Is this reasonable or just over the top?

[Lakeshore18]

Recently our Nurse Manager informed the nursing staff that we were now to conduct our shift report using certain "scripted" parameters. Basically, we are to wake patients up, conduct shift report at the bedside, include he patient in the process by giving him/her the opportunity to ask questions and add to the information we pass on to the oncoming shift, check all patient orders on the computer and then conduct a brief"physical exam" of the patient with the oncoming nurse. There are certain scripted things we are to say as well. For example the nurse going off shift is supposed to say:

"Good morning, Mr. Jones. I will be leaving shortly to go home to my family. This is Sally and she will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. I feel confident I will be leaving you in good hands wth Sally as your nurse!"

After this, we are to continue on with the above outlined report, conduct the mini physical exam, check the orders in the computer and give the patient the opportunity to give feedback during our report. Generally we each have 5-6 patients on our very busy cardiac monitoring unit and our shift report is 30 minutes long!! My colleagues and I are at a loss to figure out how we will accomplish all of this in 30 minutes! I am all for including the patient and allowing them to give feedback, but I fear shift report will now take so long we won't be able to get all our work done! And what about visiting hours? Shift report takes place right in the middle of them at 7pm. Now there will be visitors for both patients adding their comments as well.

In addition, I am uncomfortable giving my opinion about the skills and expertise of the oncoming nursing staff. We are expected to stick to the script and give positive reinforcement about the capabilities of the next nurse coming on shift. What if he/she isn't a very good nurse or has poor clinical skills? Am I supposed to lie to the patient? And if I do, won't I be undermining my own credibility? Does anyone else think this is a little over the top?

[JadeEclypse]

Increased satisfaction has been linked to poorer outcomes. It makes sense when you think about it. The diabetic patient with a blood sugar in the 600s is going to be upset about not getting his fourth ice cream cup, even though ice cream is demonstrably bad for him. The NPO patient may be incensed about not getting his cheeseburger for lunch even though you, the charge nurse, the nurse manager, the medical resident, the surgical fellow and the anesthesiologist have all done the appropriate teaching about being NPO for the OR -- giving him a cheeseburger would result in a cancelled surgery or a bad outcome from complications during intubation. He may be satisfied about getting the ice cream or the cheeseburger, but the outcome may be poor. The patient who is awakened for vital signs, incentive spirometry and PT may not be satisfied, but the outcome is likely to be better.

I just love it when recent graduates tell all the experienced nurses what they're doing wrong.

That's exactly what the articles I listed cited.

Because we don't treat them like patients any more. We're even encouraged to call them "clients" now days. And the client gets, what the client wants, even when it's not what they need. Even when you attempt to educate them. Many learn that if they pitch enough of a fit, they'll get their way (my combative turkey sandwich guy), because we're allowing certain behaviors and notions. We're telling them that their satisfaction is more important than their health and our safety.

[Penholder]

This is where I'll take my 25 in long term care any day. No bedside reporting because by 3pm almost no one is in their rooms. As a patient, I would smack any person who woke me up at 6-7am for report. Or less than 12 hours post op for that matter. And I've been a patient ALOT!

[FlyingJoey]

Is your hospital willing to pay overtime to everyone everyday? If you follow the requirements, your shift report will take like an hour everyday.

DO NOT clock out before you're done with your shift report and see what happens.

[JadeEclypse]

If your hospitals are anything like mine I'm sure your manager doesn't care about paying overtime because you're so short-staffed that it evens out in the end.

I work on a unit it supposed to have a ratio of 10 nurses and 4 CNAs for 34 patients and we're lucky if we have 6 and 0. So the extra clock in time to do bedside report really doesn't matter to them in the end.

[sdwatkins]

That's ridiculous. If I was the patient and a nurse came in my room saying that I would think something was really OFF... thats OVER THE TOP!!

[NuGuyNurse2b]

We have it at our facility. When we brought up the fact that most patients aren't awake by around 730AM when we are to do our roundings, we're greeted with a tough "they know why they're here, it's expected they'll be woken up" - so that seems contradictory to the whole patient satisfaction surveys. Then we bring up HIPAA and we're greeted with a "they should know why they're here." Then when we have patients who actually ask us not to wake them up and do it, we're told "you must still go in the room." I'm not a fan of the accountability scenario, either. So even if I'm the oncoming nurse and I see that the IV is 6 days old (our policy is 4 days MAX), the outgoing nurse will just say "I didn't get to it" and then I'm the one who has to do it. It would be the same situation if we were doing desk reporting like the olden days.

[Ellie G]

It's over the top. A short bedside report and introduction of the oncoming nurse is fine but that scripting is a bit much. I don't know about everyone else but I'm not willing to stay 30 minutes past my shift for the warm fuzzies

[1jewel, ADN]

This scene has been going on for several years! You will get used to it. I really didn't like it when it first rolled out, but unfortunately or fortunately it's all about patient satisfaction!

[klone, MSN, RN]

I'm not a fan of the accountability scenario, either. So even if I'm the oncoming nurse and I see that the IV is 6 days old (our policy is 4 days MAX), the outgoing nurse will just say "I didn't get to it" and then I'm the one who has to do it. It would be the same situation if we were doing desk reporting like the olden days.

By accountability, I'm referring to things like infiltrated IVs, sopping wet dressings, other things that the off-going nurse cannot say "Well, it wasn't like that when I left the shift" because if you're reviewing it together, you both see what the nurse is leaving you with.

[Skippingtowork]

What an attitude -- you'll "go after everyone in sight"! This is why we ask family and friends to leave for bedside rounds. The patients may hear incidentals from bedside rounds on the other patient (that can't be helped), but there's no excuse for family and friends to hear it also.

Describe "incidentals." Some people, like myself, come from cultures which are very private and secretive. What you may consider incidental, may not be incidental to me. The best and only practice which is appropriate is to first ask the patient if they want bedside reporting and what information may be discussed at the bedside. I personally find it disrespectful for someone to discuss me in front of others without my permission.

Just so you know, I didn't mean that I would be chasing anyone with a knife. I really, really try to control myself.

[SmilingBluEyes]

I remember when I had a very bad miscarriage and subsequent surgery, after grand rounds, my roommate telling me how sorry she and her husband were for my loss. While I appreciated her sentiments, I was not prepared for a total stranger to tell me this from behind a curtain.

Therefore, I am against any family being in the room for bedside report, under any circumstances, in a semi-private situation. My roommate and her husband had no business knowing my personal loss and medical history. But, they did, because of bedside reporting, done wrong.

It (beside report) may improve outcomes; I have not done the reading on all the studies, but in semi-private rooms, it should never happen. As a patient, I am completely against it unless the hospital room is PRIVATE. This "incidental" sharing of my information was completely out of line and it hurt.

The way to do it right: Skip scripts. Nurses and patients are smarter than that. If you DO do bedside report, make sure the room is private and that all visitors are asked to leave. When my son (he is an adult) was in the hospital, his room was private and yes, we left during bedside reporting. THAT is how you do it right.

[NurseAngie]

This is very true, yet I prefer scripted good manners over authentic indifference or rudeness which some nurses exhibit. The scripted good manners is a compromise I can live with if it reduces some of the rudeness/indifference. My guess is that this is the goal of management. I have seen nurses perform the scripted behavior quite well where the patient/family were comfortable with the interactions because the nurses appeared to have naturally good manners outside of the script as they provided care.

Would you mind clarifying what you mean by "indifference"? I don't want to assume your point. Thank you.