Why is hand-off reporting to so hard?

[shabbychic23]

I am a recent RN grad with only 3 months experience on a med/surg floor alone. Even though the job is tough on me in terms of patient workload, I still can handle that; but what I find most difficult for me is when it is time to hand-off report to the next shift. I don't know if its because I lack the experience or because I'm so exhausted at the end of my shift that I leave out important information that needs to be communicated to my collegue. Whatever may be the reason, I definitely need to practice my nursing lingo and/or communication.

Anyone have advise on this issue?

[Tweety, BSN, RN]

Keep a mental picture in your head of the patient and during report go head to toe.

Leave out normals, such as "alert and oriented" and "lungs clear" unless this is a change, or it's important part of their diagnosis, such as if they come in with COPD, then reporting lungs clear is important. End with things like pertinent labs, vital signs,tests done, times of treatments, etc. Don't waste a lot of time on idle gossip or insignificant details. I've found the head to toe approach works well for me.

Things get better with time. Be gentle with yourself. You're doing a good job because you care.

[rn2bn07, BSN, RN]

When I hand-off report I usually go from head to toe. If there were changes throughout your shift then that's the information I would highlight on my paper. If the nurse your handing of report is new to the patient, then I would first give the history, then the admitting diagnosis, who is consulted to see pt, treatments/test/procedures, IV lines and/or drips or fluids, Diet, any skin breakdown...you know the basics. If there is something you missed out of all of that information then don't feel bad I'm sure the next nurse may have time to find it. Its a 24-hour operation, just report significant things and/or events that happened throughout the shift and go home.

[Tait, MSN, RN]

I make myself a little "cheat sheet" of the HnP for each patient then refresh real fast as I report on each patient. This gets the most important history points fresh in my head and often then leads me right down the rest of the assessment. I also maintain a sheet from the previous report which reads head to toe.

I agree though, sometimes our brains go to mush after 12 hours lol.

Tait

[kemper1974]

We are switching to paperless charting. Our report is:

1) 15 minutes of silent reading of the clinical summary on the computer

2} Nurse to nurse report

3) rounding report...both nurses go in to the patients room, say our little scripted intros, check all line, pumps and fluids. We are supposed to awaken the patient for their very important inclusion in report, which I think is wrong, especially if the patient has had pain meds and is finally resting,, or in my case since I work nursery, we have to wake up the sleep deprived breastfeeding moms who have been up all night. Seems to me we will be getting more patient complaints because we are in there too much. (not to mention doc rounds,peds rounds, chaplain rounds, photo lady round, charge nurse rounds and our anm and nm rounds, plus we are supposed to round hourly.....)

[CathyLew]

we used to tape our off going shift report when I first started. you hear a lot of things when you play it back!

Shift report is so hard, because unless you have a set criteria of things you run thrugh, and the order you run thrugh them... each nurse has their own set of crieteria they think is important.

Our taped report was set up to follow the kardex. Name, age, Dr, diagnosis, diet, activity, any specimens needing collecting, then onto abnormal labs, Xrays, and then what happend in the shift.

face to face report after a 12 hour shift...especially if there was one or two patients that took up all your time... you may just have a brief summary of the rest of them. I have had those mornings where in report I felt like a moron. I didn't know half the questions asked of me about my own patients..... but heck, I could give them a 10 page report of the patient who crashed, got albumin, stat labs, sent to CT, had a central line placed, needed one on one care for 10 our of my 12 hours, then just before morning, we get the order to transfer them out!

[Straydandelion]

I like actual rounds, we have done a combination of both...taped report where only unusual or pertanent things to the diagnosis is mentioned and physical rounds usually encompassing checking patient and if asleep, we let stay asleep if possible...checking lines, wounds etc. If a change in medicine or waiting for a lab I mention it otherwise usually if the information can be found in the mar or care plan, I don't repeat it.

[CathyLew]

Oh, I hate those walking rounds!!! Every patient wakes up, and wants something. You have about a half hr to give report... and the patient sees two nurses walk into the room. They need to go to the bathroom, would you hand them their dentures....Im done with my bath water... can I have something for a headach.... can I have some fresh water.... even if you take the time to tell them, the aid is comming to finish your bath, the med nurse will be arround in a minute.... etc.. those walking rounds turned into an hour real fast!

[RochesterRN-BSN, BSN, RN]

When I worked on a medical/respiratory floor I had an assignment sheet that I took notes on from the RN I was getting report from at the beginning of shift and then used again a the end to report off. I made it myself and had several revisions......I did it on my computer at home and copied it at work on colored paper I brought in.....this made it easier to keep track of it.......since it is easy to set it down in a chart, etc.... The stuff u have on the sheet may vary depending on the kind of unit you are on. I would put it together by thinking about what things I would want to know about the person. I would start my report by asking the nurse if they knew the patient. This helps so you don't tell them the history that they already know...ie they just had this woman for the last 4 evening shifts..... things they will need to do need to be mentioned especially if they need to be early in their shift so they don't dind them theirself too late......things like if a level on a med needs to be drawn just BEFORE they give the med. The med could be a 1700 med, early in the shift and they could miss that order for the draw and find it at 1800 when they already gave the med. Something like the surgeon will be up at right around 8 and he called to tell us when he will be here and to have the dressing off and ready for him to see the site when he gets there and then he will redreess it or you do it after he is done......if you forget to tell the nurse this on report she may go ahead and do the dressing change and have it all back together when the doc gets there and have to change it twice and have a ticked off doc too! So stuff like that is good to know. Any precautions the patient is on is important--fall, isolation--and which kind, seizure, escape......what ever. code status, especially if DNR or a limited level of care ie comfort care, hospice, etc. I would suggest listening to report from a few nurses to maybe see how others do it. Also...though its one of those off the record things...if the next nurse needs to be warned about the patients family--heads up kind of thing---this is nice to pass on, ie. the patient's father is a big wig surgeon here, the wife will be watching everything you do and has been giving all the staff a hard time and needed to be escorted out a few times, etc. These are the kinds of things that area just nice to know so the next nurse has an idea of what they are walking into! If I still had my old work sheets on my computer I would forward one so you could get an idea. Lots of nurses used my sheets. If you need help figuring out what to put on it I would be happy to help.....I am sort of an organization freak when it comes to that kind of thing.

[oramar]

Ask people who are really good at it what they do. There are a lot of similiarities between people who give good report and I would advise you to have one of them teach you their techniques. Keep at it will come. I gave report many, many times and thought I was fairly good at it but from time to time I had to call with a bit of important into.

[fiveofpeep]

Thanks for this post. During clinicals as a nursing student our instructors are always encouraging us to practice report, but it always seems to fall by the wayside. I will try to take it more seriously now so I can get much needed critique before I get out there on my own.

[BlueBug]

See if your place has a standardized form to use, at least to organize yourself. My place has one, but nobody uses it. I think I might start using it to give myself an outline so I can be organized. I will either use theirs or make one myself that I can fill out fast before shift change so I can give an organized report and not jump around so much. And try not to talk 100mph. I hate that, but everyone seems to do that...

Everyone is different. I had a LONG day and my mind was gone when I tried to give report the other night. The nurse I was reporting off to got fustrated and gently tried to help by giving me advice and telling me what was important to him, vitals, A&O, IVs, ambulation, diet, changes in status, ect. I took it all in stride because I was really awful. The next week I had to take report from him and was expecting the organized report that he has instructed me to do, ummm, not what I got!. He rambled on, missed the all so important infor, and sounded gossipy. I thought it was kinda funny and goes to show that everyone can be really different on how they give report and what their expectations are.

If you use a brain during the day, a sheet of paper you make notes on and keep sorta organized, you can use that for report too. You will be fine.

~BlueBug