Is this reasonable or just over the top?

[Lakeshore18]

Recently our Nurse Manager informed the nursing staff that we were now to conduct our shift report using certain "scripted" parameters. Basically, we are to wake patients up, conduct shift report at the bedside, include he patient in the process by giving him/her the opportunity to ask questions and add to the information we pass on to the oncoming shift, check all patient orders on the computer and then conduct a brief"physical exam" of the patient with the oncoming nurse. There are certain scripted things we are to say as well. For example the nurse going off shift is supposed to say:

"Good morning, Mr. Jones. I will be leaving shortly to go home to my family. This is Sally and she will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. I feel confident I will be leaving you in good hands wth Sally as your nurse!"

After this, we are to continue on with the above outlined report, conduct the mini physical exam, check the orders in the computer and give the patient the opportunity to give feedback during our report. Generally we each have 5-6 patients on our very busy cardiac monitoring unit and our shift report is 30 minutes long!! My colleagues and I are at a loss to figure out how we will accomplish all of this in 30 minutes! I am all for including the patient and allowing them to give feedback, but I fear shift report will now take so long we won't be able to get all our work done! And what about visiting hours? Shift report takes place right in the middle of them at 7pm. Now there will be visitors for both patients adding their comments as well.

In addition, I am uncomfortable giving my opinion about the skills and expertise of the oncoming nursing staff. We are expected to stick to the script and give positive reinforcement about the capabilities of the next nurse coming on shift. What if he/she isn't a very good nurse or has poor clinical skills? Am I supposed to lie to the patient? And if I do, won't I be undermining my own credibility? Does anyone else think this is a little over the top?

[Julius Seizure]

Can I tell the patients that its time for my shift to end so that I can drive home, eat, and go straight to bed because I am due back in less than 12 hours to take care of them again?

[LibraSunCNM, BSN, MSN, CNM]

I don't know why, because it's probably the least important aspect of this hot mess to get upset about, but the part where you're supposed to say you're "going home to your family now" really bothers me the most. If a patient and I have a good rapport and they casually ask what my plans are after my shift, I have no problems making small talk about that. But otherwise, it's none of their damn business what I'm going home to do. Maybe I'm going home to my family. Maybe I don't have any family and I'm going home to my cats. Maybe I'm going home to drink myself silly over the fresh hell I have endured that day at work. But why should you have to volunteer any such information? Again, I know this is minor compared to the big picture of this indignity, but that would really be the straw that broke the camel's back for me. I would refuse to take any part of this and try to convince as many coworkers as possible to do the same. If that proved to be a problem, I would talk with my feet, right on out the door.

[NightNerd, MSN, RN]

Plus, can we talk about how bedside report and certain patients don't mix? I will do bedside report sometimes, but our patient population is of the psychiatric variety. I can only imagine the contributions they would make if I woke them up to participate in a summary of the shift. They might remember the tantrum they threw that involved throwing a phone at my head, that ended with restraints and IMs a little differently. I'm sure there are plenty of people who have meaningful contributions to report, but it's for such a specific purpose that I just don't see the utility in waking people up for it. We know what we need to know from the offgoing nurse and what we can ask our patient during our initial assessment; they generally don't.

[klone, MSN, RN]

I'm a fan of bedside report, but only when it's done right.

First, the whole point of bedside report is to engage the patient in their care and their discharge planning. Thus, an effective bedside report is one that the off-going nurse AND THE PATIENT give to the oncoming nurse. It should not be two nurses talking over the patient's head.

Second, having both nurses go into the room and lay eyes on the patient provides accountability for care. If you're looking at the patient together and you see a bag of fluids that have run dry, or an infiltrated IV site, or a soiled dressing, or a foley that hasn't been emptied all shift, the offgoing nurse can't say "It wasn't like that when I left!"

We have implemented it at our facility, and as part of the group that planned the roll-out, I gave my vehement objection to any kind of scripting. I am NOT requiring the nurses in my unit to say "Is there anything else you need before I leave? I have the time!" or anything else by rote, even though it says that's supposed to be done on the audit tool that we will use to audit all nurses.

Part of effective bedside report is providing education to the patient before it occurs on WHY we're doing it and what to expect. Part of that education is discussing with them beforehand on whether they want their friends and family present for report.

Finally, if patients insist they do not want to be woken for report, then we don't wake them. However, the nurses are still required to go into the patient's room to lay eyes on them, check lines and drains, and do a safety check (bed down, locked, call light in reach). That's just good nursing practice, and should happen with EVERY patient, every shift.

It's completely unreasonable and unnecessary to do an assessment during hand-off. You also shouldn't be toileting or providing pain medication. Each hand-off should take no longer than about 5 minutes. If you're taking much longer than that, you're doing it wrong, and/or your facility is being unreasonable in their expectation of what should occur during shift report.

[CrazierThanYou]

I hate beside report because I don't feel comfortable talking about the patient in front of the patient.

Making the next shift wait through an assessment? Heck no!

[VivaLasViejas, ASN, RN]

What fresh hell is this? I've been out of nursing for only three years, but from so many discussions about scripting and bedside report (hello, HIPAA anyone?) I'm glad I retired. If I were a patient---especially one in a semi-private room---I would be absolutely livid if the nurses woke me up to gab about my diagnoses and care plan. I can spot a phony a mile away and so can most patients. Scripting is an insult to both nurses and patients. I'm so sorry for those of you who have to deal with this.

[klone, MSN, RN]

Bedside report falls under "incidental disclosure" with regards to HIPAA, and as long as reasonable precautions are taken (asking beforehand if patient wants family in room; or in the case of semi-privates, closing the bedside curtains and speaking in low voices, bedside report is not considered a HIPAA violation.

http://www.ipfcc.org/bestpractices/HIPAA-Factsheet.pdf

[Apples&Oranges]

I love bedside report, and insist on doing it for every patient - HOWEVER... I refuse to be scripted, wake a sleeping patient, or engage in a long discussion when myself or the other nurse is trying to leave. I say, "Morning, Mr. X, My name is Oranges, I'm taking over for Apples. We are just going to give a quick report."

We do so, check drips, IV sites, bed alarms, sometimes look at (major) skin issues if there are any, change the whiteboard, make sure items are in reach. Done. Takes all of 3 minutes.

I then say, "I'm going to finish getting report on my other patients, but I'll be back shortly. If you need anything urgent in the meantime, press that button, but like I said, I will be back." Boom, leave the room.

If a patient or family has involved questions about the plan of care, labs, pathology, whatever, I tell them, "I need to look over the notes and morning labs have not been resulted yet. But I'll be better able to answer your questions after I have organized myself for the morning. Like I said, I'll be back shortly."

Of course labs have resulted, path and imaging are in and read, and by 07:30 I've probably touched base with the medical team and know exactly what the plan is... but I'm trying to get the nurse who has been there for 13-14 hours HOME! I try and stress this before we go in, and hope that the next shift will have the same respect for me - I try and lead by example.

Bedside report is a great tool both for patients and for nurses, but only if it's done right...

[Skippingtowork]

Bedside report falls under "incidental disclosure" with regards to HIPAA, and as long as reasonable precautions are taken (asking beforehand if patient wants family in room; or in the case of semi-privates, closing the bedside curtains and speaking in low voices, bedside report is not considered a HIPAA violation.

http://www.ipfcc.org/bestpractices/HIPAA-Factsheet.pdf

I am looking forward to bedside report on me, while I am in a semi-private room, with another patient in the next bed. I will be go after everyone in sight!. There is absolutely no reason to devulge anything in front of another patient. There is no such thing as "low, hushed voices" when there is someone in ear shot. Even the hard of hearing will perk up when private information is being discussed.

[Skippingtowork]

At one hospital I worked, management even required that we state how many years experience we had. What confidence a patient will have going from a nurse with 30 years experience to a new grad coming of orientation. They may both provide the same care, but one may be trusted less.

If you endorse the clinical skills of another nurse and something goes wrong, then what? And what you do on your personal time is no one's business, including your boss and your patient (unless it's illegal or immoral).

When I was in the hospital a couple years ago, I had just 2 requests: no charge nurse rounding and no scripting.:)

[K9lover, ASN, RN]

Eww, 'the script.' I believe it does undermine credibility to all sound like 'The Stepford Nurses', it takes away any individual care; if I were a patient I would not feel as if I my care was individualized. If I were a patient I would be in a rare position to tell the management what I think of 'scripting'. It is not new, I surmise it is based upon the concept that we all lack the intellectual capacity to greet another appropriately.

[FolksBtrippin, BSN, RN]

If you search CINAHL for bedside reporting, you'll see that it improves outcomes. It helps catch errors, educates the patient, and more.

But....

There is no evidence that scripting improves outcomes. So, I would just say drop the script. Scripting is implemented to help people get used to a new way of doing things. You don't need it for good care.

Speaking to the oncoming nurse's skills is good all around for relationships between nurse and patient and nurse to nurse. It will not harm your credibility to find something good to say about someone. But if you really can't do it honestly, skip it. I hope you aren't handing off your patient to someone without adequate skills. If that is happening, you have a different kind of problem.

This won't be popular, but the truth is that patient satisfaction is tied to outcomes. So there is a good reason why the govt reimburses based on patient satisfaction. I don't know why hospitals arent educating their nurses about this part of the equation, but I did learn it nursing school as I am a recent grad.

So the shift to improving satisfaction has a scientific basis for improving outcomes.

That's why I don't mind doing it. And it makes sense when you think about it. If a patient is poorly informed, excessively stressed out, lacking in sleep or social life, poorly nourished, etc, it's going to negatively impact their wellness and ability to heal.

It's annoying to have to change your habits and style, but if it's going to improve outcomes its worth it right? Its totally not worth it to me to just make more money for the hospital, but I think I'm like most nurses in that I would adapt to anything to improve my patients health.

Edit: I probably would not wake up a patient for bedside report. I think you need to use your judgment. Rarely would this be okay. Sometimes its not okay to talk about a patient in front of family either. Use your judgment. Nursing judgment should override policy when necessary. This is just a guideline for improvement.