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?
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.
I think I am in love with that doctor. That's awesome. And the truth is the doc and the nurses are 100% right here.
They tried to implement this where I work. They expected for us to come in 15 minutes early for group report and then to go and do bedside report. I work the night shift and the last thing I want to do is to come in early and leave late. Needless to say no one wanted to do it (that goes for day shift and night shift) and it lasted all of two weeks.
Especially for sensitive information, it seems to work fine to give report sitting down at the desk, and then walk and introduce the oncoming nurse, and anything out of the ordinary. When I worked stepdown, this was really nice so the nurses could show each other things, i.e. his slurred speech is normal for him, or look at this wound or look at this tube, etc. We'd never wake up sleeping patients unless there was something really important to show the next nurse.
I LOVE the rehab doc who wrote orders for the walking report not to be done at 7 and 11. See, there are docs out there who truly understand what nurses do!
This would be totally inappropriate except where all rooms are private and no family are present. We do report at the nurse's station, then do a quick walk-around into the rooms, introducing the oncoming nurse to any pt that is awake and their family members as well as doing a quick eyeballing and/or sign-off of dressings, drains, IV's.
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Batman25
686 Posts
I think I am in love with that doctor. That's awesome. And the truth is the doc and the nurses are 100% right here.