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?

[WKShadowNP, DNP, APRN]

I understand the rationale behind it, and I don't mind the rounding, but the bedside report is tedious. Especially in an ER. On the floor I felt I had to take longer to do bedside rounding/reporting. I like being able to express the nuances of report without input from the pt. Now, I have also been known, at shift change rounding, to ask the patient to add their thoughts. (This is a good thing AFTER report) because it makes the patient feel included and involved in their care. They can also offer information that was forgotten, left out, or unknown.

In the ER, it's so much easier to give a quick report at the desk. I can basically look at the EMR to get what I need other than the presenting complaint and what's been done about it.

Yesterday I had a new nurse in our ICU to call report to. She was so green she was asking me questions that had nothing to do with the patient in my care/my care of the patient, and instead was geared toward her admission assessment. So time consuming. But I was nice and my sweet sunshiney self.

[AJJKRN]

Not always a fan especially when giving report to multiple nurses or when the Pt has behavioral/family issues that interrupt report enough that it makes it almost dangerous/pointless because the nurses are unable to stay on track or focused with the Pt report.

Just had to call security during bedside report the last time I worked because the Pt was being their extra special self and yelling that nursing staff weren't following protocol, etc. Pt was oriented but pretty sure has a Hx of abusing drugs like meth and of course knows exactly what is going on but the nursing staff is just not following the rules.

Yep, it was awesome

[ProgressiveActivist, BSN, RN]

If I do not trust the off going nurse, I insist on a bedside report.

[WKShadowNP, DNP, APRN]

If I do not trust the off going nurse, I insist on a bedside report.

I curious about that. Is this a confrontational thing? If you did trust the nurse, do you think there is no benefit in rounding at shift change to ensure things are as they should be?

[AlwaysLearning247, BSN]

My hospital requires us to do bedside report but sadly it's not being done the way it should be. I always just walk into my patient's room and start going over the tube feed, IVs, wounds, etc. Sometimes it is hard to go into certain patients rooms at shift change because they can be pushy and it can slow things down. I like going in and looking at everything, then doing a full report right outside the door. I always go in and introduce myself and write my name on the whiteboard too.

[RNperdiem, RN]

I am a visual learner. I get a better sense of the patient if I can see them, their vital signs etc.

This works well because I work in ICU with only 1 or 2 patients to get report on, families are not allowed to visit during shift change, and a lot of ICU patients are not going to interrupt.

Sometimes when I am tired at the end of a shift, it is easier to show than tell. I joke about end of shift nurse aphasia, but a report is less wordy when I can show you the IVs and the complex array of drains and I am less likely to forget something. There are computers in the room, so I can pull up the labs and MAR as part of report.

[NICUNurseEliz]

I'm a fan of it with working in the NICU. It's a nice way to give a full report since sometimes seeing the patient triggers memories from the day or good questions from the oncoming nurse. The only time I dislike bedside report is when it's a NAS baby (addicted to drugs, whether illicit or mom was in a methadone/subutex program) and the family is at the bedside. Then I'll usually give report elsewhere and just do introductions at the bedside.

However, I hated it when I worked pediatric medsurg. Our manager would follow us all around to make sure that we did bedside report on every child, essentially waking 20-30 children and their parents up at the same time at 7 AM.

[SororAKS, ADN, RN]

It depends on the unit. I find it best to do a combination of both bedside rounding and separate private reporting. It gives incoming and offgoing nurses the best access to the computers, records, etc if it's done in a private location where the conversation is likely to be uninterrupted.

Even if patients are intubated and sedated, it's often surprising what they can hear and remember.

[1hotnurse08]

I would prefer outside the room for the report then a walk in for visualization and introductions for oncoming and offgoing nurse due to other family members, or friends visiting ( privacy).. This is how reporting was done my second time working in a hospital setting, but my first time... We used tape recorders ( many years ago) for reporting. As an offgoing nurse I reported individually and as oncoming nurse we listened as a group to the report!! If you needed to ask a question there was a good chance that nurse was already gone!!!

[emmy27]

As a floor nurse, we were supposed to do bedside report and most of us hated it. Many of our patients were confused/sundowners and/or on bowel preps that kept them awake late in to the night, and waking them up at 0645 with terms and information that they may or may not understand started shifts off badly. Not to mention, for morning report, plenty of labs and test results had come back in the night that the doctor had not yet discussed with the patient, and/or there were sundowning-related behavioral issues on night shift that the (relatively oriented now that the sun was up) patient was upset or angry to hear about. Also impossible at bedside to give (often vital) information about family dynamics or patient behavioral issues without creating further problems.

So inevitably, a large component of report was given outside the room even by those with the best will to comply.

I do think rounding at shift change is a very good idea, but it should *follow* a thorough report and consist of introductions and a quick mutual check of pertinent lines/drains/wounds/drips, not a full report. I've seen that save patients (and nurse behinds) on several occasions. But in the same way that doctors wouldn't conduct their discussion with a consulting expert in front of the patient initially, I think it's inappropriate to give nurse-to-nurse report in front of patient and family. Including them in their care is a great idea, but not everything communicated in a nursing handoff is constructive (or ethical) to say in front of patient and family.

[KatieMI, BSN, MSN, RN]

I like it when it is about business, logical and straightforward, not a collection of excuses of what was not done and why, long talk about terrible family, etc. If you noticed something which will possibly help another nurse, let it be known, doesn'the matter how small it might be. If you just want me to ask questions in my own order, it's OK too. If you need to vent a lil'bit, it's fine.

P.S. I was "on the other side", i.e. as a patient, during bedside reports when, at one point, they were supposed to be 100% bedside. With this experience, I can honestly tell anyone that anything beyond "hi, sweet, this is Mary, she will be your nurse this night, see you tomorrow" feels awful at the very best. It is humiliating, dehumanizing action where your painful and luckless attempts to, say, defecate, are told to another human being in expressive details in your very presence. Sometimes they felt something but everything that could be done was to use "medical English", which made impression of concerned people speaking of important things very much pertaining to you on a semblance of foreign language to prevent you from understanding. Less than polite, I would say. I do not know about others, and maybe I was just excessively sensitive, but I eventually demanded to stop it all and for once.

[Neural]

I am not a fan of bedside report when done in entirety. Sometimes, the most useful info is either upsetting or misunderstood by the patient, and it causes more harm than good. Some nurses omit relevant details so as to not upset the patient.

From what I've seen, it's best when the 'real' report is given outside the room and the "bedside report" is merely a 30-second introduction of the oncoming staff after the real deal.