How To Handle a Bad Shift Report as Nurse

I've been a nurse for over 20-something years - mainly in ER and ICU, but I've literally almost worked in every single area except for labor and delivery. For the most part, I've heard (or seen) enough to really know how to set my colleague for success by giving them a good report. I always take pride in giving, a good SBAR to the shift that's coming on.

I expect a good shift report in return. Sometimes, that doesn’t happen. So, when you get a sub-par shift report what do you do?

Read (or listen) on to find out what I do and what you can do if you’re ever in the same situation. 

^{This content used under license from "Ask Nurse Alice."}

What To Do When You Get a Bad Shift Report

Maybe you’ve had a bad shift report in the past. Think to yourself how you handled it?

• Did you just read the patient’s chart?
• Maybe you asked a colleague for input?
• Or did you just let it go without saying anything?
• Did you ask the outgoing nurse follow-up questions?
• Did you provide teachable moments to them?
• Did you mention how they can improve their report next time?

Now I know some of you just don't have the energy or time to have to teach someone something they should already know. That's true. I get it. However, sometimes people don't know what they don't know. This is the kind of report they give and no one has ever said anything or given feedback. So they don't know that important elements are missing.
We are a team and we all have a common goal of helping to take care of the patients and for the patient to have good outcomes and for us to have a great day, right? But you often need certain pieces of information to have a great day. That way you're not running around like a chicken with your head cut off, because an important piece of patient information was omitted and something went awry before you could discover this.

Example of a Bad Shift Report

I work as a critical care transport nurse, and a few weeks ago I was picking up a patient and transferring them to another unit, within the same level of care. It was the preferred hospital based on their insurance plan. 
When I arrived, the nurse was packing the patient's things up like she was ready for us to just take the patient. 
 
The patient was a 76-year-old male who was full code and allergic to sulfa. He had been admitted two weeks ago for fever, nausea, and vomiting two days in the ER. It was discovered that he had an increased troponin and pneumonia on x-ray. He also had a history of coronary artery disease, hypertension, and diabetes. 
As the nurse is telling me these things, I naturally had a few more questions. Was the troponin increasing? Was it a STEMI? Was it a NSTEMI?

I say to her, “I need a report.” To which she responds something like, “well, I gave a report to the receiving facility.” I then reply, “as the transporting nurse, I need a report too.” She gave me the stank eye as she proceeded to give me a full report. I looked through the chart and had even more questions. 

I asked questions about vital signs and other things. When I asked, whether the increased troponin is recent or from two weeks ago? She was unaware of what I was referring to. So I inquire as to what the cardiac rhythm is.
She said, “I don't know what the rhythm is. The patient is not on the monitor.” I asked, "with an increased troponin,  and medical history of diabetes, hypertension, and coronary artery disease, “you're not worried about the rhythm?” 
 
At this time it was 3 am in the morning.  The patient had been off monitor since she first arrived at 7 pm because she thought the patient was getting picked up sooner and that’s how she received the patient.  And because the nurse thought the status quo and she left the patient like that. So I asked again, “were you not concerned about dysrhythmias? What if there were some other arrhythmias? You would not have even known that.” She looked annoyed and said, “well, let me find out for you.”
Turns out, there were even more questions she didn’t know the answers to. I could fee her frustration growing as her tone was getting louder. She finally said in a very sarcastic way, “well, what do you want me to do?” 
 
I said, “what you should have done was put the patient on the monitor while in your care. You can’t control what the day nurse did but you as a nurse should have put the patient on the monitor. Now you're asking me to transport a patient who is sick enough to need a nurse to travel with them. I'm here for surveillance and possible interventions. And if I'm needed, then you're needed and this should be a continuum of care.”

She didn’t know what to say but needed to hear that. 

And when I did my physical assessment I noticed the patient had a zipper-like surgical mark on their sternal chest. 
At that point, I knew that this nurse didn't even do a physical assessment because she thought the patient was leaving. So she didn't worry about it. She didn't do anything for the patient.

Remember, We Are a Team!

The reason why I'm talking about this is that I wanted to strongly urge and empower my colleagues. Don't let that be you. I understand that this patient was going to be leaving. However, you don't know how soon something could happen.
We are a team. We are all running a relay race and we are passing the Baton. We should not stifle care. We gotta do the right thing. And when we do the right thing, that's when good things can happen. If we don't do the right thing, that's when bad things can happen. Then when something bad happens they do the chart audit - and it comes back to the nurse. 
So it's very important that the provider actually gets to see the scan and do their own interpretation to exercise their clinical judgment as far as what's needed, not just base it on someone else's report.

As long as that patient's in your care act accordingly, you know, this is just my 2 cents. When it comes to transferring a patient, whether you're transferring from unit to unit or facility, all of these things are very important.