Bedside Report...

[SheriLynnRN]

I am on a commitee to help implement bedside change of shift report on my unit. It is a 28 bed general surgical unit. Another unit in my hospital has done this successfully. We are just in the beginning stages of the process. Any input would be helpful..especially fro those who have experience with this type of report.

[Virgo_RN, BSN, RN]

I can think of several situations where bedside report wouldn't work. In double rooms, you'd have the other patient and all of their family members overhearing confidential patient information. Many patients where I work are not English speakers, so it would be disconcerting to have a couple of nurses walk into the room, stand next to the bed, and have a conversation that the patient cannot understsand. When I come on in the afternoon, this is often the first chance a patient has had all day to take a nap or get some rest, after the busy day of tests and procedures, physical therapy, family visits, and so on. If my patient is resting in bed with their eyes closed, I will delay my assessment for a little while to give them an opportunity to rest. Bedside report would interfere with this. Some people do have behavioral issues that would be inappropriate to discuss in front of the patient, especially in a double room. Some patients are pains in the heinies, and if you can warn the next shift right from the start, it can give them an opportunity to strategize how they will handle this person. You can also give them tips on what worked for you and what you tried that didn't work. It would be inappropriate to have this conversation in front of the patient and their family, and their roommate and their family.

Now, I personally don't routinely refer to patients as PITA/PITHs, but instead will try to use a term that gets at the root of their behavior, such as anxious or demanding or frightened or angry. But I certainly do not judge another nurse if s/he uses that term; we're human beings, not robots, and sometimes it helps to blow off a little steam after dealing with a demanding patient for eight hours. What really matters is not whether we think someone is a PITA, but that we treat them with respect and dignity while they are in our care. We can do that and still not really like them.

[lpnstudentin2010, LPN]

Where I am a patient I have only experienced bedside nursing once. It was when I was having my endoscopy a few months ago.

I kinda liked it because I knew the info I wanted said was said along with what is important.

I liked being able to hear things like:

Watch her IV it took me 20 mins to get it.

They said everything in terms that I was able to understand.

I had been freaking out a bit and hearing all this made me feel better. I knew the people who were going to be there knew about me, and I felt comfortable they were going to take good care of me.

[janetjanetbobanet]

When this first started at my hospital, we were giving each other the basics of face to face report at the desk and then going into the room to introduce the oncoming nurse to the patient and discuss any issues the patient wanted to discuss, look at the wound, etc. But now the nurse manager has the charge nurses writing down and reporting to her which nurses are at the desk giving any report to one another and threatening disciplinary action. And of course we are not supposed to talk about patients in the hall outside the room either. So this forces us to talk over sleeping patients and not be able to relay information about behavioral issues unless we want to literally hide while doing it. And it does make report take a lot longer. Personally, I think it's just a matter of time before angry patients start complaining about their personal issues being discussed over them and in a place where roommates and visitors can hear.