Ugh...Bedside Report

[Vespertinas]

A few hospitals I've worked at have started to implement bedside shift report. I dislike it. There is information that I don't feel comfortable sharing in front of the patient because 1) it may make them unnecessarily concerned 2) it may insult them 3) they'll ask questions which would interrupt the flow of report. It seems that to play along with management, RNs will stand near the bedside but report out of earshot from the patient.

Variations I do like include forms of rounding together on each patient after report to check that the patient is alive, that tubes/wires/drains are labeled and present as described, or to clarify any complex parts of report.

But giving the entire report AT the bedside I think is nonsense. I've wanted to ask management WHY they think this is important. It's not mandated by JCAHO and yet management feels very proud to implement this as a "quality improvement" project. So what are you improving exactly? Well... I looked it up and research appears to say that the benefit of bedside shift report is to make THE PATIENT feel more empowered/involved/part of the diagnostic process. They are given an opportunity to ask questions and voice concerns which is supposedly going to make their care better or seem better.

I feel that throughout my day and especially during assessments, I give my patients ample opportunity to be involved in their care. This new interaction is just a disruption to the excellent care I already DO provide. I feel like I'm starting to sound like the heartless RN who just wants to get through with her day but I'd like to think that's not me.

I think of shift report as sacred. It is an exchange that requires high-level communication and attention to transmit vital information. I take this bedside reporting idea as another encroachment on our practice in the name of "patient satisfaction". I hear about bedside charting. What's left? Should all our communication with doctors and various practitioners be projected through the patient's speakerphone?

[amoLucia]

How would this work with double rooms and the HIPAA regs??? Sheesh, folk are so nosey now! Just watch folk and try to be confidential at the nsg desk when the line resembles an ACME deli on Saturday morning!!! Now to give report at shift change with a room full of visitors to boot!

[wanderlust99]

I really don't like it either. I think things are missed and often report is dumbed down in front of patients. And sometimes the patient or family member will interrupt my flow of giving report and I could possibly leave out things. It's a distraction, being in the patient's room is a distraction. Also, we have computers mounted on the wall so I have to now try to find room to write and look at the computer while standing. I like to really focus and concentrate when receiving report, especially in the ICU. I do like going into the room to greet the patient and say this will be your nurse tonight and checking lines and drips together. I find that if you go into the room together and hand eachother off it's good for patient satisfaction and you can see things that you may have missed in report.

To me it's similiar to when doctors will make their grand rounds on patients in the morning (usually teaching hospitals). They are technical and like to discuss everything before entering the room. I think that's vital. Would physicians ever let management tell them they now have to round inside the patient's rooms? No. They would oppose it and management would listen. Management, in general, doesn't give a **** about nurse satisfaction IMO.

[KelRN215, BSN, RN]

When my old facility started doing bedside report a few years ago, administration would come in during off shifts to follow nurses around and make sure they did it. I'm not kidding, one Saturday night our educator walked in at 7PM saying "are you all ready for bedside report?" 1. What on earth is there to get "ready for" just because you want us to do it somewhere else, report is report. 2. Go away. Our primary method of report was written, so bedside report was more or less an added nuisance. I already read everything you had to say about the patient, I certainly don't need a narrative in front of the patient about his night.

We did exactly the same thing as you describe... walk down the hall while talking about the patient then poke our heads in to make sure the emergency equipment is there and that the patient is breathing. NO WAY am I waking up a sleeping child at 7:10 am or disturbing the mother who's already p*ssed because her room got moved at 3am to tell her I'll be the nurse. That information will be just as useful to them when they wake up in an hour.

[Been there,done that, ASN, RN]

Administration has deemed that we will now perform bedside report. This is a direct response to the newly mandated Medicare customer service model to fulfill the customer satisfaction scores for reimbursement.

It will NOT go away.

Patients will see that their care is handed off to another nurse. Hippa .. schimpa. Those issues will follow .. when the confidentiality issue is realized.

In the meantime.. we have been instructed to take any issues other than basic information... to a separate area.

In other words.. smile for the people. And spend time giving the unpleasant details(i.e. patient is a drug seeker).. in a private area.

[wanderlust99]

Charge nurses follow us during change of shift time too and if they find 2 nurses sitting down talking they yell "bedside report, do bedside report".

These are the same charge nurses and management who will yell at you and threaten termination if you don't check a box on the wall for hourly rounding.

Magnet hospital. Typically named top 10 in the nation.

This is a travel assignment, I can't wait to leave this place!!

[Vespertinas]

In the meantime.. we have been instructed to take any issues other than basic information... to a separate area.In other words.. smile for the people. And spend time giving the unpleasant details(i.e. patient is a drug seeker).. in a private area.

So now we have to divide our report between in and out of the room, thus creating more situations where information can get missed.

[BellaInBlueScrubsRN]

We were supposed to do bedside report in ICU. It lasted the first few shifts. They also trialed bedside report from ER to tele floor. WHAT? So the tele nurse knows nothing about the pt (except the diagnosis) until they get to the floor. Thats crazy! They did away with that though.

[anotherone, BSN, RN]

IT IS TERRIBLE and i say this from experience. If we must put on a show and tell for the patient than I rather give a real report in private then go in and introduce the other nurse etc. But managment forbids this and during the day goes around telling patients to report anytime report is not given at the bedside. ***. oh yes and have some staff nurses as spies, I sure of it. Some nurses will ask me to give a regular report in private than just introduce them to the pt, check lines, etc but sometimes I am almost afraid it is a "set up" sad sad but a real concern. Information can and does get missed often enough. We has absolutely no say in it, one day we came in and manamgent said, "on monday we will be doing bedside report here is a pamphlet on it." How many people can remember everything between the real report and the pt friendly one. It is a stressful end to a stressful day/night. Keep in mind the isolation rooms, if you are following all the guidelines you can not write down anything in the room, unless you are setting up a sterile field and gloving up and down like a nut-in front of the pt, and 14 visitors. We are supposed to ask on admission if pts mind if they are in a semi private room or if they have visitors, and guess what, that gets passed on, not! Between the nurse who has had the patient for HOURS and the providers the pt should already know what is going on.

[phillycpnp-pc, MSN, RN, NP]

My job started doing beside report a couple of years ago. And the level 4's and manager use to follow us and make sure we did it. It made me more nervous. Now it is more relaxed than it use to be. We cant sit at the nurses station but we have to do report right outside the room and then go into the room and do safety checks and line checks.

[Esme12, ASN, BSN, RN]

So now we have to divide our report between in and out of the room, thus creating more situations where information can get missed.

Yes, to the report in and out of the room....no to more information missed. The Joint Commission does require face to face hand off and the ability to ask/answer questions needs to be fulfilled.

Here the idea. Why most administrations make this so difficult is beyond me. It is easier now with 12 hour shifts. The quality expectation is to go to the room in pairs. Introduce the on coming nurse. Discuss "basic" information in front of the patient example: in the morning.

Good morning Mr. Blah. Sally is your nurse today. Mr. Blah has x IV's and X running. His PCA is xyz and is set at ABC. (you both check the fluids and IV sites) He gets IV antibiotics and is due a Gent level today. He is scheduled for a CT of his chest time to be determined. His abd remains firm and distended (you both observe).......Now everyone is on the same page. The patient speaks up and says I meant to ask the MD about xyz.....now you both will remember.

The this guy is a crack pot, I saw him sneaking food, the MD thinks he has CA, we need to get this crap dc'd, his wife is a lunatic.........are for out side the room in a confidential area.

Anything new sucks and will take time to get used to. Besides taking longer. I know administration are pit bulls when it comes to paying OT and most managers today can't/won't stand up against them for fear of their jobs. That frustrated me and makes me sad. I got approved for temporary OT I had staff come in 15 min prior to every shift for a set period of time. I made up pre-printed "script like" sheets (I know scripting has a bad rep now due to PR /customer service malarkey) for staff to have bulleted items for the bedside. I recommended they perform this similar to rounding with the attending and residents. Talk first about the patients then go room to room.

People see a mandate or "quality idea" and mandate with out research to develop the best evidence practiced way to perform new tasks. I think the Masters and PhD prepared administrators need to walk the walk if they wish to talk the talk.

But what do I know I just a lowly BSN.......

I hope my suggestions helped.

[wooh, BSN, RN]

We got chastised for not giving a "full" report even if you're handing off back and forth to the same nurse multiple days in a row. "Mr. X has a history of blahblahblah." "Yes, I know that. In fact I told YOU that 12 hours ago."