Thoughts On Eliminating Nurse Report

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

Yet another workplace rant. As of yesterday my supervisor dropped the bomb on us stating nurses caring for patients admitted from the ED are no longer required to give report. Instead the patients will be sent up with a form. I have no idea what the form will have on it, im guess sort of like a ipass sheet or sbar. If any information is missing the nurse will have to look for it in the chart. Not to mention having a hard time reading other people hand writing. 

In certain situation such as CIWA & sepsis report is required but the criteria for it is not yet known. 

However my concern is that patients transferred to the unit unstable resulting in unnecessary RRT’s. (I cant tell you how many times the ED attempted to send up pts with a bp over 200 or bs less than 60 without an intervention or even without meds listed in the mar). Also we many not have enough time too look up the patients chart especially if its a busy day. Or the form will be either lost in transport or sent up uncompleted. Also the ED nurses don’t always chart important patient information. 

I know that as I nurse I have to read my patients chart regardless. 

How would you handle this? What are your thoughts? 

I think their goal is to get the patients to the units much faster by eliminating time used to give report. Prior to this they weren’t allow to send patient without calling first. 

Whats is your companies policy on receiving and giving report?

[AnLe, ASN, RN]

Our policy currently states that ED will call to give report. If the nurse does not answer, ED will callback in 10 minutes. If nurse does not answer the 2nd time, charge will take report. Our current problem is the ED trying to send patients up during shift change. 

I have had the issue of the ED trying to give me report on a patient whose heart rate kept decreasing. We avoided receiving report and not a minute later the heart rate was zero. Mind you, I'm on a medsurg/tele floor night shift. 

[Wuzzie]

This issue has been discussed ad nauseum in hundreds of threads. It never ends well. You might want to read them. 

[JBMmom, MSN, NP]

Our hospital recently adopted a similar system. I work in the critical care unit, so we still get a bedside report (although it's often inaccurate/useless anyway), but I've also only got two patients, maybe three, so I have time to look things up if necessary.

On our general floors, the ED sends up an SBAR sheet and the nurse is expected to call with any questions. A tech then transports the patients so there isn't even an interaction between the nurses. Sounds sketchy and like an accident waiting to happen. But it's becoming more common..

[JKL33]

I am against this and don't believe that report is unimportant. I suspect some people feel superior when they can dismissively state that they don't need to hear a report because they can read the chart, and that there are a smaller subset of people who actually then do it.

3 hours ago, Lovethenurse2b25 said:

Not to mention having a hard time reading other people hand writing. 

And having to write out parts of a story that has already been documented elsewhere. I will take 60 seconds to do something with hand-off ; if I have to write there will be less information than if conveyed verbally.

This whole thing stems from not having enough help upstairs and not being willing to get enough help. The nurses up there are busy, there are delays in taking report and then bam! someone who shouldn't be making decisions decides that we can solve the whole problem by just sending patients up anyway and this is how they do it. There's also been such a big push to get patients out of the ED that I do think there is less focus on whether or not they are going to the actual correct/best place and instead it's just "get them out."

I don't like to be inefficient but allllllll of this malarkey is using efficiency as the excuse for a lot crappy care. There just isn't enough time to do anything close to the right way. It just sad and ridiculous.

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

47 minutes ago, JKL33 said:

I am against this and don't believe that report is unimportant. I suspect some people feel superior when they can dismissively state that they don't need to hear a report because they can read the chart, and that there are a smaller subset of people who actually then do it.

And having to write out parts of a story that has already been documented elsewhere. I will take 60 seconds to do something with hand-off ; if I have to write there will be less information than if conveyed verbally.

This whole thing stems from not having enough help upstairs and not being willing to get enough help. The nurses up there are busy, there are delays in taking report and then bam! someone who shouldn't be making decisions decides that we can solve the whole problem by just sending patients up anyway and this is how they do it. There's also been such a big push to get patients out of the ED that I do think there is less focus on whether or not they are going to the actual correct/best place and instead it's just "get them out."

I don't like to be inefficient but allllllll of this malarkey is using efficiency as the excuse for a lot crappy care. There just isn't enough time to do anything close to the right way. It just sad and ridiculous.

I agree, the focus seems to be on trying to fill as many beds as possible. I can only imagine the amount of errors or safety incident reports waiting to happen.

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

1 hour ago, JBMmom said:

Our hospital recently adopted a similar system. I work in the critical care unit, so we still get a bedside report (although it's often inaccurate/useless anyway), but I've also only got two patients, maybe three, so I have time to look things up if necessary.

On our general floors, the ED sends up an SBAR sheet and the nurse is expected to call with any questions. A tech then transports the patients so there isn't even an interaction between the nurses. Sounds sketchy and like an accident waiting to happen. But it's becoming more common..

Im guessing facilities want to revert back to when nurses did not utilize bedside report. But during those times nurses did not have to worry about loads of paperwork. It is yet another way to interfere with patient interaction. More time on the computer less patient care. 

[rentalnurse, RN]

Don’t even get me started on this topic, major rant! I’ve worked both places, when we get a bed after waiting sometimes hours and have 6 or more waiting on that bed and call the floor and get a million excuses ie giving meds, in patient room, on break (must be nice) wrong number etc. we are getting timed on why patient hasn’t gone up yet and dinged for each minute over. We sometimes hold more ICU patients per nurse than the ICU nurse does plus if have holds at some places just add a few more stretchers and have to take more patients. You are a nurse too, I know your ratios are terrible. But you can look up the patient too! Most charts have a summary. I could go on, management usually doesn’t care. If the patient isn’t stable that’s different, but our definition of unstable may be different than yours. Sorry rant for the morning.

[floydnightingale]

Yeah, we went to the no report thing except for ICU transfers and if a patient is unstable they should be going to an ICU or at least travel with a nurse.

Fact was, too many units avoided report which delayed care and backed up the ER. I worked at one stand alone ER and the hospital we transferred most of our patients to never took report. One could spend an entire 12 hour shift trying to get a nurse on the phone. It was a game they played and continued to play even after they began laying their overstaffed a$$es off. One legit problem was that patients would arrive too rapidly in sequence, but they made their beds and now can metaphorically lie in them. ER doesn't have the luxury of delaying admissions.

 

[Wuzzie]

On 6/4/2021 at 2:01 PM, Lovethenurse2b25 said:

I think their goal is to get the patients to the units much faster by eliminating time used to give report.

I think their goal is to get the patients to the units much faster by eliminating the time used to avoid taking report. 

The reasons for avoiding report, for the most part, are valid. Too many patients, too busy, not enough staff for the patient load. None of which are the fault of the in-patient nurse, the ED nurse or the patient. Most ED nurses understand this but it's the invalid reasons that stick in their craws. The nurse is at lunch, the room isn't cleaned (when it actually is), it's almost shift change (see below). 

On the flip side the ED has to keep turning over their rooms for the sake of the patients in the waiting rooms (arguably the riskiest patients in the hospital given that they have not received a medical evaluation) and are bound by administrative time constraints once a room has been assigned. Nothing like getting a verbal because nobody would take report.  They are also at the mercy of the physicians who write the admit orders. Despite popular opinion they don't get to decide to which unit a patient gets admitted or when that happens. The idea that they hold patients until shift change is a fallacy. Most ED nurses try to send patients up buffed and polished but unfortunately there are some that don't and it gives them all a bad name. 

Moral of the story... quit painting your nursing colleagues with the same broad brush. 

Disclaimer: I was an ED nurse that did faxed report. It worked well and there was no measurable increase  in RRTs. The floor nurses hated it at first but their attitudes changed about this once they got floated down to take care of boarded patients.  It was also good to have a chance for us to get to know each other. 

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

36 minutes ago, Wuzzie said:

I think their goal is to get the patients to the units much faster by eliminating the time used to avoid taking report. 

The reasons for avoiding report, for the most part, are valid. Too many patients, too busy, not enough staff for the patient load. None of which are the fault of the in-patient nurse, the ED nurse or the patient. Most ED nurses understand this but it's the invalid reasons that stick in their craws. The nurse is at lunch, the room isn't cleaned (when it actually is), it's almost shift change (see below). 

On the flip side the ED has to keep turning over their rooms for the sake of the patients in the waiting rooms (arguably the riskiest patients in the hospital given that they have not received a medical evaluation) and are bound by administrative time constraints once a room has been assigned. Nothing like getting a verbal because nobody would take report.  They are also at the mercy of the physicians who write the admit orders. Despite popular opinion they don't get to decide to which unit a patient gets admitted or when that happens. The idea that they hold patients until shift change is a fallacy. Most ED nurses try to send patients up buffed and polished but unfortunately there are some that don't and it gives them all a bad name. 

Moral of the story... quit painting your nursing colleagues with the same broad brush. 

Disclaimer: I was an ED nurse that did faxed report. It worked well and there was no measurable increase  in RRTs. The floor nurses hated it at first but their attitudes changed about this once they got floated down to take care of boarded patients.  It was also good to have a chance for us to get to know each other. 

Thanks for sharing your experience while working as an ED nurse. But at my hospital it is the complete opposite. In fact this past week I received a patient who came from a LTC facility with dysphagia. The ED nurse never reviewed his paperwork to see that the patient on a puree nectar thick diet and gave the patient meds whole with water, thin liquids and whole. This is the exact reason why report is vital. It is the time to ask questions and get important information that is not always documented in the chart. We got another patient that was in ED holding for two days and did not receive any of meds. No achs checks, insulin, bp meds etc. for two days. It was not caught until she arrived to my unit. In my hosptial most of the time the nurses don't even assess the  patient’s to know their status. It is not good at all. I don’t want a pt with a bp of almost 200 hitting my unit unexpectantly this has also happened. I work on a critical care floor and personally don’t believe in fax or paper report. I need much more to go off of. I also work night so the doctors are usually screaming at us when we call the order medications, procedures or obtain consents that should have already been completed in the ED. Their is a large teaching hospital in my area that have fabulous nurse who are very thorough this one is not. But what I have noticed is that about 75% of the ED nurse at the hospital I work for are all new graduates.

[Wuzzie]

Then the issue isn't  generalized it is specific to your hospital and the only way to fix that is to start writing incident reports. Giving verbal report isn't going to fix the crappy care you are describing. 

Also, faxed report on an ICU patient isn't appropriate at any time.