Bedside reporting as a management tool of humiliation

[sistrmoon]

I am just sitting here with my mouth hanging open. On Day One of go live with our bedside reporting, our big boss(not an assistant manager) was following nurses to "coach" them. A nurse who has been here for 30+ years and is probably one of the most stoic people I've ever met was apparently dressed down in front of the patient, to the point of the nurse crying so hard she couldn't speak.

Let me repeat, day one. The nurse receiving report attempted to redirect and prompt and she had the micromanaging ire turned on her. They are insisting we do everything just so(like: offgoing nurse must do x, y, and z and oncoming must do a, b, c when really either could do them, and you'd best get your scripts perfect.) Any plus sides to this are being drowned by management control and humiliation. Half the floor is looking for a new job. It's the height of inappropriate behavior.

[jadelpn, LPN, EMT-B]

I've been at my establishment for a full calendar year. In fact, I just had my year eval and recieved accolades. My leaving this particular hospital as a result of it violating nurse ethical principals isn't going to get me blacklisted. I believe my clinical skills will speak for themselves. And it's sad, because my current NM is amazing, and he's going to do great things. I doubt he'd speak ill of me simply because I disagree with bedside reporting.

Be so mindful and careful nynursey! I agree that clinical skills and excellent above par evals SHOULD determine (and be a huge dare I say only) thought process in getting a new position. But it is not, And it really is not even about clinical skills. And that is sad, just factual. If you were to go get your master's in business, however, then you may find more open to you....

[Here.I.Stand, BSN, RN]

When done with the aid of individualization and basic common sense, bedside report has its benefits.

Interrupting the pt's/family's sleep for any clinically unnecessary reason? Bad move. Interrupted sleep increases the risk of delirium (formerly commonly known as "ICU psychosis"). Sounds like some management needs some re-education in this area of EBP.

There are things that are inappropriate at the bedside. A couple of examples: 1.) Nineteen y/o pt says it's okay for Mom and Dad to hear report? Fine...until we get to the part about the white discharge around the Foley, which pt might not have known about. Besides, he's in the hospital for his fractured pelvis, not for his sx of gonorrhea. 2.) Pt's child was killed in the MVC with her. Pt doesn't know about it yet; she was just extubated before change of shift. Pt's family want to tell her themselves with the chaplain present. This info can't be passed on in bedside report...but do ya think the oncoming RN might need to know??

Scripting? Oh no. Scripting is appropriate for professionals...in stage, film, and television. Scripting has no place in nursing, any more than it has a place in medicine or law.

Sounds like you all need to unite and build a big ol' fortress around your professional interactions, to protect them from this nonsense. Say no to scripting, and for the love of all that is good, don't wake people up unless their clinical situation requires it! I feel extremely strongly about protecting sleep, yes, because it is so important. You can pander to brainless management demands, or you can advocate for your patients. What would management do, fire ALL of you??

[sistrmoon, BSN, RN]

From the picture painted here, the relationship between staff and manager was straight out of a Dickens novel ... way before the bedside report initiative came along.

And yet, professionals have remained on this unit.

Fascinating story.

The nurse in question is a year away from retirement. She has said she will be looking elsewhere to work out that last year but considering how hard it is for some early in career nurses to find work, I'd imagine it could be quite a challenge to find a new job a year away from retirement.

This manager is supposed to retire this year. I know many are interviewing but I'm sure many keep hoping things will change. This manager runs hot and cold, can be your best friend one day and the devil on your back the next.

Regardless, when you've got kids depending on you and that mortgage coming up every month, it's amazing what you'll put up with. In theory, philosophically, I agree with you. Why stay in an abusive relationship? But it isn't that simple. It's a complex set of factors at play, and victim blaming doesn't really help.

[sistrmoon, BSN, RN]

The whole thing is hard to imagine, from the managers disrespecting the nurses in front of patients to senior nurse responding with uncontrollable tears instead of dragging the manager into break room and laying into him/her.

Aside de from it being phony, did they not even have some mock reports beforehand?

I have to say though, we have staff who years later even with a bullet point guide, still won't start off with John Smith 72 yr old patient s/p..etc. they will still jump into talking about a patient without providing the preliminary info. (Team conf, not report). Even when it's relevant there is a resistance to follow a format.

I would imagine for those that are disorganized in regular report would really struggle under the negative spotlight. It's a terrible way to teach and enforce a new style of report. Not to mention perpetuating patient anxiety.

We had one role playing checkoff before going live with patients.

However, the criticism wasn't about report itself. In fact, that has been pared down to what brought the patient to the hospital , what happened on our shift , and goals for the upcoming time. History can be read in the chart and in the electronic record. Each report is to take 5 minutes. The criticism was not spouting out scripts verbatim, the "wrong" nurse checking the armband, updating the whiteboard or having the computer. Nitpicky things that ultimately do not affect anything.

[sistrmoon, BSN, RN]

I think you've hit the nail on the head here.

A manager so concerned with sticking to the script (presumably to benefit patient satisfaction scores) that she lays hands on a crying nurse in front of said patient? Come on now.

And yet, people determined to feed into the nurse-as-victim mentality just eat up farces like this.

Riiiiight, I made the whole thing up. Give me a break. Just because you would react a certain way(hauling the manager into the break room and getting aggressive) doesn't mean everyone would. And I'm not painting all nurses with any broad brush. I think this nurse was set up to be humiliated and humbled in front of a patient and coworker. If you really think it's so unbelievable that managers such as this exist and act in such ways,you've been very lucky in your work history thus far.

[sistrmoon, BSN, RN]

Bedside report is sweeping the nation because management believes it will improve press ganey scores and I believe one of the questions on the survey mentions bedside report. So it will be hard to run to another place that doesn't do this. I agree it turns into a schmoozing session with the patient which is what management wants and true report gets swept to the side because we know there are times when we can't give a full report in front of the patient for any number of reasons such as a bad test result/diagnosis the patient hasn't been told yet or language barriers or confusion. It makes no sense to talk in front of a confused patient or someone who doesn't understand what we are saying! There aren't enough interpretation phones to communicate to the many patients we have that don't speak english. That's another subject, but why don't people make the effort to learn english when they live in America?

Management has watched us several times and some people were insulted, but they at least kept their distance and listened outside the room. Still it is insulting to treat experienced professional nurses as if they were auditioning for a play! We haven't been subjected to the scripting at least. They have offered ideas possible scripts I suppose of what to say to a patient, but at least it was a suggestion not a demand.

One patient mentioned liking bedside report so that was the justification that it was really great! They are blaming the older nurses for bedside report not being done all the time. It really iust because they won't compromise with the nurses and let them get the main report at the station and then meet and greet the patients and give them a brief update of their treatment plan. They are simply not being reasonable because we all know we can't say everything in front of the patients, plus we have to dumb down the report for them to understand. If they would compromise and work with us I think everyone could be happy. Good luck with that! It is sad what nursing has become between the computers and the press ganey scores!

I've been in the hospital at bedside for 8 years. If I leave, it won't be to another hospital. I'll be looking for something else entirely.

One of my coworkers had 4 of 5 of her patients confused and they were agitated and trying to climb out of bed during report!

[sistrmoon, BSN, RN]

I personally like bedside report. If a slacker nurse fails to hang an IV bag, or leave in infiltrated IV, I can ask them to fix it before they leave.

The scripting however is crazy. I don't need someone putting words in my mouth.

We already did bedside rounding at change of shift which address the issues you mention.

[MatrixRn]

I am not as much surprised about hospital scripting for the nurses as I am disappointed.

The hospital understaffs --> the patient state the care was not optimal --> the hospital says it is because nursing is not uniform in their 'niceness'....so they implement scripts hoping that will fix the issue, when what they really need is take a closer look at staffing ratios.

[brandy1017, ASN, RN]

I personally like bedside report. If a slacker nurse fails to hang an IV bag, or leave in infiltrated IV, I can ask them to fix it before they leave.

The scripting however is crazy. I don't need someone putting words in my mouth.

Good luck with that! Not everyone is good at IV's. If there is a bad IV I suggest they have the stat nurse fix it!

[brandy1017, ASN, RN]

If the patient is HARD OF HEARING do you HOLLER THE WHOLE REPORT?

Good one! We're probably all deaf already anyway from all the alarms so no one is the wiser! haha

[brandy1017, ASN, RN]

The nurse in question is a year away from retirement. She has said she will be looking elsewhere to work out that last year but considering how hard it is for some early in career nurses to find work, I'd imagine it could be quite a challenge to find a new job a year away from retirement.

This manager is supposed to retire this year. I know many are interviewing but I'm sure many keep hoping things will change. This manager runs hot and cold, can be your best friend one day and the devil on your back the next.

Regardless, when you've got kids depending on you and that mortgage coming up every month, it's amazing what you'll put up with. In theory, philosophically, I agree with you. Why stay in an abusive relationship? But it isn't that simple. It's a complex set of factors at play, and victim blaming doesn't really help.

At least she can retire soon, the year will fly bye and she will soon be able to put this unpleasantness behind her enjoying the good life, hopefully! I would be counting down the days and probably tell the manager off on my way out the door. Luckily management is fair and decent and so that is not a problem, just feel inadequate staffing at times and too much focus on the budget which leaves us without necessary supplies, but once again I see things could always be worse!

Good luck to her and to you all!

[ArtClassRN, ADN, RN]

Obviously using anything as a "management too for humiliation" is terrible.

Bedside reporting, on the other hand, has been a great addition for me. The only problems with it I have seen are when nurses just refuse to do it.