug 30, 2005

It sounds as if you are pretty critical of another shift. I would wager that if one spoke to the day girls, they might have complaints about you all as well. It really irks me to hear one shift "blame" another, as you are doing here in this post. As a 20 year veteran of evenings, I can tell you that things do not slow down on the off shifts and as a night nurse, you should know that.
I would suggest that you ask to form some sort of task force with nurses from all your shifts (and all your managers) to start working on this problem. I have to say if I were one of those people on evenings and I had to work with the criticisms and the attitude that you have presented here, I wouldn't be too happy. Just because an order was written at 1600 does not mean it is going to get done in a timely manner (depending on the order and the acuity of the patient, of course).
I see you have been an RN for a whopping 12 months, yet you criticize newer nurses because they might be developing "bad habits?" You have hardly had time to develop any habits (good or bad) yourself! Maybe it is time for you to learn to "think outside the box" and realize that things do not always go as they should, even under the best of circumstances. Maybe your shift needs an attitude adjustment as you seem to have such a morale problem. That issue belongs to you people on nights, NOT the evening people.
I am sorry to sound so harsh, but your critical and judgemental manner will not get you too far in this profession. You have quite the nerve, placing blame on every staff member and nurse manager when you seem to take no responsibility for any of the problems yourself.
Now, to add a bit about me (as you did), I am a RN with 20 years at the bedside, with several advanced certifications after my name. I am also a regular charge nurse as well as a preceptor for new staff and students. Now, doesn't that sound silly? Please get a grip.........

Wow. Sorry to say, BetsRN, but you seem to sound just as critical of other shifts as you say the OP is. I have to say, I love the idea of a task force though. If you've only worked one shift (I'm not sure if OP has worked other shifts?) there may be issues with other shifts that you don't realize. I've worked all three in my fairly short career (7 years) and I know they all have their problems.

I also have to admit that getting an order for blood (not an order to be taken lightly in my opinion) at 1600 and not having it even started by 2300 IS a problem. And, we tape also, and it's very infrequent that I have to get a verbal, but when it happens it does throw me off and it's more time comsuming than a tape. A task force might be just what you need to come up with some ideas for solving these problems.

It's too bad your charge nurse has to take an assignment. Mine don't, and if I need help with things like hanging blood or meds, or I have a patient in crisis the charge can do an assessment or two for me on my other patients, or they take off my orders for me if I need it, etc.

Anyway, I think it's great that your being very specific with your problems with 3-11 (yes, I know that every shift complains about the shift before, but OP's problem is with 3-11, which she follows.) rather than making uprofessional generalizations.

Yes, the OP is new to nursing, but she stated she's had management experience (usually need to be a fairly organized person to do this, if you're a good manager) and she's done relief charge for 3 months....so the powers that be that trained her to do charge thought she had adequate time management skills to do relief charge with a full assignment.

I hope you can just form the task force with members from every shift (preferable not "complainers" that can never be made happy, but reasonable nurses that realize not every shift is perfect everyday, but just want to try to improve the unit) and you find some sort of compromise with everyone. Good luck! :)

misschelei · Aug 30, 2005

I can understand charting 2 hours after the shift ends after a crazy shift but if it's happening all the time either the patient loads are unsafe or the nurses have time management issues. Putting off IV starts for the next shift is a big ettiquette no no unless there has been an exhaustive effort by everyone including ER and/or anesthesia. And if that's the case and the pt needs blood why isn't the doctor ordering a picc? Nothing irks me more than the blank stare. And I'm sorry but I get it alot when I work ms. The worst is when something is occuring that the doctor needs to be made aware of and the blank stare tells me they didn't do it. I will actually ask the outgoing nurse to call the doc. I don't even know the pt well enough yet to have my ducks in a row for a MD call. I have report to get on other pt's and orders to skim and assessments to start. It is especially hard to work 8 hour shifts cuz it seems there isn't enough time to get everthing done. Nursing is a 24hr thing and its ok for some things to overlap but spending the first 2 hours of your shift finishing the last shift's work on a regular basis is a red flag that you need to move on.

fergus51 · Aug 30, 2005

Have you tried picking up some shifts on 3-11? That might give you a better idea of why things aren't getting done. It's one thing if the people are just lazy, but if they are running around like chickens with their heads cut off all day, then I think you just need to show some compassion for them, suck it up and do what they missed. The charting thing seems unimportant to me. If you aren't supposed to start until 1130 anyways, I don't see the big problem in not charting until 0100.

tridil2000, MSN, RN · Aug 30, 2005

Thanks for your input...if it was only my opinion, I would never have posted, but all nurses on our unit have the same concern. I just wanted some advise as to how to we could approach them and/or management to voice the concerns. It really has nothing to do with whether or not I like the staff, as a matter of fact, I do like all of them. My concern is that the patients may not be getting the best care from ALL of us because of this situation. I want to HELP them, not argue/fight with them. I want to be part of a team! I am sorry that I gave such a bad impression, because that is the farthest from the truth, and why I put my info at the bottom was to let you know where I am coming from, not to brag. Lord knows I have a lot to learn, and that is why I come here to allnurses.:imbar

my advice is to bag the taped report.

a face to face report forces more accountability.

cathy54 · Aug 30, 2005

As a fairly new nurse, I work 2-6, all I can say is if BETSRN was my preceptor, I would run. Some of us new and newer nurses come here to learn. We read the posts and think, "that's a good idea" or "I never thought of that before". Getting chewed out when we venture an opinion, because of our inexperience does not help anyone. When I worked last (I just started back), as a brand new nurse, the nurse I took over for me would always either give me all the stuff she did not want to do, or gave me a turn over when it suited her. She had 10 years experience. I guess my point is experience really does not mean anything, sometimes.

I think that I will believe that BETSRN, just had a bad night or just got off work.

Super_RN, BSN, RN · Aug 30, 2005

It sounds as if you are pretty critical of another shift. I would wager that if one spoke to the day girls, they might have complaints about you all as well. It really irks me to hear one shift "blame" another, as you are doing here in this post. As a 20 year veteran of evenings, I can tell you that things do not slow down on the off shifts and as a night nurse, you should know that.
I would suggest that you ask to form some sort of task force with nurses from all your shifts (and all your managers) to start working on this problem. I have to say if I were one of those people on evenings and I had to work with the criticisms and the attitude that you have presented here, I wouldn't be too happy. Just because an order was written at 1600 does not mean it is going to get done in a timely manner (depending on the order and the acuity of the patient, of course).
I see you have been an RN for a whopping 12 months, yet you criticize newer nurses because they might be developing "bad habits?" You have hardly had time to develop any habits (good or bad) yourself! Maybe it is time for you to learn to "think outside the box" and realize that things do not always go as they should, even under the best of circumstances. Maybe your shift needs an attitude adjustment as you seem to have such a morale problem. That issue belongs to you people on nights, NOT the evening people.
I am sorry to sound so harsh, but your critical and judgemental manner will not get you too far in this profession. You have quite the nerve, placing blame on every staff member and nurse manager when you seem to take no responsibility for any of the problems yourself.
Now, to add a bit about me (as you did), I am a RN with 20 years at the bedside, with several advanced certifications after my name. I am also a regular charge nurse as well as a preceptor for new staff and students. Now, doesn't that sound silly? Please get a grip.........

Wow! I think you are being too harsh. Trudlebug was simply asking for help on what to do, and yes, analyzing the previous shift. I am sorry, but if an order is written at 1600, then it should be done by 2300. That is in MORE than a timely manner. I work 12 hour midnights and are there times when day shift doesn't get everything done? Sure there is, as are there are times when we leave stuff hanging as well. Nothing critical, however. No IV's left to do, no new blood orders, etc. Even if Trudlebug has only been a nurse for 12 months, it is not hard to recognize bad habits, it doesn't take a veteran nurse to observe them. I think it is great that she is concerned enough for her unit and co-workers to even approach bringing the subject up. It's hard enough to do that, let alone when you're new to the unit and a new nurse. BUT, that is being a patient advocate and assertive, which is what you WILL need in this profession.

Jaime

mydesygn · Aug 30, 2005

Thanks for your input...if it was only my opinion, I would never have posted, but all nurses on our unit have the same concern. I just wanted some advise as to how to we could approach them and/or management to voice the concerns. It really has nothing to do with whether or not I like the staff, as a matter of fact, I do like all of them. My concern is that the patients may not be getting the best care from ALL of us because of this situation. I want to HELP them, not argue/fight with them. I want to be part of a team! I am sorry that I gave such a bad impression, because that is the farthest from the truth, and why I put my info at the bottom was to let you know where I am coming from, not to brag. Lord knows I have a lot to learn, and that is why I come here to allnurses.:imbar

I think one of the biggest problems with nursing is the "blame" game that goes on. You say all the nurses are critical of the previous shift and I bet not one person has looked at this as a unit problem and not a shift problem. What items and tasks can you prepare beforehand - like chart packs for new admits, having two nurses do an admission, preparing lab bags for common labwork, having pre-printed care plans, keeping a resource book with instructions for enetering common labs, updating phone lists. There are million things that can be organized and assigned that would make the busy times easier (and 3-11 is absolutely the busiest time, I have worked every shift) and allow the nursing staff to concentrate on tasks that only they can do and delegate out the other stuff that slows you down.

Second, stop criticizing, you are not there during their shift - - you have no idea that they spent 20 minutes trying to calm an irate family, or 30 minutes trying to clarify an ambiguous order - you see the results not the causes.

How easy it is to say what someone should have done -- after all you would never leave a task for the next shift. I would much rather the nurse on the previous shift clarify an order so I don't have to call the doc at 3 am then start my IV. It's all about priorties.

A very wise nurse once told me that nursing is 24 hours that's why there are 3 shifts. I do the very best I can and I refuse to allow anyone to make me feel guilty or inadequate for not completing a task -- nursing is 24 hours