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?

[LV3677]

ED: I prefer a quick down and dirty of the patients and the plan of care. I'll go introduce myself to them and look over the charting if I have questions.

ICU: depends. If I've had the patient before, meh, gimme updates outside. Complicated patient with gtts, wounds, etc., I prefer bedside. However, it depends on the situation- sometimes, it's better to do a quick report outside the room before going in together to look over the pumps.

[whichone'spink, BSN, RN]

When I worked inpatient, I hated giving or receiving bedside report. It's awkward speaking to another nurse in what seems to be in another language for patients. No matter our effort to get patients to participate, they would either interrupt too much or end up being talked about as if they weren't there. That's the main reason I hated it, because it makes it awkward for patients. I have caught a few errors by bedside report, including a big one with TPN that wasn't supposed to finish that fast.

[Decade1]

At this point in my career I'd rather not even get report. I can figure it out from the chart. If I can't you didn't chart well enough. We can A) go into the room and do an introduction or B) go over information in detail outside of the room. I don't need to look at things while you are there unless something is going on that you better show me. That's why I do an assessment. We cannot go over every detail in the room, with the patient, while they try to tell the history of every single thing we mention or require an in depth explanation of medical jargon that will never be relevant to their understanding of their condition and/or plan of care. And realistically I cannot do bedside report in 25 minutes for 4-5 patients with 3 or more nurses. It is logistically impossible. In a perfect world, bedside report is great. In the real world, there is not time for that. Nor is it warranted on 90% of situations. Some of our patients are on our unit for months. They do not want to hear all that at 7:15am every single day. It should be tailored to the situation, at the discretion of the nurse, who is professional, with a license and therefore should be capable of deciding how to provide care and inform their patients. Management in the halls to "check up" on us giving bedside report is insulting and demoralizing. Why aren't you working on filling the empty positions so we can adequately staff the hospital? Priorities are topsy turvy these days.

[NightOwl0624]

At this point in my career I'd rather not even get report. I can figure it out from the chart. If I can't you didn't chart well enough. We can A) go into the room and do an introduction or B) go over information in detail outside of the room. I don't need to look at things while you are there unless something is going on that you better show me. That's why I do an assessment. We cannot go over every detail in the room, with the patient, while they try to tell the history of every single thing we mention or require an in depth explanation of medical jargon that will never be relevant to their understanding of their condition and/or plan of care. And realistically I cannot do bedside report in 25 minutes for 4-5 patients with 3 or more nurses. It is logistically impossible. In a perfect world, bedside report is great. In the real world, there is not time for that. Nor is it warranted on 90% of situations. Some of our patients are on our unit for months. They do not want to hear all that at 7:15am every single day. It should be tailored to the situation, at the discretion of the nurse, who is professional, with a license and therefore should be capable of deciding how to provide care and inform their patients. Management in the halls to "check up" on us giving bedside report is insulting and demoralizing. Why aren't you working on filling the empty positions so we can adequately staff the hospital? Priorities are topsy turvy these days.

^^^^^ This!!

i wish management would trust us to decide the best way to hand off. Critical thinking, professionalism and all that. I feel like a child with administration roaming the halls scolding us, while most of the patients are asleep and would not want us in the room anyway.

[WoosahRN, MSN, RN]

Hate it. I work in PICU. Half the report has to do with social issues that you aren't going to discuss in front of the family. Family centered care means the family is a part of the care and report includes who is at bedside, their quirks, family drama, etc. There's also just the honesty of how the patient is really doing. Report ends up taking longer because you do bedside report and then have to give more report outside the room.

Also, my big rule is that if ABCs are ok and patient is safe, you do NOT wake up the patient (especially in Peds).

We go in to do safety checks (code sheets, bag, suction, check name band, fluids and drips). That's enough for me, covers safety and still gives us the privacy to give report.

I've worked at places PRN that required it and I hated it. Thankfully the two places I've been full time didn't require it (one tried and it failed because the nurses were very non-compliant for all the reason listed).

[WoosahRN, MSN, RN]

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.

I TOTALLY agree! It's awkward as the nurse to be talking about the patient in front of them. I can't imagine what it would be like as a patient. The poor teenagers that are alert and oriented would be mortified to realize we are talking about their body and pooping.

I get the idea behind it but in this day of such focus on customer service I'm surprised it's lasted this long. Still fingers crossed they never want to do it at my hospital.

[sjalv]

For clarification, I work in an ICU where the patient often has multiple drips, drains, lines, and many issues going on at once. Not to imply that other types of units don't have such patients, but rarely will you find an intubated patient with an IJ running multiple pressors outside of an ICU, or so I would hope. Our visiting hours close specifically from 0630-0800 and 1830-2000 for shift change, so visitors aren't at the bedside asking a thousand questions during report.

That being said, we are supposed to do bedside report, but you'll usually find that if you are working on the weekend, nurses just do it at the nurse's station. I personally do not care because what I have found is, the only thing I check on the patient during bedside report is sites where lines have pulled to verify there's no hematoma forming as the nurse has said, and that their rhythm is what they say it is, and that's just so I have a baseline for my shift. We still go through the chart and review orders received during the shift and ensure they were implemented.

[JerseyTomatoMDCrab, BSN]

Hated it. Took way too long. Sorry, but after a backbreaking 12 hours on the unit, the last thing I felt like doing was prolonging it by another 45 minutes before my hour long drive home. It's a job, not my life. I wanted to get home when I was finished. Not to mention "Oh while you're here, I need to go to the bathroom and my pain is a 9 and my great aunt Sally is coming to keep me company and she is in a wheelchair can you please assist her as well?"

It confused the patients too. When speaking in medical abbreviations and "nurse talk" too often I was stopped by a patient. "I didn't take any medication called PRN! What do you mean?!" and as a result, I had to dumb down my report, only to give the real details outside the room. Again: takes up too much time.

I liked sitting at the nurses station or even a computer outside the patient's room, giving the report (quickly... I was very fast!) and then going inside to say hello, update the white board, verify drips and skin issues, then off I went.

Bedside report is yet another unrealistic management tool that a bunch of suits who haven't provided care in years invented as a pathetic attempt to raise satisfaction scores, all the while ignoring what REALLY needed to change in order to make that happen.

[OyWithThePoodles, RN]

Hate having to give the full report at bedside. I prefer to give the info at the desk on all of the pts then round to make sure they are okay, lines are good, and that they don't need pain medication. I HATE coming in and the night shift nurse flipping the lights on at 0645 yelling "GOOD MORNING, MR. JONES!" scaring the crap out of the pt. Not only that but giving reports in our semi-private rooms I feel is a complete violation of HIPAA.

And the scripting.... "What is the most important thing we can do for you today?" And then having to write their confused response on the white boards. I WILL write "Stop waking me up at 0645", and "Let me sleep more". I have even wrote "Get me home, what else should you be doing?" Because I was cranky that day :)

[gcupid]

i dislike bedside report but it's another thing added to the list of bs thats required. I try not to take anything personally. Nowadays i think to myself, Just have the correct dollar amount directly deposited into my account.

[CountryMomma, ASN, RN]

We do a hybrid approach to bedside rounding. We go over the nitty-gritty at the station or at the door, then come in and introduce the next nurse, go over drains, lines, IV settings, vent settings, required equipment, and dressings/wounds. Me personally, I also check for safety items - flat edge clamps for chest tubes, wire - cutters for jaws, ambu bags in vent or bipap rooms.

Also, we are including verifying alarm settings for min/max limits.

[ixchel]

Wow, the response has been amazing! Thank you all for sharing your thoughts!

I did want to clarify a couple of things. When there are family dynamics issues, awkward situations, or details that generally would be better not to discuss in front of the patient (for instance, new diagnoses that haven't been discussed, labs/vitals/imaging that will change what the patient knows of plan of care up to that point), they are done outside the room. We don't have strict visiting hours, so if friends or family beyond spouse are in the room (and even with spouse, I like to ask discreetly), if the patient hadn't said before that they wanted report in front of them, we'll round, but not do report right then. If I've been on night and the patient has gone through something that kept them up all night (i.e. Bowel prep), we don't wake them up.

Essentially, we are allowed and encouraged to use our judgment regarding what will or will not be said at the bedside. It is expected that we do at least round. It is also expected that we take our computers around with us so that the person coming on can look things up and ask about them, and also have space to jot stuff down if they need to.

On this specific day, the first two people had things going on that really needed bedside, or at the least, rather in depth rounding. The first person also had wanted bedside reporting. The second person was so rapidly changing/increasing in mental status and had other unique things going on, so in my own discretion, bedside was needed with her, as well.

The last two were so straightforward with such benign assessments and POC included simply - as long as there are no changes today, they'll be transferred to acute rehab. These patients also preferred bedside (and we do ask during each shift what their preference is).

My point here is - we do still remain sensitive to patient status, preference, and dignity. That is definitely a priority, in my opinion. I've also found, since bedside became mandatory, that patients (most of them) do enjoy being included. Because much of what they'll hear in report they've been hearing during their admission anyway (re: medical jargon, which we try to translate when we approach education topics), it doesn't usually go over their heads. If something does when I'm the one receiving report, I'm sure to revisit it for education topics during my shift. I do actually like to say during my assessment, "you've had a pretty busy few days! It can get overwhelming. Is there anything that you were hoping to get more information on?" (Of course, day shift is not the best for finding time to talk in a lot of detail, but nights are usually wonderful for giving the patient time to just talk through what they haven't understood.)

When I do my last med pass of the shift, I will go over plan of care for the day. I try to get any questions they might have answered then. Even if I haven't been able to do that, I've found that the patients don't interrupt or hold us up with questions. This mainly is due to having these already answered before its time for report. I was initially worried that bedside would take ages, but it hasn't. Not in my own experience, anyway (and my own experience doesn't span that long, I admit [emoji5]️).

Our CNs do make sure we're going into rooms for report. Typically management isn't walking around and smacking our hands for sitting at the computers for report. That particular day was "special" (a special pain in the butt, if we're being honest here!). Even so, if the off going nurse has good reason to not report at the bedside, management is supportive, since it is patient focused to remain sensitive to their individual situations.