written up

Lucky724 · Oct 15, 2011

The hospital should have a written policy about steps for termination..how many writes ups etc. Regardless of what the other nurses are doing in report, it sounds like your manager has made it clear she expects. If possible, can you have her present at a time you give/receive report so she can see and listen first hand?

As far as finding another job..I think that's up to you at this point..if you don't feel like this place is a good fit or they are not going to really accept you then you may want to start looking around..if this is the only thing to come up..I would work on it and go about my business.

FootballGirl · Oct 15, 2011

What?? If I had to listen to a head-to-toe report on all my patients I'd go bonkers! We only report off on the pertinent information.

Mulan · Oct 15, 2011

Give her what she wants.

Start now.

Make up your own report sheet if you need to so that you give the expected info.

EmergencyNrse · Oct 15, 2011

Head to Toe? ...lol.

I don't even give that kind of report in the ICU. You're lucky to get an SBAR format.

How about a problem-focused report? Things of interest, areas of concern?

I'll tell you to keep an eye on a reddening IV site or maybe decreased urinary output over the shift. Pt complaining about increased irritation or pain somewhere...

The oncoming nurse needs to do their own head-to-toe.

But that's just me.

NaKcl, BSN, RN · Oct 15, 2011

I am guessing you are a new nurse?

It is frustrating to learn the new job and adjust to the new surroundings.

I would take that as a grain of salt to improve your reports.

I, too, had problem giving reports at the beginning of my nursing career.

So, I made a list of things that is pertinent to the patient.

1. admission date and diagnosis

2. attending doctor

3. current problem/complaints/ abnormal labe results/ scheduled lab draw or test

*from this point, head to toe

4. is patient alert and oriented?

5. Oxygen: O2 or RA

6. Heart: Tele? then what is the rate?

7. IV site and type of fluids

8. Diet and elimination route: continent or incontinent? foley, rectal tube

9. any skin issue?

10. TED hose/ SCD?

then, ask the other nurse; Is there something I missed? , if there is remember to include that aspect in next report.

Don't get discouraged. It takes times to develop a good reporting skills.

*they won't terminate you after the first written up. :nurse:

Forever Sunshine, ASN, RN · Oct 15, 2011

Bite me if you please but if I was the NM I wouldn't have written you up for that. I mean if she told you once, "Hey you know I'm hearing from other nurses that your report could use some improvement. Why don't you try organizing your information this way.... "

Obviously if your report was still lacking then that would be appropriate for further action, not necessarily a write up right away unless someone was harmed.

When I was new I had a hard time figuring out report(although the nurses I was reporting off to didn't have a problem with it) and communication with doctors. The ADON at the time suggested that I listen closely to other nurses and watch how they deal with things and the style they use and use that as a guide. So I did, and now I think I give a pretty good report to not only nurses but to doctors when we have a new admission or problem with a patient that I need to let them know about. I use head to toe format in my nurses notes but I like the SBAR method the most. Its very organized and goes well with how I like to present a situation.

luvmyhubbybunches · Oct 15, 2011

I too had problem with reporting off as new nurse. I kept a report sheet with me at all times. I used this to get report and give report. I printed it off on my computer and at top the following things were listed with boxes under each title to list information:

*pt's name-left block large enough under this heading to put pt sticker from chart, in this area I also jotted DNR in red if that was the case

*diagnosis

*vital signs

*I&O-foley, rectal, etc

*heart rate/rhythm

*IV fluids and site of IV

*then at end I had section for notes, this I left for reporting any changes, things to watch for, consults, etc

I had to tweak my flow sheet a little at first to get everything to fit, but after awhile I started learning what was pertinent and what was not to oncoming nurse. BTW, it took me more than 3 months to get in the groove with reporting, but this guideline really helped! When I left the hospital where I first started using this report sheet, I had left a few in my mailbox. I went back there about a year later to do some PRN work for them and was pleased to find out that they had implemented the use of my report sheet hospital wide!!!

You will be fine, just listen and be open to any suggestions and go back to your NM with a plan to improve your reporting technique.

JustJen, BSN, RN · Oct 15, 2011

Seems insane to give a full head to toe during report....what you might do is make yourself a form that lists head to toe info and make one for each patient. Your could give one per patient to the oncoming nurse. You could still give report but your sheet would have anything that you may not have said.

Just a thought....

llyonya · Oct 15, 2011

That's what I hate about America - you, guys, love so much to complain about one another to your managers. Try to complain to your manager about your coworker in Eastern Europe, or in Italy, for example, and you will see what will happen to a complainer... Also, if your manager wants to fire you she will do it. You are nothing in this country. For example I also was fired from hospital after working for the hospital for 2 years and getting 3 write-ups just in one month. Once I was written up because my patient complained, stating, "I thought I would fall."But she did not fall. and hospital has policy - not to punish nurses for pt's falls, just send a nurse to a fall prevention class. In my case patient even did not fall.. I appealed that write-up and lost my appeal even though hospital policy was on my side. I wish you good luck, and also encourage you to think: How many times did you complain to your manager about your coworkers? I do not mean your current job. Did you do this type of harm to someone in the past?

nerdtonurse?, BSN, RN · Oct 15, 2011

Don't know if it would help, but here's how I give report in ICU:

Mr. Smith is a 89 yo pt of Dr. Smith, Cardiology on consult, Dr. Jones saw him. Pt. came to the ER on 10/11, complaining of chest pain and shortness of breath. He had changes on the EKG, and was admitted to the unit for a STEMI. Pt is a full code, with allergies to nuts, iodine, and PCN, and the iodine and PCN cause anaphylaxis. Hippa code is "cookie." He's not from here, he's from Atlanta, and he wants to get home to his own docs, we've got his records from Emory on the chart.

HX: MI, (this is his second), CABG with stent placement x3 stents years ago, CAD, DM II, oral meds at home, AC/HS fsbs with coverage here, I haven't had to cover him, it's running 120's. HTN, hyperlipidemia, arthritis in the knees, uses a cane prn, and he's had bilateral cataract surgery, and he's got hearing aids in there in a denture cup. They did a cath the day he was admitted, nothing stentable, EF of 30%, blockages in X, Y and Z. Had been on coumadin at home after a spell of afib in the spring, that's on hold, probably restart it tomorrow, get him theraputic and let him go back to Atlanta.

Cardiac: he's in a sinus rhythm with an inverted P wave, rate 85 to 95, BP 130's-150's systolic. No complaints of pain, tightness on my shift. He's got +1 pitting to the bilat LE,

Resp: His lungs are a little dim'd in the bases, non-prod cough, and a little coorifice, he's been a 3 ppd smoker x30 or more years. We did the smoking cessation teaching last night. Got him on O2 @2, and he's sating 94, 95%. When he takes it off, he goes down into the high 80's, I'm wondering if he's got some COPD cooking down there, not on home O2.

GU: He's got a 16 french foley, when we put in the foley the urine looked like pineapple juice, we sent a UA, and he's pos for a UTI -- he's getting abx for that. Output's good, he's diuresing well, but his potassium's dropped with all the lasix, he got 4 riders yesterday, he'll probably get more on your time, the chem 7's not back yet. Cardiac 1800 cal ADA diet, eats like a horse.

GI: Good bowel sounds all 4 quads, had a good BM last night, brown and formed, no blood. He's got some spectacular hemmorhoids that are a little swollen, but no bleeding.

IV: He's got a 20 to the L wrist, NS at KVO with Heparin, it's therapeutic and your next PTT is in the morning, none on your time. He's got a SL in the LAC, and it's positional, good blood return in both, but I'd only use that LAC for pushes, or the pump beeps every time he moves.

He's alert, oriented, uses a cane occasionally like I said for the arthritis, we've got an order for OOB to chair, PT will see for ambulation, skin's great, just fragile and lot of moles. He'd been on coumadin after a spell of afib, and he's got that coumadin skin, coumadin's gonna be started tomorrow, maybe. No orders on that yet.

nice guy, wife's frail, lots of family in the daytime. Probably going to go upstairs today, and we're referring him back to his own cardiologist at Emory.

And then we'd go over labs/radiology for the shift. Hope this helps...

Mulan · Oct 15, 2011

Use the SBAR format, and give your assessment under A.