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.
It was fun giving bsr in a semi room with the curtain drawn, but the other pt was confused and hoh. So everytime we we talking about pt "a" pt "b" ( confused) would say "what??" and we'd say we were talking to "a". then he would say "what", or "are you my nurse", etc.
Im sure that was an effective bsr. Also had another bsr where things got missed. as in pt is an amputee.
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.
Surely you've heard of HIPAA? The patient has to consent to others hearing his/her medical history. Surely you have enough sense to ask visitors to leave the room.
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.
Which is why the guests would be expected to leave the room. You are the one who brought up STIs. Not me.
As a generalized response to several posts in these last couple of days...
First - If you're being told bedside must occur regardless of HIPAA violations (roommates, friends, family being present), this should not happen and no where have I advocated for that to happen. Management should be putting a stop to that. It is completely appropriate to ask family members/friends to step out of the room. In fact, a couple of units in my hospital have signs with posted hours, and for the hours surrounding shift change, no visitors are allowed in.
Second - Appropriateness of patient and/or information SHOULD be considered before walking in the door. If I received CT results that look like there may be a new Ca diagnosis, that will not be shared at the bedside. It will, however, be shared outside the room. If the patient is inappropriate (rude, just finally settled down, overly anxious, sleep, etc.), report will happen outside the door.
I'm amazed at how nurses might say it's frustrating not having enough autonomy to make easy basic decisions. We're micromanaged. Management is watching. But really, this is one prime example of not blindly doing for all as you'd do for one. Critically think here. This one isn't too difficult. Will it violate HIPAA? Will it upset the patient? Is this information appropriate? Decide if bedside make sense.
When it does make sense to do at the bedside, I love it.
As for potty breaks and needing drinks/snacks, I usually let the patient know that since we're in report, I can't help in that exact moment, but I'll quickly grab a tech for them, or I can come back in a few minutes. Not one patient has been bothered by me taking this approach yet. And it is the only time I will ever make them wait, so I think that helps.
As a generalized response to several posts in these last couple of days...
First - If you're being told bedside must occur regardless of HIPAA violations (roommates, friends, family being present), this should not happen and no where have I advocated for that to happen. Management should be putting a stop to that. It is completely appropriate to ask family members/friends to step out of the room. In fact, a couple of units in my hospital have signs with posted hours, and for the hours surrounding shift change, no visitors are allowed in.
Second - Appropriateness of patient and/or information SHOULD be considered before walking in the door. If I received CT results that look like there may be a new Ca diagnosis, that will not be shared at the bedside. It will, however, be shared outside the room. If the patient is inappropriate (rude, just finally settled down, overly anxious, sleep, etc.), report will happen outside the door.
I'm amazed at how nurses might say it's frustrating not having enough autonomy to make easy basic decisions. We're micromanaged. Management is watching. But really, this is one prime example of not blindly doing for all as you'd do for one. Critically think here. This one isn't too difficult. Will it violate HIPAA? Will it upset the patient? Is this information appropriate? Decide if bedside make sense.
When it does make sense to do at the bedside, I love it.
As for potty breaks and needing drinks/snacks, I usually let the patient know that since we're in report, I can't help in that exact moment, but I'll quickly grab a tech for them, or I can come back in a few minutes. Not one patient has been bothered by me taking this approach yet. And it is the only time I will ever make them wait, so I think that helps.
What you're describing is how bedside report ought go. The reality at many facilities is management following bedside nurses during 0700 report to ensure total compliance with ALL report being given at the bedside: no exceptions.
As others have mentioned you need the EMR and possibly the chart to get report at shift change. That can be hard to produce at bedside and chances are if you get it there you're not going to have counter space or clean space to put it down and write what you need for your report. I've also found that the nurse giving report can tend to be walking and talking while giving you report which means you're trying to walk, avoid running in to things/people and write on a clipboard.. not ideal.
The other complication others mentioned is that patients and families usually will ask questions about what you're saying, want explanations about medical terms you used or interject thinking they're being helpful by giving more details than you needed. I know the research that backs the bedside reporting theory encourages the nurses to inform and educate the patient and family on all these things but there is a time and place and it's not when the night shift is exhausted and desperately trying to go home. Not to mention the possibility of the patient being on the phone, watching a tv program, trying to sleep, visiting with family and friends, use the bathroom and you've essentially interrupted this and started a prolonged conversation in the room.
In some hospitals I have seen a station outside of the rooms that has a pull down table so you can set your things, give/get report, check your EMR data and labs, X-rays, then walk into the room and do a formal greeting and assessment of the patients. I think that is ideal.
Although in my background of the ICU we always give report at a station right outside a glass wall as we're both staring at the patient and the monitor in the room. If there is something relevant to check in the room then I'll ask them to show it to me but otherwise 7 feet from the patient behind a glass door is sufficient to me.
I didn't like the enforcement of one hospital that required we stood up from our station and walked 5 feet closer and stood in the room so it could be officially called "bedside reporting".
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.
The part bolded above made me start to fall in love with you, but then as I read the rest of your post, I fell for you hook, line, and sinker. The bolded part: perfection. Yes, we really do need to communicate with our patients on an ongoing basis; not just 5 minutes 2-3 times a day!
I got report the other day for a patient who was very "grumpy" and "unhappy" because discharge was delayed. The night nurse said she just avoided him since she couldn't do anything about it. I hear that so often (nurses avoiding grumpy patients), but communicating with patients usually makes them less grumpy and more satisfied. I called the company that was holding up discharge, and I explained the delay to the patient. The company then called ME to let me know when they would be at the hospital. As soon as the person walked in the door, I called the doc to get the discharge paperwork ready. The CNA said to me, "Hey, the patient isn't as bad as he was yesterday and the day before. What did you do?" I said that I kept him updated on the delay. She replied, "Oh, yeah. That's it. Everyone else just avoided him."
As for report in general, I have found that 50% of nurses suck at really knowing what is going on with a patient, so I just read the H&P and the last notes by the internal medicine team and the consults, and I know everything I need to know. Only with attitude/dissatisfaction issues is the nurse able to give me vital information that I wasn't able to get from the chart. I am, apparently, one of the few nurses who actually documents patient satisfaction issues and what I did to resolve them in my notes. (I do need report from the ER and PACU, though, because by the time they are transported to the floors, the ED doc/surgeon usually hasn't put in his/her note yet, and the ED/OR/PACU nursing notes are nearly worthless.)
A previous poster made an outrageous statement like, "it doesn't matter if nursing likes it or not; it's about the patient!"
********! You cannot have a system work well by continually ignoring and dismissing the needs of a key player in the system. And that a nurse would say that about nursing needs upsets me even more. Nursing's needs should NEVER be ignored or dismissed, under the guise of "patient-centered care." What a bunch of crap.
I'm ok with it as long as it doesn't to the point of waking the sleeping patient or the already awake start asking to go to the bathroom, ice water, etc. since then it can take so much longer and when you have 5 patients, it's a lot! We also have a morning meeting at 7am so we are already crunched for time.
Here is where I think it can sometimes stop things before they start:
Just the other night I gave report to on oncoming night (newer than me) nurse at 1900 and we didn't stop in to see the patient- and we were both more than ok with it- like we are supposed to (well, technically we are to do 100% of report at bedside save for sensitive issues) and I had just received this post- op patient at 17:30. She was nauseous, gave Zofran, got her settled, did a mercifully short assessment since she was so uncomfortable, then she dozed off. I was still there charting at 19:30-20:00 when the night nurse came and said pt was saying that no one took care of her, rudely demanding dinner and why didn't she get a tray and insisting her husband left her cell phone in her closet shelf (nurse called- he took it home.)
Night nurse felt that she was being treated poorly and played bit by patient and I even said to her almost aplogetically, this is where bedside report is good and we should've have at least looked in, thinking that if she woke up maybe seeing both of us could've gotten questions answered for her and not caused her and the night nurse so much grief. When I left she was getting a dose of her PRN Xanax (that's isn't a norm PRN med on my unit so I suspect she has more than mild anxiety in her history. We tend to just see depression and anxiety on the histories without severity mentioned.)
P.S. I asked the nurse if she wanted me to go in and talk to her and she said no. Hmmmm..... maybe I should have insisted.
The situation you faced was due to post-op amnesia on the part of the patient. I don't know how long you or the noc nurse have been working a surgical floor, but this is where the noc nurse should have taken your word about the 90 minutes the patient was in your care, explained temporary amnesia after surgery, and just started taking care of her needs. Her inexperience with how to handle the situation caused her to put the blame onto you, when really the patient wouldn't have remembered even if you had performed a private concert of her favorite songs on the mandolin.
In some hospitals I have seen a station outside of the rooms that has a pull down table so you can set your things, give/get report, check your EMR data and labs, X-rays, then walk into the room and do a formal greeting and assessment of the patients. I think that is ideal.
Although in my background of the ICU we always give report at a station right outside a glass wall as we're both staring at the patient and the monitor in the room. If there is something relevant to check in the room then I'll ask them to show it to me but otherwise 7 feet from the patient behind a glass door is sufficient to me.
I didn't like the enforcement of one hospital that required we stood up from our station and walked 5 feet closer and stood in the room so it could be officially called "bedside reporting".
Gee you are lucky. we have to be at the bedside. as in literally. As in close enough that we can reach out and touch the patient.
Since most of my patients are confused, it makes for a long report, as they keep talking and interrupting.
Do they do this in long term care? Rehab? or is this just acute care hospitals?
Surely you've heard of HIPAA? The patient has to consent to others hearing his/her medical history. Surely you have enough sense to ask visitors to leave the room.
HIPAA? Hmm, I dunno, it rings a bell, I guess. I mean, I've only been a nurse for 5+ years now. Is that something I should know about?
Surely, while I know you're a relatively new addition to the nursing field, you realize the issue isn't quite that easy.
When the patient refuses to have visitors leave the room, there's very little I can do at that point aside from documenting as such. How exactly do you tell a patient who very much wants their family/friends at bedside, "Hey, you really do want your family to leave the room, because me and the oncoming nurse have to talk about your... you know." There's really no way to protect patient privacy when they won't protect themselves.
Also, it is hospital policy that all report be given at bedside. I have talked about this with managers and let them know that it's a problem. You know what I've gotten back? "That's above my paygrade.".
You know what I do? Typically, I give my real report at the nurse's station either before or after I introduce the oncoming nurse to the patient and give them a quick cutesy update on their status and call that "bedside report". Is that technically what I'm supposed to do? Nope. But do I want to be that nurse who accidentally lets personal information slip in report? For sure, nope.
Which is why the guests would be expected to leave the room. You are the one who brought up STIs. Not me.
I'm not sure why who brought it up has anything to do with the discussion at hand.
Yes, I sure did bring it up. It hadn't been mentioned yet in this thread and it really casts new light on the very concept of bedside report when people realize that a nursing report encompasses all pertinent information regarding patient care, including the socially awkward ones.
As a generalized response to several posts in these last couple of days...
First - If you're being told bedside must occur regardless of HIPAA violations (roommates, friends, family being present), this should not happen and no where have I advocated for that to happen. Management should be putting a stop to that. It is completely appropriate to ask family members/friends to step out of the room. In fact, a couple of units in my hospital have signs with posted hours, and for the hours surrounding shift change, no visitors are allowed in.
No argument there. Take it up with my hospital's policy-makers and my patients, not me.
Second - Appropriateness of patient and/or information SHOULD be considered before walking in the door. If I received CT results that look like there may be a new Ca diagnosis, that will not be shared at the bedside. It will, however, be shared outside the room. If the patient is inappropriate (rude, just finally settled down, overly anxious, sleep, etc.), report will happen outside the door.
Again, take it up with the policy-makers, not me. I don't make policies in my hospital, and if I did, you can bet "bedside report" would be reduced to a nice opportunity for the outgoing nurse to introduce the new nurse.
I'm amazed at how nurses might say it's frustrating not having enough autonomy to make easy basic decisions. We're micromanaged. Management is watching. But really, this is one prime example of not blindly doing for all as you'd do for one. Critically think here. This one isn't too difficult. Will it violate HIPAA? Will it upset the patient? Is this information appropriate? Decide if bedside make sense.
You must work in a pretty nice place if you've never had someone coming in behind you to make sure report is given correctly and at bedside. I have had managers follow nurses into rooms, listen to report, and leave behind them just to ensure that all report happens at bedside. It's just as ridiculous as it sounds, but does it happen? Absolutely.
As for potty breaks and needing drinks/snacks, I usually let the patient know that since we're in report, I can't help in that exact moment, but I'll quickly grab a tech for them, or I can come back in a few minutes. Not one patient has been bothered by me taking this approach yet. And it is the only time I will ever make them wait, so I think that helps.
Again, nice in theory, but if all of your patients really need to pee or need a water refill (not an uncommon occurrence for everyone to have a pressing desire right at shift change, especially on a full moon!), are you really going to tell them they will need to wait for you to find/call a tech, tell them to get water/help them up, wait for the tech to actually arrive, and do the job? Sorry, not in line with my work ethic.
You present a very nice picture of how bedside report ought to be, but most of these policy-makers haven't worked bedside since the Constitution was written, and some of them haven't ever worked bedside at all. Reality vs. idealism...it is a consistent issue in nursing practice.
martymoose, BSN, RN
1,946 Posts
It was fun giving bsr in a semi room with the curtain drawn, but the other pt was confused and hoh. So everytime we we talking about pt "a" pt "b" ( confused) would say "what??" and we'd say we were talking to "a". then he would say "what", or "are you my nurse", etc.
Im sure that was an effective bsr. Also had another bsr where things got missed. as in pt is an amputee.
So, is bsr supposed to improve pt scores????