How to Take Nursing Report

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Study Tools For How to Take Nursing Report

Report Sheet (Cheatsheet)
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Outline

Overview

Taking an effective nursing report can set the tone for your entire shift and improve outcomes for your patient.

Nursing Points

General

  1. Be Prepared
    1. Notes
    2. Pen
    3. Report sheet
  2.  Confidence
    1. You own the process
  3. Safety/Bedside Checks
    1. MADLE
      1. M-Monitors/Machines
      2. A-Alarms
      3. D-Drips
      4. L-Lines
      5. E-Emergency Equipment
  4. Bedside Report
    1. Involve the patient
    2. Is there anything the patient needs to add
    3. Set expectations
  5. Review Orders
    1. Medications
    2. New orders
    3. Has anything changed or not been done?
  6. Ask Questions

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Transcript

Taking report can be a very intimidating process. In this lesson, I want to give you some tips and tricks that will enable you to take the nursing report with ease. This is a broad overview of nursing report, so please watch the individual report videos to see these tips. In practice specifically, we’re going to discuss six steps to taking a great nursing report. Number one, be prepared. Have a working pin review the chart and have a clean report sheet available for each patient. My recommendation for new nurses is to use the attached nursing report sheet as it can provide you with simple fill in the blank format, which will aid you in those stressful moments and make sure you don’t forget to ask the right questions. Number two, competence. Think of report is your chance to assume the care of a human being. This is a great responsibility and you can take pride in your role as a nurse.

Don’t be afraid to ask questions, hold your head up and speak with confidence whether or not you feel competent. You still have to get report and care for the patient. I want to let you know that you have every right to be where you are. Take care of that patient and push self doubt away. Number three, safety checks. The most important thing you do as a nurse is to ensure the safety of your patient and this begins the moment you start taking report with something referred to as safety checks. Now, exactly what this means from hospital to hospital may vary, but I want to give you a broad overview. Basically, before the off going nurse leaves, we want to check on a few safety measures specifically does the patient have available oxygen and resuscitation equipment available? Are the bed rails up? Is the call light available?

Are all lines clean, dated patent and the proper medication running? Is skin intact? Is the fully clean, have orders been verified, are all appropriate alarm set and has a neuro check been complete? It can be hard as a new nurse to fill enabled to raise your voice and make sure these checks are done, but they are vital. The last thing you want is to realize one hour into your shift that these will present has been running instead of Vancomyocin or that a port on a triple lumen catheter is clogged. This is not a fun conversation and more importantly, it puts the patient in further harm. I cannot stress enough the importance of these safety checks. Many times more experienced nurses blow them off or simply ask if they can skip out prior to the checks. The answer is always no. There is never an excuse for jeopardizing the safety of a patient, so let me give you a simple pneumonic to help.

Remember the safety checks for monitors and machines, alarms, drips, lines like IVs and stuff, E emergency equipment. Number four bedside report. There is much debate about whether or not bedside report is best practice. I’m not here to challenge either viewpoint. What I want to focus on here is the importance of including your patients in their plan of care. Even if the report is not done at the bedside. There were a few things that should occur at the bedside introduction or managing up. Have the off going nurse introduce you and speak to your skills. Is there anything the patient would like to add? Do they have specific questions that can be answered prior to the nurse leaving? Set expectations explained to the patient the plan for the shift, what they can expect and when. This one tip can literally save you hours on a ship, tell them what’s going to occur and when you’re going to be back.

This can help relieve anxiety and help them feel prepared and get ready for upcoming procedures. Number five, orders with the off going nurse review orders, especially any new ones that haven’t been carried out yet. This is a really great opportunity for you to ask questions and get clarification on and understand the current status of the patient and the plan going forward. Number six, questions. This is the time to ask any questions that might be lingering. Don’t just assume that you misunderstood or miss something. Asking questions during the report is a wonderful way to learn and make sure nothing was forgotten. Taking report is a skill and it can be extremely intimidating. Think of yourself as an investigator trying to uncover everything you can about this patient. I’m confident that if you follow these six steps and use the associated form, you will find great success in taking nursing report. Now go out and be your best self today. Happy nursing.

 

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Concepts Covered:

  • Studying
  • Test Taking Strategies
  • Basics of NCLEX
  • Terminology
  • Substance Abuse Disorders
  • Communication
  • Documentation and Communication
  • Legal and Ethical Issues
  • Community Health Overview
  • Respiratory Disorders
  • Suffixes
  • Cardiac Disorders
  • Respiratory
  • Respiratory System
  • Cardiovascular Disorders
  • Intraoperative Nursing
  • Microbiology
  • Postpartum Complications
  • Urinary Disorders
  • Urinary System
  • Medication Administration
  • Musculoskeletal Trauma
  • Musculoskeletal Disorders
  • Dosage Calculations
  • Central Nervous System Disorders – Brain
  • Cognitive Disorders
  • Hematologic System
  • Lower GI Disorders
  • Endocrine and Metabolic Disorders
  • Pregnancy Risks
  • Circulatory System
  • Integumentary Disorders
  • Renal Disorders
  • Disorders of Thermoregulation
  • Prefixes
  • Adult
  • Learning Pharmacology
  • EENT Disorders
  • Fundamentals of Emergency Nursing
  • Bipolar Disorders
  • Depressive Disorders
  • Emergency Care of the Cardiac Patient
  • Note Taking
  • Shock

Study Plan Lessons

Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Anatomy of an NCLEX Question
Diagnostics Terminology
Head to Toe Nursing Assessment (Physical Exam)
How to Take Nursing Report
How to Write A Nursing Progress Note
Intro to Community Health
Lung Sounds
MedTerm Suffixes
Nursing Process
Nursing Process – Assess
Nursing Process – Diagnose
Nursing Process – Evaluate
Nursing Process – Implement
Nursing Process – Plan
Nutrition (Diet) in Disease
Overview of the Nursing Process
Head to Toe Nursing Assessment (Physical Exam)
10.02 Breath Sounds for CCRN Review
Heart (Cardiac) Sound Locations and Auscultation
Heart (Cardiac) and Great Vessels Assessment
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Lung Sounds
Biohazard Material Handling and Disposition (Blood, Microbiology, Creutzfeldt-Jakob Disease) for Certified Perioperative Nurse (CNOR)
Inserting a Foley (Urinary Catheter) – Female
Inserting a Foley (Urinary Catheter) – Male
Sterile Field
Sterile Gloves
Sterile Field Maintenance (Aseptic Technique) for Certified Perioperative Nurse (CNOR)
Sterilization and Cleaning (Instruments, Reusable Goods) for Certified Perioperative Nurse (CNOR)
Sterilization and Storage Environment Conditions for Certified Perioperative Nurse (CNOR)
Transportation and Storage (Single Use Items) for Certified Perioperative Nurse (CNOR)
Using Aseptic Technique
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Wound Drains
Complex Calculations (Dosage Calculations/Med Math)
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
ABGs Nursing Normal Lab Values
Albumin Lab Values
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Blood Plasma
Bowel Obstruction Concept Map
C. Difficile for Certified Emergency Nursing (CEN)
Dehydration
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
Electrolytes – Location in Body Nursing Mnemonic (PISO)
Electrolytes Involved in Cardiac (Heart) Conduction
Fluid & Electrolytes Course Introduction
Fluid Shifts (Ascites) (Pleural Effusion)
Fluid Volume Deficit
Fluid Volume Overload
Formation & Excretion of Urine
Giving Medication Through An IV Set Port
Heart (Cardiac) Failure Therapeutic Management
Heat Temperature-related Emergencies for Certified Emergency Nursing (CEN)
12 Points to Answering Pharmacology Questions
54 Common Medication Prefixes and Suffixes
ACE (angiotensin-converting enzyme) Inhibitors
ACLS (Advanced cardiac life support) Drugs
NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
6 Rights of Medication Administration
Drawing Up Meds
EENT Medications
Ethical Dilemmas for Certified Emergency Nursing (CEN)
Hanging an IV Piggyback
Insulin Mixing
IM Injections
IV Drip Administration & Safety Checks
IV Push Medications
Medication Errors
Medications in Ampules
NG Tube Med Administration (Nasogastric)
NG Tube Medication Administration
Nursing Case Study for Mania (Manic Syndrome)
Pill Crushing & Cutting
Safety Checks
Spiking & Priming IV Bags
SubQ Injections
Topical Medications
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
ACLS (Advanced cardiac life support) Drugs
C – Content
Epinephrine (EpiPen) Nursing Considerations
Nursing Care Plan (NCP) for Angina
Renin Angiotensin Aldosterone System
Renin Angiotensin Aldosterone System (RAAS)
Artificial Airways
Hierarchy of O2 Delivery
Oxygen Delivery Module Intro
54 Common Medication Prefixes and Suffixes