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?

[Karou]

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.

[cjcsoon2bnp, MSN, RN, NP]

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...

!Chris

[ThePrincessBride, MSN, RN, NP]

Hate it. I work in med-surg with six or seven pts. Many of the pts I have are difficult and have psych issues. Then there are the ones who love to talk your ears off and question every...single...thing you do. Then there are the off-going nurses who like to chat with the patient and give you every minute detail of the patient's care/day. It just goes on.

Now, in the ICU, I would want a bedside report. On my unit? I wouldn't get started on my assessments and med passes until 8 with some of the nurses I work with!

[martymoose, BSN, RN]

I like getting report outside of room and then after, rounding very briefly for the introduction, upsell, checking pt and lines etc. take 2 seconds. But NOOOOO. This is not what they want . they want us to give full report at the bedside. Why?? so said pt can feel like special snowflake?? I dont understand this. Doing it that way, I find it is such a "clean" report, that important stuff gets missed. I mean, its one thing to say " Hi this is Ms Jones , who came in to have her hysterectomy, etc .Straight forward. Not. this is Ms SMith. She is probablly going to pass today, and she is still a full code. She is completely confused, and is is having residuals in her tubefeedings. Or this is ms brown. she is awaiting a bed on the psych unit because she completely delusional . Or what if they are admitted with someting embarrasing.you get the point.

I think its done for the customer service aspect for those who are aox3.

Also gets my goat- " oh while you are in here. I need help to the bathroom. They dont want to hear " wait for the tech. And I guess I wouldnt want to wait either if I had to go, but they prob would have just put their call light on and would have had someone help them that way,if we hadnt already been in there. Now times that by 6 pts.

No wonder report takes so long, then we get berated for taking too long in report.

[SoldierNurse22, BSN, RN]

Hate it. Because how would you like...

1. To be woken up at 0300 so your nurses can give report? (part of our hospital works 0300-1500 and 1500-0300).

2. For your entire family to hear about your herpes, chlamydia, gonorrhea, trich, etc?

3. For your entire family to hear about your lady partsl/perineal/labial tear and/or episiotomy and repair?

4. For your partner to discover during bedside report that you have a very well-kept secret case of herpes, chlamydia, gonorrhea, trich, etc?

Regardless of how we tell patients that report goes into all details of their care and history, there is always someone who doesn't really understand what that means until their family (that's glued to the laboring/new mom's side and refuses to leave the room come hell or high water) is standing in on an awkward and formerly private conversation!

Sample of post-bedside report question panel from peanut gallery:

Grandma: "What's a 'fourth degree perineal lac'?"

Uncle: "What's 'inverted' mean?"

Mother-in-law: "What's trichomonas?"

Son: "What's Valtrex?"

Me: *sigh*....

[AngelsintheNE]

Bedside reporting – I feel it really is on an individual patient basis. What aggravates me is when our management decides during shift change that this is the perfect time to circulate the unit (before retreating into their offices for the rest of the day, doors shut, blinds drawn) condescendingly asking Are we doing bedside report?” to each pair of nurses they encounter like we are misbehaving children. We are in the hallway – clearly we are NOT doing bedside report!

There is enough micromanaging in nursing, I wish our professional judgement would be trusted sometimes – and sometimes it is just NOT appropriate to do bed side report. Like most comments on this thread I prefer to do report in the hallway and then peak in on the patient to check the basics – breathing, tubes, gtts, bed alarm activated if necessary, ensure patient is not the floor, etc.

[michlynn, BSN, RN]

I hate it and I feel very strongly that it's a violation of HIPAA when pt's share a room. It's not appropriate to be going over one pt's entire medical history/current admission when the neighbor can hear everything. I do however think it's appropriate to first get report and then go eyeball everyone with the previous shift just to make sure everything is in order.

[bloatedputti, MSN, RN]

Bedside? I guess if you want to listen to a bunch of stories, complaints, questions. The patient and family have all day to do that. Professionals need to speak privately,without editing for the patients sake.OF COURSE we share sensitive info that the patient does not need to hear, but is pertinent to the plan of care. . This family involvement thing has gone too far. They don't need to see their family member coded.Why not let them sit in the OR then too during their loved ones CABG? Or maybe have the doctors do all of their consult talks in their room too? Patients understandably have generally have very little knowledge of medicine. Having them listen to report just creates more problems. I think, time allowing, introducing the next nurse and saying goodbye is very professional.

[CountryMomma, ASN, RN]

Yeah, we sat on a guys ca dx once because we didn't know the exact type or stage which meant we didn't have POC for it yet. Pretty hard to say "and he's got fungating ca of some sort" in front of a pt and not 1) have the pt start playing 20Q about what a fungating ca is or 2) go leaping over my NPA by revealing a lab result/dx to a pt without his Dr having discussed it first.

But the manager will chase us out of the station, chirping that report needs to be given at bedside, it's for pt safety!

[EaglesWings21, ASN, RN]

One of my issues: nurses who can't stick to pertinent info and take 10 to 15 minutes on one pt or spend time socializing with the family. This makes me want to scream.

[bloatedputti, MSN, RN]

You nailed it! Hope Managers are following this thread. Maybe family should be allowed in the OR too???

[CountryMomma, ASN, RN]

One of my issues: nurses who can't stick to pertinent info and take 10 to 15 minutes on one pt or spend time socializing with the family. This makes me want to scream.

But more socializing with the family = increased customer (oops, how silly of me, I meant patient) satisfaction ratings which somehow magically means better care from the staff and NOT better bonuses or pay bumps for the C-level administration.

Or something like that. They always get a little fuzzy w the details once we get past the more money part.