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.
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.
It "has to do with it" because you posted this -
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.
What prompted this was me saying that sharing the information in the following post would be illegal.
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*....
I had responded to that with-
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.
(Btw, your response to that one asks how your initial post included things against the law. While I bow down to your infinite years of wisdom and experience over me, I'm not sure you fully understand HIPAA. Also, STIs do not cast "new light" on these issues. I'm pretty sure no one believes STIs are somehow more protected than cardiac or renal or any other history.)
In another post indicating your full report outside the room, and mini inside the room, this would be appropriate. I do wonder if a disconnect has occurred somewhere in the chain of command for your unit. There is no way the hospital's legal department would be on board with full report in front of guests. I urge you to research this further. You might end up saving a colleague her license and your hospital multiple $30k fines per violation.
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.
For the above, everyone needs this all at once? Everyone, all during shift change? I get that sometimes shift change gets wild, so I'm not doubting it happens, but do you know how much less this happens when you anticipate some of this and fix it ahead of time? Bring waters at your last med pass. Heck, if you forget, no, this is not an emergency and can wait just a minute or two. For potty breaks, when I know the tech is busy, that changes things. More often than not, though, because we were all just in there at last med pass, the potty breaks just happened. Maybe if you were in their rooms with them within an hour of shift change, this would happen less for you. Just an idea.
Maybe if you were in their rooms with them within an hour of shift change, this would happen less for you. Just an idea.
Nope. Most of the requests are "if you are in the room I will think of something I want" requests. If they have water, they will ask for ginger ale. If they have been to the bathroom, they will have to go again.
We just give report at the nurses' station and then go in to meet the patient after report and also to eyeball other things (like lines, rates of drips, etc).
bedside report is a horrible idea especially in a 2 bed room. where is the confidentiality ????? and if both patients have visitors they all get to hear very private info. and so does the other patient. and I need a surface to write on . rounding after report is ok. but if something is wrong I have found the off going shift rarely corrects it. and what we report to each other may frighten and worry the patient who does not understand the technical terms. I hate bedside report .
Nope. Most of the requests are "if you are in the room I will think of something I want" requests. If they have water, they will ask for ginger ale. If they have been to the bathroom, they will have to go again.
This is so true. I find that no matter how many hours I am spot on with my 4 "P's," I will inevitably hear a call bell go off within 10-20 minutes of my having left the room.
What prompted this was me saying that sharing the information in the following post would be illegal.
I had responded to that with-
(Btw, your response to that one asks how your initial post included things against the law. While I bow down to your infinite years of wisdom and experience over me, I'm not sure you fully understand HIPAA. Also, STIs do not cast "new light" on these issues. I'm pretty sure no one believes STIs are somehow more protected than cardiac or renal or any other history.)
In another post indicating your full report outside the room, and mini inside the room, this would be appropriate. I do wonder if a disconnect has occurred somewhere in the chain of command for your unit. There is no way the hospital's legal department would be on board with full report in front of guests. I urge you to research this further. You might end up saving a colleague her license and your hospital multiple $30k fines per violation.
Wow, apparently I stepped on your toes.
I'm not asking anyone to bow to my experience, nor am I asking for a condescending analysis regarding my understanding of HIPAA. In reality, as a former military nurse, I probably understand it better than most. It simply seems to me that you may not have fully encountered the divide between theory and practice as much as other more experienced nurses have.
You also seem to have a pretty ideal workplace environment--one that encourages its nurses to use their judgment as to whether or not to give report at bedside. That's the way bedside report (and nursing in general) ought to be. But while things may run smoothly at your facility with your policies, the point is, it doesn't always work that way in other places.
I found it curious that you got so fired up over my post as to rush to tell me that it was "illegal" to share that information in bedside report (when STIs were involved, specifically) when all the other info in report is no less protected by HIPAA. That seemed to provoke a pretty strong reaction out of you versus your reactions to previous posts.
My point in fact has never been that STIs are somehow more protected than other types of information given in report; simply that it's more likely to piss off your patient if people who aren't supposed to hear that kind of diagnosis get wind of it in a bedside report scenario, which makes bedside report a tricky issue for nurses as they try to divulge pertinent care information without embarrassing/violating the rights of their patients. Granny may not know nor would she care about the patient's H&H, but if she hears the patient has an STI, that's a much bigger deal. In that kind of situation, bedside report is inappropriate, and not all hospital managements are smart enough/care enough to keep that in mind when enforcing their report policies.
As far as researching this topic further, thanks, but I'm pretty secure in my own practice. My point when giving examples as they pertained to my unit was so that people here could see the consequences of divulging that kind of information at bedside and better understand my qualms with bedside report.
I have no misconceptions about being able to "change things for the better" in a unit/hospital setting. Been there, tried that, figured out nursing isn't what it's cracked up to be in those nursing school theory classes. All I can do is try to protect my patients as best I can, and if that means practicing a little out of the narrow margins set up by my unit leaders/hospital policymakers, then so be it.
For the above, everyone needs this all at once? Everyone, all during shift change? I get that sometimes shift change gets wild, so I'm not doubting it happens, but do you know how much less this happens when you anticipate some of this and fix it ahead of time? Bring waters at your last med pass. Heck, if you forget, no, this is not an emergency and can wait just a minute or two. For potty breaks, when I know the tech is busy, that changes things. More often than not, though, because we were all just in there at last med pass, the potty breaks just happened. Maybe if you were in their rooms with them within an hour of shift change, this would happen less for you. Just an idea.
I don't know how many times I can say this, but ideal practice vs. reality. There is a divide.
I'm not saying (nor did I ever say) that everyone needs everything all at once on every shift change, but every now and then, it does happen, especially when you're caring for pregnant/laboring/postpartum women who, for one reason or another, are unable to care for themselves. In my specialty, I probably see my patients more than any other specialty aside from critical care. I round at least hourly on all patients and at least every 30 minutes on patients with epidurals. To imply that a nurse who encounters this is somehow neglecting the needs of his/her patients and everything avalanches at shift change is ridiculous as that wasn't my point, but I'm beginning to think you already know that....
The facility I used to work in required bed-side report. It was a very busy, 24 bed Med/Surg floor with large, far-spaced rooms. We RNs could have rooms from one end of the floor to another. If report were given at the desk, it's easy to find the 2,3,4, or even 5 RNs you were reporting off to, but hard to figure out where they were if they were ducking in and out of rooms. The thing I really disliked about it the most though, was that the incoming shift felt they had all the time in the world to chat with each patient, their family members, talk about how the previous shift had gone, ask if they wanted anything (food, drink, pain meds, etc.) and then proceed to fetch it before we could continue to the next patient. All while I'm just wanting to get off the floor and my feet because I'm hungry, tired, and feel filthy - and I've still got an hour drive home. Report that used to take 30 minutes for 6 patients could take upwards of an hour to give.
Those same incoming RNs, of course, wanted to NOT go into the patient's room when I came on the floor, give a report that was "Well, you gave him/her to me and s/he's still the same." Then, I walk in to the patient's room and nope, not the same!
In ICUs I feel bedside is good but not if there are a lot family members present at bedside. The other issue is some nurses like tell way too much information and some of which is not important. I will get detail information about things that are not relevant to the current situation and then they leave out the fact I have to take patient for a head CT and such. It's OK from new nurses but some older nurses are stuck in their way. Then every ICU has their own custom report sheets which can be helpful or a waste of time. Some people use them some don't...some get annoyed if you don't fill them out for them.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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 stayâ€. 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 everythingâ€.
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.
I think a lot of this depends upon your patient population. A reasonable and respectful patient population is one thing; an unreasonable, entitled and disruptive population of patients and visitors is another. Bedside report is one of those things that can be great in the right circumstances, but I'd hate to see in my SICU where one patient is a gangbanger who got stabbed in the process of shooting someone and the patient across the hall or two doors down is the banger who got shot while he was trying to stab someone and each has a roomful of his "bros" visiting.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
OKayyyy -- everyone who disagrees with you is lying. Got it.
ixchel
4,547 Posts
It "has to do with it" because you posted this -
What prompted this was me saying that sharing the information in the following post would be illegal.
I had responded to that with-
(Btw, your response to that one asks how your initial post included things against the law. While I bow down to your infinite years of wisdom and experience over me, I'm not sure you fully understand HIPAA. Also, STIs do not cast "new light" on these issues. I'm pretty sure no one believes STIs are somehow more protected than cardiac or renal or any other history.)
In another post indicating your full report outside the room, and mini inside the room, this would be appropriate. I do wonder if a disconnect has occurred somewhere in the chain of command for your unit. There is no way the hospital's legal department would be on board with full report in front of guests. I urge you to research this further. You might end up saving a colleague her license and your hospital multiple $30k fines per violation.