Bedside shift report.

bnrn03 · Dec 29, 2009

I am a per-diem nurse and I work in all of the facilities that our company owns. One of our facilities does the bedside report. Personally, I don't mind it but I know plenty of nurses who hated it. Some of the concerns I heard were the lack of confidentiality because of the other patient in the room and having to find each nurse. I have given bedside report and some things we save for outside of the room. While in the room I always try to speak softly enough that the other patient cannot hear what I am saying. For the most part I have not had a bad experience with bedside report.

makes needs known · Dec 29, 2009

How can this work when there is only 1 nurse who is reporting to only 1 relieving nurse and they have to go through 40 patient? Not to mention the fact that we have semi-private rooms and the roommate will hear what is going on with other patient.

DLS_PMHNP, MSN, RN, NP · Dec 29, 2009

We do bedside reporting, here are some of the pros/cons I've encountered

Pros:

- you know which pts are most stable, and which ones you need to assess first.

- if you are the one giving report, it can 'trigger' you to remember to tell the oncoming shift something you may have forgotten.

- it puts the pt at ease(sometimes), and they know right away who their nurse is for the day/noc shift

- pts may 'fill in the blanks' on some important info.

Cons:

- TIME! When you are taking 7 pts, you have to track down sometimes 4-5 nurses to round with. Bedside reporting takes longer!

- The infamous "while you are both in here, I'd like to get some _______________ from your kitchen.

- Family members interrupting

- Semi-private rooms; total invasion of privacy. I will ask family members of the patient in the next bed to please leave for confidentiality reasons. That goes over like a lead balloon.

- Giving bedside report to certain nurses; especially ones who start out shift report in the patient's room with "My name is Jane Doe, RN, and I'll be your nurse today. what can I get/do for you right now?" Umm... no. My scheduled time to leave is 0730, not noon. We are here to do report not room service. You can ask that after I leave.

I'm sure I'll think of more.

dan_dfc · Dec 29, 2009

Wow "Wooh", you sure can jump to some absurd conclusions and hurl needless insults can't you! Feel better after getting that off your chest? Actually, I have no problems with my ego, I assure you it is fantastic. Allow me to paint you a picture. Let's say you arrive for your shift to receive report and the nurse before you has 2 of her 4 patients who have been in the ER for 2-3 hours and not only has she not assessed them, she doesn't know their chief complaint. Is that safe? How about if you receive report on a patient sent from the doctors office for a hemoglobin of 4.0 with active rectal bleeding, and that patient has not been type and crossed, or had an IV started, or had O2 or vital signs taken in the last 4 hours. Safe? Or maybe, you receive a patient who is being held in the ER for an ICU bed and has had no vital signs documented in the past 8 hours? Sound good? Oh yes, all of these things happened, and yes I cleaned them all up with minimal drama in front of the patient. I even turned off the nitro drip on the patient with a pressure of 70/30 without making them "super-needy" I tried to offer some constructive criticism to this nurse in a polite, proffesional manner. didn't work. Then I spoke to the charge nurse and nurse manager. . .no effect. Now, let me ask you this, would you want to give report in front of the patient if you had no idea what was going on with them? I'm simply hoping that bedside report will introduce this individual to some aspect of accountability. I'd rather spend my entire shift caring for a "super-needy" patient than spend 1 hour doing post-mortem care on a patient I found dead after a report that consisted of "There's a patient in room 2, they're here for a nosebleed or something, I think" But maybe that's just my ego talking, I dunno?:icon_roll

loveu123 · Dec 29, 2009

My facility doesnt require bedside report but i have already made all nurses aware that i would only take report after seeing the patient. Most of them walk with me to all the rooms and give report along or come back to the station to give report. Some refuse to walk and I always go in to see the patient and write down my concerns before I take the report so that the nurse can address it. I had an incident in the past when the patient had a big bruise on the face and i asked the night nurse how he got it and she was unsure. We found out that it was from a fall. It seemed she did not see the patient through out the shift. Just this week, the night nurse refused to walk with me. I discovered the patient did not have his picc line anymore. I came to ask the nurse why the patient did not have his picc line and he insisted it was in. Some of the other nurses had to go in with me before the nurse agreed to come in. This would have been a surprise if i hadn't walked before the report. The night nurse had to call the doctor and take care of "his business" instead of me wasting time on my shift.

stressgal, RN · Dec 29, 2009

I work Intensive Care and here is how our shift change occurs. The off going charge nurse gives a brief report to all nurses coming on shift on all patient's in the unit. These include dx, drips, rhythms, O2, chem sticks, treatments etc, takes about 15 minutes for our 13 bed unit. On coming charge nurse hands out assignments and walking rounds are completed between off going and on coming nurse. There was a lot of resistance from staff about walking rounds initially but I love it. We have a lot of new grads on our night shift and I think it is a good time for all nurses to visualize, ask questions and transfer information. Of course we use common sense and may report sensitive information to each other away from those who don't need to hear, I think the example was given earlier about a patient not being aware yet of a diagnosis. When I have floated to the med surg units they just do walking rounds without the initial group report. They have up to 8 patients per nurse and it works for their situation.

Up2nogood RN, RN · Dec 29, 2009

We've been doing BSR for well over a year. I do believe some info is best given out of the room out of earshot of the pt. Once in awhile our NM cruises around in the noc-day shift change to make sure we're actually doing report in the pt room. I think bedside report is great to double check IV's, we check and cosign pca's/epidurals at this time, make sure bed alarms are on, and it counts toward our 'purposeful hourly rounding'. While it is a great idea I never get out on time but I really can't complain about OT pay

mamason · Dec 29, 2009

SOme very informative responses...SOme like it and others don't... Like I said, I'm willing to try it. And I too am concerned with getting out in a timely manner. That hardly ever happens now with the acuity of our pts, transfers out of ICU, and trainwrecks that the ER sends us...I have a feeling that management will start coming down on us for costing them money in pay for not being able to get out on time. LOL.

AnnaN5 · Dec 29, 2009

We have sort of being doing bedside report for about a year but our new manager is really starting to crack down on it. Before we would give the majority of the report outside the room, go inside & introduce the oncoming nurse, check IVs, drips, etc and move onto the next patient. Seemed to work fine. Now they want us to do the entire report inside of the room, which includes waking up the patient. Doesn't go over too well when the patient was just admitted a few hours prior and finally just got to sleep. I also am concerned since we have semi-private rooms and I don't understand how it is not a HIPAA violation if the roommate hears their roommates info. I know that it is helpful in catching issues when both nurses are there but I don't like being forced into waking up my patients so they can listen to us give report.

elkf · Oct 13, 2011

We are starting the bedside reporting at my hospital. Honestly, I am not excited about this at all. There are numerous variables that stand in the way of this. First, I believe the oncoming and off going nurse need to be in an area with minimal interruption so we can discuss the history, issues and areas of concern regarding the patient without interruption. It is not a time to look to try to "look good" in front of the patient to set a good image-that is not what it is about and I believe it is being treated more as a "customer service" issue rather than a serious report that needs to have limited interruption as to provide quality patient care. I don't know why the nursing desk as become an area "off limit" to reporting. I have been a nurse for 16 years-so I am old school. I like to write my report out, look at the chart to see the orders in the last 24 hours and have the computer at my disposal to discuss results of tests etc (I am in a unit so I know floor nursing may not get this involved). This is not possible with bedside reporting. Not to mention there are numerous portions of the report that the patient should NOT hear. For example, test results, interpersonal conflict with family members, etc-you get my drift. The SBAR reading at bedside doesn't get it, like I said I like to write my report which helps me organize my thoughts and is an easy reference for me to look at from a personal standpoint. SBAR is great to have, especially when patient is going to a different area but personally it is too all over the place with info-my personal opinion. Anyway, at my facility they say "just tell any portion of the report outside of the patient's room if you don't want them to hear". Really? And you think they can't hear it, especially in an ICU. Then its not really "bedside reporting" then is it? That is ridiculous. This is how pertinent info will forget to be passed along. The report process is a very crucial time to obtain pertinent info that will have an impact on the patient's care for that day. It is not a time to "look good in front of the patient" like they are staying in some 5 star hotel. Patients should not be involved in the REPORT process. The assessment is when you involve the patient. After report then the on going and off going nurse should go and look at the patient to see if the Heparin is infusing at the correct dose, or if the patient is lying in feces that they have been in for 6 hours etc. -get my drift. That is when you can introduce yourself, but only after the nurses have given report in an area were they can focus with limited interruption; which is not in the patient's room. They say this is "evidence based". Well from the evidence I have seen-no. Patient's should certainly be involved in their care, however, we have to be careful. We need to remember there is a line between caregiver and patient and when you start to enact areas with too much patient involvement the line becomes distorted. What next? Think about it.

blamejoe · Sep 1, 2012

Where I work, we started bedside shift report about 2 years ago. At first I had some of your same concerns ( and some the you don't mention, like getting out on time). Some of your concerns I don't share at all. In either event, bedside shift report turned out to be a great thing, for all of us. The nurses who don't embrace it are having trouble being successful at our network. Of course, they blame their lack of success on anything other than their failure to embrace policy, but I advise you to give it a real honest chance. There is no reason a patient ( who is the consumer, the focus of your work, and your reason for having the policy in the first place) should not be able to participate in report. The second, third, or fourth time I got wrong info ( like allergies, history, or procedures) from the off going nurse proved that this change to process was beneficial - especially when the patient "reported" that they were prescribed meds that they were allergic to, because the records weren't as accurate as we wanted to believe.

tokebi · Sep 1, 2012

Wow "Wooh", you sure can jump to some absurd conclusions and hurl needless insults can't you! Feel better after getting that off your chest? Actually, I have no problems with my ego, I assure you it is fantastic. Allow me to paint you a picture. Let's say you arrive for your shift to receive report and the nurse before you has 2 of her 4 patients who have been in the ER for 2-3 hours and not only has she not assessed them, she doesn't know their chief complaint. Is that safe? How about if you receive report on a patient sent from the doctors office for a hemoglobin of 4.0 with active rectal bleeding, and that patient has not been type and crossed, or had an IV started, or had O2 or vital signs taken in the last 4 hours. Safe? Or maybe, you receive a patient who is being held in the ER for an ICU bed and has had no vital signs documented in the past 8 hours? Sound good? Oh yes, all of these things happened, and yes I cleaned them all up with minimal drama in front of the patient. I even turned off the nitro drip on the patient with a pressure of 70/30 without making them "super-needy" I tried to offer some constructive criticism to this nurse in a polite, proffesional manner. didn't work. Then I spoke to the charge nurse and nurse manager. . .no effect. Now, let me ask you this, would you want to give report in front of the patient if you had no idea what was going on with them? I'm simply hoping that bedside report will introduce this individual to some aspect of accountability. I'd rather spend my entire shift caring for a "super-needy" patient than spend 1 hour doing post-mortem care on a patient I found dead after a report that consisted of "There's a patient in room 2, they're here for a nosebleed or something, I think" But maybe that's just my ego talking, I dunno?:icon_roll

I really try hard to be mature and not take sides, but in this case... come on, dan! Go back and read your first post. Without the above detailed explanation, your earlier post totally sounded juvenile and vindictive.

Back to the topic...

I am starting as a new grad and we have to do bedside reporting AND we are discouraged from writing things down -- no more cheat sheets or the portable "brain" on a sheet. Instead, we're to utilize the computer workstation fully. Honestly, it doesn't sound too bad since computers are available both at the bedside and nurses station. Any changes are painful, but I think it's a necessary transition in order to adapt to the changing culture (patients wanting to be more informed and empowered) and technology (availability of computers and quite sophisticated software).