Getting the right report

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One of the most nerve-wracking parts of the clinical day is the very beginning. Even if you’re working on the same floor the whole quarter, it’s quite unlikely you know everyone on the unit. We scramble to find out which nurse is assigned to our patient in a sea of tired night shifters and not-quite-ready for an eager student day shifters. And we’re looking for new orders on our patient, while trying to figure out where everything is and not looking lost all at the same time. In the morning rush, it seems like the one place where everything would come together would be in the morning report, but that’s not always the case.

As a student, my BIGGEST pet peeve is when you get morning report from the night shift nurse and all they do is read off the patient’s H&P. Since we’re the ones going in the day before to spend hours reading the patient’s chart, their day-by-day progress, and their entire medical history, we’ve already got that part down. I get that the morning nurse maybe hasn’t read the H&P yet, but that’s something he or she can do after report, I mean, we are all trained at how to find things in the computer, or can certainly flip to that section in the chart on our own accord. When you get report in the morning, the point is to “hand-off” the patient, not read off material that the MD wrote out ten days ago when the patient was admitted.

We don’t want to start the day off on the wrong foot with the nurses, but it’s our responsibility to get the right information we need on the patient. What’s been happening in the last 12 hours? Did anything significant occur? What meds is he requesting? Is his output ok? The questions we need answered will vary depending on the patient and the setting, but it’s these updates that are vital to the way we start our day and care for our patients.

So what can we do?  Well, you don’t want to be rude about it, so no yelling out, “YES, I DO KNOW HOW TO READ, thanks, I will do that on my own time” (no matter how loudly you may be screaming it in your head). But it’s important to be prepared for report. Have your paperwork ready, use a “brain” to organize yourself, and where there are gaps in your papers, ask questions (nicely!). There are plenty of reasons why report gets read off the chart in the morning, and I don’t mean offense to any nurses who refer to the chart during report, I am strictly talking about the nurses I have seen who solely read off the chart for their report. I have even had nurses say, mid-sentence, “well, you know, you can read the rest of this later, ok, any questions?” If this happens jump to it and take that opportunity to get your questions answered.  Getting a full and thorough report is just as much your responsibility as it is the other nurse’s responsibility to give it. Make sure you’re getting your questions answered so you can start the day off with one less bit of confusion on your mind!

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Ani Burr, RN

I'm a brand new, full-fledged, fresh-out-of-school RN! And better yet, I landed the job of my dreams working with children. I love what I do, and while everyday on the job is a new (and sometimes scary) experience, I'm taking it all in - absorbing everything I can about this amazing profession we all fell in love with.

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13 Responses to Getting the right report

  1. Your name

    No one has time to do reading when you practice. You just go straight into your routine taking care of 5-6 patients on the floor or 2 critical patients in the ICU. You’ll see, in time.

  2. Mandy

    It always cracks me up that student and new nurses always think they have all the answers! :)

  3. Mandy

    Im an ER night nurse and one of my most amazingly bad hand-offs occured when the day nurse, stressed because his pt in one room was crashing while his pt in the 2nd room was failing as well, reported to me that pt #2 was ready to go to ICU: “Report has been called. You just have to take him up.” I then asked my supervisor to please find me a tech so that we could take the pt up, to which she replied: “That pt has passed…” You know its been a really bad shift when you dont even reailize your pt has died.

  4. Your name

    I agree with the above comment.. unfortunately I get report on my 2 ICU patients and right away jump into my night.. and the reality is that it is incredibly rare that I have time to read an H&P. I also agree that you may see it differently in time. It is wonderful that you get to go in the day before to spend time pouring over charts and reading and in a perfect world all nurses would get to do that but we get so busy right out of the “starting gate” that most times the only history is what I get in report (especially because I work nights in ICU.. rarely many visitors and our patients tend to be either unable to give us details because they cannot communicate or are very poor historians because they are often sedated/confused).
    I appreciate your posts and look forward to reading them! Thank you for sharing your nursing school experience with us! =)

  5. Sue

    While I appreciate that the writer is a student nurse, reality is that many shifts I don’t have enough time to read h&p before I have to hit the floor running. Many have the misconception that night shift does very little but I can assure you there are many, many times that I’ve had to stay past my scheduled shift to finish charting etc. So having a nurse review the H&P with me r/t admission is a very important part of hand off! It comes under the heading of continuity of care.

  6. gg

    I hate it when I am doing bedside report and the oncoming nurse ignores me and what I am saying, and starts doing stuff to the patient.

  7. Jessica

    Thanks…I’m a night shift nurse and I have never done this. I actually give a report of the last 12 hours.

  8. Luci

    Obviously if there was something good to add to report, they would. Thats why they read the H&P so its not just a “nothing happened, have a goodmorning”, everything else you also could find out if it was that important, if the output was scant they would tell you…ie…hint hint, keep an eye on that, if not the they don’t say anything about that! It takes years to learn all this little things that experienced nurses do and not say, I am sorry but somedays I have a day where I just want another experienced nurse to give report to….

  9. Ellen Algava

    I have been an OR nurse for 25 years, eight of which have been on nights. Some of my most incomplete reports have been from the evening (1500-2300) shift. I come into a room, and I’m told what equipment was charged, and progress of the case at that moment. What I want to know are pts. allergies, past medical and surgical history. Then the change over count, and I can charge for the equipment, as they have to go home. If the charge nurse is in the room, tell me about if there are early cases, problems with machines, etc.

  10. Amy

    Here’s some advice….as a newgrad.5 (6 months in) – I work on a ridiculously busy neuro/trauma unit at a large urban level 1 trauma hospital – some of the night nurses do find time to read the patients charts and every radiology report and it’s findings. And then on report they start paraphrasing from it all……it’s terribly annoying. All I want is the meat and potatoes. I don’t care to know every individual phylanx bone that was crushed or fractured. I don’t care why the idiot got in his car peed off and drove up the highway the wrong way. Hate to sound cold, but when you have 7-9 heavy patients……give me a run down of the past 12 hours, and I’ll do what I can to improve or at least maintain stability.

    So this is how I accomplish a concise report…

    When I encounter a historian report giver RN I just politely cut them off and go to question #1 – are they alert and oriented? Are they intact neurologically? Okay great. Now lets keep goin’ down the body systems. ….I don’t care that he was an alcoholic in 1987, is he on a ETOH drip right now? No, okay. Cardiovascular wise?? If the pt. has a new funky rhythm this is a good thing to share with me. If the pt. has a funky rhythm at baseline this is also a nice thing to share. Is he symptomatic? Resp. GI – if the pt. pooped continuously all night, this would be a truly wonderful thing to share since ALL patients at my place of employment are on ATC docusate and senna. Sooooo if he pooped ALL night, I’d really like to know so I can hold the stool regimens. GU. Skin. Musculoskeletal? again, I don’t need a dictation out of an anatomy book….his leg is broke, or his ankle is broke, or ribs broke on left side is good. I don’t want to, nor will I likely go look up what a navicular is. What i will do is walk in the room, see a casted foot and tell the next nurse in report that his foot is broke, and he’s non-weight bearing. Oh and did you report the K+ of 3.2 to the MD last night? Okay, thanx. Have a nice sleep. I can read patients allergies, diet and other orders on my own.

    I made my own report sheet that goes right down the body systems, and I’d say it’s works pretty good for me. But to each his own….and everyplace you go you’re going to encounter different teams that do things different ways. And as far as being a student is concerned…..realize that real life is NOTHING like text books and nothing like lab at school, and really nothing much like your 2 patient assignment at clinical. Don’t come onto a unit and act astonished that the RN doesn’t know that a patient had acute kidney failure 27 years ago and it is unrelated to the current diagnosis. Act helpful, act willing, and unless a nurse is missing a piece of information that you think could pose potentially harmful to the patient, keep any case of Lexipedia to yourself and dive into the almighty cause of keeping patients off the floor. Thank you and good night.

  11. as a night nurse working either ortho or telemetry, I am often up to my eyeballs in work. I have issues with oncoming nurses assuming that we have nothing to do at night and why can i not give them the full h&p beginning from when the patient was an infant. Having said that, a nice balance of pertinent h&p pertaining to situation at hand is part of SBAR and helps to give a broader picture.

  12. judy

    As a newly graduated and licensed rn as of Feb of this year I am a night nurse in a nursing home with an average of 56 pts and I have 3 cnas with me. I have some wonderful supervisors who are always their when I need them and they are also running their own floor.

    I glance at dx when i need to, it is nothing like nsg school. You are learning in nsg school but in reality I only hit the chart when I need too. Report was annoying to me too at first but as long as I get the really important things at this point I am happy. We report only the need to know. I am giving out prn meds all night, doing paper work, labs, appointments, I have a med pass that has to be done as close to 6am as possible. I don’t take a break unless I am having a night and it is for like 10 minutes. I also don’t take breaks so I can get out sorta close to on time. Don’t be so hard on them. They know you are new but cut them some slack for the hard night they possibly had.Maybe asking questions would get you what you want to know. Also everything is documented and with one or two pts as a student you could look up the current #s and stuff.

    Well this is too long winded but it is quite a shift to the real world and I am just holding on tight right now. I do love nursing but it is truly the hardest thing I have ever done. I wish all the best on your career.

  13. judy

    I forgot to add doing assessments, checking on things cna’s report and any number of other things that come up unexpected. Really try not to be so hard on the nurses for not giving you the most ideal report. It is prep for the real world of unpredictable nursing. Again, Congrats on graduating this year and good luck in your career.