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?

[SoldierNurse22, BSN, RN]

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.

Why would it be against the law? It's pertinent information to the patient's care and it's being given in a report setting, which is now required per my facility to be at bedside. This is the conundrum that bedside report represents for my particular specialty.

[ArtClassRN, ADN, RN]

I hate bedside report. I feel that in 90% of cases, it's highly inappropriate.

I've noticed that nurses who hate bedside report often make similar false claims. They will simply lie about the patient sleeping or not wanting to be disturbed - even as I see their call lights on or they are up and stumbling about the room.

I yelled at one coworker when she said, "No, we can't go in there, the patient is sleeping and walks independently" I was looking into the room and the patient was stumbling around in the dark with the IV and power cords wrapped around her ankles. The outgoing nurse continued to complain I wanted to "wake up the patient."

If you don't like bedside report, fine. But stop lying.

[nynursey_]

I've noticed that nurses who hate bedside report often make similar false claims. They will simply lie about the patient sleeping or not wanting to be disturbed - even as I see their call lights on or they are up and stumbling about the room.

I yelled at one coworker when she said, "No, we can't go in there, the patient is sleeping and walks independently" I was looking into the room and the patient was stumbling around in the dark with the IV and power cords wrapped around her ankles. The outgoing nurse continued to complain I wanted to "wake up the patient."

If you don't like bedside report, fine. But stop lying.

Well, that was a rather harsh, judgmental, and unnecessary response. But since you seem to believe that I'm "lying," I'll bite.

I have participated in many a report whereby the patient has not been yet told their final diagnosis. It's an essential part of report, and yet at the bedside, I have to leave that bit out. Or better yet, the patient gives the green light for Family Member B to sit in on report, but Family Member B is feuding with Family Member A over withholding information, and now both nurses are being crucified for sharing patient's information with a nonauthorized family member, even with the patient's permission.

Or better yet (and this ACTUALLY happened), RN unknowingly walks into a scenario where the 2 patients in a semi-private room know one another socially outside of the hospital, and during the SBAR reveals Patient A has been admitted for HIV related illness. Patient B overhears and begins texting several of their acquaintances, and it begins to spread like wildfire (small town gossip runs easy).

You can say my examples are rare all you want, but in one form or another, they exist in other situations. Bedside report ought be performed in two separate steps with RN-to-RN report occurring outside the room in a private location and then reiteration of the drips, tubes, lines, and plan of care then done at the bedside during walking rounds.

[nynursey_]

Why would it be against the law? It's pertinent information to the patient's care and it's being given in a report setting, which is now required per my facility to be at bedside. This is the conundrum that bedside report represents for my particular specialty.

I agree. All medical history is shared during SBAR, not just things that are family friendly to be said during bedside report. Especially if that patient is on an infectious disease unit or admitted for PID 2/2 any of the aforementioned diseases. And/or if the patient is receiving antibiotics for those diseases.

[foggnm]

Regardless of whatever 'research' has been done on bedside report, it is another nursing/hospital scam to make nurse do more administrative work under the guise of customer service/patient care. Do you ever ask yourself, why don't MDs do bedside report? Why don't RT's, PTs, STs, techs do bedside report? Why only nursing? Why are we INCREASING The time to do a routine task rather than trying to make it more efficient? I have given report both bedside/not and generally speaking it is more important that the nurse is communicating throughout the day with the patient/family than including them in a 5 minute conversation during shift change. I have worked in extremely complex environments (i.e., L1 trauma center ICU, etc) and have seen no benefit to someone telling me about the patient in/out of the room. As a profession, we also need to protect our administrative time and realize there are some things that can be done in private. Not every single nursing task has to be put under a microscope. One of the greatest downfalls of nursing is the burdens we place on our on profession. We make things harder for ourselves. When I started nursing, we had these board in every room that we had to put names, pain scores, plan of care, diet, team, etc. Really patients didn't read it and it provided little value, but it was 'required' to be updated every shift. As a nurse you should ask yourself, is this practice improving the profession? Ask selfishly, is this practice making my job any more efficient? Are patient outcomes improving for this increased administrative task? Report is so overrated in the profession of nursing. Well defined order sets from physicians is 10x more important than what the previous nurse has to tell me about the patient. I can read the orders and maybe a progress note and have a much better idea of what is important than hearing about people's IV placement, bowel movements, gcs score blah blah blah.

[nynursey_]

Regardless of whatever 'research' has been done on bedside report, it is another nursing/hospital scam to make nurse do more administrative work under the guise of customer service/patient care. Do you ever ask yourself, why don't MDs do bedside report? Why don't RT's, PTs, STs, techs do bedside report? Why only nursing? Why are we INCREASING The time to do a routine task rather than trying to make it more efficient? I have given report both bedside/not and generally speaking it is more important that the nurse is communicating throughout the day with the patient/family than including them in a 5 minute conversation during shift change. I have worked in extremely complex environments (i.e., L1 trauma center ICU, etc) and have seen no benefit to someone telling me about the patient in/out of the room. As a profession, we also need to protect our administrative time and realize there are some things that can be done in private. Not every single nursing task has to be put under a microscope. One of the greatest downfalls of nursing is the burdens we place on our on profession. We make things harder for ourselves. When I started nursing, we had these board in every room that we had to put names, pain scores, plan of care, diet, team, etc. Really patients didn't read it and it provided little value, but it was 'required' to be updated every shift. As a nurse you should ask yourself, is this practice improving the profession? Ask selfishly, is this practice making my job any more efficient? Are patient outcomes improving for this increased administrative task? Report is so overrated in the profession of nursing. Well defined order sets from physicians is 10x more important than what the previous nurse has to tell me about the patient. I can read the orders and maybe a progress note and have a much better idea of what is important than hearing about people's IV placement, bowel movements, gcs score blah blah blah.

This.

My mind is constantly blown by how little bedside nurses are allowed to use their clinical judgment in deciding what is or is not appropriate for a patient given their condition and outlined plan of care. Why is it that I am unable to exercise my clinical judgment in deciding which patients are appropriate for bedside report and which are not, yet I am fully EXPECTED to utilize my clinical judgment in deciding whether to hold or administer a medication or whether to accept an initial BP reading as accurate versus repeating it? The constant babysitting and micromanaging of nurses is sad.

If you begin to treat nurses as automatic robots utilizing scripts and pre-determined plans of care, you will take away their independent judgement, and find yourselves in a pickle when you expect them to think critically, and they cannot.

[FineAgain]

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!

I really think we work on the same unit.

Do I like bedside reporting? NO! I hate it. I think it is demeaning to the patient, a major HIPAA violation (especially in semi privates, but with visitors as well), and like many of you, I have 7 patients to give report on. It is not the time to take people to the bathroom, fetch drinks and snacks, and answer a thousand questions about visitation policies and when is the cafeteria open. I have been running for 12 hours and want to go home.

There is always the nurse who takes the time to assess, take down dressings and ask about 3 day old vitals.

We should be giving report at the nurses station or outside the rooms, then walk in and introduce. Peace, out. The next 12 hours belong to you.

[Muser69]

I really think we work on the same unit.

Do I like bedside reporting? NO! I hate it. I think it is demeaning to the patient, a major HIPAA violation (especially in semi privates, but with visitors as well), and like many of you, I have 7 patients to give report on. It is not the time to take people to the bathroom, fetch drinks and snacks, and answer a thousand questions about visitation policies and when is the cafeteria open. I have been running for 12 hours and want to go home.

There is always the nurse who takes the time to assess, take down dressings and ask about 3 day old vitals.

We should be giving report at the nurses station or outside the rooms, then walk in and introduce. Peace, out. The next 12 hours belong to you.

Thank you!

plus the fact that maybe the patient doesnt want to be awakened , or hear about his disgusting draining bedsore. I hate bedside report!!!!!

[vbarger28, BSN]

HAA! HATE bedside report, rofl...

in my experience, almost always, the pt turns it into an arguing match haaha...

I guess they don't like us 'telling on them' for being non compliant diabetics who are refusing to let us check sugars before meals and don't want to take their metformin lol...or my most common one, COPD and refusing to take their neb treatments hahahah.....

[nynursey_]

HAA! HATE bedside report, rofl...

in my experience, almost always, the pt turns it into an arguing match haaha...

I guess they don't like us 'telling on them' for being non compliant diabetics who are refusing to let us check sugars before meals and don't want to take their metformin lol...or my most common one, COPD and refusing to take their neb treatments hahahah.....

Yet another example of a patient not appropriate for bedside report.

Do you honestly want your first task of the morning to be an argument with a patient about whether or not they were compliant? No.

[ArtClassRN, ADN, RN]

Well, that was a rather harsh, judgmental, and unnecessary response. But since you seem to believe that I'm "lying," I'll bite.

I have participated in many a report whereby the patient has not been yet told their final diagnosis. It's an essential part of report, and yet at the bedside, I have to leave that bit out. Or better yet, the patient gives the green light for Family Member B to sit in on report, but Family Member B is feuding with Family Member A over withholding information, and now both nurses are being crucified for sharing patient's information with a nonauthorized family member, even with the patient's permission.

Or better yet (and this ACTUALLY happened), RN unknowingly walks into a scenario where the 2 patients in a semi-private room know one another socially outside of the hospital, and during the SBAR reveals Patient A has been admitted for HIV related illness. Patient B overhears and begins texting several of their acquaintances, and it begins to spread like wildfire (small town gossip runs easy).

You can say my examples are rare all you want, but in one form or another, they exist in other situations. Bedside report ought be performed in two separate steps with RN-to-RN report occurring outside the room in a private location and then reiteration of the drips, tubes, lines, and plan of care then done at the bedside during walking rounds.

I am stating your 90% claim is utterly false.

[SoldierNurse22, BSN, RN]

I agree. All medical history is shared during SBAR, not just things that are family friendly to be said during bedside report. Especially if that patient is on an infectious disease unit or admitted for PID 2/2 any of the aforementioned diseases. And/or if the patient is receiving antibiotics for those diseases.

Precisely. There was a reason before bedside report was implemented that report was given in the privacy of the nurse's station. There are some things in report that aren't appropriate to say in front of a patient's friends/family/visitors.

OP, I might add that pretty much all the information given in a report is going to be protected by HIPAA, not just the awkward stuff, so to imply that it's inappropriate (or even illegal) to discuss this STI or this virus or that diagnosis in bedside report versus another is ridiculous.