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.

[LargeMarge]

It sounds like extremely poor management which is unfortunate because there are many positives to bedside report. I have been through 2 different hospital roll outs of bedside reporting and both were pretty bad. Is there anyone the nurses can complain to about how this is being handled ? Maybe your manager needs to be coached on how to talk to her nursing staff.

[imenid37]

The "thank you for allowing me to care for you"

Just not me. Scripting isn't genuine, so it isn't often ultimately successful (IMHO). I am not doing bedside care right now, but considering doing per diem because I miss it. There are (don't flame me) advantages to bedside report and involving the patient. It is for safety and accuracy, not for "butt kissing". It is difficult to work around the sleeping patient and hard to time. I do not know how to make it work for everyone. I think the oncoming team rounding (not at 0700, maybe 0800 or after trays come would work) to set the course for the day with patients would help, maybe? I think it is important to share info with patients and to be transparent (within the bounds of common sense). It seems like admin is trying to "stuff" more into bedside report than is reasonable. The schmoozing needs to go. Patient satisfaction is the result of excellent care, not PR fluff!

[Suckitupbuttercup]

Speaking as a nursing student who has observed a "common sense" bedside handoff, they can be beneficial. By that I mean the nurse-to-nurse communication took place outside of the room, then they enter together, do introductions and relay updated/pertinent information for the patient and answer questions. The oncoming nurse is then able to ensure everything is in order and move on. I would have a huge issue with having a script handed to me of what to ask, what to say, etc...Why (or when) would I need to develop those -OH SO IMPORTANT- critical thinking skills that are of the utmost importance??? You can not possibly provide any script that will cover every potential scenario for every possible patient situation. Let me use my brain... I spent years in school preparing to do so...Please and thank you very much.

[NFuser]

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.

Sad as this is, I think another tactic to "influence" new staff (of course, I am being kind). Lots of deadwood being pruned lately (AEB a 30-year nurse in uncontrollable tears over this), and Press-Gainey and ACA being what they are these days.....to me, it seems there are no depths manglement will not sink to.

[jadelpn, LPN, EMT-B]

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.

So not that I am suggesting for one moment that it is right, that it is an appropriate way to behave or manage a staff, however...

Could it be that this was all some sort of sarcastic, doing it whilst stomping your feet and rolling your eyes kind of behavior by the manger? That went horribly wrong?

If the manager is retiring this year, I am curious if she went "kicking and screaming" into a new concept that she may or may not be on board with, but that is required for her to do.

If the nurse in question and the manager have worked together a long time, perhaps the manager's actions were a wake up call to the nurse, and just overwhelmingly sad. And that was the time that those feelings came out. Now, nurse in question is faced with conforming to something that isn't familiar, and dare I say goes almost against what nurses 30 years ago were taught as a priority, so close to retirement. And the realization that manager--who is a seasoned nurse--has drank the kool aid, and now is offering the same to the staff.

Again, I am not suggesting any of it was appropriate. It was a passive-aggressive display of disapproval or power or the like. It really is humiliating to break down in front of a patient. And to be called out. Wrong on so many levels.

But I am curious if it is more of a lighbulb/a-ha moment for the nurse--and the overwhelming sadness that accompanies this.

[Tenebrae, BSN, RN]

I knew this was coming. Believe me, I called it from Day 1.

When we had our "Go Live" launch, I was horrified. I was forced to wake sleeping patients in spite of my strong wishes not to. .......

i had a stay in hospital just before Christmas. Sleeping was a mission and sometimes had to get sleep when I could. Had any of the nurses woken me up for bedside report I would have been telling them exactly what they could do with it

How under any circumstances is it useful, or productive to wake a patient who may have only been asleep for a very short time? Someone needs to go back to managers school or perhaps do some study on the impact of sleep deprivation and its role in recovery from illness or injury

[Muser69]

They tried this at my hospital. Lasted less than a week. We refused to do this and wake up patients. We threw out the informational signs posted in every pt room about in room report. Too much time on someone's hands.

[sistrmoon, BSN, RN]

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.

Yeah there is a staffing ratio bill coming down the pipeline here in NY. I'm hoping it will pass, even if only under the guise of "so we can provide you with a superior customer experience!"

[sistrmoon, BSN, RN]

It sounds like extremely poor management which is unfortunate because there are many positives to bedside report. I have been through 2 different hospital roll outs of bedside reporting and both were pretty bad. Is there anyone the nurses can complain to about how this is being handled ? Maybe your manager needs to be coached on how to talk to her nursing staff.

Most of us very much like the idea of it, involving the patient in the communication and plan, but the implementation...yeah. We could complain, but we could also be the subject of retaliation. A coworker of mine put in for 4 weeks of FMLA to be with her father with cancer, boss only wanted to give 3 weeks, coworker went to HR and got the 4 weeks approved, manager has been nasty to her since. And that's about a legally mandated issue!

[sistrmoon, BSN, RN]

So not that I am suggesting for one moment that it is right, that it is an appropriate way to behave or manage a staff, however...

Could it be that this was all some sort of sarcastic, doing it whilst stomping your feet and rolling your eyes kind of behavior by the manger? That went horribly wrong?

If the manager is retiring this year, I am curious if she went "kicking and screaming" into a new concept that she may or may not be on board with, but that is required for her to do.

If the nurse in question and the manager have worked together a long time, perhaps the manager's actions were a wake up call to the nurse, and just overwhelmingly sad. And that was the time that those feelings came out. Now, nurse in question is faced with conforming to something that isn't familiar, and dare I say goes almost against what nurses 30 years ago were taught as a priority, so close to retirement. And the realization that manager--who is a seasoned nurse--has drank the kool aid, and now is offering the same to the staff.

Again, I am not suggesting any of it was appropriate. It was a passive-aggressive display of disapproval or power or the like. It really is humiliating to break down in front of a patient. And to be called out. Wrong on so many levels.

But I am curious if it is more of a lighbulb/a-ha moment for the nurse--and the overwhelming sadness that accompanies this.

Not my read on the situation. But if being scripted robots is the direction we are headed as nurses, that is pretty sad.

[nynursey_]

i had a stay in hospital just before Christmas. Sleeping was a mission and sometimes had to get sleep when I could. Had any of the nurses woken me up for bedside report I would have been telling them exactly what they could do with it

How under any circumstances is it useful, or productive to wake a patient who may have only been asleep for a very short time? Someone needs to go back to managers school or perhaps do some study on the impact of sleep deprivation and its role in recovery from illness or injury

I'm strongly considering finding evidence-based articles on the link between sleep deprivation in hospitals and recovery time and sending them to the morons that are demanding we wake sleeping patients for bedside report. I actually had an ANM demand I wake a patient at 2200. I refused. And continued with report in the hallway where the oncoming RN and I could lay eyes on said patient who was resting comfortably.

I'm an advocate. Not a robot. And I'll be damned if I'm going to undo all the hard work I spent 8 hours on making my patients happy and comfortable.

[jamiern123]

They don't have a choice?!?!?!?!?!?!?! WTH is wrong with people these days