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.
Hate it with a passion. It takes longer so you're behind when you're shift starts and late to get out the door when your shift ends. Why do I hate it? Several reasons - the pt's need to go to the bathroom. So you have to stop and take a newly replaced knee to the bathroom. How long does that take?! 15-20 mins. Another reason...some nurses think that's the time to do their assessment or straighten the bed sheets or flush the IV or whatever. Or the pt wants to talk talk talk. I can't stand bedside shift report. It's been policy at my workplace for about a year now and I thought I'd begin to surely find something about it I like. Nope.
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.
You hit the nail on the head. I hate it too because after 12 hrs my feet are killing me can I please enjoy 10 mins of rest!!?? I have an hr drive home as well.
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.
Since bedside report became all the rage, management not only roams the halls, but makes us do an audition for them, not once but twice so they can critique us! This has been happening yearly! Crazy hey having to put on a show every year for a job many of us have done for years! Tell me again about how we are professionals, capable of making life and death decisions, but need to be micromanaged like children!
I try to make the best of it, here's my chance to be an actress on stage and play my part! lol
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.
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]ï¸).
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.
Personally, if a patient is complex and having problems, a thorough indepth report at the nurses station allows one to sit and listen and write and not be distracted by standing and trying to write in the air, play maid to the patient. I think bedside reports ends up being about customer service get me food, water, or help me to the bathroom, takes too long and vital info is missed because of the distractions, interruptions and focus on customer service. I think report should be at the nurses station first then do a meet and greet, explain the plan of care, answer any questions. Bedside report is really just a marketing customer service gimmick to try to raise the press ganey scores if you ask me!
I usually don't mind it, have gotten quite used to it. My unit has now moved to required bedside reporting (and yes management does notice if you aren't doing it). I work in a busy Labor & Delivery unit (mostly 1:1, and can be 2:1 depending on the assignment/patient). Report depends on what is going on with the patient. I mean, if I am coming on shift and the patient is very active or pushing, I'll simply go in and introduce myself and ask the leaving nurse what is pertinent and what the plan is and the rest I can look up after. Usually what we do is come on shift find out who we are assigned to, go over the chart ourselves and write down information, find the nurse we are getting report from, go into the room to introduce ourselves, go over pertinent information (briefly), check all the IV lines/drips, look over the patient, go over the Fetal Heart Rate strip, and the plan of care. Then we will ask the patient if we have missed anything that they would like to add about their medical history/plan. If done right it usually shouldn't and doesn't take that long (again brief is the word and what management wants). Of course there can be interruptions, but usually we try to make it sweet and short. Each room already has a computer and a surface area to use to write on, so looking at anything EMR wise or writing extra report findings isn't too difficult.
Of course that is the average patient without any major issues. If a patient has social issues, we talk about those outside of the room at the nurses station. Also, if the patient is sleeping we will do report at the nurses station as well, only going in quietly at the end for a minute to look over a few things that are necessary.
After bedside report was required, management went around rounding on patients asking how they felt about it and most stated they liked being involved and able to give input during bedside report if necessary.
Loved bedside report as a patient. Once I received important information about my condition that no one bothered to tell me earlier.
Liked bedside report as a nurse too - too often something about the patient is 'off' and its nice to lay eyes on them and have confirmation from the offgoing nurse that that's their baseline. Very nice to start the day having already eyeballed all your patients, knowing there is no urgent issue. Management doesn't require waking sleeping patients which is good.
Since bedside report became all the rage, management not only roams the halls, but makes us do an audition for them, not once but twice so they can critique us! This has been happening yearly! Crazy hey having to put on a show every year for a job many of us have done for years! Tell me again about how we are professionals, capable of making life and death decisions, but need to be micromanaged like children!
I try to make the best of it, here's my chance to be an actress on stage and play my part! lol
Since bedside report became all the rage, management not only roams the halls, but makes us do an audition for them, not once but twice so they can critique us! This has been happening yearly! Crazy hey having to put on a show every year for a job many of us have done for years! Tell me again about how we are professionals, capable of making life and death decisions, but need to be micromanaged like children!
I try to make the best of it, here's my chance to be an actress on stage and play my part! lol
Are you serious? That's ridiculous!! I cannot believe they're doing that. I believe what's going on there is a going way too far.
We are supposed to do bedside report but it isn't strictly enforced unless our manager happens to pop in early. I dislike it. I personally feel like it takes more time.
Medical jargon or specific medical terms that we normally use in report have to be explained additionally in layman's terms so that the patient isn't confused and understands. As everyone knows, some things are not appropriate at the bedside either. So some sensitive things (psych dx, possible cancer dx, behavioral issues, ect) have to be communicated outside of the patients room. So you end up giving report both inside and outside of the room. Then there are the nurses who astonishingly think it's appropriate to assess the patient during bedside (it's NOT!!).
For some patients, it can be totally appropriate and beneficial. It lets the patient know the plan of care, meet new staff, ask questions, and builds rapport. For some difficult patients a unified bedside report ensures that boundaries are reestablished and can decrease manipulative behaviors.
I personally like to give report outside, then go to each room to introduce the oncoming nurse and briefly (1-2 sentences) reiterate the plan of care. Thats how I like to receive report also.
If the offgoing nurse wants to do strict bedside (and we do have a few that do), then I am fine with that. I'll ask any questions that seem sensitive outside of the room. I agree 100% that the offgoing nurse should be the one to decide how and where to give report (strict bedside, hybrid, or just outside of the room with a brief introduction after).
Overall I am easy going and go with the flow of whatever the offgoing nurse wants to do. If the oncoming nurse wants bedside, I will do that too, but always have to supplement it with an additional report outside of the room also.
When I did Med/Surg. I loved doing bedside report. I used to work noc. shift (1900 - 0700 or 1100 - 0700). I always wanted to do a bedside report because you can visualize the patient and see quickly if something that is being reported is off from what is actually happening or if you need to attend to something right away after report (TPA was turned off and left off accidentally following a blood draw from a central line, PCA machine is almost out of the patients pain med., IVF almost run out or not turned back on, patient is in respiratory distress or severe pain etc.)
I found that sometimes it made report longer but if you were organized and stuck to the facts then it went pretty smoothly, if the patient has questions you can answer them with both nurses present and if you provided some prompting before report started it minimized the interruptions. EX: "Hi Ms. Jones its time for change of shift report and I will be giving report off to Sam here, she will be the nurse taking care of you for today. At the end of the report if there is anything that I might have forgotten or you have any questions or just anything to add please let us know." For most patients that worked and they felt included in the process.
With that being said, if the patient was clearly asleep or for some other reason I didn't want to disturb them we would do report outside of the door but within eyesight. As far as day shift report goes, when I went to pass my 0600 meds. I tell patients that in 1 hour we would be doing report and ask if they wanted us to come in the room so they could hear it or to let them sleep (most patients said let them sleep but a few really appreciated hearing the report).
I personally think that the "not enough time" rationale isn't a good enough reason to not do beside rounding, I think the prevention of falls and other safety related issues outweighs the "lost time" and if report is done in a succinct and organized way with a bit of patient prompting I think that you can limit the time "lost/wasted" doing report with the patient. Again its just an opinion...
CBlover, BSN, RN
419 Posts
Hate it with a passion. It takes longer so you're behind when you're shift starts and late to get out the door when your shift ends. Why do I hate it? Several reasons - the pt's need to go to the bathroom. So you have to stop and take a newly replaced knee to the bathroom. How long does that take?! 15-20 mins. Another reason...some nurses think that's the time to do their assessment or straighten the bed sheets or flush the IV or whatever. Or the pt wants to talk talk talk. I can't stand bedside shift report. It's been policy at my workplace for about a year now and I thought I'd begin to surely find something about it I like. Nope.