Shift change/report problems (long)

[trudlebug]

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)

[BETSRN]

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! :)

I,too, would agree that not getting blood started in all those hours is unacceptable. Hence, my comment about the aquity. Yes, I am a long term evening nurse, but it's not as if I don't do nights on occasion or days,either. I stay on evenings because I like the personality of that shift the best. There are too many extraneous staff and administrators there on days.

Actually, regarding involving the complainers.....sometimes getting them on a committee is just what you do need. Sometimes, when these people are given some input, they really come around. If those considered "the complainers" are involved, you may just solve a lot of issues at one time. Nurses are great at complaining and then not having the guts to stand up behind their issues. People like this don't do a lot to further nursing's cause.

[BETSRN]

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

Excellent post! Thanks for supporting my thoughts. All I want to know when I come on is what I need to do when.....If the nurse before me has been unable to do something or has forgotten something, I just want to know. It helps me to prioritize my time. The longer you newer nurses are around, the more patience and humility you will develop.

[BETSRN]

my advice is to bag the taped report.

a face to face report forces more accountability.

I agree. I think a lot more gets accomplished (and less time is wasted) if you just talk to the nurse taking your assignment. This taping report is a waste of time. No wonder the nurses before you are not getting finished.

[Super_RN, BSN, RN]

I,too, would agree that not getting blood started in all those hours is unacceptable. Hence, my comment about the aquity. Yes, I am a long term evening nurse, but it's not as if I don't do nights on occasion or days,either. I stay on evenings because I like the personality of that shift the best. There are too many extraneous staff and administrators there on days.

Actually, regarding involving the complainers.....sometimes getting them on a committee is just what you do need. Sometimes, when these people are given some input, they really come around. If those considered "the complainers" are involved, you may just solve a lot of issues at one time. Nurses are great at complaining and then not having the guts to stand up behind their issues. People like this don't do a lot to further nursing's cause.

I agree. I think a lot of time nurses don't follow through because they are afraid of losing their job or being "marked".

:) Jaime