Bedside report - hate it? Like it? Love it?

[ixchel]

I had the worst experience in a very long time giving report this morning. My unit requires bedside report, which I actually love. Apparently a recent new grad hire hates it. Waited until 15 min into her shift to even try to get report.

She came to room #1. Parked across the hall and silently waited. I called her in, we got started. Shortly into it (I mean, I had just finished saying background info), newbie nurse turns the patient's lights off and leaves the room. I looked up and saw the patient was confused, too. Nurse says the patient was sleeping. Patient denies it, which was obviously more than enough evidence to verify the patient was, in fact, awake.

Finished up (at the bedside), went to #2. I walked in the room thinking she was right behind me. She definitely was NOT. Once again, butt hugged the other side of the hallway, just waiting.

The thing is, not only was today an accreditation visit, but these two patients were extremely complex, both unstable, both with multiple skin "things" going on. #2 had had an RRT called on her a few hours prior. Lots of stuff going on there!

And, bedside is required!

Room #3, she took the lead on introductions, and then actually told the patient we would be leaving the room to do report in the hallway. I stopped her the doorway, told her this patient actually prefers report at the bedside and reminded her that bedside is required on our unit (and management was crawling all over the place tidying things for our horrible, day-destroying visit).

She came back in. Patient #s 3 & 4 were quick and easy, so we were done there quickly.

Personally, I absolutely love bedside reporting. When the situation is inappropriate, I may opt out of it, but I love getting to visualize and verify the patient is alright.

So, me, I vote love it. I also think if you have opposite feelings of the person you're sharing patients with, whichever one of you is giving report should choose location if you are able. If you have had that patient all day long, you know if that patient is appropriate to include.

What do you guys think and do for report?

[Ruby Vee, BSN]

I work med/surg on a floor with all private rooms. We changed to bed side reporting about a year ago. Been an RN for 3 years. I think it is irrelevant whether it is liked or not” by the nurses. I think the discussion should be Is it better for patient care?” I think it is.

Having a visual during report is valuable. It can prompt many questions that are important and might otherwise be missed.

It gets patients and family involved. A lot of times after hearing the care plan a family member will ensure the patient complies! Yes, that is a win for me!

If the patient is disruptive to the process, then you need to set boundaries like anything else. If a patient has too many questions it might indicate there is a communication problem somewhere. For confused patients, I answer and then redirect them. Sometime I will tell them we will discuss it in more detail when the spouse or care giver comes.

I have never seen a patient or family member object. Even sleeping ones. If they ever do I will give report in the hall and chart bedside reporting was refused. When I ask visitors to step out of the room, I have never had anyone object. Sometimes the patient may say, They can stay”. I never ask the patient if someone can stay in the room for report in front of the visitor because it puts too much pressure on the patient. Esp. with the Asian/pacific islander population I work with.

Sleep is important, I agree. Our shift changes are at 7 (just before breakfast) and 19 so we are not waking for report at normal sleeping times. I will get/give bedside report it the room of sleeping patient some times with the entrance light on and let them sleep if they need to.

At the end I ask if the patient has any questions or anything to add. This is a good opportunity for the patient and the oncoming RN. Although, I usually get no, that was everything”.

I do not use the computer when I do report. I go off my notes and use a clip board. We have stacks of clip boards at the nursing station for that reason. If you rely on computer for report, I could see how that would slow you down esp. in isolation rooms. For isolation (non-airborne) we enter into the first 3 feet of the room and do report there without touching anything. Otherwise we gown up if we need to show and tell.

I have never found it inappropriate. I think it is extremely appropriate to involve the patient directly. Doing report q12 hours allows for repetition and reinforcement. It is more transparent. Personally I want my patients to understand their dx and tx as best they can because it makes my shift easier.

I will often be very frank. Although Mr. X has bee told not to get up on his own, he has use the bathroom without calling. I explained this was a safety issue...” This allows shift to share boundaries so patients don't try to play the oncoming staff.

The only exception I have run into is the CA or similar terminal patient who has not yet been told. I will preface my report with this info in the hallway and then go into the room for report.

If you are stuck with bedside nursing, I hope my post helps in some way. I have not found it to take longer. It depends on the patients. If it is policy well then you might find a way to make it work for you or work on getting your policy changed. I don't think it takes longer” is a good enough reason not to use bedside reporting.

Ask yourself, if you were a patient, would want bedside report? I would.

I think a lot of this depends upon your patient population. A reasonable and respectful patient population is one thing; an unreasonable, entitled and disruptive population of patients and visitors is another. Bedside report is one of those things that can be great in the right circumstances, but I'd hate to see in my SICU where one patient is a gangbanger who got stabbed in the process of shooting someone and the patient across the hall or two doors down is the banger who got shot while he was trying to stab someone and each has a roomful of his "bros" visiting.

[Ruby Vee, BSN]

I've noticed that nurses who hate bedside report often make similar false claims. They will simply lie about the patient sleeping or not wanting to be disturbed - even as I see their call lights on or they are up and stumbling about the room.

I yelled at one coworker when she said, "No, we can't go in there, the patient is sleeping and walks independently" I was looking into the room and the patient was stumbling around in the dark with the IV and power cords wrapped around her ankles. The outgoing nurse continued to complain I wanted to "wake up the patient."

If you don't like bedside report, fine. But stop lying.

OKayyyy -- everyone who disagrees with you is lying. Got it.

[Ruby Vee, BSN]

Surely you've heard of HIPAA? The patient has to consent to others hearing his/her medical history. Surely you have enough sense to ask visitors to leave the room.

This is a little confrontational.

If you ask visitors to leave the room and the patient insists that they stay, then what? If it were me, I'd retreat to the nurse's station to give report. Are you going to just go ahead and give it at the bedside anyway? I don't want to be the one to caught in the middle of "HEART Failure? No one ever told us THAT! The doctor says he has CHF." again.

[Ruby Vee, BSN]

Nope. Most of the requests are "if you are in the room I will think of something I want" requests. If they have water, they will ask for ginger ale. If they have been to the bathroom, they will have to go again.

Or they will want their TV channel changed, a "bendier straw", a "squishier pillow", more pain meds or a more comfortable chair for the guest who, by the way, seems to have some sort of upper extremity disfunction that makes them incapable of bending the straw, changing the TV channel or fluffing the patient's pillow.

[ArtClassRN, ADN, RN]

OKayyyy -- everyone who disagrees with you is lying. Got it.

Not at all, but far too many certainly are and my example you responded to (and ignored) certainly showed it.

Sure, there are times when bedside report is inappropriate and I don't do it. But the times it IS appropriate - I do it. It saves time and patients like it.

My last shift, I did bedside report with an outgoing nurse who is notorious for babbling on and on about random things during report. She takes forever. I reviewed signouts, found her and said, "Let's go see them."

She, of course, tried to give reasons why the patients should not be seen, but I knew these particular patients fairly well and we went in and saw the patients (who were perfectly appropriate).

She did the standard bedside-report-resistor schtick, saying nothing but "This is your nurse, Art. Art, do you have any questions??" I asked the very few I had, mostly to the patient, as she rarely has any idea. The important thing is the assessment data I gathered in those 2-3 minutes looking at and talking to the patient. A wealth of information.

After that I went and finished my workup while she gave her standard babbling brook stream of consciousness report on her ONE remaining patient to the other oncoming nurse. I was halfway into my assessments by the time she left while the other nurse was just getting started.

So, no, not everyone who disagrees with me is lying, but used properly, bedside report is a fantastic nursing tool.

[MunoRN, RN]

It "has to do with it" because you posted this -

What prompted this was me saying that sharing the information in the following post would be illegal.

I had responded to that with-

(Btw, your response to that one asks how your initial post included things against the law. While I bow down to your infinite years of wisdom and experience over me, I'm not sure you fully understand HIPAA. Also, STIs do not cast "new light" on these issues. I'm pretty sure no one believes STIs are somehow more protected than cardiac or renal or any other history.)

In another post indicating your full report outside the room, and mini inside the room, this would be appropriate. I do wonder if a disconnect has occurred somewhere in the chain of command for your unit. There is no way the hospital's legal department would be on board with full report in front of guests. I urge you to research this further. You might end up saving a colleague her license and your hospital multiple $30k fines per violation.

Incidental disclosures are very clearly not HIPAA violations. As much as I wish HIPAA essentially banned the use of double rooms, it does not. It's certainly reasonable to clear the room of anybody not involved in the ongoing care of the patient, but part of an overall nursing assessment is to identify the support people the patient will utilize in various capacities, and in general we highly encourage them to present when we discuss the overall plan and progress, they will often have questions, which is the point.

In terms of policy, it's the sole responsibility of the nurse to ensure they are receiving report in a reasonably safe manner, which is why "bedside reports" have largely transitioned into a bedside safety check and patient update with the remainder of report done where it's safest (access to info, ability to write, lack of distractions). There are certainly still places where a policy that contradicts patient safety and good nursing practice is actually integrated into practice by nursing staff, which is much more the fault of the nursing staff than it is the policy.

[LRKirkman]

Hate it. Nothing like having a lengthy discussion every 12 hours about the extent of someone's widely metastatic cancer, subsequent renal failure, infections not responding to treatment and inappropriate code status. All of this in the company of 5 family members at the bedside who have to interject every 5 seconds to ask you what one of those "big words" means and argues with you about your response. Never mind the poor patient, who has to be awakened to hear of their poor prognosis and impending death every 12 hours. It's cruel. Give them some peace. They know why they are there. There is nothing wrong with a brief introduction, review of the plan of care and examination of pertinent wounds and vasoactive infusions. Please, spare the entire dog and pony show and allow our patients some peace.

[rockchickrn, ADN]

I hated it when I was still in the hospital. I understand the rationale behind it but I preferred the old way.

[SarHat17, ASN, RN]

Other people visiting in the room would possibly have questions/responses to sensitive information (not to mention that it would be inappropriate to share this information to whoever else besides the patient is in the room in the majority of situations if the patient had not consented), and the time spent requesting everyone leave, then the time used while everyone does leave, etc, all eats into the 30 minutes for report between shifts. On my unit, I would be giving bedside report on 3-4 patients, usually to 2-4 nurses, who are taking 4-5 patients at night, so that could leave approximately 6-7 minutes for report on each patient for the oncoming nurse. Asking/explaining/moving family/visitors, etc, to the hall for each report could probably cut actual report time to approximately 3-5 minutes per patient, if we are aiming to stay within the 30 minute report time. (luckily, MOST of the time, there are not visitors present at report times.) The time spent is the part of bedside report I get stuck on. We are trying to implement it consistently at my hospital, and the culture of my unit, plus the actual time logistics/time crunch seem to be the biggest obstacles. I'm game to start doing it, but I am so over having to go find someone, "drag" them (if unwilling) to the room, and then start report. The response from management when I shared that scenario was to wait outside the room for the oncoming nurse to come to the room, which will prolong MY waiting time, and ultimately prolong the whole process.

I'm hopeful it will get easier with practice; I am on a committee that is working to address all the roadblocks that come up, but truthfully, I think the general feeling on our unit is just so tired of all the issues and short-staffing, there is a real lack of engagement and initiative to start something that so many people are already uncomfortable/annoyed with.

I fully support report outside the room and then both nurses go to the bedside to check/introduce/quick update to the patient the POC for the day.

[ladedah1, BSN, RN]

I never really minded a quick meet n' greet after receiving report, as it does help insofar as safety / line checks, verifying patient condition (I.e. "Yes, that's the same amount of blood I saw on the dressing earlier", etc.), and letting the patient know that you'll be around with meds after looking up their information (so they don't call a million times while you're looking stuff up)...

I did, however, always despise formal bedside report for a number of reasons already mentioned (which all typically add up to the fact that bedside report more or less prevents us from getting out on time and / or needlessly delays our start of shift routines).

I will definitely say that is one of the benefits of my unit having morphed into the primary unit for covid inpatients: the longstanding requirement for bedside report just simply disappeared! ?