Describe Your Bedside Report

[ak3991]

I'm looking for suggestions on how to make bedside shift report quicker and more efficient on my 40 bed unit. On my floor, we clock in by 6:45 and clock out no earlier than 7:15 (making up for 30 min deduction for lunch). Shift report takes so long that we rarely clock out before 7:30, turning our 12hr shift into a 13hr shift. Our unit has been complemented on how thorough our bedside reports are and the patients have expressed their satisfaction with the way it's currently done, but I feel that it would make all the nurses happier to not be waiting around until 7:05-7:10 to actually begin taking report and getting home unnecessarily late. I will describe the way that shift change currently goes and I ask for suggestions or examples from your units on ways to speed up the process.

First, we clock in by 6:45. Everyone grabs an assignment sheet and picks up a kardex for each of their patients. Next, we head to the break room to unpack and put away purses and coats. We all sit in the break room and fill out a report sheet with the info from the kardex (we all use similar, but slightly different report sheets based on how we like to take notes during the shift). We then head out to the floors (our unit takes up two floors of the hospital) to find the nurses who had our patients during the previous shift. It's rarely the same nurse giving report on all of your assigned patients so we normally have to wait around for our reporting nurses to be finished with their other reports until they come find us. We do bedside report in the room, which doesn't take that long as long as the reporting/receiving nurse doesn't chat with the patient too long. (We are going to start requiring daily goals to be discussed w/ report too so that will add some time). When we leave the room we are usually on the hunt for our next hand-off nurse to get report from.

The whole process takes way too long and there are some obvious ways to improve it like getting to the unit earlier and photocopying the kardex itself instead of writing in report sheets, but some really time consuming things cannot be avoided. We can't always get report from one nurse for all of our patients. That won't happen, but I'm sure there are better ways to streamline that process that I'm not thinking of. What do you do on your unit to make shift report more efficient?

[dream'n, BSN, RN]

The nurses should be ready for report at 6:45, not putting coats up and adding items to their brain sheets from the Kardex. The on coming shift needs to be on the floor ready for report at 6:45, not looking up their patient's first. When nurses do that it eats up at least 20 minutes prior to getting even one report.

[kaylee.]

This seems like a drawn out process and should be streamlined.

And they are proposing a 'goals' convo with pt/fam to be added in as well.? I love when management tries to throw in an extra time suck that is not reasonable for an already jam-packed window of time.

Goals are very important, therefore should not even be brought up in such a deliberate way if you only have 3-5 min, most of which will be spent on the report...

I already see how that will go. The goals will inevitably lead to a flood of questions from the pt/fam, and since the nurses are the ones who opened the flood gate, are they supposed to just give clipped answers and quickly cut them off?

Does management think that the goals discussion will be close ended? Doubtful...

Goals need to be addressed when the nurse can really be present to address concerns/questions...its just going to come off as rushed/insincere...kindof the same way the docs do it and bolt within 2 minutes.

Also, Is the conference room thing mandatory? I would just start my report right at end of shift.

[Here.I.Stand, BSN, RN]

Report should begin at 6:45; if the nurse needs to stow a coat and purse, that should be done at 6:40ish. Oncoming nurses can look at Kardexes after report.

As for goals, I would ask your manager: assuming you work on a floor, you have what, 5 minutes per pt if you're to be completed in the remaining 1/2 hr of your shift? "What action steps or practical suggestions do you have for completing a proper report AND goals in five minutes?" If this is a reasonable thing in her/his mind, s/he should be able to effectively guide you in implementing it. If s/he has no suggestions, that's a sure sign that it is not an attainable goal. Think about it, when doing pt education -- say you're teaching pt how to administer abx through his PICC at home -- you are going to actually tell him how to do it, right? Or when your child is learning to ride a bike, you tell her the tricks for keeping balanced, right? You don't just say, "Oh I'm sure you can figure it out." Pt: "I really don't know how to do it. I don't even know how to start." You: "Well, you're dc'ing in 3 days. You will HAVE to continue your IV abx at home, so you are required to know how." That would be a ridiculous thing to say to someone. Substitute "Goals set during bedside report" for "IV abx" and "RN" for "pt" and you have the same ridiculous instruction.