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?

[RNperdiem, RN]

I have had to work hard at giving report since we switched from paper to computer charting.

I am visually oriented. At the end of the shift I can barely string a sentence together and sometimes forget common words(end of shift aphasia).

I like to show rather than just tell. I will flip through the medex to show what PRN meds I gave, I will take the oncoming nurse into the room and show the IV infusions, arterial lines and other things.

I work in ICU, and am not excessive in the time it takes to give report.

[NurseKatie08, MSN]

It's taken me a while to get used to giving report. I work on a transitional care unit within a LTC facility, so most of our patients are there for probably as brief a stay of two weeks to as long as six weeks depending on why they came to us.

It depends on the nurse I'm giving report to--if I know they've been working the past couple of nights in a row and know the patients, I just report anything new that happened during my shift, if they were seen by the doc/NP, any labs or new orders, prns given, antibiotics they might be on and why.

If the patient is a new admission, I give history, and a brief head to toe--a&ox3/alert & confused, vitals, lung sounds, peripheral pulses as applicable, blood sugars & insulin given if diabetic, continent/incontinent/ostomy/foley etc, diet, activity status, skin & what any wounds look like, dressings etc, follow up appointments, labs ordered, prns given, antibiotics they might be on and why.

Hope this helps some!

[Virgo_RN, BSN, RN]

We are supposed to use the SBAR format for giving report. S=Situation, B=Background, A=Assessment, and R=Recommendation. An example might be something like:

Situation: Mr. Jones is a 65 year old male who was walking his dog yesterday and experienced crushing substernal pain. He went home and his wife called 911, he was brought to the ED, and admitted for CP r/o MI.

Background: Mr. Jones has a history of diabetes (diet controlled), hypertension, and dyslipidemia. He currently smokes a pack a day.

Assessment: Mr. Jones is in a NSR with no ectopy, and has not complained of any CP today. His troponins are negative. He is alert and oriented, and up adlib in his room. He has a 20 gauge IV in the RAC, it is a field start. He is Full Code. His wife is at the bedside.

Recommendation: Mr. Jones is scheduled for a stress test in the morning. He's watched the video and signed the consent.

Then I always ask: "Do you have any questions?". This gives them the opportunity to get the information they want, and leave out the extraneous stuff that they can just look up for themselves.

[Virgo_RN, BSN, RN]

Mrs. Smith is a 92yo LOL who comes to us from Pleasant Acres nursing home. She was experiencing SOB and confusion, and was diagnosed here with pneumonia and ARF.

Mrs. Smith has a history of dementia, AF not on Coumadin, osteoporosis, chronic renal insufficiency, CHF, hypertension, and GERD.

Mrs. Smith is A&OX1, is impulsive and has been trying to climb out of bed. The bed alarm is on. She has a productive cough and ronchi throughout. Her BUN and creatinine are 45 and 1.9. She is not on tele, and is a Full Code. Her son is at the bedside. She is on droplet precautions.

Mrs. Smith is getting IV Levaquin, Ativan PRN, and D5NS c 20 at 75/hr. Plan is to DC back to Pleasant Acres.

Any questions?

[Virgo_RN, BSN, RN]

Heheh, that was fun!

[sunshines66, BSN]

Ithnk the forced nature of it makes it more difficult. I like the opportunity to write things in a sit down nurse to nurse conversation. Then going round to the patients and recapping what is important. I am a traveler and at one hospital I worked we did a modified hand-off. We talked about the patients then went around to the room. They were all private rooms each had a dry erase board that we confirmed had the latest info on. ie drs on the case, diet, activity, tests for today. It made it easier for anyone to go in answer the call light know what was going on. It also let us talk to the patient to clear up any confusion. We did not wake a sleeping pt. We entered the room and update the board.

[nerdtonurse?, BSN, RN]

I go by ABCs, and "what will kill you faster" -- mine sounds something like this:

John Smith is a 87 year old male in Room XXXX is a patient of Dr. Jones. Patient is a full code. He was admitted 1/10/09 with a diagnosis of rule out CVA. Allergies to sulfa and PCN, ingestion of either causing anaphlactic shock. Paitent is on fall precautions, aspiration precautions, and seizure precautions, blue pads in place. No falls, s/s aspiration, or seizures my shift. Patient is a q2h turn.

Patient has a history significant for afib, HTN, DM2, MI in 04, cath with 2 stents, sleep apnea with CPAP at night. Pt's vitals are within norms with exception of BP, which was 180/92 beginning of my shift, rec'd Vasotec 1.25 at 2015, second dose at 0300 for BP of 185/95. Dr. Jones does not want the bp to fall below 160/80, but to give Vasotec 1.25 PRN Q6h for BP greater than 180/90.

Mr. Smith is currently getting q4h neuro checks, and showing L sided weakness, deviation of the tongue, sluggish pupillary reactions, and pt is currently verbally aphasic, which was not his norm prior to admission. Unable to use speech board, possibly expressive aphasic. Pt is currently NPO, pending swallow eval., results of CT still pending. SCDs in place for DVT prevention.

2100 FS was 339, pt got 15 units of coverage. IV in L hand, running NS at 70cc/hr. Currently running afib on the monitor at 87, patient's norm. Bowel sounds present x4 quads, last BM yesterday per wife, who is at the bedside. No edema, skin warm, dry and intact. Foley is patent and draining yellow urine without complaint/obvious discomfort. No edema, good pulses x4 extremities.

Per the wife, pt was c/o headache all day, went to get up from lunch, and collapsed. Wife states pt experienced a seizure, no prior hx seizure. States he did not strike his head, but sorta "slid down the wall" on his right side, started seizing, and she called 911. No obvious abrasions/bruising, but patient is on blood thinners d/t afib, so I don't think he took a hard impact. Was eval'd in ER, and the thinking is the stroke is hemmorrhagic, not ischemic. Monitor for exacerbation of stroke. Wife instructed to not feed pt/give him something to drink without one of us present to prevent aspiration. This is Nerd2Nurse, giving report.