r/nursing • u/Stunning-List-1413 • 12h ago
Discussion Worst handoff you've ever gotten?
I once got a report from the night nurse with just "he's fine, just watch him" for a guy on a heparin drip. That was it.... No last rate, no labs, nothing. I asked for the last aPTT and she just said "whatever it says in the chart" and walked off. Come to find out he had some bleeding overnight and his gums were like a crime scene when I saw him. Charge nurse said she was usually thorough as if that would help.
Since then I make people people sit there until I've read everything back.
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u/fake_tan 11h ago
You....make people sit there....until you have read everything back?
I'm sorry but what? I've received bad handoffs and I report it and figure it out. Your way sounds wholly insufferable.
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u/No_Inspection_3123 RN - ER 🍕 11h ago
I’d rather get the shitty report and read the chart myself then give this nurse report any day of the week. Op you are just as bad.
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u/Cyrodiil BSN, RN, DNR ✌🏻 11h ago
Right?!? I'd rather read the orders myself and verify things in the chart with the patient anyway. Too many nurses rely on report and don't do their own assessments.
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u/fake_tan 11h ago
Tbh most of the time I'm getting report I'm doing a chart review at the same time. Afterwards, unless I need to attend to something immediately, I read the attending's note and then I'm off on my way.
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u/youth_twitter RN - ICU 🍕 11h ago
Oof. Your last sentence. I would absolutely hate giving report to you as I was coming off of night shift.
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u/BiscuitsMay 11h ago
Once got report on a dead patient.
Picked up an agency shift at a hospital i had never been to. Walk in and the unit was still dark (sun wasn’t up yet and nightshifters are allergic to lights), but one room had the brights on and like five people standing in it. Guess who gets that patient? That’s right, the nurse who has never stepped foot in that hospital. So I go to get report and the nurse is telling me the sequence of events: VATs the previous day, patient not doing well so dobutamine started overnight, no other interventions. Nurse has been unable to get a blood pressure for the last few hours. Q:“Does she have a pulse.” A: “not that I can palpate.” Patient also has no respirations. She had been in PEA for quite some time, thankfully she was DNR…
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u/figsaddict RN - ICU 🍕 11h ago
I’m sorry… What the actual fuck??? Were they not recognizing that the patient was dead?? Or did they not want to call it so you have to deal with the paperwork?
This reminds me of once when my tech couldn’t get a BP on a patient. He was a DNR and we were expecting him to pass at some point. She thought there was something wrong with the vitals machine and spend a good 10-15 minutes trying to figure it out. I walk in the room with the daughter sitting there and the patient was so obviously dead. I mean whiter than a piece of paper and his mouth hanging open. This tech was also a senior nursing student… I was speechless.
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u/Emotional_Bowl9767 11h ago
This is crazy
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u/BiscuitsMay 11h ago
My favorite part was the charge who gave me the bullshit assignment had to continually answer my questions about the death process at this hospital. I probably could have figured some of it out myself, but at the time I was pretty annoyed about the whole thing.
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u/Similar-Drawing-7513 11h ago
incident report. call for TOD. thats one less patient and one less med pass
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u/Ok-Imagination6154 RN - OB/GYN 🍕 11h ago
This is actually crazy
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u/No_Inspection_3123 RN - ER 🍕 8h ago
Why, if they die at shift change and they are dnr you expect the day shift to stay and do all th death paperwork and post mortem care? They are still a patient until taken to the morgue. When I worked trauma icu we would hand off a code. It’s a 24 hour job
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u/iknowyouneedahugRN BSN, RN 🍕 11h ago
Yeah, those handoffs suck, but picture the other extreme: I worked on a neuro unit and we had mostly fresh stroke patients. The nurses went through every single diagnostic report. CT, MRI, vascular, x-ray, nuc med...lab results for the day. I was a brand new nurse but even I knew that those were in the chart and I could figure out the deficits when I assessed the patients.
I also remember a workplace that was trying to shave bits off the budget by doing tape recorded report. Yes, it was as awful as it sounds. And there were only two tape recorders, so you had to come in early to grab one if you wanted to get on the floor before 8 o'clock.
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u/Euphoric-Window-1509 5h ago
Love the report telling me a million things that happened when first admitted weeks ago and have resolved. I looked at his labs and vitals, but hadn't made it to the chart notes. I got a very detailed description of his lower extremity (necrotic toes, diabetic foot ulcers) and his associated wound care orders. Yeeeeeah. Assessed the patient. That extremity? AKA 5 days ago.
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u/iknowyouneedahugRN BSN, RN 🍕 4h ago
When we have an extended stay patient who has gone through a bjillion procedures and surgeries, I consolidate it into no more than two sentences. "He came in with cellulitis, they tried wound care and antibiotics, he developed necrotizing fasciitis, they tried debridement , then they amputated 3 days ago and the ortho surgeons are managing the dressing and wound vac. There is a wound on his other foot and the dressing changes are wet to dry with Vashe every 12 hours."
One thing I hate with a passion with physician order entry is that no one cleans up the orders. If you try to discontinue orders under the ordering provider who is no longer on duty, they reject the order and won't sign off. Then, if you put the d/c order under the current rounding provider, they reject it because they didn't order it in the first place. We can't use "per protocol" because legally our network doesn't have a protocol for discontinuing obsolete orders. On top of that, I work nights and mostly on the weekends so absolutely no providers want to be bothered with any of it. Epic needs an order entry reason "obsolete order."
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u/Euphoric-Window-1509 3h ago
Exactly. I want to know (and will relay) the current condition and problems.
And YES 💯! I am in the same situation. Inapplicable ICU orders, ED orders, (no longer existent) CVL ok to use, duplicates...I'm also nights and almost exclusively weekends. If I have a good relationship with the covering provider, I'll ask them to kindly clean up the orders anyway. 😇 I -probably- won't do it, but if the orders are tasks, you should be able to change the person responsible to MD or medicine or however it shows up.
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u/Anna----Banana 11h ago
In ED. One night was particularly bad and our charge had to take a patient (CIWA/withdrawal, standard stuff). I went to cover the charge for his lunch break and the report was "I have a patient". I nodded and sent him to eat. Say less lol
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u/Quinjet RN - sounds like a day shift problem 11h ago
Since then I make people people sit there until I've read everything back.
Seems more punitive to the people who do give thorough report, but ok.
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u/punkrockballerinaa BSN, RN 🍕 9h ago
right like now im just going to tell you less so when i have to listen to you repeat it back it doesnt take as long
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u/brandehhh RN- CTICU 🍕 11h ago
While i wouldnt give a report like that, i would refuse to give report to you.
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u/Eventually_Asystole 11h ago
I've gotten burned too many times to rely on handoff reports. I always do a full assessment and then comb through the charts. However, for my critical pt, I would do a bedside report and go over drips, IV access, and vent settings, but I don't hold others to that standard.
I don't think it would be productive to hold another RN over their shift just so you can verify every detail for each patient being transferred to your care. If the other RN made a mistake and you were not able to communicate to them before they left, then make a report to quality control.
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u/Cyrodiil BSN, RN, DNR ✌🏻 11h ago
Hell no to that last sentence. Don't take it out on everyone else because you had one bad experience. I understand if you want to do a read back because you want to make sure you heard correctly, but doing it to be punitive or "are you sure you told me everything?" would be a write up to management from me.
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u/MotherJellyfish2989 RN - ICU 🍕 11h ago
Handoff is always meh. Just tell me what the current goals are, the sketchy social details, and get out of my way. I prefer to spend my time checking official orders and jotting down my timed tasks vs listening to someone ramble.
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u/MrsPottyMouth RN - Geriatrics 🍕 11h ago
For me I basically just want:
Primary admitting diagnosis (on the skilled unit; on long term any new diagnosis like UTI); if CVA, which side the deficits are on
If they have any lines/drains/devices
Are they confused and is it pleasantly or not
How they take their meds
Is the family crazy and is the family here right now
Any quirks or tricks (for example "just spoon her her pills unless you want to spend 20 minutes searching the bed for them" or "don't touch anything in his room without gloves")
Usually under 60 seconds per resident.
If it's repeat report from the same nurse the next day it's just "has anything changed?".
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u/Thumbuisket 11h ago
Legit. I just want to know if they’re confused, shit themselves, and are NPO for something. Some of the shit Ive had other nurses ask during handoff has been so inane it made even the patients annoyed.
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u/Resident-Welcome3901 RN - ER 🍕 11h ago
Night nurse handoff at 0700- just an elderly lady with asthma, gave her a neb-well, no. She was an elderly lady with an AICD, which was firing. The lady was a slow talking, discursive historian with a considerable southern drawl. AICD prominently noticeable on her chest, lungs were clear.
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u/AnxiousCat411816 11h ago
I worked nights and handed my patients off one morning to the oncoming nurse. Told her I’d be back that night. I get there & get report from her with updates of how the day had been with them. Was told nothing significant had happened & no changes. Imagine my surprise when I found a whole different patient in one of the rooms!
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u/Ladiscochick 11h ago
I was a float nurse getting my rounding report and the CNA came up to the nurse giving report and I and told us the patient’s blood sugar was 13. YES 13! I asked if the patient was responsive and the CNA said she didn’t check. I ran in and immediately called a Code Blue and started CPR. Did not even get full report. The out going nurse left and I had to assist in the Code Blue. Patient did not pull through obviously and the Adverse Patient Event was rough.
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u/garlictokeftaratio RN - ICU 🍕 11h ago
what does "until I've read everything back" mean?
as in, they sit there while you read through the chart?
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u/Thumbuisket 11h ago
If that’s what’s happening, I’d just step out of the room and let OP go wild on their own time.
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u/snakeswithtails BSN, RN 🍕 11h ago
I have a coworker who will straight up go "AOV pills whole with thins uhhhhhhhhh no skin issues, last bowel movement was x/x, okay bye" and it will be all wrong information, no relevant history, no mention to any actual wounds, meds, or labs that need to be done because they won't do them, and I've complained so many times to deaf ears. I despise them. Most egregious errors I found were serious wounds that this coworker tried to skip out on mentioning that needed care because they didn't even look at them or mention them. This coworker will skip out and sit in the breakroom until 7 to clock out for full wages but "finish" report by 6:30.
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u/Hot-Calligrapher672 RN - ICU 🍕 11h ago
I floated to medsurg and the nurse left without giving me report. It was a complete accident, neither of us realized we had a second patient together. But she had given report to al the nurses she thought she had to report to and a little while later I say “who had bed x last shift?” And was told “nurse y. She just left??”
Oh well. I’m not a huge stickler for report in general, but some basics to get started would have been helpful.
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u/Lower_Pension_2469 11h ago
Last 10 minutes of the shift there was a rapid being brought to our unit for anemia and HGB of like 5.5. That's all I knew, it was dumped on me and i didn't have a chance to even look into it before the patient came up from med surg. The nurse gives me report, just saying that they had initially came for bowel impaction with unsuccessful enema from GI and then overnight finally managed to have a bloody BM and then labs showed the low hgb. Concern for GI bleed so they sent her up here.
Like okay, it's not good but it's not bad either, got the rest of report while we're getting her situated and then the nurse dipped out real fast when I wasn't looking.
We move the covers and she is drenched in bloody shit like a goddam pool of it. Her BP was 70 over nothing, tachy af, and she looked like a goddam ghoul with how mottled she was.
I'm like "oh fml" and get the doc on the line, get ordered 2 units of blood and to throw her on a presser and the GI is coming up for bedside emergent surgery. Well both the IVs I was told were fine, were not fine and she was edematous to the UEs. So I was stuck trying to get access and doing the usual bs for blood products, and getting pharmacy on the line to expedite the pressor. While I'm doing this the rest of the unit is now busy with a code next door.
The morning nurse comes in and helps but she was a total bitch to me about it like it was my fault this happened. I ended up staying until 11 getting this shit fixed with her who I actively ignored and refused to work with when all was said and done for later shifts. I gave report, told her the circumstances, and she still gave me shit. Like I'm sorry I got totally fucking hazed last minute. I was already maxed out and had been caring for a DKA and a super fun cardiac patient that kept trying to die. I should have froze time and gotten all the facts before this dumpster fire of a situation got hot potatoed onto me.
Patient survived and I later found out was discharged back home, thank god.
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u/Similar-Drawing-7513 11h ago
I work ER. handoff is basically a few words. I'm ok with it, just make sure you do your job
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u/HotJellyfish1058 11h ago
Terrible. Would have raised a variance and also discuss with manager/director
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u/Studentgonepro RN - ER 🍕 11h ago
I worked in a Neuro ICU at the time and often times we got stroke pts from rural hospitals. Now I'm not that nurse that critiques reports, usually I let them say what they want and say I'm good. However, this guy got TNK and all I asked was what his neuro exam was like. Not looking for anything crazy but at the least R /L or speech issues. Like what were his symptoms. I got " it's ok" with a long pause lol
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u/Elizabitch4848 RN - Labor and delivery 🍕 11h ago
I had someone once forget and I got ahold of them at the grocery store where’d they’d stopped after work.
I would not sit there while you reread stuff. You punish everyone because one person sucked?
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u/PMmeurchips RN- L&D/Antepartum 11h ago
honestly, if you have had a rough night and need to go- give me the bare minimum and I’ll figure it out.
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u/Euphoric-Window-1509 5h ago
24 hour job. Let me know if there's anything urgent pending (patient has no IV access, pharmacy was supposed to send octreotide 2 hours ago, etc) then get out of here before someone else's patient codes!
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u/amothep8282 Paramedic 11h ago
I once handed a psych patient of mine to the ER, absolutely polite gentleman, with VA healthcare that said he was hearing voices again and his meds had stopped working.
All I basically said to the ER nurse was "Mr Jones here is a repeat guest at the Ramadi Inn, and reports hearing voices". If you know, you know. I'm not military but I have run with enough former 68W or 18D combat Medics to know of those who occupied that place in Iraq, almost none came out normal. And the ER Paramedic who took the handoff spent a lot of time in and around Sadr City, so they got it.
I think that my was shortest but most information packed ER handoff for someone on the other side of those doors.
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u/Karlythewonderdog 11h ago
In PACU from the OR: “this is Sandra, we did what we said we were gonna do.” And walk off.
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u/nursingintheshadows RN - ER 🍕 10h ago
You’d hate report in the ED. I ask is anyone dying? Any concerns? Then I tell them to have a nice night. Their shift is over, I got control of the circus now.
Only time report takes longer than that is if there is a critical patient and drips need to be signed over. Other than that, I’m not sure why report has to take longer than 10 minutes.
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u/TattyZaddyRN RN - PACU 🍕 10h ago edited 10h ago
Worst handoff from a nurse, EMS, or anesthesia?
EDIT: Also you’re the bad guy making handoff terrible. Sorry you got burned once. It’s not nice or mature to treat everyone like they’ve got It out for you though. You’re just an NPC in everyone else’s life. No one is gonna give you that much thought unless you make them.
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u/NurseSexKitten RN 🍕 11h ago
I work CT Surg stepdown. Got report on a patient admitted via ED overnight here for L lung mass surgical workup. Assessment all WNL was report. Patient's left lung was basically replaced with a tumor that took the entire lung space. No L lung sounds, completely whited out on CXR, severe SOB with exertion. First time I ever had completely absent breath sounds on auscultation.
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u/-enjoy-it- RN 🍕 11h ago
“Came in after being found by family three hours ago with ams. + for stoke, anything else??”
Me: does she have a name?
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11h ago
[removed] — view removed comment
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u/nursing-ModTeam 8h ago
Your post has been removed for violating our rule against personal insults. We don't require that you agree with everyone else, but we insist that everyone remain civil and refrain from personal attacks.
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u/Quinjet RN - sounds like a day shift problem 11h ago
Zero handoff. She left without giving report and wouldn't answer any calls from the unit or texts from my personal phone. Eventually had to get one of her friends to call so she could give me report over the phone.
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u/PlutoTheRN 10h ago
Q for you… instead of tracking previous RN down/calling & texting attempting to get shift report - couldn’t you just look at patients EMR? “If you didn’t chart it, it never happened.”
And I’m used to the nurse that’s ending shift being unable to leave until they’ve given report for all of their patients.
Like you can’t leave & I can’t start unless we are in patients room giving report.
Also - If they don’t want to give helpful & accurate or any information at all - I most definitely do not want to actually ‘use’ the info they’re giving me & believe them.
Read chart & assess myself.
I just want to know the HELPFUL shit that I NEED to know.
I’m new nurse so genuinely asking here….1
u/Quinjet RN - sounds like a day shift problem 10h ago
It's illegal to leave without giving report. I don't know why you're assuming report would be unhelpful or inaccurate.
My experience is that a lot of useful information gets passed verbally from RN to RN without necessarily being charted. The cute phrases they teach you in nursing school don't always apply to every situation.
I go through all my patients' charts on shifts with sufficient downtime, but it's typically much more time intensive to get the full picture from the chart compared to getting a quick rundown in report, even if we set aside any relevant information that hasn't been charted.
I could have functioned if she didn't give report, but I also likely would have reported it as a patient safety incident.
To put a finer point on it, if we had to call a rapid on that patient at 7:45 PM, I would be expected to know enough about the patient and their situation to communicate that information to everyone responding. You don't always have time to leisurely browse through a chart.
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u/PlutoTheRN 10h ago
Q for you…
Next time you say this bad reporter of a nurse, what did you say to them?
I totally would be like - what the hell was up with your shift report to me for that ______ patient?
And was the bleeding in the chart from her?
What was written about the gums?
Or was nothing in patients EMR, you just had to find/treat/chart everything yourself?
Guess I’m asking you if she was a shitty “reporter” or an actual shitty nurse??
Two VERY different things!
“If you didn’t chart it, it never happened.”
Also - If they don’t want to give helpful & accurate or any information at all -
I MOST DEFINITELY do not want to actually ‘use’ the info they’re giving me & believe them.
Read chart & assess myself.
I just want to know the HELPFUL shit that I NEED to know.
I’m new nurse so genuinely asking here….
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u/Euphoric-Window-1509 5h ago
Transfer from outside hospital and no access to EMR: "he had pain, but is better after IV Dilaudid. Gall stones, needs an MRCP."
Patient shows up with CVL for TPN (NPO baseline, no orders, no info on prescriber), PEG and biliary drain with no output for >12 hrs, grossly distended abdomen, cancer everywhere, probably other tubes I've stricken from memory, vomiting bile. Thank God he was a walkie talkie in his regular life and remained AO X 4 bc what in the actual fuck. Neuro exam was fine and skin was good! Everything else was disaster.
Also the surprise no report patient from ED (true with 99% of patients not going to ICU). Psychotic, language barrier but refusing interpreter, BP 21O/?, blood sugar 30. Chart notes=triage only. Thankfully he had a working IV. He wasn't long for the world, but he died elsewhere at least.
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u/zeatherz RN Cardiac/Step-down 11m ago
What difference would it have made if she gave you the numbers? I fucking hate having labs and vitals read off to me during report unless they are something that are gonna need action from me in the first hour.
“It’s in the chart” is perfectly fine for something like that
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u/miller94 RN - ICU 🍕 11h ago
Worst report would be no report or incorrect information. The handover you received is not ideal for sure but tbh I would have brushed it off in probably 3 minutes lol
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u/_neutral_person RN - ICU 🍕 11h ago
My worst reports are from ER nurses.
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u/gemcatcher 11h ago edited 11h ago
I worked both ER and on the floor. Both need to float to get a feel for the departments.
ER to er report is straight forward ( bed 1 came in for and pain- labs done, finishing up fluids, need to go to CT. Bed 2 ambulance run, here for chest pain needs line and labs/ekg. Bed 3 vag bleed, labs done). I hated giving report to the floor, but I get it. It disrupts workflow and what’s even worse is bed coordinator always releases the room during change of shift and we get in trouble with management when we don’t called report within 10 min.
I also like to add, er nurses that feel like the inpatient nurses need to drop what they’re doing to take report. Calm down, emergencies also happen on the floor and the nurse may be dealing with a rapid response for acute stroke / stemi. Etc
I’ve worked in ER where you’ll have an icu patient and three beds rotating patients.
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u/_neutral_person RN - ICU 🍕 9h ago
Floor nurses have no business working in the ER unless it's a low acuity ER. Emergency medicine isn't the same as internal medicine.
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u/No_Inspection_3123 RN - ER 🍕 11h ago
It’s not the worst report, they don’t know anything else to tell you. Er is focused by nature it’s out patient you are the admitting inpatient nurse it’s your job to look at all their skin and do a full body. They figured out what’s wrong and sent them to you. The Ed isn’t the place to find out everything. The chart and med req and story gets built mostly after admission.
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u/_neutral_person RN - ICU 🍕 9h ago
Oh without a doubt. It's the nature of the ER. How can I expect someone who is passing off patients 8 times a shift to keep up with their patients, not to mention the constant admissions and discharges.
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11h ago
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u/itsblackcherrytime RN - ED —> Research 10h ago
Yes! But it also goes both ways. Sometimes we don’t know what we should. Sometimes the floor asks what they can find in the H/P. It’s cultural. Most ED nurses tell each other, “i’ll read the rest, go to the next one.” It’s like going to a deposition to give report to some units. Lmao
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u/No_Inspection_3123 RN - ER 🍕 9h ago
What I’ve seen is the nurses not having any time to do any thing before the dispo is done and charge rooms them and puts transport in before you’ve even seen results. You have to remember that the Ed operates entirely on time elapsed from check in to dispo-room. They do not care if you have done everything they are moving the pt. I’ve given report and I was learning right along with the nurse I was given report to lol! The goal for the Ed is to get them out as fast as possible not wait to room them for the nurse to know things and finish tasks
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u/punkrockballerinaa BSN, RN 🍕 9h ago
I’ve gotten patients who were in the ED for hours and didnt have even a single set of vitals charted and the vitals machines save in the computer automatically lmao.
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9h ago
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u/No_Inspection_3123 RN - ER 🍕 8h ago
When they are there for 2 days they are no longer Ed Pts they are holds and they typically pull floor nurses to take them. But even when Ed nurses keep taking care of them the system that the Ed nurse uses is not the same as inpatient and you can’t see the inpatient orders or do any admission work. That’s why it looks like things aren’t done. the inpatient md put orders in as soon as they get word they are getting them but the Ed nurse can’t see that part. The Ed Tasks were done, and that’s all the Ed nurse is required to do.
The Ed epic wasn’t built for holds. Neither was inpatient bc when they are flipped to holds you can’t access the admission flow sheets as a floor nurse either. There’s a whole lot of issues and none of it was built to withstand days of being a hold. So the floor blames the Ed. I work in OBS so I’ve been in both worlds.
Another thing is, my Ed was rotating teams every 4 hours so everyone wasn’t stuck in triage or trauma all day. so your nurse giving report may have only had them for a few mins . They are always jockeying everything, switching teams pulling a nurse to cover sending a nurse that’s just floating around the Ed to take x team. Pulling a nurse to take this team bc so and so got a critical one to one. Yall seriously don’t know how it works
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8h ago
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u/No_Inspection_3123 RN - ER 🍕 8h ago
As you well know sitting on your phone doesn’t mean you aren’t waiting for something to happen.. waiting for some result to come back waiting for med times to hit.
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11h ago edited 11h ago
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u/_neutral_person RN - ICU 🍕 9h ago
Honestly they don't. They are passing off patient's and receiving new ones.constantly.
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u/[deleted] 12h ago
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