Students giving and getting report?

Lizzie21 · Oct 13, 2010

I'm sorry you feel that you are bothersome to the nurses. I love students (i'm a new grad and know exactly how you feel). Even when I give report I feel I'm not doing a good job or the other nurses think that I'm incompetent. What I find to be helpful when I give report is this:

Name of Pt

Age

Dx or why they are here

IVs or central lines

what important things that went on during the shift (gave blood, electrolytes are low, they were aggressive, ect...)

what the plan of care is for the day

I also follow this tool when I get report. That way if they missed something I could go back and ask them.

I hope this helps!

shoegalRN, RN · Oct 13, 2010

When I work the floor, I give report by body systems.

I start with the pt's name, age, team, dx, hx and code status.

Then I hit all body systems:

Neuro-A&OX3, pupils round equal and reactive, etc (if any abnormalities with neuro state them, seizures, ETOH W/D and precautions, etc)

Resp-room air, oxygen (how much, what route), lung sounds, sats, cough, sputum, what does sputum look like

Cardio-if on a monitored floor, what is the pt's heart rhythm, HR, BP, pulses, edema, afebrile/febrile, if febrile what was the temp and what was given, is fluids going, if so, what are they and at what rate (NS @ 100 ml/hr)

GI-how does the abdomen look, is it flat, round, distended, is there active bowel sounds, last bowel movement, if bowel movement what did stools look like, what does abdomen feel like, is it soft or firm, any tenderness or pain, any N/V, if so, what was given (Zofran, Phenegren, etc), was there any emesis, if so what did it look like and how many times.

GU-is the pt voiding or has a foley, what does urine output look like, is it cloudy or clear, is there adequate urine output.

Diet-is pt NPO, regular diet, etc

Skin-is pt's skin dry and intact, if not intact, describe wounds or skin issues, if a surgical incision, what does it look like, is it stapled and open to air, is there drainage, if so, what does it look like and how much, are there any drains, if so what kind of drains, is there any output, if so, how much, is there a current dressing, what kind of dressing is it, is it dry and intact, etc.

Activity: is the pt a fall risk, or can be up as tolerated, or bedrest

Does the patient have any accu checks? If so, how often and is there a sliding scale, if so what level is it? What was last blood sugar and did you have to give any insulin?

After going through all body systems, give other info such as if labs needs to be done, abnormal labs (such as low K+, state intervention, KCL 40 mEq given IV, on second bag now) pt has consults in AM, social issues (family issues, financial concerns), etc.

Always after giving report, ask if the person have any further questions. It's best to give report with the chart open or if computer charting, have the pt's computer chart pulled up.

Hoozdo, ADN · Oct 13, 2010

Hello.... I am currently in my last semester of nursing school and seem to be having trouble giving and receiving report from my nurses. I always feel like I am a bother, or am just being given the bare minimum to get me out of their way! I normally try to come in early so I can sit in on change of shift reports, but sometimes all of my patients have different nurses and they all do report at the same time, or I am just in the background trying to be involved!?!? I am just not sure how to be assertive and get the proper report any tips? I just feel like some of the nurses treat me like its my first time on the floor I would really appreciate any tips Thanks

Your best bet is to be there in person while the off-going nurse is giving report to

the oncoming nurse. Sit in a spot where you can hear everything. Don't interrupt

report.

If you don't understand something then wait until report is over and ask your preceptor.

You really can not expect to get a real report if you are not present at report time.

Usually, there is no time for a nurse to "regive" report. It would be nice if there

was time, but there isn't. Nurses need to go home after 13+ hours.

SassyRuca · Oct 13, 2010

Thank you all so much!!! It is hard to be present for every report because they are all going on at the same time all in different areas on the floor. example: today I was "modular leader" so I had a team of me and 3 other students 1 student had 3 pt the other 2 had 2 each, so I needed report 3 different nurses on 7 pt. I just don't see how I can split myself up and get them all. I understand it must be hard for the nurses to deal with the students on the floor, but some of them are just kind of nasty for instance one report I got from a nurse was what the IV was and rate, and that the J-P was draining.... as I'm running after her asking her questions that she I guess didn't hear. I just feel like if certain nurses don't want students they should make it clear and discuss it with there manager, or the instructor. Most of the time it makes the students look dumb when the RN tells us one thing, or never tells us then when questioned by the instructor about it tells her another. I don't know I guess I should just grin and bare it! I've made it this far, and have only been on one floor that was excepting of the students and that was because they were pretty much all recent grads from my school. Just a rant, but again thank you for the advice!!! :up:

noahsmama · Oct 13, 2010

I'm not sure what a "modular leader" is, or why you were, apparently, leading 3 other students -- but if that's the case, then why not let each of the other 3 students listen to report on their 2-3 pts each, then have these 3 students give report to you? You can't expect up to 7 nurses to each wait her/his turn to give you report -- they have work to do!

nyteshade, BSN · Oct 13, 2010

If you happen to miss a patient report, because you were listening in at another, check the H&P in the chart, and the last 24 hours of orders. I know it is not ideal, but you need to get your information somehow.

P.S. In real world nursing, sometimes you may not even get a face to face verbal report.

BittyBabyGrower, MSN, RN · Oct 13, 2010

Okay, I have to ask...where is the instructer and why isn't she helping you get report or listen to report on all these other people's patients? This seems like a flawed method. I have to agree....We get report from7-730am and then we start our day....we can't be waiting around much after 730am to report off/on. It may not be that they don't want students, it may be that your school's method of report is irritating them!

BluegrassRN · Oct 13, 2010

Afrocentric's report would be too comprehensive for me...that's because our computer system has a couple of screens that supply all this info. You need to model your report after your precepting nurse...some floors do a comprehensive report like Afrocentric, our floor does a super short, touch base report.

I will make a brief attempt to wait for a student to get there so that I can give report, but in no way am I waiting to the point that I'm late getting off because I was giving report to several different people, including students. I won't get pulled into the manager's office for something like that.

Make sure the info you need isn't available elsewhere. In your example, if you were chasing after me, asking about IV stuff, I would have ignored you, too: it's on the computer, easily accessible. If you can't find it, I'd be happy to show you at some point. Just make sure you're not asking for something that you can actually easily find.

Maybe you can discuss the difficulty of getting report on so many patients with your clinical instructor. What exactly is the expectation? Does he/she really expect the floor nurses to take the time to give you an extra report? Or would a secondary report from your fellow students (like noahsmama suggests) be sufficient? How are other students able to get this report? I think your clinical instructor should be able to offer you some guidance here. If not, he/she needs to be made aware of how difficult it is to get report for all those patients. And frankly, your school isn't making any friends on the unit with such a practice, either.

muesli · Oct 13, 2010

I sometimes have a student nurse taking care of my patient. I love the help and I love to teach when I can. But often the student nurses will be assigned to me after the change of shift and will come to me and ask me for report when I'm at my busiest, trying to assess all my patients, do med passes and discharges. And sometimes I'm on the other end of the attitude - I've had student nurses give me attitude because I just don't have time at the moment to give a report.

The best thing to do is get there early, introduce yourself to the nurse of your patient, and ask if you can listen in on verbal report. If they don't have time to give report or give you bare bones, do your assessment and look in the chart. Take the time to familiarize yourself with the patient's chart. That's the one thing I miss having the time to do!

Side note - my eyes were wide when I was looking at some of the detailed verbal reports people give! We write system by system change of shift notes, and often times it is the culture in my hospital to not give a verbal report. Even when I do try to give a verbal summary of the patient to the next nurse, a lot of nurses will "yeah yeah yeah" you and sigh as if you're wasting their time! I've learned to always give a verbal report but sum it up and only include important hilights. The rest is in their record which they will see anyway.

OttawaRPN · Oct 13, 2010

Well, maybe this is a skill honed by experience. I don't know how many times I've come on shift and the outgoing nurse has already taken off just shoving the patients' care plans in their respective cubby holes for me to find. Is this ideal? No, but on a busy, bustling, constantly adapting unit, it happens.

However, everything I need to know immediately should be on the care plan/Kardex/MAR which requires a little bit more investigative talent and effort on my part, but is by no means impossible to navigate. I've often thought of verbal/written report as a courtesy to get you to hit the ground running faster, that's all.

Although in a perfect world, going through all the body systems or nursing interventions would be ideal, this would never work on my ortho unit, d/t the time constraints involved, but at the very least I like to receive:

Why are they here? Bilat TKA

When is/was OR? POD #4

Why are they still here? d/c STR WBA

Remember folks what we were taught in nursing school!

Q. When do you plan for discharge?

A. On admission.

The only other info I require is anything pertinent or abnormal that needs to be addressed today ie) Hgb 89, pt not mobilizing, incision edematous/warm to touch, no BM x 4 days, etc. Don't tell me the normal things ie) A&Ox3, VSS, slept well. I don't need to know any of that right now.

Everything else I need can be found in the care plan/Kardex.

I absolutely LOVE :redbeathe student nurses, my goodness... they do half my job for me! But it's true we're not nearly as accommodating and considerate as we should be with them, despite the fact that we were all there once.

jjjoy, LPN · Oct 13, 2010

Given that many nurses are too stretched thin to take extra time for students and given that students may not get time to familiarize themselves with a unit's methods (where to find certain info, what to expect from hand-off report), I wouldn't say students are "being set up to fail" but they aren't "being set up to succeed" either.

Nursing still seems to be a lot of "sink-or-swim"... which means quite a bit of floundering. You rarely hear anyone say "Great job with the floundering!" You hear lots of "You're sinking! Swim!" If you're swimming? No one notices!

In fact, nursing instruction/precepting can sometimes seem more like having lifeguards at a beach watching over people trying to teach themselves how to swim - there to tell you if you've gone too far, to pull you out of the water if you're going down, and to shout out a few pieces of advice from the shore - as opposed to it being like formal swimming lessons in a swimming pool. Maybe it's the only way.