Anything Good About Bedside Report?

Nurses General Nursing

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maxthecat

243 Posts

If you don't have private rooms aren't you risking violating privacy of health information?

If you split the reporting, as some have said they do, and discuss sensitive psychosocial issues away from the bedside and go to the bedside just to look at lines, drains, etc., how is that a more efficient use of time.?

sparketteinok

136 Posts

We just started it at my hospital, and I think it will be better once all the kinks are worked out. But my biggest question is, if the patient(s) are in pain/nausea, whose responsibility is it to medicate, the oncoming who hasn't checked the chart yet, or the offgoing who just wants to get out of there? And, any tips on getting offgoing nurses to complete stuff they should have done (such as a pt waiting hour or more for pain meds)? I am all for helping out a team effort, but if a pt has been waiting an hr or 2 for pain meds, isn't that the responsibility of the offgoing nurse? Ihave encountered some resistance in this area.

And, should the oncoming nurse be allowed to head to toe assess during report? This is a huge waste of offgoing nurses' time.

Specializes in PACU, Surgery, Acute Medicine.

I was very resistant to bedside report when we first implemented it but I have been won over. I had thought it would take much longer but I find that it's actually much faster. The reason? You cut out all elements of "what a pain the butt this pt is" from report. The oncoming nurse is going to find out anyway. And maybe the pt will be different on the next shift, happens all the time. It's unnecessary information. With bedside report, I find it's much more "just the facts."

We only have one nurse on our unit who is famous for essentially starting assessments and providing care during report. I deal with it by doing all of my talking and just not stopping for her to start providing care. If she does, I just keep on talking. When I'm done, I say, "Okay, Jane, I need to go give report to Sally now, do you have any questions?" and then I leave the room. She can stay if she wants, I've got to go. If I have to report to her on more than one patient, I'll say "Jane, I still need to report to you on 74b, let's take care of that first." It generally works. Once, I was done reporting to everyone else and just had her left (I have since learned to jump on her first if I'm reporting to her.) I waited for 10 minutes and finally called her phone. She was already providing care to one of her patients. I told her I was waiting and she said she was cleaning her pt up, she'd be out in a minute (right). I told her it would have to wait until after report. The night nurse should have taken care of that pt but even though she didn't, it could wait for the 3-4 minutes it would take me to report on our final pt. But she is the only one who tries to start providing care or doing assessments. With everyone else, the things they are looking at are confirming important settings or finding errors, and that's a good thing.

Other than that, the very best part is finding stuff that the offcoming nurse missed, and sometimes that's me! I leave out less information by accident from report when I have the visual cues of the pt in front of me and the room and equipment right there. We don't go to the degree of checking lines and we only check dressings if there's something tricky to it or the oncoming nurse has a question about how to do the dressing change. It also has the advantage of peer-pressuring offcoming nurses to do a better job keeping up and not leaving the room a disaster. If a pt asks for pain or nausea meds that they have already asked the offcoming nurse for, I'll say "Would you mind getting that before you go?" No one has ever said no. If it's a new request, then it's not the offcoming nurse's obligation. I tell the pt "I need to check in with the rest of my pts first, and then I can bring it back to you." It's okay for pts to understand that we do not practice one-to-one nursing and we need to keep the safety of *all* of our patients in check, not just them. That means that I make sure that all of my patients are alive before I take care of your tummy ache or even your pain. My patients have generally been very reasonable about this, as long as I follow through. I'm always polite about it, and if a pt gets snotty about it as though I've said "You're not my only pt, you know!" (which I would never do), I am careful to readdress it, remain polite.

It used to drive me nuts when pts would ask for snacks when I was doing assessments. Don't they know how much work I have to get done during the first few hours of my shift?! Well, no, they don't! It's not been a problem since I enacted my policy of saying, "I can definitely get you a snack, but I haven't finished passing evening medications to all of my patients yet so as soon as I'm done with that, I can bring you something. What would you like?" They always respond positively to that. It tells them, "I've protected *your* safety by getting you your medications, now I would like to protect the safety of my other patients, too, and then we can get to comfort things."

The biggest problem I have with walking report is that none of the other nurses want to do it. It leaves me in the position of being the bad guy if I ask to do it. I know that I shouldn't be susceptible to peer pressure like that, but in a profession where we rely on each other so much, it matters. Management has done everything but write people up trying to get us to comply with this and sometimes I just wish they would so that everyone would do it. Another good point, I find that it enhances our professionalism in front of the patient. We don't do it in a way that involves the pt in the conversation, rather we are having the conversation in front of the patient. I've never had anyone ask what we meant by something, rather they seem impressed with our knowledge when they hear the person they've been asking to fetch them popsicles and extra blankets all night go on in medical terms they don't even know about things that actually matter to their health.

Didn't mean to drone on, it's a fault of mine!

mappers

437 Posts

Specializes in Med/Surg/Tele/Onc.

solneeshka that's they way i think it is supposed to work and a good 75% of the time it does. but i have a few questions.

do you wake patients up in the am, turn lights on etc? what do you do when there are several visitors, for your patient or for your paitent's roommate? are there times when you give info outside the room, like when the pt is a known drug seeker and the doctors have said do not call for more pain meds, or do you say this in the room as well? how does it go over?

thanks!

rntg

53 Posts

From what I am reading, those who like the process, it is really a way to check up on the nurse you are following and make sure they have left nothing over from their shift for you to do. I am seeing nothing about the patient involvement in the report which is really what this is supposedly about. And still not seeing how the rest of the staff stays informed about what is going on on the floor.

Specializes in PACU, Surgery, Acute Medicine.

If I m oncoming, I wake them. We had a couple of cases where pts had turned critical and neither nurse realized it, wasn't disobeyed until oncoming nurse got to that room, and by then it was too late to ask offcoming nurse anything because she was gone. If I'm offcoming and daynurse doesn't want to wake the pt, that's up to her. I don't turn on the lights and all that, I don't want to assess, just make sure they're not in distress. If drug seeking, I just point out the "allergies" before we go in the room, that's usually all that needs to be said about that. If MD has said we're not increasing the pain meds, I think that's good information for the patient to know, and to know that everyone is in the loop on that.

Specializes in PACU, Surgery, Acute Medicine.
From what I am reading, those who like the process, it is really a way to check up on the nurse you are following and make sure they have left nothing over from their shift for you to do. I am seeing nothing about the patient involvement in the report which is really what this is supposedly about. And still not seeing how the rest of the staff stays informed about what is going on on the floor.

It does give the pt the chance to speak up with points of clarification, that happens all the time and is very useful. My impression is that it helps pt to see that there is actually a plan for them, there is plenty going on that the pt otherwise wouldnt know about, and their care is actively being managed.

rntg

53 Posts

It does give the pt the chance to speak up with points of clarification, that happens all the time and is very useful. My impression is that it helps pt to see that there is actually a plan for them, there is plenty going on that the pt otherwise wouldnt know about, and their care is actively being managed.

I get that part, but how does the charge nurse and the manager stay informed about each patient so they can help where needed, answer questions and make appropriate assignments.

Specializes in PACU, Surgery, Acute Medicine.
I get that part, but how does the charge nurse and the manager stay informed about each patient so they can help where needed, answer questions and make appropriate assignments.

Well maybe the way you all do report is different from how we did it before walking report, but our charge nurses and unit manager have never been involved in the report process. We would just pair up with the nurse who was taking the patient from us, give report, do the same for any other patients of ours that she had, then find the next nurse who had the next patient of ours. I honestly have no idea how our charges stay informed of what's going on with individual patients. (I work nights so I almost never encounter them - we don't have charge nurses per se at night, rather, one of us is designated to be the charge but she still carries a full patient load.) I think the charges do their own rounds on patients in the morning.

zoebaily

6 Posts

The positive thing is ...you are doing "Joint Commission-centered care".

Specializes in Geriatrics, Transplant, Education.

We do bedside report/walking rounds at my hospital as well. The charge nurses get a quick report from everyone toward the end of the shift re: how their group was so that they can make appropriate assignments.

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