Tips for Giving & Getting Report for New Nurses

I’ve been a bedside nurse for nearly a decade and still, one of my biggest pet peeves with nursing is the way that some nurses give and get report.  Unfortunately, it seems that some nurses take this time as an opportunity to belittle, bully, or be rude to their co-workers.  And needless to say – that is neither helpful for our profession nor is it cool.  So I decided to write this guide as a source of inspiration to new nurses who might be struggling with giving and getting report and share actionable tips to help you get better.  But trust me when I tell you – getting and giving report is scary for every nurse when they are first starting out.  So you aren’t alone!

 

Breaking Down SBAR

We can’t get into my personal tips for giving and getting report without actually mastering the basics of report – SBAR.  In short, SBAR is generally how you will give/receive report and it’s also a good guideline for relaying information to a provider.  The SBAR acronym stands for “situation”, “background”, “assessment”, “request/recommendation”.

When you’re giving or getting report, your report sheets will follow a general “SBAR” flow, but maybe won’t be as obvious.  Report will most likely start with why the patient is at the hospital – SITUATION.  Patient history – BACKGROUND.  Then report will probably go through different systems (i.e. cardiac, GI, neurological, etc) – ASSESSMENT.  And finally the nurse might say to you, “I noticed this and I would request this to fix it, please ask the provider…” – REQUEST/RECOMMENDATION.

If you’re telling the provider about a change in patient status, an example might look like…

• Gather all relevant information – make sure to look up vital trends and lab values before notifying provider
• Start with your SITUATION – what happened?  “Patient had significant bradycardia episode with HR of X”…
• Move onto BACKGROUND – “I’m worried because this is abnormal, they don’t have a history of bradycardic episodes”…
• Next is your ASSESSMENT (do not call the provider without first assessing your patient so you have all the necessary information) – “I assessed the patient and all seems to be fine, there are no other changes in patient status so I’m unsure what brought this on”…
• Lastly, you want to give a REQUEST/RECOMMENDATION – this part will be hard if you’re new, but I always like to try to predict what the doctor will want done about the issue so that the provider knows I am thinking ahead; plus this is a really good time to learn so you might say something like, “Right now I want to continue to monitor but if it happens again, I’m wondering if we should get labs (say what labs you think) to make sure there isn’t anything else going on”…

Remember, before calling a provider about something you need to gather all relevant information (labs, vitals, etc), assess your patient, and finally think about your end goal – what do you want to come from the phone call?

Of course, this is all easier said than done but the more you practice the better you’ll get.  Try not to be flustered, you’ll get it down eventually!

 

Mastering Your Report Sheet

One way to get more comfortable with giving and getting report is to master your report sheet.  Again, every unit will have different report sheets and depending on what unit you’re on your report sheet might emphasis one body system over the other (i.e. if you’re working on a neurology floor, your report sheet will focus heavily on neuro).

One thing that helped me as a new nurse was to take a blank report sheet home and just visualize what kind of information would go in each section.  I would recite “report” in front of the mirror with my made up report sheet.  This allowed me to predict what kinds of questions the nurses were going to ask and I didn’t fumble through report for long.  I knew I would discuss “X, Y, Z” in order and that was comforting.

 

Asking Good Questions

For the record:  Every question is a good question when you’re learning and there is no question off limits.  With that being said, don’t be scared to ask any question you need an answer to.  If you don’t understand something – ask.  And that’s not to say it’s “okay” to keep a nurse there for hours because you have endless questions.  What I mean is, if you need clarification in lab values or you don’t understand what’s going on with the patient – make sure you clarify.  If you don’t understand a diagnosis or what a medicine does, maybe highlight that on your report sheet and look it up when you have time.  Report is a great time to take stock of what you are struggling with and need to spend more time learning.

On the flip side, if you’re giving report and an experienced nurse asks you a question that maybe you don’t understand why he/she asked – clarify that as well!  I learned so much when I would ask senior nurses, “That’s a good question but I don’t understand why you thought to ask that.  Can you explain it to me?”  This is a great way to learn too!

 

Color Code Your Report Sheet

Color coding your report sheet is not only a fun way to spice up your report sheet, but it also helps with organization.  This is how I use different colors to help me give and get report…

• Start with black for the basics
• Red – for *bad* changes or critical lab values
• Purple – information that is important to remember but not critical (i.e. Mom does not like nurse to change diaper without her, etc)
• Green – information or questions that you have for the provider
• Blue – you might circle something in blue that you don’t understand and want to look up later
• Yellow – changes throughout your shift that you’ll need to pass on to the next nurse

You don’t have to use these specific colors for these specifics categories, but it is something that greatly helped me when I was learning.

 

Jot Down Notes As Your Shift Progresses

As things change during your shift, make sure to make note of it as you go.  There are two ways that I did this when I was learning.  The first was just to jot down a short note on my report sheet and then highlight it so I knew that I needed to relay the information to the nurse.  Or if I was really busy, I would carry around sticky notes with me and jot notes down at the bedside – put the sticky notes on my bedside computer – and come back to it later.  This tactic was mainly for the shifts that I was running around with my hair on fire.

 

When you’re leaving yourself notes, don’t forget to write down the exact time that the event/change took place!

 

Learn to Use the Computer to Supplement Your Report

Computer charting is very challenging when you’re first starting out.  But there are tons of tricks and tools to navigate your charting and make giving report easier.  Ask your preceptor or a senior nurse what their tips and tricks are for using the computer charting system.

 

Pay Attention to the Other Nurses Cues

This can be challenging when you’re first starting out, but pay attention to the cues that the oncoming nurse is giving you – especially if they are a senior nurse.  If they say, “I don’t need the background information” then it’s okay to skip ahead.  If they say, “only tell me what happened on your shift”, then only tell them what happened on your shift.  I know that this might be somewhat controversial but you’ll understand after you’ve been a nurse for years and you know the ins and outs of the unit.

 

Speak Up

Although I briefly addressed this, I need to reiterate – if you do not understand something SPEAK UP.  The last thing that you want as a new grad nurse is to start your shift confused about something or miss something because you don’t understand something that was said in report.  Don’t feel stupid for speaking up and asking questions.  And if you’re still having trouble grasping the information, ask the charge nurse to help clarify things for you.  And remember, if you’re working your shifts back to back, it’s okay to ask for a refresher on background information even if you were there the shift before!

 

Nurse Essentials

 

I hope that these tips for giving and getting report as a new nurse helps!  If you have any questions, let me know in a comment below.

 

If you’re a new grad nurse, you might find these posts helpful…

• Night Shift Nurse Essentials – What You Need to Get Through Your Night Shift
• 6 Tips for Sleeping During the Day if You’re a Night Shift Nurse
• Nurse Essentials – 15+ Things Every Nurse Needs
• 10 Things I Wish I Knew Before Becoming a Nurse
• 6 Tips for Working a Rotating Schedule
• How to Prepare for 12 Hour Shift Schedules As a Nurse
• 10 Tips for Working Night Shift
• 6 Essential Tips for New Nurses

 

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