Shortening report on an ICU step-down unit

[nminodob]

I work in a busy tele unit with a census between 20-29. Ratio is 1:3, and we have many unstable pts as we are an ICU stepdown unit. Our traditional reporting method is to gather for a general report (all nurses), assign pts. (this takes a few minutes because of continuity of care, etc.), and then go to the bedside for our assignment report. The whole process takes up to 30 min. We are experimenting with new ways to shorten the report.

We have tried eliminating the general report and everyone got done 15-20 minutes earlier. The problem is, without a general report, nurses lose the ability to choose their own assignments, since they don't know anything about the other pts. Also, since the day-shift charge nurse puts all the assignments together for the night shift (and vice-versa), we sometimes ended up with 2 trach pts in one assignment, or 2 contact iso pts together, etc. There is no opportunity to jiggle the assignments around to improve them. There is also the problem of the nurses who float to us from less acute floors, because they can't take all the drips, art lines etc., that we often get.

Any suggestions on how to speed the process up? How do other units with high acuity keep all the nurses up to date on the most critical pts and not run overtime? Thanks for any suggestions!

[GM2RN]

I work in the ED so can't really give much help. But reading your post prompts me to wonder why the day charge can't do a better job of assigning patients. He/she has to be taking these things into consideration for the day shift (unless the night charge is assigning pts for days), so why not for nights?

[Up2nogood RN, RN]

I'm not on a step down unit but we have don't have a general report. Our assignments are made by the previous charge and they do try to keep continuity of care and make sure the post ops are spread out. We have bedside report with the off going nurse, do our safety checks and it's been working pretty well for us.

[Flo., BSN, RN]

That sounds like it was a pretty nice set up that you had in the past. We have our assignments made on the previous shift, an acuity tool is used to ensure that it is as fair as possible. The Charge RNs on your unit sound out of practice in giving asignments, it will improve with time. Most of it is common sense.

[HamsterRN, ADN, RN]

I work on a similar unit and our goal is to keep the whole process to 30 minutes, although it usually takes closer to 45, so 30 minutes sounds pretty good. And that is with the assignments already done. We have also had problems with unbalanced assignments and we are currently working on an acuity scoring system to ensure that each assignment has relatively similar levels of acuity/time demands. We are building our own but there are scoring systems out there that can be purchased.

[RNperdiem, RN]

When my unit expanded, the charge nurse for oncoming shift came in early and the day and night charge nurses gave each other report, divided patients up into assignments and assigned nurses to them.

The charge nurses know our abilities and preferences well, so the system has worked out well in my opinion.

At 0700 the day staff is assembled. The day charge nurse reads out the quick 20 second rundown on each of our 16 patients, gives assignments and we are out to get reports from the night nurses.

[CNL2B]

At the tail end of every shift, the offgoing charge goes around to the staff and checks on their patient status and what is going on with them and then tries to split them up equitably when making assignments. Isn't that the charge RNs job? If you guys seriously sit there at the beginning of the shift and pick patients out yourselves, that seems unnecessary. Your charge either needs to take "charge" and actually do his/her job or needs to be given the power to do that.

[nminodob]

First, thanks to all for your replies. I also wanted to mention that the freedom to pick our own assignments is what makes our unit special, and we don't want to lose that privilege. We use the heirarchy of who has worked last - for example, on his/her 2nd day the nurse can pick before a nurse that has had 1 day off, and he/she can pick over someone who had 2 days off, etc. We love this arrangement. We are the county hospital for San Francisco and see a heavily addicted, psych-impaired population with complex medical issues. Sometimes we just can't take the same pt assignment 2 days in a row without going batty - most of the time though we want to have our pts back, for continuity of care and also because we can sense when they are going "south." We are reluctant to abandon the general report, because without it we will effectively lose our right to choose - since we won't know any other patients from which to choose.

I will let everyone know what solutions we come up with. Hopefully, we will retain our right to choose.