Bedside Report dillema

[DJ-Adia]

At this months unit meeting, we were informed that we'd be starting Bedside Report to increase staff accountability & decrease shift "Dumping". We were told that only "abnormal" findings would be communicated to cut down on the amount of time. I'm completely receptive to making changes if it promotes efficiency, patient safety and/or improves staff morale. I work part-time 3p-11p (6 days every 2 weeks) which significantly affects the continuity of patient assignments. Most times having new patients each time I work.

I consistently follow the same Day Shift RN each time I work - which is the basis of my concern. The pertinent information she communicates in report is minimal. She often times does not know the recent vitals, pertinent daily labs ie; elevated INR's Low K+, Low Na, elevated creatinines or the telemetry rhythm they were in for the duration of her shift. If a patient is admitted w/ CHF or Pneumonia - she doesn't remember her lung assessment or I&O. She often answers "I'm not sure but I'm think they were fine". When I start my shift, I find a patient with a Potassium 2.0, Urine output of 100 cc/shift, BP 80/40's etc. It's very frustrating and not to mention sets me up for "liabilty" issues. I can't trust the info she gives in face to face report, much less at bedside where only the "abnormals" are communicated. I've spoke with the nurse supervisor numerous times about this RN & completed many incident reports for situations involving this RN. Any suggestions on how to address this situation?

[mpccrn, BSN, RN]

I'd continue to ask this nurse questions about the information I think I need to get the picture of the patient's course. If she responds "I don't know but I think they were fine"....I'd say "well you best find out for sure, I'll wait while you look it up". For your patient's safety ...and yours.....you have the right to expect accurate information and settle for nothing less. Eventually, she'll get the picture I would hope!

[proudnurseRN]

Whenever I know I'm going to get a lousy report from the previous shift, I take a few minutes to look over the chart before report begins. I don't know if you have that opportunity, but you may want to consider that. I look at the last couple of pages of orders to make sure they were addressed/signed off, labs, and vitals.

[mama_d, BSN, RN]

We have had issues on my floor recently regarding reports being given adequately. Eventually a list was drawn up of what is to be communicated during hand-off...perhaps you could request that mgmt come up with something similar to "ease the transition". You'll look pro-active to mgmt and you'll have a list in black and white of what's expected that you can wave in Ms. Incompetent's face PRN.

[AOx1]

The bedside report may help. We had a nurse that was notorious for leaving a huge mess because she was "too busy," yet always found time to read a book while on shift. She would leave soiled patients, infiltrated IVs, etc. I told her I would not accept care until we checked over the patient together. After a few times of making her restart IVs, change linens, call in labs she was too lazy to report, and give overdue meds, she caught on. I wrote her up each time and she was nearly fired, but eventually clued in that we work while at work, and read while at home.

[CTNurse678]

What I would do is to ask her the questions if she doesn't know, if accessable, I would take a computer around and look it up at that point in time if not beforehand. Then at first I am sure it would take longer to do report but issues were dealt with at the beginning of the shift. If she is like some of the people I work with being a clock watcher, I am sure that after doing it a couple times she would get the point. I am an extremely detail oriented nurse and it annoys me that working on a telemetry unit that I can't count how many times I don't even get a rhythm. For newer gards I often recommed for them to write out a report so they don't get off of topic or some staff create handout so they can write out the abnormals. Is it purely laziness, being burned out or a knowledge deficit problem? Have you asked her what was wrong in the day that she does not know?

I can also see from a management perspectative that this is an issue that should be dealt among the nurses. But I think it is great to make them aware.

We have a nurse like this who when I get 8 hr evening shift report nothing happens for 8 hrs. Gee?? Imagine that. I write her up for the things I see not done as a delay in pt care. I also agree with mpccrn statement.

[Daliadreamer]

Make her sit in front of you while she pages all the docs regarding the above issues you mentioned, and make sure she puts her name in the page and not yours.

I've had one particular nurse do this to me several times. When asked if the lowered K levels were addressed, her answer was "Well, the doctor was here, he must have seen them." Um, no?

[cookienay]

THis is slightly off topic, but your management's reasons for starting this practice are puzzling. Bedside reporting is actually a component of Joint Commission's NPSG to increase effective communication between caregivers. (As was the read back and verify component you are probably familiar with by now).

The whole "increase staff accountability" and prevent "dumping" issue makes it sound like there is a problem with each of these and they don't know what to do about it. Good luck with this issue and the above posters have all given good ways to handle this issue.

Just my $0.02

[Sugarcoma, RN]

Is this a new RN? You are really going to have to take her by the hand and lead her through report and tell her point blank this is what I expect and you have to be able to tell me this information. If she tells you she doesn't know tell her you will wait while she finds the info out. Bedside report with her is either going to be a total disaster or like another poster stated it may get her to get her act together. If this continues I would tell your manager, I have brought this issue to your attention, I have made multiple write-ups, I have attempted to assist and teach this RN all to no avail. I will not follow her again until some action is taken. If your manager balks at this you may have to go up the chain.

[carolmaccas66, BSN, RN]

I'm a straight talking Aussie and I would be asking her directly why she has not got this info, and why it is important. I would also be waiting while she has to run around and get the info, though this would waste more time. You need to tell her straight I'm afraid.

I wouldn't even go to management - they don't do eff all IMP and from experience.