Bedside shift reporting, Do your facilities do it?

[mappers]

This is the thing at our hospital and nurses on my floor hate it. We're a Med Surg/Tele/Onc floor. I'm on the fence about it.

If you don't know what I mean, it is going into the patient's room together and giving report. It is supposed to give you the opportunity to involve the patient in their care, asses skin together, answer questions, etc. I think in about 75% of the situations, it works well.

But here is where it doesn't IMHO:

1. It is 0645 and pt is FINALLY sleeping. How rude to just walk in, turn lights on and start talking. (I've seen one or two nurses do this, I think in retaliation for having to do the report at bedside. Unprofessional much?)

2. Patient or family member is crazy! You know, overly anxious, overly talkative, etc. If I walk in and start talking about them, we'll NEVER get out of the room. Or they're hostile, even worse.

3. Biggest issues I have with it. HIPAA There are 10 family members in the room and I have to report on how many loose stools the 30 yo man has had, or how he hasn't pooped in 3 days, or how swollen is scrotum is, etc. OR Their roommate has 10 family members, even worse. The fact that they have a roommate at all and we're doing this.

4. When said roommate is CRAZY!!! Keeps interrupting your report to ask questions about their own care, suddenly starts having the same symptoms your patient has, keeps talking to your patient even though your patient just wants to tell them to SHUT the F*** UP!!!

5. How about that the test results have come back + for CA and the doctor hasn't been in to tell them yet??

6. Chatty nurses who take waaaayyy too long to give report anyway. I've been report for over an hour doing this. When you have 6 - 7 patients, this can be time consuming.

(OK, after this list, lets say it works in 50% of the time....LOL )

What we usually do is give report outside the room, then walk into the room together, introduce ourselves, and then ask a few questions, show a few things, etc. But this isn't how management wants it done.

My manager said it can accomplish several things to make our jobs easier. We can assess skin and help each other turn the patient and do our first hourly round all at the same time. Since we are seeing the patient first, we can prioritize better. If the night shift nurse has left a mess, we can "encourage" them to clean it up before they leave. We don't walk in on a surpise mess after he/she's gone. It reduces call lights, because we can find out what a patient needs before they call out. For example, he asks for pain medicine...Night Nurse can say, I gave it to you at XXX and you can have it again at XXX. I can then say, "I'll bring it to you then...OK?" And it helps those precious PG scores.

This does all make sense to me. If we all had private rooms I think it would work well. And I think it works great in ICU and TCU where there are only 2 -4 patients per nurse. (I'm in med surg). And I just had another idea. We should give patients a code word. If they have friends and family in the room and we walk in to give report, they can use this word to let us know NOT to give report in front of these people. Hmmmm Maybe I'll suggest that.

Does anyone else do this and how does it work at your places?

[charley75]

My work just started bed side report, I work in the ER so Hippa with roommates is not a problem for me but one problem I have is with our psych patients. We have to go in to tell the next shift how the pt attempted suicide or took ?amt of pills, or what tox screen showed and it just seems to get the pt more aggitated and defensive. The intoxicated pt just passed out and now u are going in to wake them. Or the trauma that u have to relive the story with the family at bedside and the pt trying to hold on. Not liking it much either, I see fewer benefits than it may be worth.

[mappers]

In our ER, we have double rooms with nothing but a curtain between patients.

[ladybugbaby161]

We are supposed to do it like your said management wants it done, but usually we talk outside the room then go in and introduce ourselves and talk about pain meds and look at dressings together. Our management isn't satisfied either, but they aren't the ones doing it and it can become really awkward discussing loose stools in front of the patient. Also, we get a lot of narc-seeking behaviors on our floor and I like to know ahead of time so I can expect it - I don't feel that it is appropriate to say in front of the patient that he/she asks for pain pills once every hour even after we discussed when they were due!

Also, the chatty nurses when you have 6-7 patients to report on....takes forever....

It's a good system and means well, but definitely flawed.

[caliotter3]

In a LTC facility the oncoming nurse was required to come in 15 minutes before start of shift to do bedside report with offgoing nurse. They had to clock in and out at the right time and continue until report was finished. Even then, we didn't do skin checks together. I have never had any problem doing skin checks when the CNA came to get me at an opportune time. If they expect this at shift change, then a certain amount of time should be allowed for overlap of shifts and both nurses should be on the clock.

[mappers]

Ladybug LOL...Do we work on the same floor???

And Otter, I can't imagine doing this in LTC with as many patients as you have. God Bless you! We are supposed to clock in 15 minutes til and clock out 15 minutes after, giving us 30 minutes for report. We don't clock out until we are ready to leave. If we run long, so be it. Management complains, but that doesn't stop us.

I try to get to work before 0630 to give me 15 - 20 minutes of time before report to get stuff together...review kardex, labs, orders. I clock in when I get there. No one has told me to stop yet. Some people get there at 0600 for the same thing and don't clock in until 0630. This is wrong, imo. Never work off the clock!! Heck if I'm done with report and charting and need to pee before I go home, I don't clock out until that's done. They need to pay for me to pee, especially if it's only my 2nd time in 12 hours!! I said this one time as I trotted off to the bathroom and a fellow nurse burst out laughing and said she liked my attitude...LOL

[DF-LPN]

I also work LTC, and we no longer do this as it is a direct violation of HIPPA. Got sitation for doing report in hallways on walking rounds with oncoming shift. The cena's still do walking rounds, but this is so both shifts could check on residents bed alarms and make sure rms arn't left a mess. This has cut down alot of those shift change falls by about 75% .

Dee

[caliotter3]

I like that. Getting paid to pee!

[ladybugbaby161]

I think we must work at the same place LOL

I clock in as soon as I get there. Also something I noticed was that with bedside reporting, nurses that come on shift are ready to do it, but nurses that are getting off shift don't want to do it. So as a night nurse I find myself getting report in the nurses station and in the morning walking around with the oncoming day nurse to give report.

Also, some nurses will flat out say they aren't going to do it. LOL. There is even talk about having other RNs in the educational dept who work at our hospital come and watch us give bedside report and even follow us around to make sure we are doing it right. Seriously?

[mappers]

I heard an educator talking about having a class on how to give report. Sometimes I think this would be a great idea. Some nurses seem to give too short a report, while others meandor around telling me about every med they gave, but foget to tell me why the patient is even in the hospital!

And don't you wonder about nurses who don't seem to connect the dots? I got report once where the nurse told me the patient came in with SOA and CAP and then said they are NPO p Midnight for a lap chole.....Ummm What??? So when did lap chole's become a treatment for pneumonia? When I asked how they went from pneumonia to a lap chole, she just gave me a blank stare like she'd never even considered the question. I understand being so busy you don't have time to look up histories...happens all the time, but I'd at least question that a little bit.

Mappers, who NEVER makes a mistake and is related to Mary Poppins ...practically perfect in every way...

[sassy_cassie]

According to managment we do. I work hospital inpatient rehab and we were told we had to do bedside report every shift hospital wide. I work 3-11pm (luv 8hour shifts). 11pm is a horrible time for walking rounds due to the night shift would kill me if we woke everyone up. So I talked to the rehab doctor and we have a standing order from him not to do them. Next 7am wasn't working becasue most of the pt's are getting dressed with ot at that time and don't appreciate the parade while they are changing, so Dr. ordered no walking rounds then either. So now we do them only at 3pm and only if the pt is awake, has only a few visitors, and not working with therapy. I'm not sure upper managment has caught on that this is how we do them.

[mappers]

LOL Sassy. Love it.