Studer Group "Bedside Shift Report SM"

[DVorahRN]

Our facility introduced the concept of Bedside Shift Report^SM as proposed by the Studer Group a few years ago. Frankly, I think they did a poor job of introducing it and an even worse job of training us (yes, scripts and role play feel silly, but it does give you a starting point -- something my hospital skipped over completely).

My unit has really had a difficult time with implementing this process as we find it takes far more time to give report this way, and off-going shift RNs are inevitably leaving late. One of the challenges is that the patient decides that "as long as you are here" they need to go to the bathroom, get pain medicine, get nausea medicine, get a warm blanket, get ice water/coffee/food, etc. Obviously some of these needs can easily be met by ancillary staff, however, since there are 2 RNs at bedside, the RNs have to do it right then. This eats into the time available for report on the remaining patients. And if you are giving report to/getting report from multiple nurses, an awful lot of time can pass.

Our unit management is really cracking down on us to do it every patient, every shift, and it is causing a lot of push-back and stress. Has anyone who is using this program found a way for it to work smoothly, without making shift report last forever?

[Here.I.Stand, BSN, RN]

You know how are nurses got around it?.They do it outside the room to start.ehere the patient and family cant' see fir the most part. Then they do go in together and the incoming nurse is introduced and they look at whatever they need to look at and on to the next

This is exactly how we do it where I work. Basically we introduce ourselves, check the drips together, and if it's a neuro pt do a neuro check together. NO WAY are we getting into inappropriate behavior, family dynamics, drug screen results, and new genital sx at the bedside.

The last place I worked also had the policy of doing bedside report, and we never did...it was an LTACH so we're talking 4-5 pts on days and 6-7 on nocs...and they rarely kept the same assignments together. So I'd take report from 2-3 nurses and GIVE report to 2-3 nurses. This would not have been logistically reasonable. As it was, report often took 45 minutes between waiting for one of your replacements to finish and getting into complex hospital courses.

[martymoose, BSN, RN]

The thing is that you need to make it clear to patients that this time is not for nursing care, but to introduce the incoming nurse to the patient and clarify that day's goals with everyone, and to allow the off-going nurse,

Yeah,right. They DONT CARE about you getting out on time. They GET angry that you don't drop everything you are doing RIGHT NOW and help them. Of course they are usually a two + assist to a commode or something. Sure there are techs, aides, etc, but THEY are helping the rest of the floor with the foofoo demands( well, not toileting- im not a complete jerk).

Customers don't like being told No, you might have to wait a moment.

And then we get spanked at the end of the day for going over shift.

Thanks Studor!!!!!First class customer service at it's finest!

[martymoose, BSN, RN]

it has been reflected several times in the satisfaction survey about a "great nurse lost points with me in the end because there were two of them in my room at shift change and they told me to press my call button instead of them helping me to the bathroom".

YUP, THIS.

My stance is this: since the techs do nothing from 7pm-11pm (I don't know about days), just dividede that pay among us nurses for those hours and have them work from 11p-7am. Maybe the cut in hours/pay for them will make them get off their rears and do their jobs.

I will this time, stand up for the techs, well, that is when we even have them available. Where I am they run their butts off! like I said previously- 80 percent of the floor is 2 assists or apex lifts to the bsc. the rest are bedpans that cant even roll them selves over without 2 assist. Maybe 1 walkie talkie. And if the techs aren't doing that, they are drawing labs and trying to get foofoo stuff for the 20 family members . No, they don't like being told no, or having boundaries described to them.

[sistrmoon, BSN, RN]

Yeah we currently round together at the bedside after report to check lines/fluids/drips and introduce the oncoming nurse.

[TeflonNurse]

Urgh! I hated the mini consultations during bedside report with the families chiming in and contradicting everything! Thank goodness for ICU where we kick out the families and can give a nice thorough report without additional drama

You lucky dog!

i was so looking forward to working in ICU and having set visiting hours with only 2 visitors allowed at a time. Of course I managed to get hired into an icu that doesn't believe in visiting hours. It actually hasn't been that bad except for 1 or 2 yahoos who insist on making trouble.

[Godivaa]

A couple things that helped at the facility I work at is first, CNAs do rounds at 6am. ( I work nights). They toilet patients, change briefs, reposition, etc. They also fill waters. At 6 am, the nurses do rounds for pain, check IV fluid bags etc. I think it is great, but it depends on the nurse you are giving report to. Some want to go over orders and labs from several days ago, and that can be done after report. It is like they are delaying starting their shift. I like it because you see all your patients, know that they are stable, check all your lines, and are not getting surprises when you go see your patient after report. It holds the nurses that like to leave messes accountable. Before the bedside report, there were nurses notorious for leaving IV bags empty, patients in pain, room messy, and IVs infiltrated or not working.

[wheeliesurfer]

I learned a trick from nurses who cared for me in the hospital previously prior to them doing bedside report. The nurse/tech who would round at 0600 would let you know they they are going to be going off shift soon and that from 0700/1900 to at least 0730/1930 they would be in report with the oncoming nurse and would ask if you needed to use the restroom or PRN medications before shift change. Of course when they asked they "had the time." If it was the tech rounding and the pt. needed PRNs, they would notify the nurse so s/he could administer.

This is a good way to let your patients know that a change is coming and if they call during report the response will be slower. It also allows them to get the things they need prior to shift change to minimize interruptions to bedside report (granted some patients will STILL "need" SOMETHING during report, but admittedly not as many as if they didn't get a heads up.)

[Esme12, ASN, BSN, RN]

The idea of bedside report is to NOT give details of the entire report at the bedside. The "real" report is at the nurses station or outside the room. The bedside report is introducing the next nurse and checking line, drips, PCA pumps, and other focused assessment like pulses and neuro exams so that the off going and on coming shift agree. It minimizes the incorrect drip rates dry bags and forgotten/necessary tasks. How many times have you questioned if the patient neuro assessment or pulses have changed?

CNA/techs need to make rounds and be available during these times to toilet. Instruction of the patient begins on admission what the expectations are at shift change.

It can work IF the management supplies sufficient staff but we all know that management isn't listening.

[annie.rn]

We give the patients a letter in their admission folder describing bedside report and hourly rounding. We get so much flak if we don't do it and the patients (the ones who like to read handouts at least) know we are supposed to. We generally do it outside the door and then do a bedside check as Esme 12 described above. That works out the best but management is not happy w/ it. They don't want to see us in the hallway at all when giving report. I don't think that is practical.

As far as minimizing pt. requests during report, there has to be some kind of pt. education about the process. That def. won't eliminate the requests but it might minimize them.

[RNx8yrs]

Don't write that in an email and hit reply all. Trust me (and my corrective action) it does not go over well. Shoot. I can't even figure out how to reply to BSNbeDONE.