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?

[martymoose, BSN, RN]

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

You wait- that is next. a glass room where they can see in and have the conversation pipped in by speaker.

You know, that may not be a bad idea- I bet a lot more docs would have to censor themselves. wouldnt have to hear f bombs from them lol. That could be a win win situation

[CJMR]

We have 2 patients to a room so at times it can be invasive. I work nights so at some time before the end of my shift I explain bedside report and ask if it's okay to do in the room, if they want me to kick out friends and family first, and if they'd prefer if I let them sleep. Other than that, I like it because I prefer show-and-tell. It's easier to know if you have a neuro change if you talk to the patient at the beginning of shift. And I've had 3 different occasions where I've called a rapid as soon as I walk into the room and had to transfer the patient to the ICU. One was in DIC and the outgoing nurse somehow didn't think that bleeding from every orifice constituted an emergency.

We use a 1 page printed SBAR and I always update it every shift. I prompt the oncoming nurse to read that as we are walking down the hall into the patient's room. I can usually give report on 5 med-surg patients in 15-20 minutes.

[guest112]

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.

[guest112]

In my post I explained why I like it. But nursing judgement needs to prevail over blind policy. After all, we are individualizing care, and that may mean, not to share certain info with the patient until the MDs have already done so.

[guest112]

Yeah, we sat on a guys ca dx once... But the manager will chase us out of the station, chirping that report needs to be given at bedside, it's for pt safety!

In my post I explained why I like it. But nursing judgement needs to prevail over blind policy. After all, we are individualizing care, and that may mean, not to share certain info with the patient until the MDs have already done so.

[AliceTrout]

I like to give report somewhere quiet without interruption (no family or patient trying to play HouseMD and misinterpret or get nervous from things in our report, no oncoming nurse looking around the room while I talk and missing important information).

Once that is done, go to room and look at everything together.

Easy.

[kasmom95]

I love bedside. I think it is a great way for an introduction. It is also a great time to find out if the patient had issues that weren't addressed on the previous shift. I always include my patient's in the report, first by telling them why we are in their room talking about them, then I ask the patient if I forgot something. I find it makes them feel more included in their care and that the next nurse knows what is happening with them.

[msfb]

A previous post referred to the charge nurse keeping an eye on all tbe patients. I though this reply would be attached to that post. How am I as charge supposed to be responsible for the whole unit? They are your assignment. Do your job and take care of your patients. Don't blame it on charge. I don't like bedside report. Report should be done and then an introduction and drip sign off should be done.

[NanaPoo]

Having been a patient roughly 3 times in the past 3 years I can tell you I HATED bedside report. I always have a horrible time sleeping in the hospital and usually can fall asleep by 5 a.m. and really get going good about 6 or 7. When those nurses would roll in about 6:45 I wanted to die. Please go back to report in the conference room and say ANYTHING you want about me or my family in private. PLEASE!

Then they always commented about how quiet I was and how I never asked for anything. Yes, because I'm a nurse and I know how annoying those call lights and 20 questions are. I will only ring you in an extreme emergency, I promise. And I am always quiet in hopes that others around me will follow my example...now scoot! I'm enjoying my hospital vacation!

[ixchel]

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

This has been my observation as well. When report is organized and delivered concisely, patients seem to love just listening. This is especially true when you've ensured all of the questions you can answer have been answered throughout the shift. I like to get a head start on my last med pass to make sure they get those last few questions in, and they can be updated on plan of care. Then, their questions are answered without slowing down report to ask them.

[ixchel]

Hate it. Because how would you like...

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?

I can't think of any way to say this gently, so please forgive me for this being blunt and sounding rude. Doing any of these things would be against the law. I do hope very much that no one would ever give report like this, and if they did, I hope they would be fired rather quickly.

[drod1989]

There are many reasons we do bedside reporting at my hospital. The number one reason is patient satisfaction. 9 times out of 10, a patient is dissatisfied because they are not in the loop as to what is going on with their plan of care. They know that shift change happens, but some patients go hours without knowing who is actually taking care of them. Falls happen more often because the patient s are not rounded on more frequent. We do bedside reporting whenever possible, and appropriate for the patient. Our hourly rounding is alternated between staff . we check on pain, possessions, potty, and personal belongings, as well as protection. Nurses not being present for bedside report while patients asleep is one thing, but if the patients are willing to listen and participate in bedside report then it is their right. they are the reason we are there. let's not forget that.