Nurse's Brain, Part 4: Giving report to the oncoming nurse

by Cathy Parkes July 11, 2020 2 Comments

RECAP: What is a Nurse’s Brain?

A Nurse’s Brain, also known as a nursing report sheet, is a term for a sheet of paper that nurses use to capture important patient information and stay organized. It contains sections for key areas like patient history, diagnoses, labs, medications, body systems status, and more.

In part 1 of this video series, Cathy walks through her Nurse’s Brain and how to use it. Using your Nurse’s Brain ensures a seamless end-of-shift report—to your CNA, other nurses, and the doctor or hospitalist. In this video, Cathy explains how to give a good nursing handoff report and improve your nurse-to-nurse communication.

Download Cathy’s Nurse’s Brain template


What is the end of shift report for oncoming nurses?

An end of shift report is a detailed record of a patient’s current medical status. It’s written by nurses who are finishing up their shifts and are then given to nurses who are beginning their next shifts. It should include the patient’s medical history, current medication, allergies, pain levels and pain management plan, and discharge instructions. Providing these sorts of details about your patient in your end of shift report decreases the risk of an oncoming nurse putting the patient in danger.

Why is the end of shift report for oncoming nurses important?

An end of shift report allows oncoming nurses to understand the medical needs of their patients and provides a picture of a patient’s recovery or decline within the last several hours. By knowing what has previously occurred in a patient’s treatment plan, nurses can continue to provide care that will result in a positive outcome.

How to use your nurse’s brain to give report to the oncoming nurse

At the end of your nursing shift, you’ll have a short window of time to give a report to the oncoming nurse. During this transfer of responsibility, the oncoming nurse needs to know the most important information about your patients, so it’s your job to give a concise, organized report on each of them. The amount of time you have for each patient's report depends on where you work and the nurse to patient ratio, but it's usually around 5 minutes per patient.

Your Nurse's Brain can function as a nursing handoff report template. If you have kept track of this information using your Nurse’s Brain, it’s easy to quickly transfer the knowledge at shift change. 

What to cover in your nurse-to-nurse handoff report

  • The patient’s name and age
  • The patient’s code status
  • Any isolation precautions
  • The patient’s admitting diagnosis, including the most relevant parts of their history and other diagnoses
  • Important or abnormal findings for all body systems:
  • Respiratory: Is the patient on oxygen? If so, how many liters per minute are they getting?
  • Cardiovascular: Is the patient on telemetry? Are they on a cardiac drip or heparin drip?
  • Neuro: What is the patient’s level of consciousness?
  • Musculoskeletal: Is the patient mobile or bed-bound? Can they get up independently or do they require assistance?
  • Gastrointestinal & Urinary: Does the patient have any diet restrictions? When was their last bowel movement? Are they incontinent and do they have a catheter in place? What kind of catheter?
  • Skin: Does the patient have any wounds or pressure injuries?
  • Is the patient diabetic and are blood sugar checks required?
  • What kind of IV access does the patient have? Are they getting continuous fluids? If so, which fluid? 
  • Is the patient on any antibiotics? Are they taking pain medication(s)? If so, when was their last dose?
  • Does the patient require certain tests that day? Do they need wound care? Will the patient be discharged during that nurse’s shift?

What not to cover

There is such a thing as too much information. There are some areas you don’t need to give every detail on because they are either not relevant to the admitting diagnosis or something the oncoming nurse can easily look up. Using too much time on one patient will reduce the amount of time you have to give a report on the next patient. In your nurse-to-nurse report, avoid spending inordinate time on:

  • The patient’s non-essential comorbidities. Sometimes patients have 30+ comorbidities and it would use all of your 30 minutes to talk about them. 
  • Every single medication the patient takes. Again, sometimes patients are on a laundry list of medications that the oncoming nurse can and will look up, so stick to the important ones. 
  • The patient’s specific labs. The oncoming nurse has access to these details if needed.

What if you are the oncoming nurse?

If you are the oncoming nurse, the best way to receive a report is to be punctual and focused. If you are late, it shortens the window of time that the departing nurse can report on patients. 

Patient Involvement

There is good evidence that when a patient is involved in their care they experience improvements in safety and quality. Engaging with a patient and their families during a handoff with an oncoming nurse ensures a safe and effective transfer between shifts. It also gives nurses more time with the patients to answer questions and take care of any needs they may have.

Handoff communication in nursing

Giving a focused, efficient report is an important communication skill in nursing. Others will respect the care and organization you put in--which can improve your nursing relationships with coworkers. Giving a good report builds trust, ensures continuity of care, and improves patient safety. 


FULL TRANSCRIPT

In this video, I am going to share how to give a good report to the oncoming nurse. 

As you know, you have a really short amount of time, 30 minutes max to give report for all your patients. And this could be three patients, four patients, five, maybe even more depending on where you work. You're going to have to be really focused and really concise on how you give report to the oncoming nurse. 

If you are the oncoming nurse, be sure you get to work on time and be ready to get report at 7:00. I had a couple situations where I worked night shift and the oncoming day shift nurse would roll in around 7:07 A.M and get her coffee and chitchat and she really didn't come to get report until almost 7:15. And it's not really respectful and it really condenses that 30 minutes into a much shorter window to convey a lot of information. Just try to be respectful, get there early, get your lunch put away and just be ready to get that report at 7:00.

When you are giving report, what information is important to convey? Because, again, you only have about five, seven minutes per patient. You want to communicate the patient's name, their age, their date of birth. 

You want to talk about their code status because if the patient were to code, right? Like have a cardiac arrest for the oncoming nurse, should they perform CPR or is the patient a DNR patient? 

In addition, you want to let the oncoming nurse know if a patient is on contact, airborne or droplet precautions. 

In addition, you want to explain the patient's admitting diagnosis and maybe briefly describe their hospital stay and what the status is regarding that admitting diagnosis. 

In terms of the comorbidities, I wouldn't go into a lot of detail about those. Some of the patients we get have like 30, 40 comorbidities. If you talk about all of those with the oncoming nurse you're going to be there for the whole 30 minutes on that one patient. If some of those comorbidities are really relevant to the admitting diagnosis, then definitely share that. Otherwise, I wouldn't really go into a lot of detail about that.

Then you want to run down all of the body systems and give the relevant information that you need to give to the oncoming nurse. 

So, respiratory. Is the patient on oxygen? If they are, how many liters per minute are they getting? 

Cardiovascular; is the patient on telemetry? Are they on a cardiac drip or a heparin drip? That's going to be important information to convey. 

Nervous system; what is the patient's level of consciousness? Are they alert and oriented times four or are they confused? Definitely share that information with the nurse. 

What about the patient's mobility? Are they bed-bound? Do they have any kind of paralysis? Can they get up independently or do they require assistance? Those are going to be important things to convey. 

In addition, gastrointestinal and the urinary system. Let the oncoming nurse know if the patient is incontinent and whether they have a Foley catheter in place or maybe a condom cath or a Purewick. If you know the patient's last bowel movement, that's always really helpful information for the oncoming nurse to know. 

Skin; does the patient have any wounds or pressure injuries? Pressure injuries is the current term for a pressure ulcer or a bedsore is what it was called previously. But if the patient has any wounds or pressure injuries, you definitely want to convey that to the oncoming nurse. And if there's any wound care that is required in the coming shift then definitely remind the nurse of that as well.

If your patient is diabetic definitely tell that to the nurse and let her know that blood sugar checks are required. 

Then you want to let the oncoming nurse know what kind of IV access the patient has. Is it a peripheral line? Is it a PICC line or a central line? Are they getting continuous IV fluids and if so, what is it? Is it normal saline, 75ml an hour? You want to give all of that information. 

In terms of medications, you're not going to run through all of the medications that the patient needs to get. But I would review any antibiotics that the patient's on. In addition, I would also review any pain medications that the patient takes and when you gave the last pain medicine and when they're due for their next dose, if that's appropriate. 

And then you want to convey the plan for the next shift. If you're night shift and you're handing off to a day shift nurse, you want to make them aware if the patient's getting any kind of procedures. Like a CT scan or an MRI or if they're having surgery. Definitely want to give the nurse a heads-up about that. 

If the patient requires wound care, you want to let them know about that. 

If the patient's going to discharge that day or be transferred to a skilled nursing facility, definitely communicate that so that the oncoming nurse knows what the plan is for the patient. And then that's pretty much it.

As far as other details, like specific labs and some of those comorbidities and other medications, the nurse can look up that information. You're really going to focus on those essential things when you are giving report to a nurse. 

Hopefully, this video has been helpful. It takes some practice to get really good at report but I know you can do it. If you can, have your Nurse's Brain in front of you to keep track of stuff. But again, don't go through everything. Just focus on those few vital pieces of information that I shared in this video. 

If this video's been helpful be sure to like, subscribe, leave your comments here and I look forward to seeing you soon. Thanks so much for watching!


2 Responses

Jordan
Jordan

November 09, 2020

I have read this every shift during my residency, it always centers my attention and allows myself to transition into the oncoming role of care. I really appreciate the time and dedication you put into these videos. Everyday you make the world a better place! Jordan RN. CVPCU

catherine ofeinmun
catherine ofeinmun

August 11, 2020

You are a wonderful person Cathy. Please keep up with the good works. I can’t wait to buy ur flashcards for my fundamentals of nursing because i believe it will really help. Thanks so much

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