When Giving Report Please....

[lilarox]

Everyone has an opinion on the best way to give report, and opinions on what not to do. I like to believe that most of the time I do a good job. There are days where things just do not flow well, and I do not win report giving awards. That said, I always try to be respectful of the oncoming shift when giving report. I think it is important to mentally put yourself in their shoes (or think back 12 hours...) so you give the report in a manner in which you wish to receive it.

So I'd like this thread to be a sort of feedback for report giving. It can even be a dumping ground for things that irritate you while getting report. All positive and negative comments can teach us something, and I am constantly trying to improve.

So I'll start, with more of a dumping versus a positive uplifting.

We have a nurse that tells you NOTHING in report, to sum it up it goes something like this: You have a patient in room xx, Any questions? Obviously he/she says other things, what he/she does say however is usually superfluous. Granted report is really short, guess that gives me plenty of time to figure out all that I needed to know.

Okay I will leave it at that and let everyone else chime in. For now.

[PacoUSA, BSN, RN]

My pet peeve during shift report is INTERRUPTIONS! The family leaving and saying "Excuse me, can I ask you a question?" or the patient wanting their water pitcher refilled at that very moment. Or the (think they would know better) nurse who insists on interrupting to ask one of the nurses if they watched Grey's Anatomy last night, or the manager who interrupts to point out that you forgot to chart a specific section on your patient. Seriously, the only interruption warranted during report is a rapid response or a code. My other annoyance is the impatient nurse that is either insisting to give report before 0700/1900 or one that is rushing the other nurse. While I understand your need to either start your assessments or to get going home, you need to be respectful of the other nurse either way. As a general rule, I never rush any nurse, incoming or outgoing. The work gets done.

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[Caffeine_IV]

I'm about to start on an RN job and the director made it clear that they do bedside reporting.

Can you give me tips on how not to make it awkward in front of the patient and also as occasional, in front of family members. :)

Most places will be doing this eventually. Tell the patient that you are doing bedside report and ask if it is ok to speak in front of their visitors/family and proceed. Of course I avoid detailing sensitive or unclear info and save that for outside the room.

[PacoUSA, BSN, RN]

Our hospital does bedside reporting. It is not however required that we do actual shift report literally at the bedside (for concerns of HIPAA in double rooms). We do report outside the room and then go into the room together to check lines, bed alarms, assess the room environment and eyeball the patient before official handoff. Last minute items missed on report are often shared at this time too.

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[tareija]

On my unit we have a group report. The oncoming nurses get together and we read out the Kardex for all the patients. This takes about half an hour , which is a bit more than 1 minute per patient.

My main complaint is that some nurses don't read everything in the report from the previous shift. More than once I have written something in the Kardex that needs to be followed up on next day (if I'm working next day), and then I found out it didn't get read out and the next day's nurse didn't follow up because they didn't hear that they needed to. Frustrating.

[bamaguy1989]

I work med/surg and we are supposed to start report at 6:45. Last week this nurse that is float pool( and every floor dreads when they learn she is coming to their floor that day) did not start report until 7:30. She basically told me nothing....as usual but expects everything in report and is obsessed with the white board and takes 10 minutes to erase my name and put hers up there. Gives pain meds late, give 4 hour infusion Zosyn hours late so the schedule is off......ugh. But U digress.... I just need name, dx, whats been going on with them, what we are doing for them, procedures, when next pain med is, consults, and are they blood sugar

[nynursey_]

When giving report, I like to receive the full picture. My facility has made strong attempts to push for bedside report, but in certain patient instances, bedside report is not always appropriate and/or possible. We follow report sheets that encompass all body systems, and at the end of report, always include a discharge disposition as to be updated on what the current plan is for the patient. We also include any consults, pertinent labs, drips, and/or daily tests. I think that a comprehensive patient picture is essential for the oncoming nurse as it prepares them for questions they might field in the first 30 minutes of their shift where they may/may not have had time to get into the patient's chart.

Our shift change report occurs at 0700. Day shift reports at 0700 and night shift stays until 0730. This 30-minute window allows for a through report to be exchanged from nurse-to-nurse and I find that the nurses in my facility give excellent report as this time is written into their scheduled time.

[ThePrincessBride, MSN, RN, NP]

From what I've read you all would hate the way I give report. I'm not even the exception in my unit, either. Sometimes report on one patient can last half an hour. Granted, we only have one or two patients, but our culture is to give very thorough and detailed reports.

I remember in my clinical for nursing school on a gen med floor we were practicing giving hand off report. I went first and went by systems, mirroring what I had observed in my internship (the ICU where I currently work). I was talking about peripheral pulses, bowel sounds, skin turgor, etc. My instructor let me finish and sort of laughed and said, "that was nice, but I stopped listening 10 min ago!"

I think you bring up a good point. If I'm taking care of a sick, sick patient, I want a very thorough report. However, if it is a walkie-talkie, A & Ox4, etc, we don't need to be there all day!

[nynursey_]

I think you bring up a good point. If I'm taking care of a sick, sick patient, I want a very thorough report. However, if it is a walkie-talkie, A & Ox4, etc, we don't need to be there all day!

It definitely helps to know your unit and what sorts of patients you might encounter!

[calivianya, BSN, RN]

Day shift arrives at 0645 and night shift is supposed to end at 0715, so we have 30 minutes for report. Unless the day nurse is getting the same two patients back, in which case report may take less than 10 minutes, we usually go over. I expect a full systems review. Don't bother telling me normal labs - those are in the computer, but do tell me how recent x-rays/CT scans/ultrasounds turned out. Feel free to tell me labs if they're critically abnormal - I like knowing my patient has a WBC count of 0.6 so I can wear a mask and that he/she has a platelet count of 10 so I can be careful not to bruise him. I would also like to know if any of the labs that have replacement protocols are abnormal and if the patient is on the protocols even if the labs are fine. Tell me any MDROs. Tell me who all of those family members are and if there are any dynamics I need to know about. Tell me everything you didn't get done today, please, so I don't walk into the room blindsided. If the person's vitals have been changing throughout the day, tell me trends you've noticed even if they aren't technically abnormal. If the patient started in the 150s/90s all day and has been running 110s/70s suddenly for the last couple of hours for no apparent reason, I would really like to be aware of that. Same with labs, really - if the hemoglobin was 16 yesterday but 12 today, did you call a physician? It's not critical but I really hope someone already knows about a drop that large and fast. Tell me if you called any MD about anything - I'd like to know what was said if they happen to round on my shift and have any follow up questions.

I've had patients that have been in the hospital so long that report has taken more than 45 minutes on that patient, and that's okay sometimes. If the patient is really complicated I would rather have all of the necessary information than too little information.

I think what bothers me most during report is when the nurse I am giving report to doesn't write anything down. There is one nurse on my unit that does this and I guess she must have a photographic memory, because otherwise I couldn't possibly imagine how she is providing competent care. You can't find everything that's important in the chart, esp. when you're talking about the family, and even when you can - who has time to spend all day reading through the chart to look up things that could have easily been transmitted in report that you forgot?

[CodeteamB]

I think what bothers me most during report is when the nurse I am giving report to doesn't write anything down. There is one nurse on my unit that does this and I guess she must have a photographic memory because otherwise I couldn't possibly imagine how she is providing competent care. You can't find everything that's important in the chart, esp. when you're talking about the family, and even when you can - who has time to spend all day reading through the chart to look up things that could have easily been transmitted in report that you forgot?[/quote']

Meh, I haven't written down anything in report in the last 3 years. The things that are tough to remember (eg: specific lab values, vitals trends etc) are easily accessible in the chart, my orders are there and flagged, and I find it easy to locate things in our charts. Also I don't have trouble remembering family stuff... To each their own, I would say that I and my coworkers (I can think of only one who takes notes during report) provide more than competent care :)

[sistrmoon, BSN, RN]

I arrive to the unit and get my assignment and am ready to receive report. I despise when day shift comes in and is off getting coffee and snacks, chatting, etc before moseying over to receive report. I also could really do without interrogation, eye-rolling, and major attitude copping over minor things. If I've been in one room all night trying to control a patient's pain, then maybe a minor detail got missed on an admission(minor detail being a piece of paper detailing history, which is already in the H&P and in the computer under med surg history, so 2 other places)...that sort of thing. As for me, just major details, age, gender, room, diagnosis, pain, what we're giving for pain, skin, any skin interventions, anything in particular outstanding that needs to be done or special labs, how they get up, any samples still needed. And yes, it's true as a night nurse that we often don't know "the plan." That seems to be a recurring question from day shift. IF I have time to read the progress notes, then I'll know the plan, but otherwise, that doesn't really get discussed on nights unless the patient's acuity changes during the night and the plan changes. The worst detail left out of report for me was that the patient had a trach! But I also had an admission from the ED who was a new quadriplegic who had a giant unstageable pressure ulcer and a PEG tube...none of those details were communicated in report.

[nynursey_]

I arrive to the unit and get my assignment and am ready to receive report. I despise when day shift comes in and is off getting coffee and snacks chatting, etc before moseying over to receive report. I also could really do without interrogation, eye-rolling, and major attitude copping over minor things. If I've been in one room all night trying to control a patient's pain, then maybe a minor detail got missed on an admission(minor detail being a piece of paper detailing history, which is already in the H&P and in the computer under med surg history, so 2 other places)...that sort of thing. As for me, just major details, age, gender, room, diagnosis, pain, what we're giving for pain, skin, any skin interventions, anything in particular outstanding that needs to be done or special labs, how they get up, any samples still needed. And yes, it's true as a night nurse that we often don't know "the plan." That seems to be a recurring question from day shift. IF I have time to read the progress notes, then I'll know the plan, but otherwise, that doesn't really get discussed on nights unless the patient's acuity changes during the night and the plan changes. The worst detail left out of report for me was that the patient had a trach! But I also had an admission from the ED who was a new quadriplegic who had a giant unstageable pressure ulcer and a PEG tube...none of those details were communicated in report.[/quote']

In regards to the plan, I *always* keep night shift in the loop of the plan. I let them know anticipated discharge date, disposition, and any pending consults. I think it's important for them to know for a variety of reasons, and honestly, it helps promote continuity of care.