Bedside Report

LovingLife123 · Aug 25, 2022

14 hours ago, HiddenAngels said:

Yep they are paying the overtime

They aren’t. When you work 3 12 hour shifts that’s 36 hours. Say you are 7-1930 and the next shift is 1900-0730 that’s thirty minutes for report. Even if your report takes 90 minutes each shift, you would still only be at 39 hours…….

Been there,done that, ASN, RN · Aug 25, 2022

Bedside report is a HIPAA violation. Unless it is a private room. Report should not be given in a hallway or at a desk. Anybody could over hear the information. I am surprised the powers that be don't consider that.

DaniannaRN, ASN, BSN · Aug 25, 2022

7 hours ago, Been there,done that said:

Bedside report is a HIPAA violation. Unless it is a private room. Report should not be given in a hallway or at a desk. Anybody could over hear the information. I am surprised the powers that be don't consider that.

I was about to ask about this. I've been out of bedside nursing for a very long time (thank goodness!!) so I'm not aware of the new procedures in bedside. But discussing patient A in the same room as patient B can't be OK. I would be angry if the nurses/doctors/whoever were discussing my personal health info in front of my roommate. Likewise, I don't really want to hear what's going on with my roommate. How is beside report OK? Why are no higher ups thinking about HIPAA?

ladedah1, BSN, RN · Aug 25, 2022

On 8/24/2022 at 3:42 AM, kp2016 said:

In theory bedside report sounds like a great idea, probably why it's a bad idea that just won't go away. The reality is it always takes a lot longer than giving handover at the desk and then doing a rapid once over at the beside.

I'm honestly curious if the hospitals that are enforcing it are paying overtime for the nurses who leave late after handover inevitably took 3 times as long as it should have...... yeah, probably not

A couple years back, my unit was tracking both bedside report and overtime simultaneously.

When we inevitably ended up with overtime, they would make rounds asking what factors we believe contributed and what changes could be made to help us get out on time in the future. Whenever we pointed out that the overtime was related to some aspect of bedside report (toileting, questions, excessive pt input, etc.), they would basically gloss over our feedback and bring it back to our need to delegate to our techs (as though we didn't know when to delegate!).

Oh, sure, that's a real solution ?. I'm sorry, Mrs. I-have-to-pee-real-bad, we're busy with report right now. You'll just have to wait for the tech (who is currently toileting the other five people we just woke up)... would just love to see the HCAHPS scores and fall charts associated with that response!

Don't get me wrong, laying eyes on the patient can certainly help catch problems before they become catastrophic. But if their focus is truly on increasing the quality of care, then they have to be willing to accept that there is a higher price tag associated with it. They should really get out of the office and into the real world; things that seem possible on paper (I.e. bedside report and no overtime) rarely go according to plan.

Mr. Murse · Aug 26, 2022

On 8/23/2022 at 9:33 AM, HiddenAngels said:

I walked into a patient in full blown sepsis on regular floor at change of shift, I’ve seen bleeding from fem sites, desats, so I honestly don’t mind this but I agree with you 100% that we should go in greet the patient assess mentation and then go give report quietly by the door.

Yeah I've walked into patients lying on the floor and other crazy things before too. Which is why I'm 100% on board with going in the room together at shift change, but I feel like it should be after report instead of before. That way the oncoming nurse has a good idea of what's going on with the patient so they can immediately go assess drains or mentation or whatever else is most pressing for that particular patient without wasting time on unimportant things.

BeatsPerMinute, BSN, RN · Aug 28, 2022

The whole "how hospitals want bedside shift report done" vs "reality" issue drives me freaking nuts... How many times has one experienced a someone interrupting you during report for another straw / glass of water / a bedpan / can we get up and move the patient THIS INSTANT / "it's beeping - can you make it stop??" / "any overnight events?" just need a "quick" update / "when will the doctor be coming around?" ...only for it to result in an incomplete nurse report and the off going nurse at their wits end trying to keep things straight and also just get home and get some rest?

What about sensitive information that NO ONE ELSE has privy to?

This leaves all nurses frustrated and tired. Those kind of interactions with the expectation of hand off be seamless and please everyone would leave anyone frustrated and tired. It's not practical.

Following the lazier nurses is another story and I will be double checking their stuff before they leave ... Very high acuity leveled critical care situations are another beast. I do believe in going into a room together at some point. Absolutely disagree with the ridiculous idea of giving "bedside report." To just walk into a room and give report for anyone who just happens to be there and present at that time is a stupid idea. To agree to allowing XXX many opportunities for disruption (leading to a janky report) is a stupid idea.

BeatsPerMinute, BSN, RN · Aug 28, 2022

On 8/25/2022 at 3:45 AM, Been there,done that said:

Bedside report is a HIPAA violation. Unless it is a private room. Report should not be given in a hallway or at a desk. Anybody could over hear the information. I am surprised the powers that be don't consider that.

100% !

Tweety, BSN, RN · Aug 28, 2022

On 8/25/2022 at 11:42 AM, ladedah1 said:

A couple years back, my unit was tracking both bedside report and overtime simultaneously.

When we inevitably ended up with overtime, they would make rounds asking what factors we believe contributed and what changes could be made to help us get out on time in the future. Whenever we pointed out that the overtime was related to some aspect of bedside report (toileting, questions, excessive pt input, etc.), they would basically gloss over our feedback and bring it back to our need to delegate to our techs (as though we didn't know when to delegate!).

Oh, sure, that's a real solution ?. I'm sorry, Mrs. I-have-to-pee-real-bad, we're busy with report right now. You'll just have to wait for the tech (who is currently toileting the other five people we just woke up)... would just love to see the HCAHPS scores and fall charts associated with that response!

Don't get me wrong, laying eyes on the patient can certainly help catch problems before they become catastrophic. But if their focus is truly on increasing the quality of care, then they have to be willing to accept that there is a higher price tag associated with it. They should really get out of the office and into the real world; things that seem possible on paper (I.e. bedside report and no overtime) rarely go according to plan.

I agree, don't complain about incidental overtime when you've increased the time of shift change report by making us do bedside report.

On the other hand I can see their commitment because I've read some studies that it increases patient satisfaction and those every important scores. I do imagine that those patients that see their nurse and are able to get their needs met then and there are more satisfied.

From my point of view it might take a little longer getting through report but also if I can take care of those things like toileting (which really doesn't happen all that often on my unit) it gets that out of the way so I better be organized. Plus if someone needs pain medication I can ask the off going nurse to medicate them before they leave.

Also bedside shift report can help clarify things. I've had patients say "no I'm not allergic to that"...or you can ask questions like "how long ago did you have that chemo".

I acknowledge it's got it's problems but also staying positive, it's not all bad.

Ioreth, ADN, RN · Aug 28, 2022

I have a love/hate relationship with bedside shift report.

Positives: Patient is involved in their care plan and its a good way to involve them in their goals for the day. They can also answer positively on the HCAPS questions about beside shift report. It's a good time to do a safety check on drips, PCA handoffs, wounds/incisions, bed alarm, trip hazards, etc. I don't do a full assessment but I will usually ask them about pain (PT and OT come early for my unit and I don't want them to refuse therapy) and if they have any immediate needs. If the answer is bathroom, then I'll promise to return first after my reports, and then I do just that. Ticks them off a bit sometimes, but most understand.

Negatives: The dreaded bathroom request. The nurses that do a full assessment. The patient that won't shut up. Often there are things that we do need to talk about (unrealistic pain expectations, temper tantrums, altered mental status, family issues, declining condition, labs/results not yet disclosed by physician, etc.) that can't be spoken about frankly in front of the patient. I've seen nurses that insist on a full only at the bedside report just leave these things out, and it is inappropriate to do so.

I think the ideal would be a report in a private place outside the room to cover the basics and necessary info that is needed to start the day, then go to the bedside to do a meet and greet with a safety check and wound check. This may take slightly longer than just at the bedside or just away from the bedside, but it gets the best of both worlds.

Aloe_sky · Aug 28, 2022

On 8/23/2022 at 7:11 AM, Mr. Murse said:

I'm wondering if anyone else thinks the incessant push by unit managers to do a "bedside report" is ridiculous (I assume the facilities I work at are not the only ones doing it).

Don't get me wrong, I fully support the idea that both the nurses coming and going should visit each patient together before one leaves, but it's the push to actually do the full report at bedside that's just a good intention gone wrong. On many floors and ICUs the manager intentionally makes a round during shift change to nag and enforce this petty and unnecessary policy.

I understand the intended purpose, I really do, but inevitably bedside reports become unnecessarily long as the patient and family want to chime in about their great uncle who had really bad hemorrhoids or their friend whose cat just had kittens. Even if you manage to keep it on track, bedside report is a waste of everyone's time in my opinion.

Just let the nurses report in the hall or at the desk, then round through every room to visualize the patients, then move on with the day.

I know I'm venting, but surely I'm not the only one annoyed by this?

Im annoyed, I got report on ONE patient that took 45minutes! The patient was extubated on dayshift and was mouthing words. The dayshift nurse spent most of the time asking “what are you trying to say?” “Do you want to try to write it down” “ do you want….” “Are you asking for…..”. She was talking to the patient also eg. when she would tell me about his wound, she would say “remember the wound on your bottom, I’m just telling the nurse it has to heal so along with turning we will….”. I’m all for education but during report is not the time for every system. She should have done that during her shift when she was turning and doing wound care. Then2nd patient she was talking to the family and patient, It was very annoying. The whole report took over an hour for 2 patients, I was mind blown!

I’m usually finished assessing and charting 1 patient at that time!

Googlenurse, ASN, BSN, RN · Aug 29, 2022

I actually appreciate bedside report. Nothing like getting report at the station and you go into the room 10 minutes later and the trach is out or worse, you see a patient that was reported to be stable and they are as cold and stiff as a board.

Mr. Murse · Aug 29, 2022

4 hours ago, Googlenurse said:

I actually appreciate bedside report. Nothing like getting report at the station and you go into the room 10 minutes later and the trach is out or worse, you see a patient that was reported to be stable and they are as cold and stiff as a board.

I'm not sure if you read the original post or most of the other responses on the thread, but we all agree that briefly going in to your patient's rooms together after report is a good and necessary thing. Verify patient well-being, check IV drips, check wounds or drains, establish immediate needs, etc. This all makes a lot of sense.

Giving a FULL bedside report, on the other hand, does not. It's a waste of time and completely unnecessary.